More Than Just an Entertainment Show: Identification of Medical Clowns’ Communication Skills and Therapeutic Goals

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.

[1]  S. Blain-Moraes,et al.  “We are still doing some magic”: Exploring the effectiveness of online therapeutic clowning , 2022, Arts & health.

[2]  K. Olson,et al.  Effectiveness of hospital clowns for symptom management in paediatrics: systematic review of randomised and non-randomised controlled trials , 2020, BMJ.

[3]  Walter Ferreira de Oliveira,et al.  Clown Therapy: Recovering Health, Social Identities, and Citizenship , 2020 .

[4]  E. Fenig,et al.  Saving Costs for Hospitals Through Medical Clowning: A Study of Hospital Staff Perspectives on the Impact of the Medical Clown , 2020, Clinical medicine insights. Pediatrics.

[5]  S. Yuvaraj,et al.  Being a therapeutic clown- an exploration of their lived experiences and well-being , 2020 .

[6]  Alberto Dionigi,et al.  Highly sensitive persons, caregiving strategies and humour: the case of Italian and Israeli medical clowns , 2020 .

[7]  Jonathan G. Shaw,et al.  Practices to Foster Physician Presence and Connection With Patients in the Clinical Encounter. , 2020, JAMA.

[8]  O. Karnieli-Miller,et al.  Students' patient-centered-care attitudes: The contribution of self-efficacy, communication, and empathy. , 2019, Patient education and counseling.

[9]  B. Gibson,et al.  Seriously Foolish and Foolishly Serious: The Art and Practice of Clowning in Children’s Rehabilitation , 2019, Journal of Medical Humanities.

[10]  Charlotte Grinberg 'These Things Sometimes Happen': Speaking Up About Harassment. , 2018, Health affairs.

[11]  O. Karnieli-Miller,et al.  Significant life events as a journey of meaning making and change among at-risk youths , 2018 .

[12]  N. Roumeliotis,et al.  Is there a role for clowns in paediatric intensive care units? , 2017, Archives of Disease in Childhood.

[13]  L. Lerner-Geva,et al.  Patients’ Evaluation of Intervention by a Medical Clown Visit or by Viewing a Humorous Film Following In Vitro Fertilization and Embryo Transfer , 2017, Journal of evidence-based complementary & alternative medicine.

[14]  P. Kontos,et al.  Presence redefined: The reciprocal nature of engagement between elder-clowns and persons with dementia , 2017, Dementia.

[15]  P. Barnhoorn,et al.  Hospital clowning: a paediatrician’s view , 2016, European Journal of Pediatrics.

[16]  Carla Canestrari,et al.  Clowning in Health Care Settings: The Point of View of Adults , 2016, Europe's journal of psychology.

[17]  Dafna Tener,et al.  The Therapy Beneath the Fun , 2016, Clinical pediatrics.

[18]  S. Mercer,et al.  Randomised controlled trial of a brief intervention targeting predominantly non-verbal communication in general practice consultations. , 2015, The British journal of general practice : the journal of the Royal College of General Practitioners.

[19]  M. Patton Qualitative Research & Evaluation Methods: Integrating Theory and Practice , 2014 .

[20]  F. Finlay,et al.  Therapeutic clowning in paediatric practice , 2014, Clinical child psychology and psychiatry.

[21]  A. Raviv The clown's carnival in the hospital: a semiotic analysis of the medical clown's performance , 2014 .

[22]  C. Barkmann,et al.  Clowning as a supportive measure in paediatrics - a survey of clowns, parents and nursing staff , 2013, BMC Pediatrics.

[23]  P. Spitzer,et al.  Smiles are Everywhere: Integrating Clown-Play into Healthcare Practice , 2013 .

[24]  S. G. Stanley Failure Theatre: An Artist's Statement , 2013 .

[25]  Lotta Linge Joyful and serious intentions in the work of hospital clowns: A meta-analysis based on a 7-year research project conducted in three parts , 2013, International journal of qualitative studies on health and well-being.

[26]  P. Werner,et al.  Are you talking to me?! An exploration of the triadic physician-patient-companion communication within memory clinics encounters. , 2012, Patient education and counseling.

[27]  L. Butler “Everything seemed new”: Clown as Embodied Critical Pedagogy , 2012 .

[28]  R. Frankel,et al.  Understanding Values in a Large Health Care Organization through Work-Life Narratives of High-Performing Employees , 2011, Rambam Maimonides medical journal.

[29]  Y. Uziel,et al.  Medical clowns: dream doctors as an important team member in the treatment of young children with juvenile idiopathic arthritis , 2011, Harefuah.

[30]  Susana Pendzik,et al.  Therapeutic clowning and drama therapy: A family resemblance , 2011 .

[31]  P. Spitzer,et al.  Laughing to longevity—the work of elder clowns , 2011, The Lancet.

[32]  J. Gross,et al.  The temporal dynamics of emotion regulation: An EEG study of distraction and reappraisal , 2011, Biological Psychology.

[33]  M. Neumann,et al.  Sharing qualitative research findings with participants: study experiences of methodological and ethical dilemmas. , 2011, Patient education and counseling.

[34]  R. Frankel,et al.  Which Experiences in the Hidden Curriculum Teach Students About Professionalism? , 2011, Academic medicine : journal of the Association of American Medical Colleges.

[35]  T. Abma,et al.  qualitative research: is meaning lost in translation? , 2022 .

