title: Strategies for diversity: medical clowns in dementia care - an ethnographic study.
abstract: As nursing homes become increasingly diverse, dementia care needs a wider range of culturally responsive strategies for individual and collective social interactions. While previous studies conclude that medical clowns have positive effects on verbal and non verbal social interactions, research is lacking from the perspective of residents' cultural background. The aim of this study was to identify interaction strategies employed by medical clowns in culturally diverse dementia care settings.
  
  
  
  An ethnographic approach was used and data were collected through observation of interactions between medical clowns and residents with dementia in two nursing homes during a ten week period.
  
  
  
  The observations showed that the medical clowns interacted with residents by being tuned in and attentive to the residents as individuals with a unique life-history, confirming each person´s sense of self. The clowns used sensory triggers, encouragement and confirmation in culturally responsive ways to bond socially with the residents in their personal spaces. The clowns involved objects in the daily environment that were meaningful for the residents, and paid attention to significant places and habits in the past. The clowns further contributed to joint interaction in the common spaces in the nursing homes, using music and drama.
  
  
  
  The strategies employed by medical clowns in activities with older people with dementia appear to support social interaction. The medical clowns used the social and material environment in culturally responsive ways to strengthen individuals' sense of self, while contributing to a sense of togetherness and interaction among residents in the common spaces. Findings suggest that both verbal and non-verbal cultural content affected social interaction. The non-demanding encouraging way the clowns tuned in to the residents as individuals could help nurses and staff members improve ways of communication in social activities inside the nursing home.
authors.affiliation: Department of Care Science, Malmö University, Jan Waldenströms gata 25, 205 06, Malmö, Sweden.
authors.forename: Margareta
authors.initials: M
authors.lastname: Rämgård
authors.affiliation: Department of Care Science, Malmö University, Jan Waldenströms gata 25, 205 06, Malmö, Sweden.
authors.forename: Elisabeth
authors.initials: E
authors.lastname: Carlson
authors.affiliation: Department of Care Science, Malmö University, Jan Waldenströms gata 25, 205 06, Malmö, Sweden. elisabeth.mangrio@mah.se.
authors.forename: Elisabeth
authors.initials: E
authors.lastname: Mangrio
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000884:Anthropology, Cultural / Q000379:methods; D065246:Culturally Competent Care / Q000379:methods*; D003704:Dementia / Q000523:psychology / Q000628:therapy; D005008:Ethnopsychology / Q000379:methods*; D005260:Female; D006707:Homes for the Aged / Q000458:organization & administration*; D006801:Humans; D007398:Interpersonal Relations; D008297:Male; D009735:Nursing Homes / Q000458:organization & administration*; D011580:Psychological Techniques; D016896:Treatment Outcome