Joyful and serious intentions in the work of hospital clowns: A meta-analysis based on a 7-year research project conducted in three parts

The present meta-analysis focuses on a 7-year research project entitled "Hospital clowns-in encounters with ailing children" and funded by the Swedish Childhood Cancer Foundation. The aim of the meta-analysis, which is based on the project's three studies, was to attempt to achieve a deeper psychological and more nuanced understanding of the unique encounters taking place between the hospital clowns and ailing children in the study. The methodological procedures were qualitative and included 51 interviews with four informant groups: the clowns, staff, children, and their parents. The meta-analysis revealed the unique aspects of hospital clowns' work with respect to: a) a quality of care that transcends boundaries, that is, a magical safe area where demands and adjustment were temporarily set aside and where the lighter side of life took precedence; b) a non-demanding quality of care, where joy could be experienced without requiring something in return, where the child's terms mattered and where the child perspective was clearly in focus; and c) a defusing quality of care, which is expressed as a positive counterweight that was otherwise lacking in medical care, where the hospital clowns used different solutions that bypassed regular hospital routines by temporarily distracting and making things easier for the children, parents, and staff in various care situations. Finally, the aim of the theoretical framework, in its synthesizing form, was to promote further psychological understanding of the area of humor that exists between fantasy and reality-an intermediate or transitional area that the hospital clowns created together with the children. In this transitional area, the hospital clowns' unique contribution can be interpreted, in psychological terms, as being available as a vicarious therapeutic clown figure in a magical world that parallels reality.