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Published in: BMC Health Services Research 1/2020

Open Access 01-12-2020 | Anxiety | Research article

Measuring patient experiences in a Children’s hospital with a medical clowning intervention: a case-control study

Authors: Nina Karisalmi, Katja Mäenpää, Johanna Kaipio, Pekka Lahdenne

Published in: BMC Health Services Research | Issue 1/2020

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Abstract

Background

Because the healthcare sector is shifting to a customer-oriented approach, it is important to understand experiences of children as users of healthcare services. So far, studies that measure the influence of medical clowning on patient experiences are scarce. This study aims to measure experiences of children and their parents during day-surgery in hospital setting.

Methods

A case-control study was conducted in a large Finnish children’s hospital. Seventy children aged 4–17 years coming for a minor operative procedure including pre-operative cannula insertion prior to surgery were included. Thirty-eight children were exposed to the medical clowning intervention and 32 children (the reference group) did not receive exposure to medical clowning. A novel digital survey tool was used to measure patient experiences before and after the insertion of a venous cannula needed for anaesthesia. The children were asked about their emotions, anxiety levels, the pain from the cannula insertion and the best and worst things about the hospital. The parents were asked about their emotions, expectations and the fluency of the procedure and the hospital day.

Results

Before the procedure, 32% or 36% of the children in the intervention group and 44% or 28% of those in the reference group expressed positive or neutral emotions, respectively. After the procedure, 76% or 63% of children in the intervention group or reference group, respectively, expressed positive emotions. The intervention group rated the medical clowns as the best aspect of the hospital day. Both groups reported that the best aspects of the hospital day were related to the nurses and food and the worst were related to waiting and pain. Most commonly the parents felt uncertainty, anxiety or calmness before the procedure and relief afterwards. Their expectations towards the procedure related to its success and the certainty of the diagnosis.

Conclusions

The results show a trend towards more positive emotions in children with exposure to medical clowning. The digital survey tool was suitable for gathering information about the experiences of children and their parents. Information on emotions and expectations of children and parents during a procedure is useful when improving the quality of healthcare services.

