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Healthcare Clowning: Use of Specific Complementary and Alternative Medicine for Hospitalized Children
Abstract
Clowning has a varied tradition and a long history. Recently, clowns have entered the medical setting and this has become an appreciated approach aimed at decreasing the negative emotions that can be experienced during hospitalization and medical procedures, as well as inducing positive feelings in patients, their relatives, and the hospital’s staff. Due to an increase in the number of clowns working in hospitals and the large amount of interest shown in utilizing this approach, more research studies have focused on testing the efficacy of this complementary and alternative approach. This paper provides an overview of the concept of healthcare clowning followed by a literature review conducted on 28 randomized controlled trials (RCTs) drawn from two databases (PubMed and Google Scholar), aimed at investigating and discussing evidence for the effects that clowning has on children. The search revealed the different settings in which RCTs have been conducted: preoperative areas, during medical procedures, and during hospitalization. The search also identified different outcomes that were measured. In general, the results show that clown intervention is effective in decreasing negative emotions and psychological symptoms and in enhancing the well-being of patients and their relatives. Appreciation of clown intervention by healthcare staff has increased in the last several years.
... More recently, in 1986, Michael Christensen, a professional clown, established the first Clown Care Unit that was active in a pediatric department and following this example, several associations were shortly established worldwide (Dionigi, 2018). The main aims of healthcare clowning have been described as: a) creating a positive emotional state in patients, relatives and staff by providing joy, happiness, good spirit, laughter, amusement and a sense of meaningfulness in life; b) promoting interaction between parents and their children; c) fostering affirmative environmental conditions; d) decreasing negative emotions experienced by both children and their relatives (Dionigi, 2018;Finlay et al., 2014;Tan et al., 2014). ...
... More recently, in 1986, Michael Christensen, a professional clown, established the first Clown Care Unit that was active in a pediatric department and following this example, several associations were shortly established worldwide (Dionigi, 2018). The main aims of healthcare clowning have been described as: a) creating a positive emotional state in patients, relatives and staff by providing joy, happiness, good spirit, laughter, amusement and a sense of meaningfulness in life; b) promoting interaction between parents and their children; c) fostering affirmative environmental conditions; d) decreasing negative emotions experienced by both children and their relatives (Dionigi, 2018;Finlay et al., 2014;Tan et al., 2014). ...
... Overall, the findings are conflicting: some studies showed how clowns help children in adapting to their hospital surroundings and distracting them from painful or frightening procedures (Finlay et al., 2014). Other reports have shown no effectiveness of clown intervention, especially on parents accompanying children to the operation room (for reviews, see Dionigi, 2018;Pinna, Mahtani-Chugani, Sánchez Correas, & Sanz Rubiales, 2018). ...
The aim of this qualitative research is to describe how the parents perceive the work of hospital clowns in the context of bereavement. Using the text analysis software T-LAB (Version 9.1.3) with a co-occurrence strategy we examined several bereaved parents’ narratives related to the clowning. We showed six themes from parents’ narratives: “The Funny Side of Life”, “Good Memories,” “The Clown is a ‘Big Kid’,” “They Are Part of My Family,” “Bringing Life and Creating Vital Disorder,” and “Awareness of a Clown’s Abilities.”We will interpret the themes according to a humanistic/existential framework as the theoretical base. According to parents’ experience, professional hospital clowns appear to bring a positive contribution in terms of the reconstruction of meaning in the context of bereavement.
Keywords: parents, clowning, humanistic/existential framework, reconstructing meaning,
bereavement
... The use of alternative non-pharmacological interventions to manage psychological distress has increased considerably especially in pediatrics (4), including behavioral preparation programs, acupuncture, and art, music, and pet therapies (5,6). Among these, healthcare clown interventions stand out, because the goal of clowns is not only to distract children from the hospital situation, but to actively evoke positive feelings and increase well-being (7). In fact, already in ancient Greece, doctors were aware of the positive effects of humor on health (8), and theatrical interventions and humor in the treatment of patients have been documented as early as in the thirteenth century [cf. ...
