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Dionigi A, Fermani A, Canestrari C. Jesters of Well-Being: Examining the Relationship between Clown Doctors and Patients. Behav Sci (Basel) 2024; 14:398. [PMID: 38785889 PMCID: PMC11118205 DOI: 10.3390/bs14050398] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2024] [Revised: 05/02/2024] [Accepted: 05/06/2024] [Indexed: 05/25/2024] Open
Abstract
Clown doctors play a crucial role in enhancing the well-being of patients through the use of humor. However, little is known about how the use of humor by clown doctors changes in relation to the developmental age of patients. This research explores the interplay between the type of humor used by clown doctors, their experience (in terms of years of clowning and type of clowning), and the developmental age of the patients (children, adolescents, adults, elderly). Data for this cross-sectional study were collected through an online survey distributed to 210 Italian clown doctors (143 females, 67 males), aged between 18 and 75 years (M = 47.34, SD = 12.31), affiliated with different Clown Care Units. The survey included the Comic Styles Markers, questions on the patients' developmental age, type of clowning (Auguste vs. Whiteface), and years of experience. The findings enhance our understanding on how clown doctors interact with patients of different developmental ages. The discussion draws connections to previous studies conducted on groups of clown doctors, providing a broader context for understanding the implications of humorous interactions in this unique healthcare domain.
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Affiliation(s)
| | - Alessandra Fermani
- Department of Education, Cultural Heritage and Tourism, University of Macerata, 62100 Macerata, Italy;
| | - Carla Canestrari
- Department of Education, Cultural Heritage and Tourism, University of Macerata, 62100 Macerata, Italy;
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2
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Korin O, Babis D. Medical clowning in hospitals: practices, training and perception. MEDICAL HUMANITIES 2024:medhum-2023-012785. [PMID: 38360796 DOI: 10.1136/medhum-2023-012785] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 11/21/2023] [Indexed: 02/17/2024]
Abstract
Previous studies on medical clowning focused on patients, while research remains inadequate concerning clowning itself: training programmes and prerequisite requirements, clowning methods, deontology and accepted practices. Diverse approaches and paradigms in this field of complementary medicine are promoted by non-profit organisations worldwide. Based on an ethnographic study, we explore the current forms of medical clowning in 5 Israeli hospitals. The observed clowns are from the two Israeli organisations, Dream Doctors and Simchat Halev (in Hebrew: joy of the heart), consisting of paid professional medical clowns and volunteers, respectively. According to the findings, significant differences were observed to exist between the organisations. Dream Doctors is conceived and pursued as an expertise practised by performance art professionals, requiring extensive training. These clowns work unaccompanied, receive a salary, are considered members of the medical team, and, given their privileged status, have access to hospitals' open and closed areas. The Dream Doctors consider medical clowning as a paramedical practice, in which interventions are individually suited to the circumstances of each patient, and obtain therapeutic results. In contrast, Simchat Halev's medical clowns are volunteers with no prerequisite artistic background and undergo shorter periods of training. The access granted to these clowns, usually working in pairs, is restricted to open areas. Simchat Halev promotes medical clowning as a volunteer-based public practice, offering general entertainment to all patients indiscriminately, and their contribution is characterised as achieving basic entertainment value.
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Medical clowns in Coronavirus wards: A milestone in further integration into Israeli hospitals. Complement Ther Clin Pract 2023; 51:101742. [PMID: 36867999 PMCID: PMC9943748 DOI: 10.1016/j.ctcp.2023.101742] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Revised: 01/22/2023] [Accepted: 02/18/2023] [Indexed: 02/24/2023]
Abstract
BACKGROUND During Covid-19, medical clowns disappeared from hospitals worldwide, ending their in-person visits. However, Israeli 'Dream Doctors' continued in children's wards and gained entrance to the Coronavirus wards. METHODS Using qualitative data from interviews and digital ethnography, the involvement of medical clowns in Coronavirus wards and their challenges were studied. RESULTS Medical clowns integrated mandatory protective gear and adapted their art: altering outfits, body language and interactivity. Spreading laughter and joy improved wards' ambience by uplifting patients', families' and staff's mood. Staff joined the clowns and loosened up in front of them. Reported need for this interaction was great and the clowns' intervention was crucial, leading to a successful trial in general wards, funded by one hospital. CONCLUSIONS Additional working hours and direct payment increased medical clowning's integration in Israeli hospitals. Entering the general wards evolved from the clowns' involvement in the Coronavirus wards.
