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.

The aim of the present study was to achieve a theoretical understanding of several different-age children´s experiences of magic relations with hospital clowns in the context of medical care, and to do so using psychological theory and a child perspective. The method used was qualitative and focused on nine children. The results showed that age was important to consider in better understanding how the children experienced the relation with the hospital clowns, how they described the magical aspects of the encounter and how they viewed the importance of clown encounters to their own well-being. The present theoreetical interpretation characterized the encounter with hospital clowns as a magical safe area, an intermediate area between fantasy and reality. The discussion presented a line of reasoning concerning a magical attachment between the child and the hospital clowns, stating that this attachment: a) comprised a temporary relation; b) gave anonymity; c) entailed reversed roles; and d) created an emotional experience of boundary-transcending opportunities.

The aim of the present study was to achieve, using an affect theory approach (Tomkins, 1962; 1963; 1991), a deeper theoretical understanding of the psychological significance of hospital clowns´work in caring for ailing children viewed from a care-giver perspective. The methodological approach was qualitative and based on 20 interviews with healthcare staff: 3 men and 17 women. The result showed how the staff emphasized a psychological quality of care alongside the physical quality of care. The hospital clowns´"unexpected possibility" provided a safe area for recovery, for both the childrren and the staff. The theoretical interpretation showed the presence of the affects surprise/startle, interest/excitement, and enjoyment/joy, as well as specifically how "joy without demands" often had a lingering effects in the form of vitality. Joy without demands is discussed in relation to psychological theory with emphasis on: a confirmation of the body´s possibilities, a magical attachment, a chance to transcend boundaries, and a non-demanding situation.

The study was aimed at evaluation of the hospital clowns´work from the perspective of medical staff. The methodological approach entailed in-depth interviews with twenty professionals working at different hospitals in Sweden. The results showed specific patterns in the work of the hospital clowns with an emphasis on the joyful side of life. Interpretation of a value of the hospital clowns´work revealed an underlying meaning in the development of positive attitudes toward life in the ailing children. The clowns´work also facilitated the staff interactions with their patients and improved a quality of support and assistance to them.

Föreliggande artikel är ett led i en pågående forskningsstudie i tre steg med den övergripande titeln "Sjukhusclowner - i möten med sjuka barn", en studie finansierad av Barncancerfonden. En tidigare artikel, Steg 1 "Sjukhusclowner - i kommunikation med sjuka barn", har lyft fram ett sjukhusclownperspektiv. Föreliggande Steg 2 "Med fokus på sjukhusclowner - ett vårdgivarperspektiv" vill visa sjukhusclownernas arbete belyst från personalens sida. Med ett senare Steg 3 kommer fokuseringen att ligga på barnens och föräldrarnas upplevelser av att ha mött sjukhusclowner i vården. Forskningsstudien i sin helhet är till sin ansats kvalitativ och baserad på intervjuer, med avsikten att få fram en djupare förståelse för sjukhusclownernas arbetsinsats inom vården, belyst från såväl ett vuxen- som ett barnperspektiv.

The aim of the present study was to gain a deeper understanding of the work of some hospital clowns with ailing children. What distinctive features and working methods can be seen in the hospitals clowns' work? The approach taken involved an interview study with 13 hospital clowns, 10 women, and 3 men, between 30 and 60 years of age. The study was qualitative in design and took a hermeneutic approach. The analysis of data included descriptive and theoretical analyses. The descriptive analysis showed that the clowns' strategy of working in pairs enables them to treat the child with empathy and to acknowledge the child in a sensitive manner. The theoretical analysis of hospital clowns' method of working in pairs indicated: (a) a relational pattern, characterized by empathic preparedness: to capture and shelter the current affect climate, to express various child and adult positions, as well as to cognitively process and return, if appropriate, a humoristic message in a "digestible, humoristic form" and (b) a communication pattern, characterized by balanced synchronization of body language and verbal expressions, in terms of pace as well as conformability, which in optimal cases gives rise to an enhanced feeling of presence and mutuality in the communication process between the hospital clowns and the child. The humoristic communication between the hospital clowns and the child worked to create an open space for play-a space in which all affects were allowed. The discussion concerned possible forms of this working method (working in pairs) that function optimally with regard to relational and communication patterns. The discussion also addressed the psychological value of hospital clowns' work with ailing children, as seen from the perspective of the hospital clowns.

The aim of the present study was to gain a deeper understanding of the work of hospital clowns - in their communication with child patients. The methodological approach entailed an interview study with thirteen hospital clowns, working at different hospitals in Sweden. The results showed specific patterns in the communication involving synchronicity of movement patterns and not forcing the speed of non-verbal communication. Interpretation of the value of this kind of communication revealed a deeper psychological meaning, mamely the positive attitudes toward life in the child patients, the empathic attitudes of the hospital clowns and the hopeful and facilitating attitudes of the staff.

Intentionen med föreliggande artikel är att fokusera på clownkommunikation och ge en inblick i en pågående forskningsstudie om några svenska sjukhusclowner. Syftet är att få en djupare förståelse för sjukhusclownernas medverkan i vården och vilken betydelse detta har för de sjuka barnens välbefinnande. Den kvalitativa forskningsdesignen har inneburit en intervjustudie med tretton sjukhusclowner, tio kvinnor och tre män. Resultatet visar specifika mönster i clownkommunikationen, med en tydlig synkronisering av rörelsemönster och ett balanserat tempo i den icke-verbala kommunikationen. Lyhördhet och samarbete betonas. Det psykologiska värdet med denna typ av clownkommunikation kan beskrivas från ett barnperspektiv i sin livsbefrämjande funktion; från ett clownperspektiv i sin empatiska funktion; samt från ett vårdperspektiv i sin underlättande och hoppingivande funktion.