HLSC122 Evidence for Practice

Introduction

This study aims to check the hospital clown effectiveness in both adolescents and children that are hospitalized and are suffering from any medical conditions (acute and chronic). In this paper, the clinical problem shall be discussed, research question and justification, findings from the critical appraisal skills program checklist, application of evidence in a clinical area. In this study, randomized and non-randomized controlled trials were reviewed. The studies which compared the use of standard care with hospital clowns, and studies evaluating hospital clown’s effect on managing symptoms of inpatient adolescents and children as the major result.

Identifying the clinical problem

The PRISMA guidelines (preferred reporting items for systematic reviews and meta-analysis) were used in this study. It also used the methods of Cochrane Handbook for Systematic Reviews of Interventions (version 5.1.0.). The search for studies in this database showed 131 results, and five additional studies searched manually in clinical trials registries, Google Scholar were included. Randomized controlled trials predominated the review, but many non-randomized controlled trials were analyzed and they met the inclusion criteria. No study before this study evaluated the effectiveness of clinical clowns for managing symptoms in pediatric patients along with taking into consideration acute and chronic illnesses. Research shall include methodology that is appropriate and data collection methods, in this particular article the author has chosen methods that were appropriate but size of the sample was small, although the topic of the study was broad enough. There should have been a suitable selection of design for the study that focus on research problems or questions as methodology is dependent on the designing and collection and analyzing the data (Flick, 2018).

Research justification and question

The study was conducted to evaluate evidences to check the effectivity of hospital clowns for a wide range of symptoms clusters in adolescents and symptoms. In paediatric care, the alleviation of symptom clusters during the process of admission is prioritised in care of pediatric patients. Previous studies have only evaluated the meta-analysis and reviews on the hospital clowns in acute conditions and during the medical procedures. They have a positive effect on the outcome of the paediatric patients. The results in the previous studies shall be considered with caution. In studies in the past, strong effects on the hospital clowns showed an important role in reduction of the psychological stress in children before any surgical procedure (Sridharan & Sivaramakrishnan, 2016). In another study, the clowning effectiveness on anxiety in children who were undergoing procedures, suggests that clowing has improved the anxiety levels in children (Zhang et al., 2017)

Critical appraisal

The researcher has discussed the research problem well, (Lopes-Júnior et al., 2020), as in the past studies were done and they showed positive effects on the patient outcomes in the pediatric population for conditions and during medical procedures. But no study was done to understand the interaction of hospital clowns in medical procedures and hospitals clowns, during the administration of anesthesia, pre-operative rooms along with chronic conditions (cancer), and checked how they can be beneficial in managing symptom clusters (fatigue, pain, stress, and anxiety) and also examined the improvements in psychological well-being and responses to emotions in both the groups, so this study was conducted. A systematic review was done.                                                    

In this study, internal validity, reliability, objectivity, and external validity were taken into consideration. Evidence supports the fact that credibility shall be the trustworthy. It shall be achieved when results and interpretation are truthful and accurate. The author has described the introduction part well, all the content which is required in the introduction part is mentioned well, so the introduction is good. Limitations in this study include heterogeneity related to the collection of the data, follow-up, symptom clusters heterogeneity, onset, and severity of conditions (chronic or acute). Most of the studies included in this article, were conducted with adolescents or children with the acute diagnosis, which increases the level of bias in these studies. The researcher mentioned the problems and challenges faced by the researchers. The article compared the findings with other studies. The author has elaborated the discussion part well. Evidence suggest that Hartas in (2015), the author shall discuss the results of the study in the context of already known information. In the discussion part, the findings of any study shall be described by the purpose of research and it shall be shown whether it has been addressed or not. The results showed that anxiety was the most analyzed symptom, which was followed by pain, emotional and psychological responses, and perceived well-being, crying, and fatigue. Most of the non-randomized control studies showed that a moderate risk of bias was found based on ROBINS-I-tool. Therefore in the hospital settings, the hospital clown help in psychological well-being in hospitalised children and adolescence patients with chronic and acute disorders, as they are  standard care. There was no requirement for ethical consent. Research is very limited concerning this topic.