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Dionigi A, Fermani A, Canestrari C. Do Clowns Really Taste Funny? An Investigation of the Relationship between Humor and Playfulness in Clown Doctors. Behav Sci (Basel) 2023; 13:bs13040328. [PMID: 37102842 PMCID: PMC10135840 DOI: 10.3390/bs13040328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Revised: 03/30/2023] [Accepted: 04/06/2023] [Indexed: 04/28/2023] Open
Abstract
Healthcare clowning represents a well-established method for relieving patients and their relatives of discomfort during hospitalization. Although studies concerning the effectiveness of this approach are increasing in number, state-of-the-art studies conducted to evaluate the psychological characteristics of clown doctors are scarce. In this cross-sectional study, a convenient sample of 210 clown doctors (143 females, 67 males) aged between 18 and 75 years (M = 47.34, SD = 12.31) completed a demographic questionnaire, the Comic Styles Markers, and the Short Measure for Adult Playfulness. The results demonstrated that clown doctors bring higher levels of fun, benevolent humor, and nonsense and a lower level of cynicism compared to the populace. Moreover, the participants with more experience tend to use less irony, sarcasm, and cynicism than those with less experience. Playfulness was primarily related to the lighter styles of humor, and specific differences between the Whiteface and the Auguste clown doctors were observed. The results are discussed with reference to previous studies conducted on groups of clown doctors.
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Affiliation(s)
| | - Alessandra Fermani
- Department of Education, Cultural Heritage and Tourism, University of Macerata, 62100 Macerata, Italy
| | - Carla Canestrari
- Department of Education, Cultural Heritage and Tourism, University of Macerata, 62100 Macerata, Italy
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Karnieli-Miller O, Divon-Ophir O, Sagi D, Pessach-Gelblum L, Ziv A, Rozental L. More Than Just an Entertainment Show: Identification of Medical Clowns' Communication Skills and Therapeutic Goals. QUALITATIVE HEALTH RESEARCH 2023; 33:25-38. [PMID: 36384326 PMCID: PMC9827496 DOI: 10.1177/10497323221139781] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
Medical clowns (MCs) are trained professionals who aim to change the hospital environment through humor. Previous studies focused on their positive impact and began identifying their various skills in specific situations. When placed in pediatrics, MCs face various challenges, including approaching frustrated adolescents who are unwilling to cooperate with their care, dealing with their anxious parents, and communicating in a team in the presence of other health professionals. Research that systematically describes MCs' skills and therapeutic goals in meeting these challenges is limited. This article describes a qualitative, immersion/crystallization study, triangulating between 26 video-recorded simulations and 12 in-depth-semi-structured interviews with MCs. Through an iterative consensus-building process we identified 40 different skills, not limited to humor and entertainment. Four main therapeutic goals emerged: building a relationship, dealing with emotions, enhancing a sense of control, caring, and encouragement, and motivating treatment adherence. Mapping MCs' skills and goals enhances the understanding of MCs' role and actions to illustrate their unique caring practices. This clarification may help other healthcare professionals to recognize their practices and the benefits in involving them in care. Furthermore, other health professionals may apply some of the identified skills when faced with these challenges themselves.
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Affiliation(s)
| | | | | | | | - Amitai Ziv
- Tel Aviv
University, Tel Aviv, Israel
- Sheba Medical
Center, Israel
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6
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Reizer A, Koslowsky M, Antilevich-Steg R. Turnover among medical clowns early in their career. AUSTRALIAN JOURNAL OF CAREER DEVELOPMENT 2021. [DOI: 10.1177/1038416221994567] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
In recent years, several investigations of the medical clowning profession have appeared in the literature. However, few studies have focused on factors associated with turnover among medical clowns early in their careers. The current study examined whether individual differences in humor disposition predicted turnover behavior. Participants were 111 medical clowns in a three-phase longitudinal study. Humor disposition was measured in the first week of their training, clowns' job satisfaction two months later, and turnover six months after that. Results showed that humor appreciation decreased actual turnover through the mediating role of job satisfaction, whereas individual differences in humor creation directly decreased turnover. In addition, previous traumatic experiences moderated the associations between humor appreciation and turnover. Overall, our research findings support the notion that humor disposition can help predict which clowns remain in the hospital.
