Scientific Background

 

RED NOSES is working to become a leading authority amongst clowndoctor organisations, specialising in scientific research on the use and impact of humour within the healthcare, educational and humanitarian sectors. We are committed to build and maintain a “research culture” exploring all aspects of bringing joy and laughter to the sick and suffering.

Our mission is to:

- improve the understanding of humour in the global healthcare/educational/humanitarian sectors
- produce scientific evidence of the working and effectiveness of medical clowning 
- develop a research environment with other clowndoctor organisations
- support and strengthen the high quality work of the RED NOSES Clowndoctors

 

Theoretical considerations

Why is healthcare clowning important?

Children in hospitals experience symptoms of distress due to the unfamiliar environment, separation from the parents, and possible painful procedures. Likewise symptoms of depression and anxiety; but also behavioural and emotional changes as sleep disturbances and social isolation are commonly reported problems in association to longer hospital stays (Rennick & Rashotte, 2009). Other institutions, like orphanages and refugee shelters, share similar settings that are associated with decreased well-being and a general diminished quality of life. Painful medical procedures can be traumatic for children and also their families, and thus have long-term negative emotional and psychological consequences (Alexander & Manno, 2003). Similar results have been found for elderly patients in nursing homes and adult patients in rehabilitation centres. 


Why is healthcare clowning beneficial?

Existing research shows that humour and laughter promote health at various levels, suggesting that by maintaining a positive emotional state humour may help to sustain a body’s basic health and healing mechanisms (McGhee, 2010). Humour can be viewed as an important emotion regulation mechanism – the positive emotion of mirth accompanying humour replaces negative feelings and experience of adversities, enabling a person to think more broadly and flexibly and to engage in creative problem solving (Martin, 2007). Humour also has the potential to create a powerful emotional connection between two people, thus enhancing and stimulating social interactions (Martin, 2007). 

Despite the rapid growth of healthcare clowning in hospitals, there is a paucity of research examining the specific impact of clowning in healthcare settings. The goal of healthcare clowns is to engage with the patient’s emotions, to reduce anxiety related to hospitalization, treatment and the disease itself (Dionigi et al., 2012). In fact, several studies have shown that a healthcare clown intervention can, in general, reduce stress in paediatric patients (Sridharan & Sivaramakrishnan, 2016) , which is, in turn, perceived as beneficial by both parents and hospital staff (e.g., Barkmann et al., 2013; Smerling et al., 1999). As such, healthcare clowns can be seen as complementary care providers who improve certain aspects of the paediatric experience. 

 

How does healthcare clowning affect stress?

Studies have shown that a healthcare clown intervention reduces children’s preoperative anxiety, which leads to a shortened hospitalization time and is thus cost-effective (Kocherov et al., 2016). Similar results have been found for children undergoing magnetic resonance imaging examinations, additionally to reducing the need for sedation in this situation (Viaggiano et al., 2015). Research shows that through a healthcare clown intervention mothers can also experience the preoperative period with less anxiety and perceived stress (Agostini et al., 2014). Thus, the presence of healthcare clowns during medical procedures is highly desirable and recommended as it has positive effects for all parties involved. 

 

For whom is healthcare clowning beneficial?

Although most research on the impact of healthcare clowning has been conducted with children, few recent studies show that clowning interventions are effective at every age. 

A recent study, conducted in collaboration with the University of Vienna, has shown that even very young infants react positively to the visits of healthcare clowns, while their reactions were largely dependent on the behaviours of their parents (Markova et al., in preparation). A study conducted by scientists at the University of Zürich found that healthcare clown intervention implemented in adult rehabilitation care elicit a positive emotional state in adult patients, thus contributing to more health and well-being (Auerbach et al., 2016). Finally, healthcare clowning in nursing homes seems to reduce moderate to severe behavioural and psychological symptoms of dementia, primarily of the Alzheimer’s type, suggesting that this so-called elder-clowning approach may be a promising tool to improve Alzheimer’s dementia care (Kontos et al., 2016). Taking together the results of recent studies suggest that healthcare clowning is beneficial for all age groups. 