Trial registration

Current Controlled Trials NCT04312217, date of registration 17.03.2020.
Retrospectively registered.
Literature
1.
go back to reference LaVela SL, Gallan A. Evaluation and measurement of patient experience. Rochester: Social Science Research Network; 2014. LaVela SL, Gallan A. Evaluation and measurement of patient experience. Rochester: Social Science Research Network; 2014.
6.
go back to reference Needham BR. The truth about patient experience: what we can learn from other industries, and how three Ps can improve health outcomes, strengthen brands, and delight customers. J Healthc Manag. 2012;57:255.CrossRef Needham BR. The truth about patient experience: what we can learn from other industries, and how three Ps can improve health outcomes, strengthen brands, and delight customers. J Healthc Manag. 2012;57:255.CrossRef
9.
go back to reference Wolf J, Niederhauser V, Marshburn D, LaVela S. Defining patient experience. Patient Exp J. 2014;1:7–19. Wolf J, Niederhauser V, Marshburn D, LaVela S. Defining patient experience. Patient Exp J. 2014;1:7–19.
10.
go back to reference Foot C, Fitzsimons B. The policy and practice of measuring patient experience. Nursing management (through 2013). London. 2011;18:18–9. Foot C, Fitzsimons B. The policy and practice of measuring patient experience. Nursing management (through 2013). London. 2011;18:18–9.
12.
go back to reference Karisalmi N, Stenhammar H, Kaipio J. What constitutes the patient experience of children? Findings from the photo elicitation and the video diary study. PXJ. 2018;5:54–68. Karisalmi N, Stenhammar H, Kaipio J. What constitutes the patient experience of children? Findings from the photo elicitation and the video diary study. PXJ. 2018;5:54–68.
18.
go back to reference Dionigi A. Clowns as interpreters of emotions. Bologna: University of Bologna, Department of Psychology; 2012. Dionigi A. Clowns as interpreters of emotions. Bologna: University of Bologna, Department of Psychology; 2012.
19.
go back to reference Lindberg J, Söderholm D, Tapio P. Toimenpiteeseen valmistava klovneria; 2017. Lindberg J, Söderholm D, Tapio P. Toimenpiteeseen valmistava klovneria; 2017.
23.
go back to reference Oppenheim D, Simonds C, Hartmann O. Clowning on children’s wards. Lancet. 1997;350(9094):1838–1840F.CrossRef Oppenheim D, Simonds C, Hartmann O. Clowning on children’s wards. Lancet. 1997;350(9094):1838–1840F.CrossRef
24.
go back to reference Dionigi A, Gremigni P. A combined intervention of art therapy and clown visits to reduce preoperative anxiety in children. J Clin Nurs. 2016;26(5–6):632–40.PubMed Dionigi A, Gremigni P. A combined intervention of art therapy and clown visits to reduce preoperative anxiety in children. J Clin Nurs. 2016;26(5–6):632–40.PubMed
25.
go back to reference Meiri N, Ankri A, Hamad-Saied M, Konopnicki M, Pillar G. The effect of medical clowning on reducing pain, crying, and anxi- ety in children aged 2–10 years old undergoing venous blood drawing — a randomized controlled study. Eur J Pediatr. 2016;175(3):373–9.CrossRef Meiri N, Ankri A, Hamad-Saied M, Konopnicki M, Pillar G. The effect of medical clowning on reducing pain, crying, and anxi- ety in children aged 2–10 years old undergoing venous blood drawing — a randomized controlled study. Eur J Pediatr. 2016;175(3):373–9.CrossRef
27.
go back to reference Ofir S, Tener D, Lev-Wiesel R, On A, Lang-Franco NL. The therapy beneath the fun: medical clowning during invasive examina- tions on children. Clin Pediatr. 2016;55(1):56–65.CrossRef Ofir S, Tener D, Lev-Wiesel R, On A, Lang-Franco NL. The therapy beneath the fun: medical clowning during invasive examina- tions on children. Clin Pediatr. 2016;55(1):56–65.CrossRef
28.
go back to reference Tener D, Ofir S, Lev-Wiesel R, Franco NL, On A. Seriously clowning: medical clowning interaction with children undergoing invasive examinations in hospitals. Soc Work Health Care. 2016;55(4):296–313.CrossRef Tener D, Ofir S, Lev-Wiesel R, Franco NL, On A. Seriously clowning: medical clowning interaction with children undergoing invasive examinations in hospitals. Soc Work Health Care. 2016;55(4):296–313.CrossRef
31.
go back to reference Plutchik’s wheel of emotion. Image created by Doomdorm64 [Public domain], from Wikimedia Commons. Accessed 24 Sept 2018. Plutchik’s wheel of emotion. Image created by Doomdorm64 [Public domain], from Wikimedia Commons. Accessed 24 Sept 2018.
32.
go back to reference Bjertnaes OA, Sjetne IS, Iversen HH. Overall patient satisfaction with hospitals: effects of patient-reported experiences and fulfilment of expectations. BMJ Quality & Safety 2012;21:39–46. Bjertnaes OA, Sjetne IS, Iversen HH. Overall patient satisfaction with hospitals: effects of patient-reported experiences and fulfilment of expectations. BMJ Quality & Safety 2012;21:39–46.
35.
go back to reference Wright KD, Eisner A, Stewart SH, Finley GA. Mea- surement of preoperative anxiety in young children: self-report versus observer-rated. J Psychopathol Behav Assess. 2010;32(3):416–27.CrossRef Wright KD, Eisner A, Stewart SH, Finley GA. Mea- surement of preoperative anxiety in young children: self-report versus observer-rated. J Psychopathol Behav Assess. 2010;32(3):416–27.CrossRef
36.
go back to reference Bone C, O’Reilly M, Karim K, Vostanis P. ‘They’re not witches. … ’ young children and their parents’ perceptions and experiences of child and adolescent mental health services: Children’s perceptions of CAMHS. Child: care. Health and Development. 2015;41:450–8. https://doi.org/10.1111/cch.12161.CrossRef Bone C, O’Reilly M, Karim K, Vostanis P. ‘They’re not witches. … ’ young children and their parents’ perceptions and experiences of child and adolescent mental health services: Children’s perceptions of CAMHS. Child: care. Health and Development. 2015;41:450–8. https://​doi.​org/​10.​1111/​cch.​12161.CrossRef
38.
go back to reference Mäenpää K. Digital service for measuring children’s patient experience of preoperative medical clowning. Espoo: Aalto University; 2018. Master’s thesis. Mäenpää K. Digital service for measuring children’s patient experience of preoperative medical clowning. Espoo: Aalto University; 2018. Master’s thesis.
39.
go back to reference Karisalmi N. The patient experience of children expressed by them- selves - applicability of video diaries as a data gathering method. Espoo: Aalto University; 2016. Master’s thesis, Written in Finnish. Karisalmi N. The patient experience of children expressed by them- selves - applicability of video diaries as a data gathering method. Espoo: Aalto University; 2016. Master’s thesis, Written in Finnish.
40.
go back to reference Lazar J, Feng JH, Hochheiser H. Research methods in human-computer interaction. Cambridge: Morgan Kaufmann; 2017. Lazar J, Feng JH, Hochheiser H. Research methods in human-computer interaction. Cambridge: Morgan Kaufmann; 2017.
42.
go back to reference Kuttner L, LePage T. Face scales for the assessment of pediatric pain: a critical review. Can J Behav Sci Revue canadienne des sciences du comportement. 1989;21:198.CrossRef Kuttner L, LePage T. Face scales for the assessment of pediatric pain: a critical review. Can J Behav Sci Revue canadienne des sciences du comportement. 1989;21:198.CrossRef
43.
44.
go back to reference Russell JA, Lewicka M, Niit T. A cross-cultural study of a circumplex model of affect. J Pers Soc Psychol. 1989;57:848–56.CrossRef Russell JA, Lewicka M, Niit T. A cross-cultural study of a circumplex model of affect. J Pers Soc Psychol. 1989;57:848–56.CrossRef
Metadata
Title
Measuring patient experiences in a Children’s hospital with a medical clowning intervention: a case-control study
Authors
Nina Karisalmi
Katja Mäenpää
Johanna Kaipio
Pekka Lahdenne
Publication date
01-12-2020
Publisher
BioMed Central
Keyword
Anxiety
Published in
BMC Health Services Research / Issue 1/2020
Electronic ISSN: 1472-6963
DOI
https://doi.org/10.1186/s12913-020-05128-2

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