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Affiliation(s)
- Abira Reizer
- Department of Behavioral Sciences, Ariel University, Ariel, Israel
| | - Meni Koslowsky
- Department of Behavioral Sciences, Ariel University, Ariel, Israel
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Efrat-Triester D, Altman D, Friedmann E, Margalit DLA, Teodorescu K. Exploring the usefulness of medical clowns in elevating satisfaction and reducing aggressive tendencies in pediatric and adult hospital wards. BMC Health Serv Res 2021; 21:15. [PMID: 33407400 PMCID: PMC7789247 DOI: 10.1186/s12913-020-05987-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Accepted: 12/01/2020] [Indexed: 12/28/2022] Open
Abstract
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.
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Affiliation(s)
| | - Daniel Altman
- Technion - Israel Institute of Technology, Haifa, Israel
| | - Enav Friedmann
- Ben-Gurion University of the Negev, 8499000, Beer-Sheva, Israel
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Siddiqui SA, Singh MV. Therapeutic Clowning in Pediatric Practice: A Novel Concept to Think About in India. Indian Pediatr 2020. [PMID: 32893831 PMCID: PMC7605477 DOI: 10.1007/s13312-020-2015-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Shahid Akhtar Siddiqui
- Department of Pediatrics, SN Children Hospital, MLN Medical College, Allahabad, Uttar Pradesh, India.
| | - Mukesh Vir Singh
- Department of Pediatrics, SN Children Hospital, MLN Medical College, Allahabad, Uttar Pradesh, India
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Gomberg J, Raviv A, Fenig E, Meiri N. Saving Costs for Hospitals Through Medical Clowning: A Study of Hospital Staff Perspectives on the Impact of the Medical Clown. CLINICAL MEDICINE INSIGHTS-PEDIATRICS 2020; 14:1179556520909376. [PMID: 32214864 PMCID: PMC7065276 DOI: 10.1177/1179556520909376] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/19/2019] [Accepted: 02/03/2020] [Indexed: 11/24/2022]
Abstract
This study explores the perspectives of doctors, nurses, and technicians on the medical clown. A total of 35 subjects were interviewed one on one. Interviews were transcribed and analyzed for common themes. Medical staff outlined novel limitations and views of future directions for the field of medical clowning. Most importantly, many previously unpublished benefits of medical clowns were described. These reported benefits included cost-saving measures for the hospital, increases in staff efficiency, better patient outcomes, and lower stress in medical staff. Given that most of the limitations on medical clowning are financial in nature, these findings have substantial implications for the future of the field. As medical clowning continues to grow, this study outlines the potential for various future research projects within this field of study.
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Affiliation(s)
| | - Amnon Raviv
- Tel Hai Academic College, Dream Doctors Project, Upper Galilee, Israel
| | - Eyal Fenig
- Institute of Oncology, Davidoff Cancer Center, Beilinson Hospital, Rabin Medical Center, Petah Tikva, Israel
| | - Noam Meiri
- Department of Pediatrics, Carmel Medical Center, Technion Faculty of Medicine, Haifa, Israel
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Newman N, Kogan S, Stavsky M, Pintov S, Lior Y. The impact of medical clowns exposure over postoperative pain and anxiety in children and caregivers: An Israeli experience. Pediatr Rep 2019; 11:8165. [PMID: 31579203 PMCID: PMC6769359 DOI: 10.4081/pr.2019.8165] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2019] [Accepted: 06/05/2019] [Indexed: 12/27/2022] Open
Abstract
While postoperative pain management was shown to reduce unwanted physiological and emotional outcomes, pediatric postoperative pain management remains suboptimal. Medical-clowns were shown to be beneficial in many medical contexts including reduction of stress, anxiety and pain. This study was set to assess the effectiveness of medical-clowns on pediatric postoperative pain reduction. Children age 4 or above, planned for elective hernia repair surgery were recruited. Children were randomly divided to a control or medicalclown escorted groups. Demographical and clinical data were collected using questionnaires and electronic sheets. Children escorted by clowns reported lower levels of pain upon admittance, discharge and 12- hours post-surgery. Statistically significant reduction of parental distress and significantly higher serum cortisol levels were observed in the clown-therapy group. Although small, our study supports the possibility that preoperative medical-clown therapy might be a cheap, safe and yet beneficial method for postoperative pain reduction.