Ongoing Research Activities of the RED NOSES Group


Emotional skills of healthcare clowns
(in cooperation with University of Vienna, Faculty of Psychology)

While most of the research activities in the field of healthcare clowning focused on examining the impact of healthcare clowning, only very few studies investigated the psychological characteristics of clowns working in the healthcare setting. Similar to nursing staff (Zyga et al., 2016), healthcare clowns are exposed to demanding stressors when engaged in interactions with patients in hospitals or various care institutions. Consequently, in this project we are examining the emotional and coping skills of healthcare clowns in comparison with nursing staff and a normal population.

 

Understanding of and reaction to RED NOSES Clown humour by hospitalized infants and toddlers: A pilot study (in cooperation with University of Vienna, Faculty of Psychology)

Whereas the general positive effects of the clowns in pediatric wards have been confirmed by Reviews and Meta-analysis, the question about clown behaviour reaches younger pediatric patients, like infants and toddler remained largely unknown. This is why in this study we examine how the clowns adapt their humorous actions to the children's age and how hospitalized infants and toddler with their parents react to the healthcare clown interventions. 

 

Positive effects of a healthcare clown intervention in children undergoing surgery (in cooperation with Motol University Hospital, Prague, CZ)

While there is evidence showing that healthcare clowning interventions effectively reduce stress and anxiety associated with medical procedures, we know little about the effect of such interventions on emotional well-being of paediatric patients. Consequently, the goal of this project is to examine not only the positive effects of a healthcare clown intervention on children undergoing surgeries, but also their parents and hospital staff. 

 

Publications, Presentations, and Research supervision


Publications

Auerbach, S., Ruch, W., & Fehling, A. (2016). Positive emotions elicited by clowns and nurses: An experimental study in a hospital setting. Translational Issues in Psychological Science (Special Issue: The Psychology of Humor), 2, 14-24.

Houdek, L. (2015). The healing power of Clowns, Svět a divadlo,  4. http://www.svetadivadlo.cz/cz/2015/sad-4-2015

Auerbach, S., Hofmann, J., Platt, T., & Ruch, W.(2014). An Investigation of the Emotions Elicited by Hospital Clowns in Comparison to Circus Clowns and Nursing Staff. European Journal of Humour Research 1(3) 26-54. (https://www.europeanjournalofhumour.org/index.php/ejhr/article/view/Auerbach%20et%20al)

Anes, L. & Obi, M. (2014). Hospital clowning as play stimulus in healthcare. Children, 1, 374-389. (http://www.mdpi.com/2227-9067/1/3/374

 

Conference presentations

2017

Anes, L. (September, 2017). Hospital clowning as a play stimulus in healthcare. Paper to be presented at International Play Association World Conference, Calgary, Canada. 

Anes, L. (September, 2017). Clowns nudging - Experiential learning in crisis environments. Paper to be presented at International Play Association World Conference, Calgary, Canada. 

Beck, M. (April, 2017). Clowns im medizinischen Behandlungsalltag einer Kinderambulanz - Möglichkeiten der humorvollen Interaktion mit kleinen PatientInnen. Paper presented at International Conference on Health Promoting Hospitals and Health Services, Vienna, Austria.

Markova, G. (April, 2017). Parental influence on infant appreciation of clown humour. Paper presented at International Conference on Health Promoting Hospitals and Health Services, Vienna, Austria.

Markova, G. & Göbel, V. (March, 2017). The role of social referencing in infant appreciation of clown humour. Poster presented at International Convention of Psychological Science, Vienna, Austria.

2016

Haslhofer, M. (November, 2016). ROTE NASEN Clowndcotors bewegen bis zuletzt. Paper presented at 21. Österreichische Konferenz Gesundheitsfördernder Krankenhäuser und Gesundheitseinrichtungen, Baden bei Wien, Austria. 