... Surprisingly, the majority of studies examining the effects of a healthcare clown intervention focused on the reduction in negative outcome measures, such as anxiety and negative emotionality, while only few studies have investigated the hypothesized increase in positive outcomes. Moreover, clowns do not exist in a vacuum and when they enter a hospital room, they are incorporated into a pre-existing system that is determined by factors such as the medical conditions of the patients and associated therapeutic procedures, but also the support from the medical team and family functioning (7,11). For young children, the relationship with their caregivers is a particularly crucial mechanism influencing their regulatory abilities [e.g., (12)], and thus could co-determine whether they experience and show positive emotions in stressful and emotionally arousing situations. ...
... In recent years, it has been increasingly argued that humor and laughter have unique properties that help in coping with pain and stress (8). Previous research has examined the effects of healthcare clown interventions on decreasing anxiety and negative emotions in children during the preoperative period and various, often painful, medical procedures [see (7), for review]. For example, studies have consistently found a reduction in preoperative anxiety measured through observation or self-assessment in children between 3 and 12 years of age (9,(13)(14)(15)(16)(17)(18). ...
In the present study we examined the positive effects of a healthcare clown intervention on children undergoing surgeries, and the role parent-child relationships may play in their effectiveness. Children between 5 and 12 years, who were scheduled to undergo elective surgical procedures in a large university hospital, were randomly assigned to an intervention group (IG; n = 35) that was visited by a healthcare clown, and a control group (CG; n = 27) that received treatment as usual (i.e., company of parents before the surgery). Children in both groups were videotaped and the videos were later used to rate their activity, arousal, emotional expressivity, and vocalizations. Additionally, children and parents rated their mood and perceived quality of life at several points during the procedure, and parents reported their perceptions of the relationship with their children. Results showed that children in the IG showed more positive emotions and vocalizations than children in the CG. Parents of children in the IG also reported more positive mood than parents of children in the CG. In contrast, children in the CG reported higher quality of life than children in the IG. Importantly, analyses showed considerable effects of the parent-child relationship on all outcome measures. Results of the present study demonstrate that a healthcare clown intervention had some positive effects on behaviors and mood of hospitalized children and their parents. Importantly, our findings also suggest that we need to consider the pre-existing “relationship microcosmos” that the clowns enter when assessing their effectiveness in the hospital.
... The use of medical clowns in hospitals is a growing phenomenon, used as a therapeutic method in addition to traditional medical practices and as a negative affectivity buffer (27). Previous research shows that medical clowns have a positive impact on the physical and psychological well-being of health consumers (25,28,29), reducing the need for pain medications (30), lowering negative affectivity levels (31,32), increasing positive feelings (20,33,34), and enhancing health consumer satisfaction with the hospital service (1). The positive effect of medical clowns on both health consumers and medical staff can improve the outcomes of medical interventions (16,20). ...
... Most ndings on medical clowns are based on separate children or adult samples, rather than on integrated samples, and the placement t of the medical clown versus audience age has not been addressed (e.g. only adult wards: (8,33,34); only pediatric wards: (25,28,32,37)). Medical clowns are usually placed in pediatric wards (38), and so the majority of research on medical clowns is based on children samples. Since the presence of medical clowns in adult wards has increased substantially in the past decade, especially with older (27), and chronic health consumers (24), more research examining the unique effect of medical clowns on adults vs. children is necessary. ...
Background – Most existing research on medical clowns in health care services has investigated their usefulness mainly among child health consumers. In this research we examined multiple viewpoints of medical staff, clowns, and health consumers aiming to identify the optimal audience (adult or child health consumers) for which medical clowns are most useful. We focused on exploring their usefulness in enhancing health consumers’ satisfaction and, in turn, reducing their aggressive tendencies.
