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Therapeutic Clowns in the Emergency Department - Mount Sinai


									        Assessing Emotions and Attitudes
    Towards Using Therapeutic Clowns in the
     Pediatric Emergency Department (PED)


                            IPEME 2011 PROJECT

Roni Shreberk (Tel Aviv University, Israel)
Anas Al Karasneh (Jordan University of Science and Technology, Jordan)
Dahlia Balaban (University of Toronto, Canada)
Our Group

 Background
 Rationale
 Research Questions
 Study Design
 Emotion Wheel
 Expected Outcomes
 Limitations
 Future directions
 Acknowledgements
        Background – Emotions in the ED

 Illness + Visiting the PED  Anxiety (Hatcher et al., 1989).

 Children in the PED fear pain, hospitalization, undressing, parental
  separation, strangers, talking about personal problems and getting
  shots (Magaret et al., 2002).
                  Emotions in the PED = ???
 Children with pain and trauma are more likely to experience clinical
  anxiety (Nager et al., 2010).

 Caregivers experience greater anxiety with longer wait times and think
  about wait times before bringing their children to the PED (Parkinson
  et al, 1999).
   Background – Complementary Therapies in Clinical

 Music Therapy

 Aromatherapy

 Pet Therapy

 Medical Clowns
  medical clowns = therapeutic clowns = clown doctors
Background – History of Therapeutic Clowns

 Use humor and laughter to positively affect well-
  being and health (Fry, 1992).

 1986: "Big Apple Circus" in New-York.

 1998: Movie about Patch Adams, the medical clown.

 2011: Medical clowning is now wide-spread.
   Background – Specific Uses of Clowns

 In induction of anesthesia (pre-operatively)
  (Yip et al., 2010)

 In children’s mental health (Tener et al.,

 In adults (haematology, geriatrics, IVF) (eg.
  Friedler et al., 2011)
  Background – Therapeutic Clowns in Israel

 2000: 1st medical clown started to work in "Assaf Haroffe" medical
 2009: Haifa University launched a B.A. program in medical
 2011: Medical clowns are found in almost all pediatric wards
  around Israel, even in some PEDs.

                   Dream Doctors, North of Israel
     Background – Therapeutic Clowns in Canada

 1986: 1st program founded at Winnipeg Children's Hospital.
 1993: Therapeutic Clown Program launched at Sick Kids Hospital.

             Flora the Clown - Camilla Gryski, Sick Kids
 Background – Therapeutic Clowns in Jordan

 No formal use of medical clowns, but Jordanian visitors in
  Israeli health centers express interest in the possibility of
  medical clowns being used.

                    Clown Required, Jordan
  Background - Emergency Department Models

                Canada                 Jordan                Israel
Model           Patients wait many     Patients see MD in    Patients see MD in
                hours before           shared area and       private area and
                seeing MD in           return to waiting     return to waiting
                private area           area to await tests   area to await tests
Waiting Times   Patients spend 11      Patients see MD       Patients see MD
                hrs in the ED for      after 1hr and leave   after >30 mins and
                complex problems       the ED after 3 hrs    spend 3-4 hrs in
                and >4 hrs for                               the ED
                simple problems

                (From Ontario Health                         (From News Article in
                                       (Anecdotal)           2003)

 Few studies have assessed emotions in the PED, but
  we know it is a stressful environment.

 Medical clowns have been used effectively in clinical
  settings, mostly in paediatric wards and rarely in the

 Patients and families spend many hours in the PED
  and medical clowns could help address negative
  emotions there.
               Research Questions

1) What emotions are experienced by adults
accompanying children in PEDs?

2) Are adults accompanying children in PEDs aware of
the existence and use of therapeutic clowns?

3) Would they see value in the addition of therapeutic
clowns to PED waiting areas to address their
        Study Design – Needs Assessment

 Where: PEDs in Israel, Jordan and Canada.

 Population: Adults accompanying children.

 Sample Size: > 50 responses per region (simultaneously in each
  region, in 3 shifts).

 Method: Survey (in English, Hebrew or Arabic) given during
  waiting times to be filled out on the spot.

 Consent: Implied (by filling out survey).

 Immediate Intervention: Educational pamphlet to take home.
The Questionnaire
              Geneva Emotions Wheel

                                                Irritation            Involvement
                                                    Anger             Interest
                                  Contempt                                            Amusement
                                      Scorn                                           Laughter

                        Disgust                                                               Pride
                      Repulsion                                                               Elation

                   Envy                                                                                 Happiness
               Jealousy                                                                                 Joy
    Disappointment                                      No Emotion Felt                                         Enjoyment

             Regret                                                                                             Pleasure
             Guilt                                                                                              Tenderness
          Remorse                                            Other:                                             Feeling love
      Embarrassment                                                                                         Wonderment
             Shame                                                                                          Feeling awe
                          Worry                                                                Feeling disburdened
                           Fear                                                                Relief
                                   Sadness                                            Astonishment
                                   Despair                                            Surprise
                                                    Pity                  Longing
                                              Compassion                  Nostalgia
The Questionnaire
               Expected Outcomes

 Characterize emotions in the PED.

 Jordanians will have little knowledge but will be
  interested in learning more about medical clowns
  (culturally acceptable).

 Some Israelis and Canadians will be aware of the
  existence of therapeutic clowns and will be open to
  having them in the PED.

 Survey format

 Pilot study

 Only surveying adults (not the patients)

 Survey will only be available in English, Hebrew or

 Coulrophobia= fear of clowns
                Future Directions

 Use results to inform a new study with a greater
  sample size and greater scientific validity.

 Similar survey of pediatric emergency physicians.

 Use the data to support the implementation of
  therapeutic clowns in PEDs.

 Dr. Joy Fitzgibbon
 Dr. Dennis Scolnik
 Dr. Rahim Valani
 Dr. Sarah Khan
 Morgan Livingstone
 Members of IPEME 2011
Quotes about Laughter

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