The effectiveness of a medical clowning program on improving emotional status among hospitalized children undergoing cancer treatment: A quasi-experimental study

Identifying the Needs of Paediatric-Friendly Care in Emergency Department: A Delphi Study

AIMS

To systematically analyse expert perspectives on paediatric-friendly care in the emergency department and establish specific indicators.

BACKGROUND

With an increasing number of children seeking emergency care, nurses must understand the specific needs of paediatric patients and their families.

DESIGN

A two-round modified Delphi method was used in this study.

METHODS

In this study, experts from clinical practice and academia assessed 56 paediatric-friendly care criteria in the emergency department. Data were collected to establish a consensus and ensure content validity.

RESULTS

Thirty experts completed two survey rounds with response rates of 100% and 93.3%, respectively. In the initial survey, no consensus was reached for eight items. After the items were consolidated, 37 paediatric emergency-friendly care needs were identified. For each need, the item-level content validity index exceeded 0.79 for importance and feasibility. The average scale-level content validity index values were 0.95 and 0.92 for importance and feasibility. These needs were categorised into six dimensions: timely comfort (3 items), emotional care (5 items), frontline safety (11 items), emergency response (10 items), human resources support (5 items) and treatment efficiency (3 items).

CONCLUSION

Paediatric emergency nurses play a vital role in caring for children, improving soft skills through compassion and training and ensuring a well-equipped, safe environment in the emergency department.

RELEVANCE OF CLINICAL PRACTICE

This study offers valuable insights for emergency department nurses on the needs of children and their families, emphasising the importance of patient and family education, environmental considerations and the role of certified child life specialists in supporting the emergency healthcare team and ensuring appropriate paediatric care.

PATIENT/PUBLIC CONTRIBUTION

No direct patient, service user, caregiver or public involvement existed in this study.

Nurses' perspectives on child-friendly care needs in emergency departments: A qualitative study

BACKGROUND

Children can become anxious when undergoing emergency medical treatment. Therefore, emergency departments should be child friendly. This study explored emergency nurses' perspectives on children's needs during emergency care.

METHOD

This qualitative study employed purposive sampling to recruit 17 emergency nurses from 3 medical centers in northern and central Taiwan. Individual interviews were conducted between January and August 2021. Data were analyzed through qualitative content analysis.

RESULTS

The participants had 2-23 years of experience in caring for children in emergency departments. We identified 208 unique meaning units in the interview data, 79 of which were related to child-friendly emergency care. These were classified into 42 codes across 6 categories and 27 subcategories. The six categories were timely comfort, emotional care, frontline safety, emergency response, human resources support, and treatment efficiency.

CONCLUSION

Emergency nurses have professional competencies, play a crucial role as care providers for children in the emergency department, and ensure the comfort and safety of children seeking treatment. The categories related to child-friendly emergency care identified in this study can serve as a basis for developing child-friendly care emergency guidelines.

Medical clowning influences the emotions of parents of children undergoing cancer treatment: A quasi-experimental study

BACKGROUND

Medical clowning for children has been found to be effective at enhancing parents' psychological well-being during preoperative preparation, but has not been found during cancer treatment. This study aimed to examine whether and how medical clowning influenced the emotions of parents of children undergoing cancer treatment.

METHODS

In this quasi-experimental study, 96 parents of children receiving inpatient cancer treatment were recruited, from June 2018 through April 2020. A demographic questionnaire measuring characteristics of parent and dyadic child, Brief Symptom Rating Scale measuring psychological distress of the parent, and Mood Assessment Scale measuring emotional status of parent and child were administered 1 day before a clowning service. The day after the clowning service, the Mood Assessment Scale again collected emotional status for parent and child. Descriptive analysis, bivariate analysis, and structural equation modeling to fit the actor-partner, cross-lagged model were used.

FINDINGS

Parents experienced a low degree of psychological distress that called for emotional management. The indirect effect of medical clowning on parents' emotions through children's emotions was significant, as were the direct effect and total effect of medical clowning on parents' emotions.

DISCUSSION

Parents experienced psychological distress during their child's inpatient cancer treatment. Medical clowning can directly improve children's emotions and through this pathway indirectly improve their parents' emotions.

APPLICATION TO PRACTICE

There is need to monitor psychological distress and provide interventions for parents of children undergoing cancer treatment. Medical clowns should continue to serve parent-child dyads in pediatric oncology practice and become members of multidisciplinary health care teams.

Butterflies, Dwarves, and Plastic Lollypops: A Case Report on Medical Clowning in a Children's Rehabilitation Hospital

Medical clowning has been evolving in the past three decades and now plays a significant role in the rehabilitation processes of children who have suffered injuries and undergone complex medical procedures. The current paper focuses on this topic by presenting a case study of a young girl who lost most of her functional abilities due to brain damage. During the child's physiotherapy sessions at the rehabilitation hospital, a medical clown was brought in to work together with the physiotherapist in providing the treatment. The case study brings an in-depth perspective on the therapeutic process, as it is based on documentation of the sessions while addressing key stages in the child's rehabilitation, alongside core concepts in drama therapy. The qualitative analysis shows how the playful space in the rehabilitation process enhanced the child's inner motivation, provided a space for role expansion, and promoted the connection between the child and the environment. This paper demonstrates how the involvement of medical clowns can promote the rehabilitation processes of children who have suffered traumatic injuries and help them cope with functional losses.

Motivations and Personal Traits Can Predict Self-Efficacy of the Clown Therapist: A Descriptive Study

The individual and collective perception of self-efficacy in clown therapists is fundamental in order to be able to be active, restrained, energetic and defocused, if necessary, without being overwhelmed by any problems patients might have. The present study evaluated both the incidence of motivational and dispositional functions on the level of perceived self-efficacy with a sample of 259 Italian clown therapists who were administered The Volunteer Self-Efficacy Scale, the Volunteer Process Model and the Italy Personality Inventory. The significance of a hierarchical linear regression model of perceived self-efficacy was tested. The results showed that the value orientation of the operators mainly influenced the level of perceived self-efficacy, that is, the search for actions with a high social meaning, rather than the orientation towards situations and experiences that allow one to expand one's knowledge and promote one's own person. Profiles with higher perceived self-efficacy were associated with the trait of dynamism and conscientiousness, while a person's vulnerability was found to be a significant negative predictor of self-efficacy. An additional significant predictor was the experience of the clown therapist. The results of the study also showed a positive and functional role of the synergy conferred by teamwork. The group mitigates the emotional difficulties of the individual and supports him/her by orienting him/her technically and compensating for any inexperience in the field of animation in sensitive contexts, such as hospital wards with serious and vulnerable patients, such as children.