Methods – We conducted three studies that examined the placement fit of medical clowns from different points of view: medical staff (Study 1, n = 88), medical clowns (Study 2, n = 20), and health consumers (Study 3, n = 397). The main analyses in Studies 1 and 2 included frequencies and t-tests comparing perceived adult and child satisfaction with clowns’ performance. Study 3 used moderated-mediation PROCESS bootstrapping regression analysis to test the indirect effect of negative affectivity on aggressive tendencies via satisfaction. Exposure to the medical clown moderated this relationship differently for different ages.
Results – Studies 1 and 2 show that the majority of medical clowns and medical staff report that the current placement of the medical clowns is in pediatric wards; about half (44% of medical staff, 54% of medical clowns) thought that this placement policy should change.
In Study 3, data from health consumers in seven different hospital wards showed that clowns are useful in mitigating the effect of negative affectivity on satisfaction, thereby reducing aggressive tendencies among health consumers under the age of 21.6 years .
Surprisingly, medical clowns had the opposite effect on most adults: for health consumers who were exposed to the medical clown and were above the age of 21.6 negative affectivity was related to decreased satisfaction, and an increase in aggressive tendencies was observed.
Discussion - Medical clowns are most useful in elevating satisfaction and reducing aggressive tendencies of children. Older adults, on the other hand, exhibit lower satisfaction and higher aggressive tendencies following exposure to the performance of medical clowns.
Conclusion – Medical clowns should be placed primarily in children’s wards.
... The use of medical clowns in hospitals is a growing phenomenon, used as a therapeutic method in addition to traditional medical practices and as a negative affectivity buffer [27]. Previous research shows that medical clowns have a positive impact on the physical and psychological well-being of health consumers [25,28,29], reducing the need for pain medications [30], lowering negative affectivity levels [31,32], increasing positive feelings [20,33,34], and enhancing health consumer satisfaction with the hospital service [1]. The positive effect of medical clowns on both health consumers and medical staff can improve the outcomes of medical interventions [16,20]. ...
... Most findings on medical clowns are based on separate children or adult samples, rather than on integrated samples, and the placement fit of the medical clown versus audience age has not been addressed (e.g. only adult wards: [8,33,34]; only pediatric wards: [25,28,32,37]. Medical clowns are usually placed in pediatric wards [38], and so the majority of research on medical clowns is based on children samples. ...
Background
Most existing research on medical clowns in health care services has investigated their usefulness mainly among child health consumers. In this research we examined multiple viewpoints of medical staff, clowns, and health consumers aiming to identify the optimal audience (adult or child health consumers) for which medical clowns are most useful. We focused on exploring their usefulness in enhancing health consumers’ satisfaction and, in turn, reducing their aggressive tendencies.
Methods
We conducted three studies that examined the placement fit of medical clowns from different points of view: medical staff (Study 1, n = 88), medical clowns (Study 2, n = 20), and health consumers (Study 3, n = 397). The main analyses in Studies 1 and 2 included frequencies and t-tests comparing perceived adult and child satisfaction with clowns’ performance. Study 3 used moderated-mediation PROCESS bootstrapping regression analysis to test the indirect effect of negative affectivity on aggressive tendencies via satisfaction. Exposure to the medical clown moderated this relationship differently for different ages.
Results
Studies 1 and 2 show that the majority of medical clowns and medical staff report that the current placement of the medical clowns is in pediatric wards; about half (44% of medical staff, 54% of medical clowns) thought that this placement policy should change.
In Study 3, data from health consumers in seven different hospital wards showed that clowns are useful in mitigating the effect of negative affectivity on satisfaction, thereby reducing aggressive tendencies among health consumers under the age of 21.6 years.
Surprisingly, medical clowns had the opposite effect on most adults: for health consumers who were exposed to the medical clown and were above the age of 21.6 negative affectivity was related to decreased satisfaction, and an increase in aggressive tendencies was observed.
Discussion
Medical clowns are most useful in elevating satisfaction and reducing aggressive tendencies of children. Older adults, on the other hand, exhibit lower satisfaction and higher aggressive tendencies following exposure to the performance of medical clowns.
Conclusion
Medical clowns should be placed primarily in children’s wards.