Seeliger, G. & Dumalin, C. (March, 2016). Emergency Smile International – When laughter becomes the biggest treasure and not a drop on the hot stone. Paper presented at Healthcare Clowning International Meeting, Lisbon, Portugal. 

2015

Kustermann, P. (September, 2015). Im Ernstfall mit Humor – für Pflegende und deren Trainer. Paper presented at Humorkongress, Basel, Switzerland. 

Haslhofer, M. (November, 2015). Was gibt es da zu lachen? Humor als Gesundheitspotenzial. Paper presented at 20. Österreichische Konferenz Gesundheitsfördernder Krankenhäuser und Gesundheitseinrichtungen, Vienna, Austria. 

Obi, M. (September, 2015). Celebrating the power of humour. A practical success story of verbal and non-verbal communication. Paper presented at 12. Dreiländerkongress: Pflege in der Psychiatrie, Vienna, Austria. 

Obi, M. (July, 2015). The power of humour in the healthcare sector and beyond. A descriptive portrayal. Paper presented at 15th International Summer School & Symposium on Humour and Laughter: Theory, Research and Application, St. Petersburg, Russian Federation.

Obi, M. (June, 2015). Celebrating age! Nurturing the spirit of life. Paper presented at 23rd International Conference on Health-Promoting Hospitals and Health Services, Oslo, Norway. 

Obi, M. (June, 2015). Crossing boundaries: Health and the performing arts. Poster presented at 23rd International Conference on Health-Promoting Hospitals and Health Services, Oslo, Norway.

Obi, M. (June, 2015). Emergency Smile: Refugees in Jordan. Poster presented at 23rd International Conference on Health-Promoting Hospitals and Health Services, Oslo, Norway.

2014

Obi, M. (October, 2014). Laughter and joy – A basic need for children in healthcare settings. Poster presented at the First International Conference on Pediatric Hospital Clown: The meaning of research and training, Florence, Italy. 

Obi, M. (October, 2014). Red noses in balance between the healthcare setting and the community. Poster presented at the First International Conference on Pediatric Hospital Clown: The meaning of research and training, Florence, Italy.

Obi, M. (September, 2014). Lachen: Eine Unterstützung zur Stressbewältigung im Spital. Paper presented at 19. Österreichische Konferenz Gesundheitsfördernder Krankenhäuser und Gesundheitseinrichtungen, Innsbruck, Austria.

 

Supervision of Master and Bachelor Thesis

2017

Kraszewski, C. A. (2017). Humor und Symbolspiel im zweiten Lebensjahr : eine längsschnittliche Untersuchung zur Erforschung des Zusammenhangs dieser beiden Faktoren in der frühen Kindheit (unpublished MA Thesis)

2016

Göbel, V. (2016) Die Auswirkung von sozialem Referenzieren in der Eltern-Kind Interaktion auf die Humorproduktion von Säuglingen in der Interaktion mit den Roten Nasen Clowndoctors. (unpublished MA Thesis)

Obernhumer, S. (2016) Das Humor-Verhalten der ROTE NASEN Clowndoctors bei hospitalisierten Säuglingen und Kleinkindern (unpublished MA Thesis)

Zapletal, M. (2016). Einfluss der Synchronie auf die frühkindliche Humorentwicklung (unpublished MA Thesis)

Angenbauer, S. (2016) Humor als Hilfsmechanismus für die Emotionsregulationsfähigkeit von Kleinkindern. (unpublished MA Thesis)


References

Agostini, F., Monti, F., Neri, E., Dellabartola, S., De Pascalis, L., & Bozicevic, L. (2014). Parental anxiety and stress before pediatric anesthesia: A pilot study on the effectiveness of preoperative clown intervention. Journal of Health Psychology, 19, 587-601. (http://journals.sagepub.com/doi/abs/10.1177/1359105313475900

