Clown performances in hospitals—from the perspective of pediatricians
Published in 2016 by two Dutch public health scholars, this paper used qualitative research methods to investigate the views of a total of fourteen pediatricians regarding medical clowns. Its central research question was: “What are pediatricians’ views of medical clowns and their work?” The participating pediatricians were divided into two focus groups and interviewed separately. They answered questions based on their own experiences interacting with medical clowns and provided further opinions.
The subjects of this study were pediatricians at Haga Hospital in The Hague, the Netherlands, and Leiden University Medical Center. The researchers conducted sixty-minute interviews with each of the two groups of physicians about medical clown performances at their respective institutions. The interview questions were divided into four major areas, and the physicians were asked for their views on each:
The overall work of medical clowns in hospitals
The physicians generally had positive views of the clowns’ performances in hospitals, believing that clowns could indeed help their patients relieve stress and shift their attention away from their illness. However, some physicians pointed out that, compared with the frequency and duration of clowns’ interactions with patients, physicians had significantly fewer opportunities to interact with clowns.
The clinical effectiveness of medical clowns
The interviewed physicians generally remained reserved about the clowns’ actual clinical effects, such as postoperative pain scores. Rather than clinical effectiveness, the physicians cared more about the patients’ own experiences interacting with the clowns.
Standard procedures for coordinating clown performances with the institution’s services
The interviewed physicians generally did not feel that they were included in the medical clowns’ work processes. Whether regarding performance scheduling, lists of patients to be visited by clowns, or pre-performance briefings on patients’ conditions, most physicians believed that nurses, social workers, or administrative units knew more about patients’ social and family backgrounds and were therefore better suited to arrange clown performances in the hospital.
Direct collaboration between physicians and medical clowns
Neither of the two groups of interviewed physicians had ever worked “directly” with clowns. The interviewers then brought up Israel’s “Dream Doctors Program.” In this program, medical clowns undergo a series of training sessions, become members of the medical team, and participate in formal medical procedures. The participants were asked to imagine a similar situation, and the interviewed physicians believed that formal collaboration between physicians and medical clowns would have to meet the following four conditions:
（1）The collaboration must be able to soothe children and redirect their attention.
（2）The collaboration must not interfere with medical procedures (for example, it must not be excessively noisy).
（3）For children, it must not create the impression of associating “clowns” with “unpleasant medical procedures.”
（4）Physicians and medical clowns must clearly communicate with each other and reach a consensus regarding the expected effects of the clown performance.
The physicians believed that if the above four conditions could be met, collaboration between clowns and physicians could produce positive effects. In addition, some physicians mentioned that if medical clowns were to be incorporated into treatment planning, they might prefer to get to know the individual clown performers further before making a decision.
Overall, the physicians who participated in this study held positive views of interactions between medical clowns and pediatric patients. They also proposed several possible conditions that could improve future interactions with medical clowns, such as more frequent and detailed prior communication and collaborative models that do not interfere with medical procedures, among others. With reasonable guidelines and mutual understanding, pediatricians would be very willing to develop deeper collaborative relationships with medical clowns.
References
European Journal of Pediatrics 2017 Feb;176(2):191-197. doi: 10.1007/s00431-016-2821-8.
- Researchers from the Department of Public Health and Primary Care, Leiden University Medical Center, the Netherlands
- Lennard T. van Venrooij
- Pieter C. Barnhoorn
- Abstract transcription: Chia-An Cho