... The use of medical clowns in hospitals is a growing phenomenon, used as a therapeutic method in addition to traditional medical practices and as a negative affectivity buffer (18). Previous research shows that medical clowns have a positive impact on the physical and psychological well-being of health consumers (19)(20)(21), reducing the need for pain medications (22), lowering negative affectivity levels (23,24), increasing positive feelings (16,25,26), and enhancing health consumer satisfaction from the hospital service (1). The positive effect of medical clowns on both health consumers and medical staff can improve medical intervention outcomes (12,16). ...
... Most ndings on medical clowns are, however, based on separate children or adult samples, rather than on integrated samples and the placement t of the medical clown versus audience age has not been addressed (e.g. only adult wards: (6,25,26) ; only pediatric wards: (19,21,24,27). Medical clowns are usually placed in pediatric wards (28), and so the majority of research on medical clowns is based on children samples. ...
Background – Most existing research on medical clowns in health care service has investigated their usefulness among child health consumers. In a 360-degree research stream, we aim to identify the optimal audience (adults or children health consumers), for which medical clowns are most useful in enhancing health consumers’ satisfaction and, in turn, reducing their aggressive tendencies.
Methods – We conducted three studies, which examined the placement fit of medical clowns from a different point of view: medical staff (Study 1a, n = 88), medical clowns (Study 1b, n = 20), and health consumers (Study 2, n = 397).
Results – Studies 1a and 1b demonstrate that both medical staff and clowns believe that child health consumers profit most from the clowns. In Study 2, data from health consumers in seven different hospital wards showed that clowns are useful in mitigating the effect of negative affectivity on satisfaction, thereby reducing aggressive tendencies among children. Surprisingly, the effect of medical clowns on adults is not only weaker, but reversed, such that interactions with medical clowns decrease adults’ satisfaction and increase their aggressive tendencies.
Discussion - The medical clowns are most useful in elevating satisfaction and reducing aggressive tendencies of children. However, older adults show lower satisfaction and higher aggressive tendencies following the performance of the medical clown. The main limitation of the study is investigating aggressive tendencies rather than actual aggression. Future research should examine actual aggression.
Conclusion – Medical clowns should be placed in children’s wards. This conclusion can guide health care service policy makers by indicating the optimal placement of clowns, thereby benefitting most from the clowns’ efforts, elevating health consumer satisfaction, and reducing aggressive tendencies.
Trial registration – article doesn’t report a health care intervention on human participants.
... intervention, a non-pharmacological approach, has been shown to have a generally positive effect in the outcomes of paediatric patients, 18-20 reviews conducted on this theme showed conflicting results. [21][22][23] It has been shown that this intervention can enhance emotional and behavioural processes, for instance, improving well-being and self-confidence, and reducing stress and anxiety levels. [24][25][26][27][28][29][30][31][32] In addition, evidence suggests that hospital clowns help paediatric patients to better adapt to their hospital surroundings and can distract from, and demystify painful or frightening procedures through 'doses of fun' to complement traditional clinical interventions. ...
... Overall, the results show that clown interventions are effective in decreasing negative emotions and psychological symptoms and in enhancing the well-being of patients and their relatives. 23 Additionally, two systematic reviews and meta-analyses looked at the effects of clown intervention in paediatric hospital settings. 21 22 One of them concluded that hospital clowns play a significant role in reducing stress and anxiety levels in children staying in a paediatric ward or undergoing invasive procedures or minor surgeries under anaesthesia, as well as in their parents, 21 and the other confirmed the strong effect of clown intervention in reducing children's preoperative psychological distress. ...
Introduction
Clown intervention may playing an important complementary role in paediatric care and recovery. However, data on its utility for symptom cluster management of hospitalised children and adolescents in acute and chronic disorders are yet to be critically evaluated. As clinicians strive to minimise the psychological burden during hospitalisation, it is important that they are aware of the scientific evidences available regarding clown intervention for symptom management. We aim to provide quality evidence for the effectiveness of clown intervention on symptom cluster management in paediatric inpatients, both in acute and chronic conditions.