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Affiliation(s)
- Nitza Newman
- Pediatric Surgery Department, Faculty of Health Sciences, Soroka University Medical Center, Ben-Gurion University of the Negev, Beer-Sheva
| | - Slava Kogan
- Joyce and Irwing Goldman Medical School, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva.,Soroka Clinical Research Center, Soroka University Medical Center, Beer-Sheva
| | - Moshe Stavsky
- Joyce and Irwing Goldman Medical School, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva.,Soroka Clinical Research Center, Soroka University Medical Center, Beer-Sheva
| | - Shay Pintov
- The Medical School for International Health, Faculty of Health Sciences, Ben Gurion University of the Negev, Beer-Sheva, Israel
| | - Yotam Lior
- Joyce and Irwing Goldman Medical School, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva.,Soroka Clinical Research Center, Soroka University Medical Center, Beer-Sheva
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Dionigi A, Canestrari C. Clowning in Health Care Settings: The Point of View of Adults. EUROPES JOURNAL OF PSYCHOLOGY 2016; 12:473-88. [PMID: 27547261 PMCID: PMC4991052 DOI: 10.5964/ejop.v12i3.1107] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2016] [Accepted: 04/17/2016] [Indexed: 11/20/2022]
Abstract
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.
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Affiliation(s)
- Alberto Dionigi
- Alberto Dionigi, Federazione Nazionale Clowndottori (FNC), Cesena, Italy
| | - Carla Canestrari
- Department of Education, Cultural Heritage and Tourism, University of Macerata, Macerata, Italy
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Tener D, Ofir S, Lev-Wiesel R, Franco NL, On A. Seriously clowning: Medical clowning interaction with children undergoing invasive examinations in hospitals. SOCIAL WORK IN HEALTH CARE 2016; 55:296-313. [PMID: 27123686 DOI: 10.1080/00981389.2016.1141826] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
This qualitative study examined the subjective experience of children undergoing an invasive examination in the hospital when accompanied by a medical clown. In-depth semi-structured interviews were conducted with nine such children and nine of their accompanying parents. The children were patients in two outpatient departments (Pediatric Gastroenterology and a Center for the Sexually Abused) in a hospital in Israel. Interviews were coded thematically using an Atlas.ti software program. Analysis of the interviews indicated that the intervention of the clown positively changed the children's perceptions of the hospital, of experiencing the examination, and of their life narrative. Medical clowns thus appear to be a central, meaningful, and therapeutic source for children undergoing invasive examinations in hospital, as well as for their parents. Therefore, it may be advisable to incorporate medical clowns as an integral part of medical teams performing invasive procedures and to include the clowns in all stages of the hospital visit.
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Affiliation(s)
- Dafna Tener
- a The Paul Baerwald School of Social Work and Social Welfare , The Hebrew University of Jerusalem , Jerusalem , Israel
| | - Shoshi Ofir
- b The Baruch Padeh Medical Center , Poriya , Israel
| | - Rachel Lev-Wiesel
- c The Emili Sagol Creative Arts Therapies Research Center , University of Haifa , Haifa , Israel
| | | | - Avi On
- e Pediatric GI Unit , Baruch Padeh Medical Center, The Faculty of Medicine in the Galilee, Bar-Ilan University , Safed , Israel
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Raviv A. Humor in the "Twilight Zone": My Work as a Medical Clown With Patients With Dementia. J Holist Nurs 2013; 32:226-31. [PMID: 24305659 DOI: 10.1177/0898010113513511] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Medical clowning has been primarily identified with working with children in pediatrics wards in hospitals. Over the past decade, more and more medical clowns have been working with adults and with patients with dementia as part of holistic care. Along with traditional medical care by hospital staff, the medical clown treats the patient's emotional side. Furthermore, medical clowning has unique advantages in working with patients with dementia. Several studies have shown that humor assists in improving the quality of life of patients with dementia. The clown, as the ultimate comic figure, creates interactions with patients based on humor, which empowers, calms, and strengthens the patient while reinforcing the patient's connection with the surroundings. Medical clowning is an interdisciplinary therapeutic art, and the medical clown has a "kit" of multiple skills (including humor, drama, music, and dance), all of which have a beneficial, therapeutic impact on patients. The current article presents and analyzes case studies from my work as a medical clown with patients with dementia.
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Affiliation(s)
- Amnon Raviv
- Ben-Gurion University, IsraelHaifa University, Israel
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15
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