[36]  S. Bailes Performance theatre and the poetics of failure : Forced Entertainment, Goat Island, Elevator Repair Service , 2010 .

[37]  R. Frankel,et al.  Exploring the Meaning of Respect in Medical Student Education: an Analysis of Student Narratives , 2010, Journal of General Internal Medicine.

[38]  O. Nuttman-Shwartz,et al.  Medical Clowning: Even Adults Deserve a Dream , 2010, Social work in health care.

[39]  Orit Nuttman-Shwartz PhD Msw,et al.  Medical clowning: even adults deserve a dream. , 2010 .

[40]  R. Epstein,et al.  Developing physician communication skills for patient-centered care. , 2010, Health affairs.

[41]  Dafna Tener,et al.  Laughing Through This Pain: Medical Clowning During Examination of Sexually Abused Children: An Innovative Approach , 2010, Journal of child sexual abuse.

[42]  M. Megel,et al.  The voices of children: stories about hospitalization. , 2010, Journal of pediatric health care : official publication of National Association of Pediatric Nurse Associates & Practitioners.

[43]  T. Inui,et al.  Medical Students' Professionalism Narratives: A Window on the Informal and Hidden Curriculum , 2010, Academic medicine : journal of the Association of American Medical Colleges.

[44]  Steve Oakes Freedom and constraint in the empowerment as jazz metaphor , 2009 .

[45]  S. Eidelman,et al.  The Impact of Senior Medical Students' Personal Difficulties on Their Communication Patterns in Breaking Bad News , 2009, Academic medicine : journal of the Association of American Medical Colleges.

[46]  J. Rashotte,et al.  Psychological outcomes in children following pediatric intensive care unit hospitalization: a systematic review of the research , 2009, Journal of child health care : for professionals working with children in the hospital and community.

[47]  Sharan B. Merriam,et al.  Qualitative Research: A Guide to Design and Implementation , 2009 .

[48]  A. Squires Methodological challenges in cross-language qualitative research: a research review. , 2009, International journal of nursing studies.

[49]  Julie Salverson Taking liberties: a theatre class of foolish witnesses , 2008 .

[50]  Lotta Linge Hospital clowns working in pairs—in synchronized communication with ailing children , 2008 .

[51]  G. Prudhoe,et al.  Sick children’s perceptions of clown doctor humour , 2007 .

[52]  G. Prudhoe,et al.  Clown humour: The perceptions of doctors, nurses, parents and children , 2007 .

[53]  D. Koller,et al.  The Life Threatened Child and the Life Enhancing Clown: Towards a Model of Therapeutic Clowning , 2007, Evidence-based complementary and alternative medicine : eCAM.

[54]  J. Dale,et al.  Effects of Distraction on Pain, Fear, and Distress During Venous Port Access and Venipuncture in Children and Adolescents With Cancer , 2007, Journal of pediatric oncology nursing : official journal of the Association of Pediatric Oncology Nurses.

[55]  Julie Salverson,et al.  WITNESSING Witnessing subjects: a fool’s help , 2006 .

[56]  Alice Frohna,et al.  Medical students' professionalism , 2006, Medical teacher.

[57]  R. Epstein,et al.  Measuring patient-centered communication in patient-physician consultations: theoretical and practical issues. , 2005, Social science & medicine.

[58]  A. Ziv,et al.  Features and uses of high-fidelity medical simulations that lead to effective learning: a BEME systematic review , 2005, Medical teacher.

[59]  R. Frankel,et al.  Assessing Competence in Communication and Interpersonal Skills: The Kalamazoo II Report , 2004, Academic medicine : journal of the Association of American Medical Colleges.

[60]  A. Duff,et al.  Incorporating psychological approaches into routine paediatric venepuncture , 2003, Archives of disease in childhood.

[61]  K. Slifer,et al.  Distraction for Children of Different Ages Who Undergo Repeated Needle Sticks , 2002, Journal of pediatric oncology nursing : official journal of the Association of Pediatric Oncology Nurses.

[62]  P. Bower,et al.  Patient-centredness: a conceptual framework and review of the empirical literature. , 2000, Social science & medicine.

[63]  Deborah A. Cai,et al.  A test of a cultural model of patients' motivation for verbal communication in patient‐doctor interactions , 2000 .

[64]  J. Vessey,et al.  Using distraction to reduce reported pain, fear, and behavioral distress in children and adolescents: a multisite study. , 2000, Journal of the Society of Pediatric Nurses : JSPN.

[65]  M. Patton,et al.  Enhancing the quality and credibility of qualitative analysis. , 1999, Health services research.

[66]  F. Shih Triangulation in nursing research: issues of conceptual clarity and purpose. , 1998, Journal of advanced nursing.

[67]  M. Patton,et al.  Qualitative evaluation and research methods , 1992 .

[68]  D. Campbell,et al.  Convergent and discriminant validation by the multitrait-multimethod matrix. , 1959, Psychological bulletin.

[69]  A. Farneti,et al.  Clowning Training to Improve Working Conditions and Increase the Well-Being of Employees , 2020 .

[70]  P. Gremigni Humor and health promotion , 2012 .

[71]  H. Carretero-Dios,et al.  Effects of a humor-centered activity on disruptive behavior in patients in a general hospital psychiatric ward , 2006 .

[72]  Maria Fenech Adami,et al.  The use of triangulation for completeness purposes. , 2005, Nurse researcher.

[73]  J. Hunter,et al.  A test of a cultural model of conflict styles , 2004 .