Methods and analysis
A systematic review of randomised controlled trials (RCTs) and non-randomised controlled trials (NRCTs) will be conducted. MEDLINE, Web of Science, Cochrane Library, Science Direct, PsycINFO, CINAHL, LILACS and SciELO databases will be searched from January 2000 to December 2018. Primary outcomes will include measures related with the effect of clown intervention on symptom cluster of paediatric inpatients (anxiety, depression, pain, fatigue, stress and psychological, emotional responses and perceived well-being). Study selection will follow the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, and the methodological appraisal of the studies will be assessed by the Jadad Scale as well as Cochrane Risk-of-Bias Tool for RCTs, and Risk-of-Bias In Non-Randomized Studies Tool for NRCTs. A narrative synthesis will be conducted for all included studies. Also, if sufficient data are available, a meta-analysis will be conducted. The effect sizes will be generated using Hedges’ g score for both fixed and random effect models. I ² statistics will be used to assess heterogeneity and identify their potential sources.
Ethics and dissemination
As it will be a systematic review, without human beings involvement, there will be no requirement for ethical approval. Findings will be disseminated widely through peer-reviewed publication and in various media, for example, conferences, congresses or symposia.
Trial registration number
CRD42018107099.
... fear and anxiety surrounding impending operations) and enhance the psychological well-being of both the patients and their families. Although largely successful results have been reported for such initiatives (see Lopes-J unior et al., 2020: Slot et al., 2018: Dionigi et al., 2018 a substantial minority of negative reactions are consistently observed, including from the young patient themselves, their parents and the attending medical professionals. ...
Although clowns have traditionally been portrayed as figures of fun in popular culture, more recent representations have been of fear-inducing characters such as “Pennywise” from the book and movie “IT”. However, it is not known whether these representations reflect fear of clowns within the general population, and there is a lack of data on the extent of this phenomenon. This study investigated the prevalence of clown fear in an international population, and the severity of this fear in those who reported it. The Fear of Clowns Questionnaire (FCQ), was designed for this purpose. Psychometric data indicated high levels of reliability for our new scale, with a Cronbach's alpha of .980, and a split-half reliability coefficient of .973. Demographic factors associated with clown fear were also explored; gender, age and country of birth. An opportunist sample of 987 participants were surveyed, consisting of 790 females and 197 males, aged between 18 to 77 years (M=29.79; SD=11.08). Of these, 272 (27.6%) reported a fear of clowns, whilst 50 (5.1%) rated this fear as extreme. A higher prevalence of clown fear was found for females compared to males (29.6 vs. 19.3%) and with a higher severity according to the FCQ. Age was negatively correlated with clown fear, and participants from the Asian continent exhibited the highest frequency of clown fear. We conclude that fear of clowns is common in the general population, although extreme fear has a similar incidence to that of other specific phobias.
... Within the past two decades, there has been a surge of interest in investigating the effects of clown intervention in a large variety of clinical settings (Dionigi, 2018;Ford et al., 2014). However, only a few studies have investigated the personality traits of medical clowns, and they have been in specific countries (Dionigi, 2017;Dionigi & Canestrari, 2016). ...
The medical clown is a healthcare practitioner whose character is strictly associated with the performer's own personality. In this study, the relationships between the level of sensory processing sensitivity (SPS), caregiving strategies and humour in Italian and Israeli clowns were examined. Participants were 159 medical clowns (97 Italian and 62 Israeli), ranging from 22 to 74 years of age, who completed a demographic questionnaire, the self-reported Highly Sensitive Person Scale, the Caregiving System Scale and the BenCor. Results showed that a higher SPS was related to higher hyperactivation and deactivation, and that hyperactivation was related to lower benevolent humour and greater corrective humour. Hyperactivation negatively predicts benevolent humour but positively predicts corrective humour, beyond the effect of SPS. Deactivation had no relationship to either benevolent or corrective humour. The results are also discussed in reference to the two culture groups and to previous studies conducted with general populations.
