Mortamet G, Simonds C, Hattab A, Delpy S, Hubert P, Dupic L
Service de réanimation et de surveillance continue médicochirurgicale pédiatrique, hôpital Necker, Assistance publique-Hôpitaux de Paris, 149, rue de Sèvres, 75015 Paris, France.
Association « Le rire médecin », 64-70, rue de Crimée, 75019 Paris, France.
Arch Pediatr. 2015 Jul;22(7):718-23. doi: 10.1016/j.arcped.2015.04.011. Epub 2015 Jun 3.
In recent years, in children's hospitals, clowns are involved in pediatric intensive care units (PICUs), at the bedside of the most severely ill children. This study is the first that addresses the work of professional clowns in the PICU. Its aim is to describe this practice in French hospitals.
This study is a descriptive and prospective study conducted in December 2013 involving all the pediatric PICUs in French hospitals. A survey was emailed to all the PICU department heads in France.
Questionnaires were sent to 32 PICUs (21 pediatric and neonatal intensive care units and 11 pediatric intensive care units). The response rate was 81.2% (26 questionnaires completed). Among the 26 units that responded to the survey, clowns intervened in 13 of them (50%). Eight had an exclusive pediatric activity and five had both pediatric and neonatal activities. The clown visit was twice a week in six units and once in seven (missing data: one unit). The head doctor was satisfied or very satisfied in 92.3% of the cases (n=12/13). Medical clowns were trained and professional artists in all of the units. They worked in duo in most units (n=12/13) and solo in one unit. The clown rounds were preceded by a meeting with a healthcare worker in 12 of the 13 PICUs in which the clowns worked. They dialogued with a doctor in four and a nurse (or head nurse) in eight.
Prior to implementation, the clowns' work should be understood, accepted, and supported by each PICU team, to be validated in the overall care plan for each child.
Despite the severity of the situations met in the PICU, the instability of patients and the technical environment, clowning in PICUs appears to be a common and worthwhile practice in most French pediatric hospitals.
近年来，在儿童医院，小丑参与到儿科重症监护病房（PICU）中，陪伴在病情最为严重的儿童床边。本研究首次探讨了专业小丑在PICU的工作情况。其目的是描述法国医院的这种做法。
本研究是一项描述性前瞻性研究，于2013年12月开展，涉及法国医院的所有儿科PICU。向法国所有PICU科室主任发送了一份调查问卷。
共向32个PICU（21个儿科和新生儿重症监护病房以及11个儿科重症监护病房）发送了问卷。回复率为81.2%（共完成26份问卷）。在回复调查的26个科室中，有13个科室有小丑介入（占50%）。其中8个科室专门开展儿科活动，5个科室同时开展儿科和新生儿活动。在6个科室中，小丑每周探访两次，7个科室每周探访一次（缺失数据：1个科室）。92.3%的科室主任表示满意或非常满意（n=12/13）。所有科室的医疗小丑均经过培训且为专业艺术家。大多数科室（n=12/13）的小丑以两人一组的形式工作，1个科室为单人工作。在小丑开展工作的13个PICU中，有12个在小丑查房前会与一名医护人员开会。其中，他们与医生交流的有4个科室，与护士（或护士长）交流的有8个科室。
在实施之前，每个PICU团队都应理解、接受并支持小丑的工作，使其在每个儿童的整体护理计划中得到认可。
尽管PICU中遇到的情况严峻，患者病情不稳定且技术环境复杂，但在大多数法国儿科医院，小丑在PICU开展工作似乎是一种常见且有价值的做法。