Alexander, J., & Manno, M. (2003). Underuse of analgesia in very young pediatric patients with isolated painful injuries. Annual Emergency Medicine, 41, 617-622. (https://www.ncbi.nlm.nih.gov/pubmed/12712027

Auerbach, S., Ruch, W., & Fehling, A. (2016). Positive emotions elicited by clowns and nurses: An experimental study in a hospital setting. Translational Issues in Psychological Science (Special Issue: The Psychology of Humor), 2, 14-24. (http://www.zora.uzh.ch/id/eprint/130327/1/257_m_2016_AuerbachRuchFehling.pdf)

Barkmann, C., Siem, A., Wessolowski, N., Schulte-Markwort, M. (2013). Clownin gas a supportive measure in paediatrics – a survey of clowns, parents and nursing staff. BMC Pediatrics, 13, 166. (https://bmcpediatr.biomedcentral.com/articles/10.1186/1471-2431-13-166

Dionigi, A., Flangini, R., & Gremigni, P. (2012). Clowns in hospital. In P. Gremigni (Ed.), Humor and health promotion (pp. 213-228). New York: Nova Science Publishers. (https://www.researchgate.net/publication/259892132_Clowns_in_Hospital

Kocherov, S. et al. (2016). Medical clowns reduce pre-operative anxiety, post-operative pain and medical costs in children undergoing outpatient penile surgery: A randomised controlled trial. Journal of Paediatrics and Child Health, 52, 877-881. (http://onlinelibrary.wiley.com/doi/10.1111/jpc.13242/full

Kontos, P. et al. (2016). Elder-clowning in long-term dementia care: Results of a pilot study. Journal of the American Geriatric Society, 64, 347-353. (https://www.ncbi.nlm.nih.gov/pubmed/26889843)

Markova, G. et al. (in preparation). Understanding of and reaction to RED NOSES clown humour by hospitalized infants and toddlers: A pilot study.

Martin, R. A. (2007). The psychology of humor: An integrative approach. Burlington, MA: Elsevier. (http://www.sciencedirect.com/science/book/9780123725646

McGhee, P. (2010). Humor: The lighter path to resilience and health. Bloomington, IN: Authorhouse. (https://www.goodreads.com/book/show/9097360-humor

Rennick, J.E., & Rashotte, J. (2009). Psychological outcomes in children following paediatric intensive care unit hospitalization: a systematic review of the research. Journal of Child Health Care, 13, 128-149. (https://www.ncbi.nlm.nih.gov/pubmed/19458168)

Smerling, A. J., Skolnick, E., Bagiella, E., Rose, C., Labinsky, E., & Tager, F. (1999). Perioperative clown therapy for pediatric patients. Anesthesia & Analgesia, 88, 243-56. (http://journals.lww.com/anesthesia-analgesia/Fulltext/1999/02001/PERIOPERATIVE_CLOWN_THERAPY_FOR_PEDIATRIC_PATIENTS.303.aspx

Sridharan, K., & Sivaramakrishnan,G. (2016). Therapeutic clowns in paediatrics: a systematic review and meta-analysis of randomized controlled trails. European Journal Paediatrics, 175, 1353-1560. (https://www.ncbi.nlm.nih.gov/pubmed/27605131)  

Viaggiano, M. P., Giganti, F., Rossi, A., Di Feo, D., Vagnoli, L., Calcagno, G., & Defilippi, C. (2015). Impact of psychological interventions on reducing anxiety, fear and the need for sedation in children undergoing magnetic resonance imaging. Pediatric Reports, 7, 5682. (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4387329/

Zyga, S. et al. (2016). Assessing factors that affect strategies among nursing personnel. Materia Socio Medica, 28, 146. (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4851525/


Contact 

Mag. Gabriela Markova, PhD
Head of Scientific Research
gabriela.markova@rednoses.eu
T: +43 1 318 03 13 – 43

Florian Prommegger, MA MSc
Scientific Research
florian.prommegger@rednoses.eu
T: +43 1 318 03 13 – 43

 

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