Social bonds may assist in cultivating a more positive attitude to life through commonly shared meanings about the COVID-19 pandemic. The key challenge, however, is how to foster social bonds meeting the changing demands in a post pandemic world. Yet, it is in the middle of a crisis that the conversation needs to start about how to strategically plan for the recovery. This is important not only in the current pandemic, but also in a post pandemic world. Reinforcing or fostering new social bonds is likely to bring positive experiences. The latter is central to human health and wellbeing, and has potential to contribute greatly in enhancing people’s quality of life. In an attempt to foster place social bonding in the COVID-19 pandemic and beyond to subsequently contribute to wellbeing, this paper develops and proposes a new conceptual framework suggesting the need for adaptive social bonding interventions in the SARS-CoV-2 pandemic. This is an essential measure to manage the significant impacts on our global health services due to a decline in people’s mental health in addition to COVID-19 physical impacts. The paper discusses how promoting adaptive social bonding interventions (psycho-socio, digital and nature social bonding) can make people more resilient. It further discusses how they can be empowered psychologically, socially, and emotionally in the current challenging times. The conceptual framework posits that social bonding interventions can assist in maintaining better mental, physical, emotional, and spiritual wellbeing and discusses how these wellbeing outcomes may also be experienced post the pandemic. This has important benefits and is of relevance to governments, policy makers and healthcare professionals in delivering better health care and equipping people with coping mechanisms both throughout the pandemic and in the long run.
Hospitalized children who undergo painful procedures are more susceptible than others to experiencing iatrogenic effects, such as anxiety, pain, and severe stress. Clowns in clinical setting have been found to be effective in reducing children's experiences of these effects during hospitalization and before procedures. This article provides an overview of clowning in health care settings; reviews major studies conducted on clowning for hospitalized children, discussing evidence that clown interventions decrease pain and distress in pediatric patients; and concludes with a discussion of health care clowning as a profession.
Purpose
Medical clowning has proven effective for reducing pain, anxiety, and stress, however, its differential effects on children from different cultures have not yet been researched. This study evaluated the effects of medical-clowning intervention on anxiety and pain among Jewish and Bedouin children, and anxiety among their parents, in southern Israel.
Patients and methods
The study was conducted in hospital pediatric departments and employed a pre–post design involving quantitative and qualitative methods. The study included 89 children whose ages ranged from 7.5 to 12 years (39 Jewish and 50 Bedouin) and 69 parents (19 Jewish and 50 Bedouin). Questionnaires assessing pain, anxiety, and demographics were used at the pre-intervention stage and pain, anxiety, and enjoyment of different aspects of the intervention were evaluated following the intervention. The intervention stage lasted for 8–10 minutes and included the use of word play, body language, and making faces, as well as the use of props brought by the clown. Semi-structured interviews were also conducted at the post-intervention stage.
Results
The intervention reduced pain and anxiety among both groups of children and reduced anxiety among both groups of parents. However, anxiety levels were reduced more significantly among Bedouin children. The nonverbal components of the clowns’ humor were most central, but it was the verbal components that mediated the reduction in anxiety among the Bedouin children.
Conclusion
This study underscored the effectiveness and importance of medical clowning in reducing pain and anxiety among children in different cultural contexts. Moreover, the issue of culturally appropriate humor was underscored and implications for intercultural clown training are discussed.
Background: This study aims to investigate the effect of hospital clowns on the anxiety and depression level of child patients and their mothers during hospital stay.
Methods: 99 children (7–13 years old) and their mothers were randomly divided into clown and control groups. Anxiety and depression levels of the groups were measured with the State-Trait Anxiety Inventory and the Beck Depression Inventory.
Results: 96% of the children stated that they had enjoyed the clowns, 84% said the clowns had been entertaining and relieving, 60% reported the clowns had reduced their fear and excitement, 94% wished the clowns would visit them again and 80% said the first thing they would remember when they were hospitalized again would be the clowns. The presence of clowns during hospital stay was found useful for managing children’s anxiety and depression (p < .05), but it was not efficient for their mothers (p > .05).
