LESSONS FROM THE RED NOSE: WHAT NURSES CAN LEARN FROM THERAPEUTIC CLOWNS by SANDRA J. GRAHAM BSN, University of Saskatchewan, 1985 A THESIS PAPER SUBMITTED IN PARTIAL FULFILLMENT OF THE REQUIREMENTS FOR THE DEGREE OF MASTER OF SCIENCE IN NURSING in THE FACULTY OF GRADUATE STUDIES We accept this thesis as conforming to the required standard _________________________________________________ Dr. Sonya Grypma, Thesis Supervisor _________________________________________________ Dr. Landa Terblanche, Second Reader _________________________________________________ Dr. Joan Boyce, Third Reader TRINITY WESTERN UNIVERSITY September 2015 © Sandra Graham LESSONS FROM THERAPEUTIC CLOWNS 2 Abstract In this qualitative study, seven participants from two volunteer therapeutic clown troupes were interviewed about their experiences in order to discover how clowns and clowning techniques can inform nursing practice, specifically in the art of relationship. Clowning emerged as a complex art, combining the visual elements of the costume, make-up and props with ubiquitous humour, laced with sensitivity and compassion. Participants described having a vocation for clowning, with intrinsic motivation and passion. They articulated how their clown costumes and personas provided emotional shielding, giving them protection from – while also allowing entrance into – emotionally difficult situations. They also used judicious humour, intuiting when, where and how best to use humour in myriad patient situations in a way that brought relief to patients and families. Insights from clowning can help nurses to expand their relational art: In patient settings, when used judiciously, there may be no place where humour is off limits. LESSONS FROM THERAPEUTIC CLOWNS 3 Table of Contents Abstract ................................................................................................................................ 2 Acknowledgements .............................................................................................................. 7 Dedication ............................................................................................................................ 8 Chapter One – Introduction ............................................................................................. 9 Historical Background ............................................................................................. 9 Terminology ........................................................................................................... 11 Professional Clown Programs in Canada ............................................................... 14 Rationale for This Study ........................................................................................ 14 Purpose and Research Questions ........................................................................... 15 Study Method ......................................................................................................... 16 Outline of Paper ..................................................................................................... 16 Chapter Two – Literature Review ................................................................................. 18 Search and Retrieval Strategies .............................................................................. 18 Literature Review ................................................................................................... 19 Literature related to the pediatric population ........................................ 19 Literature related to the adult population .............................................. 21 Literature related to the geriatric population ......................................... 22 Literature related to healthcare staff ...................................................... 23 Literature related to the clown’s perspective ......................................... 24 Literature related to multiple groups ..................................................... 24 Literature related to current research focus ........................................... 26 Chapter Summary ................................................................................................... 27 LESSONS FROM THERAPEUTIC CLOWNS 4 Chapter Three – Research Design, Methodology, and Procedure .............................. 28 Interpretive Description Research Methodology ................................................... 28 Methodology Procedures ....................................................................................... 30 Sampling ................................................................................................ 30 Description of Sample ........................................................................... 36 Data Collection ...................................................................................... 37 Data Analysis ......................................................................................... 42 Ethical Considerations ........................................................................................... 45 Scientific Quality ................................................................................................... 48 Chapter Summary ................................................................................................... 49 Chapter Four – Study Findings ...................................................................................... 51 Theme One – The Clown Within ........................................................................... 52 Self-identification .................................................................................. 52 A persona and name as a natural fit ....................................................... 54 Generous by nature ................................................................................ 55 Clowning is integral............................................................................... 57 Theme Two – The Wholistic Clown ...................................................................... 59 Costume ................................................................................................. 59 Props ...................................................................................................... 62 Personal attributes.................................................................................. 64 Theme Three – The “Magical” Clown ................................................................... 68 Dissolving discontent ............................................................................ 69 Magic shield .......................................................................................... 71 LESSONS FROM THERAPEUTIC CLOWNS 5 Transports one momentarily .................................................................. 74 Momentary encounter, lasting impressions ........................................... 75 Theme Four – The Transcendent Clown ................................................................ 77 The clown has liberties .......................................................................... 78 The clown’s audience is limitless .......................................................... 81 The clown as spiritual ............................................................................ 85 Theme Five – The Clown’s Role in Healthcare ..................................................... 89 Chapter Summary ................................................................................................... 91 Chapter Five – Discussion ............................................................................................... 92 Vocation ................................................................................................................. 93 Emotional Shielding ............................................................................................... 98 Judicious Humour ................................................................................................ 104 Chapter Summary ................................................................................................. 110 Chapter Six –Conclusions and Recommendation ....................................................... 111 Conclusions .......................................................................................................... 111 Limitations ........................................................................................................... 113 Recommendations ................................................................................................ 115 Recommendations for nursing practice ............................................... 115 Recommendations for nursing education ............................................ 116 Recommendations for future research ................................................. 117 Chapter Summary ................................................................................................. 119 References ........................................................................................................................ 120 Appendices ....................................................................................................................... 135 LESSONS FROM THERAPEUTIC CLOWNS 6 Appendix A – E-mail Recruitment Request ......................................................... 135 Appendix B – Recruitment Poster........................................................................ 137 Appendix C – Demographic Collection