Application of evidence in the clinical area

In the past, many studies have been done in investigating the results of intervention of clown in the hospital settings and clinics too (Dionigi & Canestrari, 2016). There is a positive result which is given by the parents, doctors, nurses, and relatives and they appreciate this practice. Various studies have also shown that studies have shown the interference of these clowns in medical processes/procedures. To combat such challenges, workshops are being made that aim and introduce the function and role of clowning, along with health-care settings to nurses and also involving them in training so that relational skills are improved. Further research is required in this area and it is progressing, but still, there is a gap that determines aspects that are more relevant and lead to positive results. In another study, the aim was to investigate the effects of the hospital clowns on depression and anxiety levels of the child patients, including their mother during their stay in the hospital (Alparslan & Bozkurt, 2018). Ninety-six percent of children said that they enjoyed with the clowns, eighty-four percent mentioned clown entertained and were relieving, sixty percent said that the clowns reduce their excitement and fear, ninety-four percent mentioned that clowns shall meet them again, and eighty percent mentioned the very first thing whenever they are hospitalized that will be meeting with the clowns shall be a lovely experience. Therefore, it was concluded that the presence of clowns plays an important role in managing the depression in children and anxiety (Auerbach & Ruch 2017) shows that the hospital clown interventions shall have beneficial effects on the patient. The main aim of such a professional is to work with the emotions of the patient, reduction of levels of anxiety with patients that are hospitalized, treatments, and disease itself. The clown doctors are made to work in partnership with the medical professionals, they aim in diverting the children during painful procedures, distract and calm the patient whenever there is an emergency, encourage and assist during physiotherapy and occupational therapy, it improves the quality of life of the most vulnerable community members, injured and sick kids.

Conclusion

Therefore, from the above-mentioned discussion, it can be concluded that the aim of the study was met. Hospital clowns shall contribute to improving well-being (psychological) and an emotional responses in adolescents and children. Hospital clowns are a subjective intervention, studies in bio-behavioral and psychoneuroimmunology are studying this intervention deeply. Studies in the future help in elucidating the mechanisms which are underlying the effects of this treatment option. Studies in the future help in elucidating the mechanism underlying effects of this intervention. Studies in the future shall be encouraged, for investigating the potential coulrophobia in pediatric patients. 

References

Alparslan, Ö., & Bozkurt, G. (2018). The effect of a clown model implemented in hospital on the anxiety and depression level of ill children and their mothers. Arts & Health, 10(2), 138-150. https://doi.org/10.1080/17533015.2017.1334679

Auerbach, S., & Ruch, W. (2017). Send in the clowns? Emotional reactions to hospital clown interventions, 121. https://www.zora.uzh.ch/id/eprint/140339/1/20172964.pdf#page=139

Dionigi, A., & Canestrari, C. (2016). Clowning in health care settings: The point of view of adults. Europe's journal of psychology, 12(3), 473. https://dx.doi.org/10.5964%2Fejop.v12i3.1107

Hartas, D. (Ed.). (2015). Educational research and inquiry: Qualitative and quantitative approaches. Bloomsbury Publishing.

Lopes-Júnior, L. C., Bomfim, E., Olson, K., Neves, E. T., Silveira, D. S. C., Nunes, M. D. R., ... & Lima, R. A. G. (2020). Effectiveness of hospital clowns for symptom management in paediatrics: systematic review of randomised and non-randomised controlled trials. bmj, 371. https://doi.org/10.1136/bmj.m4290

Sridharan, K., & Sivaramakrishnan, G. (2016). Therapeutic clowns in pediatrics: a systematic review and meta-analysis of randomized controlled trials. European journal of pediatrics, 175(10), 1353-1360. https://doi.org/10.1007/s00431-016-2764-0

Tener, D., Ofir, S., Lev-Wiesel, R., Franco, N. L., & On, A. (2016). Seriously clowning: Medical clowning interaction with children undergoing invasive examinations in hospitals. Social work in health care, 55(4), 296-313. https://doi.org/10.1080/00981389.2016.1141826

Zhang, Y., Yang, Y., Lau, W. Y., Garg, S., & Lao, J. (2017). Effectiveness of pre‐operative clown intervention on psychological distress: A systematic review and meta‐analysis. Journal of Paediatrics and Child Health, 53(3), 237-245. https://doi.org/10.1111/jpc.13369