Conclusion: Clown intervention is effective in reducing anxiety and depression levels in children during hospitalization.
Objective
We investigated the impact of clown-care on pain in 45 children with cerebral palsy who underwent recurrent Botulinum-toxin injections (age 7.04± 4.68 years). Participants were randomized to receive either clown (n = 20) or standard (n = 25) -care.
Methods
Pain Visual-Analogue-Scale (range 1–5) was reported before and after procedures. Pain assessment was lower for children undergoing Botulinum-toxin injections with clown-care (2.89± 1.36) compared to standard-care (3.85± 1.39; p = 0.036) even though pain anticipated prior to procedures was similar (~3).
Findings
Children who underwent the first procedure with clown-care reported lower pain even after they crossed-over to the following procedure which was standard (p = 0.048). Carryover effect was more prominent in injection-naïve children (p = 0.019) and during multiple procedures (p = 0.009). Prior pain experience correlated with pain in subsequent procedures only when first experience was standard-care (p = 0.001).
Conclusions
Clown-care alleviated pain sensation during Botulinum-toxin injections and initial clown-care experience reduced pain during subsequent injections even though clowns were not present.
Trial registration
clinicaltrials.gov ID # NCT01377883.
This study investigated the effects of hospital Clown Doctors intervention on child and caregiver preoperative anxiety at the entrance to the surgery care unit and separation from caregivers. A total of 88 children (aged 4-12 years) were assigned to one of the following two groups: Clown Doctors intervention or control group (standard care). Independent observational records using the modified Yale Preoperative Anxiety Scale instrument assessed children's anxiety, while the State-Trait Anxiety Inventory measured caregiver's state anxiety. In addition, caregivers assessed the children's functional health problems by completing the Functional Status Questionnaire. Although no effects of Clown Doctors were found on children's anxiety, results showed that both low functional health problems and Clown Doctors intervention were significant predictors of lower caregiver anxiety. Caregivers also reported being very satisfied with their intervention. Overall, this study demonstrated the positive role of Clown Doctors for caregivers at a specific pediatric hospital setting.
Aims:
To test whether a combined intervention of art therapy and clown visits could enhance the efficacy of oral medication in reducing children's anxiety at parental separation prior to induction of anesthesia.
Background:
Approximately 50% of children undergoing surgery report high anxiety at anesthesia induction. Complementary therapies have been used to decrease children's anxiety, but no study has evaluated the efficacy of a combination of such therapies.
Design:
This is an observational study, which involved allocating different interventions to two groups and measuring their anxiety at two time points.
Methods:
This study assigned 78 children (aged 3-11 years) undergoing general anesthesia for surgery to two conditions. The control group underwent general anesthesia following standard practice, and the intervention group received an intervention of integrated art therapy and clown visits upon their arrival at the hospital and throughout their time in the preoperating room. Each child in both groups received 0.5 mg/kg oral midazolam 30 minutes before surgery and had a parent present throughout their time in the preoperating room. Each child's anxiety was evaluated twice using the Modified Yale Preoperative Anxiety Scale (mYPAS): at baseline and at separation from parents. Repeated measures ANOVA was used to test for differences between the time points and the two groups.
Results:
Children in the intervention group showed a significant (P < 0.001) reduction in mYPAS scores at parental separation compared to those in the control group. Additionally, the majority of parents and nurses evaluated the intervention to be effective for reducing children's anxiety.
Conclusions:
This study found that an intervention based on art therapy and clown visits enhanced the effect of midazolam in reducing children's anxiety at preoperative separation from parents. This article is protected by copyright. All rights reserved.
