Clowns have entertained people for millennia. However, the use of humour as a therapy is receiving increasing attention from health-care professionals who are interested in both the psychological and physical effects on patients’ wellbeing. Nevertheless, there is however a paucity of English-language empirical data to underpin the use of clown humour in children’s health-care settings. The primary objective of this study was to elicit the perceptions of doctors, nurses, parents and children regarding the efficacy of performances by Theodora Trust Special Clowns to sick children in a children’s hospital in the south of England. Participants included 49 children, 43 parents/carers, 17 doctors and 93 other health-care staff. A questionnaire was used that employed a mixture of closed and attitudinal Likert-type questions, and descriptive statistics were calculated of how individual groups of respondents view the efficacy of clown doctor humour delivered to sick children in hospital. The majority of children indicated that they liked playing with clowns during their hospital stay, and the majority of parents agreed that the presence of clown doctors has a positive impact on sick children and their families. The majority of the paediatricians who participated also agreed that the presence of clown doctors has a positive impact on sick children and their families during a hospital stay. However, six of them revealed that they did not personally like clowns. Among the other health-care staff, a large majority agreed that clown doctors have a positive impact on the child and family and that the clown encounter was helpful to the sick child, although 22 did not personally like clowns. The results show that the parents and children are enthusiastic about the presence of clown doctors in clinical environments where sick children are cared for. The majority of health care professionals including paediatricians are supportive of clown doctor activities for children, despite some of their own personal prejudices.

This patient and public involvement study revealed a number areas that children and young people believe to be important for the future training of children's nurses. Additionally, the factors which children consider inhibit or enhance the experience of hospital admission have been identified.

Clowns and their humour have entertained human beings for centuries. However the literature as yet fails to demonstrate a significant research evidence base on the efficacy of clown humour as a therapy within children’s hospitals/units. Despite this, many health professionals with an interest in both the psychological and physical aspects of patients well-being are showing an increased interest in the use of clown humour within health-care settings. This study focuses on the perceived effects of clown doctor humour as experienced by children in a large children’s inpatient facility in the South of England. 42 children between the ages of four and 11 years were approached and 20 participated fully in the 2 stage process. Data was collected from 17th January 2007–16th May 2007 (over 4 month period). The draw and write/draw and tell technique was used to elicit information from the children. The results pertaining to the draw and write/draw and tell study were considered in two categories, i.e. ‘written’ words and ‘spoken’ words. Before the clown visit the majority of written comments made by the children to annotate their drawings were negative (scared/worried/nervous) and ‘negative’ and ‘sad’ appeared to be the prominent theme. Subsequent to the clown doctor visit to the children there was a significant increase in positive written comments made with no negative comments recorded. There were 34 negative spoken comments articulated by the children and only 14 positive comments, suggesting that the dominant theme before a clown visit was totally negative. Analysis of data elicited after the clown doctor visit showed a much more positive theme, with 57 positive comments being articulated by the children with only three negative comments being generated. This qualitative study of children’s perceptions of hospital clown humour, using the draw and write /draw and tell techniques, has shown that children appreciate the beneficial effects of a clown visit to them during their hospital stay. The data suggests that clown humour can mitigate some of the negative effects of hospitalisation for sick children. Of the 23 suggestions made by the children after the clown encounter, 19 of them were requests for more frequent clown visits or more clown doctors.

This paper describes the development of a specific play policy guideline and suggested protocol to manage children with debilitating fears such as needle phobia. The fear of clinical procedures which involve sharps such as needles is increasingly recognized by nurses as being problematic and this guideline will be a useful adjunct to any professional involved with children undergoing such procedures.

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