Intensive care staff perception of medical clowns to an adult intensive care unit: a before-and-after study

Introduction: Medical clowning enhances patient experiences across various clinical contexts. In pediatric ICUs, it reduces stress, sedative use, pain, and family anxiety. It supports pediatric ICU care staff via stress reduction and enhanced workplace morale. Despite this, its application in adult ICUs remains unexplored. This study evaluates staff experiences and perceptions of a novel adult ICU medical clowning program, focusing on staff attitudes before and after implementation and assessing perceived impact on work environment, patients and families. Methods: A medical clown program was initiated in our ICU due to perceived clinical need. The present study took advantage of program initiation to evaluate staff experiences. ICU staff were asked to fill out anonymous questionnaires vis-a-vis their reactions to the program pre- and 6 months post-implementation. Questionnaires were adapted from surveys of clinical staff vis-a-vis medical clowns that were validated in other clinical circumstances. Perceptions of clowning's effects on patients, families, and staff were assessed using a five-point Likert scale and qualitative feedback. Results: 87 surveys (45 pre-, 42 post-implementation) were assessed. Respondents (74.1% nurses, 27.6% male, mean age 39+/-2) reported moderately positive attitudes toward clowns (median score 4). Pre-implementation, staff expected moderate benefits for patients, families, and themselves, with stronger effects on patient mood. Post-implementation, perceptions of patient and family effects remained unchanged, but non-significantly improved workplace atmosphere and mood were reported, though differences were not statistically significant. Qualitative feedback highlighted reduced anxiety and calls for program expansion, with some concerns about relevance for unconscious patients. Conclusion: An adult ICU clowning program was well-received, enhancing staff morale without disrupting workflow, suggesting its potential as a non-pharmacological intervention in critical care.