Within the past decade, there has been a surge of interest in investigating the effects of clown intervention in a large variety of clinical settings. Many studies have focused on the effects of clown intervention on children. However, few studies have investigated clowning effects on adults. This paper presents an overview of the concept of medical clowning followed by a literature review conducted on the empirical studies drawn from three data bases (PubMed, PsycINFO, and Google Scholar), with the aim of mapping and discussing the evidence of clowning effects on non-children, namely adults. The following areas were investigated: Adult and elderly patients (mainly those with dementia), observers of clowning, namely non-hospitalized adults who are at the hospital as relatives of patients or health-care staff, and finally clowns themselves. The main results are that 1) clown intervention induces positive emotions, thereby enhancing the patient’s well-being, reduces psychological symptoms and emotional reactivity, and prompts a decrease in negative emotions, such as anxiety and stress; 2) clown doctors are also well-perceived by relatives and healthcare staff and their presence appears to be useful in creating a lighter atmosphere in the health setting; 3) few pilot studies have been conducted on clown doctors and this lacuna represents a subject for future research.
This study was designed to correlate enter-tainment of clown-doctors (CD) activities on hospitalized children and aphysiological biomarker. For this purpose we collected saliva samples and verified children satisfaction with these activities by using a visual analog scale (VAS). Children from 6 to 7 years-old, with diagnosis of any acute pathology, interned in the Pediatric Ward of the Botucatu Medical School Hospital (São Paulo, Brazil) were interviewed. Two groups were taken into consideration: lunchCD and dinnerCD. The following protocol was applied in each group (lunch and dinner): collection of the first saliva sample and presentation of VAS prior to CD activities, followed by collection of a second saliva sample and another VAS assessment after CD activities. The salivary cortisol was reduced in both groups comparing the first saliva sample. The satisfaction of the intervention was evident for lunchCD. The CD intervention is effective in decreasing an important physiological biomarker of stress factor, cortisol, in hospitalized children, been effective for the healing process.
Background:
A good physical exam is necessary to help pediatricians make the correct diagnosis and can save unnecessary imaging or invasive procedures. Distraction by medical clowns may create the optimal conditions for a proper physical examination.
Methods:
Children aged 2-6 years who required physical examination in the pediatric emergency department were recruited and randomly assigned to one of two groups: physical exam by a pediatrician in the presence of caregivers vs. physical exam with the assistance of a medical clown. Outcome measures consisted of the level of child's discomfort, anxiety, and the quality of the physical examination.
Results:
Ninety three children participated. Mean age was 3.3 ± 3.6 years (range 2-6). The duration of the physical exam was similar between the clown and control groups (4.6 ± 1.4 minutes vs. 4.5 ± 1.1 minutes (P = 0.64). The duration of discomfort was shorter in the clown group (0.2 ± 0.6 minutes) than the control group(1.6 ± 2.0 minutes, P = 0.001). In the medical clown group, 94% of pediatricians reported that the medical clown improved their ability to perform a complete physical examination. A trend of less hospitalization in the medical clown group was also noticed (11.3% in the medical clown group vs. 18.3% in the control group, P = 0.1); however, further study is required to verify this observation.
Conclusions:
Integration of a medical clown in physical examination improves the overall experience of the child and the caregivers and helps the pediatrician to perform a complete physical examination.
Background:
Medical clowns are increasingly used for diminishing pain and anxiety during painful procedures being performed on children in the hospital setting. Cortisol levels rise as a response to emotional distress.
Objectives:
To investigate whether medical clown-assisted interventions to reduce child's distress during venipuncture have an effect on cortisol levels.
Methods:
During a 1 year period, children requiring blood work or intravenous access in the pediatric emergency department were prospectively randomized to either the presence or absence of a medical clown during the procedure. The child's distress was evaluated using the Faces Pain Scale - revised (FPS-R) for the 4-7 year age group and the visual analog scales (VAS) for those aged 8-15 years. Serum cortisol levels were measured in blood samples obtained by venipuncture.
Results:
Fifty-three children aged 2-15 years were randomly assigned to the study group (with medical clown, n=29) or to the control group (without medical clown, n=24). Combined pain scores of the study group and control group were 2.2 and 7.5 respectively (P < 0.001). No difference in mean cortisol levels was found between the study group and the control group at all ages (16.4 µg/dl vs. 18.3 µg/dl, P = 0.65).
Conclusions:
In this pilot study, medical clowns reduced the distress from venipuncture in children. No effect on cortisol levels was observed.