| Laugh and Be Well Tapping the therapeutic power of humor |
| Jocularity GuidelinesTips for using humor with your patientsNo two clinicians use humor in exactly the same way. “One person’s ‘ha-ha’ is another person’s ‘ho-hum,’” said Patty Wooten, RN, a nurse humorist and founder of Jest for the Health of It! But the following guidelines may be useful in keeping your efforts therapeutic:Test the waters. Not everyone likes or responds well to humor. “I tell my audiences to wait for the patient to throw the first [comedic] punch,” said Josh Sickel, MD, a pathologist at El Camino Hospital in Mountain View, and a frequent lecturer on humor in health care. Or try an innocuous riddle on a patient to gauge their response, suggested Wooten.Time your humor appropriately. Even patients who are open to your wit may not always welcome it. Attend to people’s emotional and physical pain first, Wooten recommended. If someone is writhing in pain, it’s probably not a good time to start a wacky routine, Sickel advised. Nor is a joke a good idea immediately after someone receives a dire prognosis, said Steven Sultanoff, PhD, a psychologist and president of the American Association for Therapeutic Humor.Keep it tasteful. Avoid ethnic, religious, sexual, or political humor, Wooten said. “Once you alienate someone, you have to work twice as hard to bring them back,” she explained.Establish your competency and compassion first. Wooten said, “You need to let your patients know that you’re competent before you let them know you’re funny.”~ Anne Federwisch, OTR | Oak, RN, doesn’t wear a nurse’s cap at work. She wears a beanie. Or a court jester’s hat. Or even a dragon cap. Whatever might coax a smile from the children she cares for in the ICU at Children’s Hospital-San Diego. “It works. Kids trust me. I’m somebody who is a little bit funny,” she said. “Because of that, there’s a relationship that develops.”Oak’s hat antics are part of a growing trend of using humor therapeutically to help patients cope with difficult situations. The movement, which many say originated with the 1979 publication of Norman Cousins’ best-seller Anatomy of an Illness, received a boost in recent years from the movie “Patch Adams,” in which a physician uses humor as a healing tool to connect with his patients. “We’ve been seeing a geometric explosion of interest in the humor-health connection,” said Joel Goodman, EdD, founder and director of The HUMOR Project, an organization that promotes the positive power of humor through training, conferences, and publications.Though humor rooms, comedy carts, and hospital clowning programs have sprouted up across the country in the last two decades, the true extent of humor’s use on the healthcare front is difficult to ascertain. Much of it occurs on an informal, individual basis between health professionals and their patients rather than on an institutional level, said Patty Wooten, RN, a nurse humorist and founder of Jest for the Health of It!, a Santa Cruz-based company providing seminars and services related to therapeutic humor.Clown nose optionalAlthough some clinicians may wear clown noses in their jesting, that’s not the only way to use humor therapeutically. “I think everyone has their own style,” said Josh Sickel, MD, an attending pathologist at El Camino Hospital in Mountain View. “You don’t have to look for belly laughs. It’s gentle—a traditional, caring nurse approach,” Sickel said.Despite his primary expertise in one of the most serious subspecialties of medicine, Sickel has developed his passion for humor into more than a hobby, lecturing on such topics as “Caution: Humor may be hazardous to your illness.” He also launched the hospital’s Good Humor Channel, which gives patients 24-hour access to comedy videos such as “I Love Lucy” episodes, the best of Johnny Carson, and Louie Anderson routines.Humor is much more than mere joke telling or sight gags, Goodman said. “It’s really an attitude, a perspective, a way of looking at life and looking at health and illness and helping you look at the lighter side of it,” he said.Physiological responseThough studies on humor are lacking, research on laughter suggests that it helps reduce stress hormones, aids in combating emotional distress, and improves people’s attitudes, said Steven Sultanoff, PhD, a psychologist and president of the American Association for Therapeutic Humor. Although it may act as a diversion to pain, no definitive evidence exists proving either humor or laughter is an analgesic. The rumored connection between laughter and an increase in endorphins has yet to be confirmed, he noted.In fact, studies indicate that tragedy may be almost as effective as humor in relieving pain, said Margo McCaffery, MS, RN, FAAN, a consultant in the nursing care of patients with pain. The research she’s reviewed suggests that “sad movies were almost as effective as funny movies [in relieving pain], although I don’t think we really want to go around making patients feel sad.” Though McCaffery doesn’t object to using humor in a healthcare setting, she says “we want to be careful about tying in the use of humor with any significant relief in pain.”Humor advocates acknowledge the limitations of laughter, but support its positive aspects. “Humor is not a panacea. It’s not a cure for cancer. It’s a way for patients to cope,” Sickel said.”It’s not as simple as laughing three times and your cold will go away or laughing a hundred times and you’ll prevent cancer,” Goodman said. “But what we have been discovering over the years is that when we laugh, there are a lot of good things that happen inside.”Humor how-toHow you choose to infuse humor into your practice depends a lot on your personality as well as your patient mix, experts say. But they suggest the following possibilities:Wear a funny button or hat. If patients respond positively, you can launch into more active humor.Share an amusing cartoon with a patient. Wooten suggests laminating funny ones that are particularly apropos to your patient mix.Keep a “mirth aid kit” filled with whimsical props. Wooten eased an anxious patient’s mood by donning bunny ears from her own mirth stash and quipping, “I know you ordered a Playboy bunny, but this is all your insurance would pay for.”Collect jokes and riddles that fit your situation. With high patient turnover, you can use the same ones repeatedly. One of Wooten’s favorites: What do you give an elephant with diarrhea? Lots of room!Look for the humor in your own life. “The more that you increase humor outside your medical work, the more you’re going to be able to spontaneously use humor within your medical work,” Sultanoff said.Not just fun and gamesSultanoff acknowledges that using humor is not a risk-free situation. Too much levity may prompt your patients to question your competence. Some clients might not realize that you’re trying to be funny. Others might overhear your banter with a patient and misunderstand your intent, he said.But wit and whimsy can still play a role in the workplace. Though Oak recently assumed duties as nursing liaison for the unit, she told management what she’d really like to be is team leader of fun.She also realizes that humor is not always suitable. Last year, a favorite patient went into respiratory arrest. “So I took the hat off,” she said. The child’s parents noticed, and commented on her unadorned head. “I took it off out of respect. I didn’t think the timing was appropriate,” she explained.The parents appreciated her sensitivity. As the day progressed, so did the little boy. His relieved mother found Oak and said, “I think it’s time for the hat to go back on.”That concern is an essential element of using humor with your patients, Sultanoff said. “It’s not about being a clown or a comedian,” he explained. “It’s about using humor as a part of one’s being, as a part of one’s empathy, understanding, and caring for the patient, so that humor becomes integrated into the entire care package.”Humor is just one of the many tools at the disposal of healthcare practitioners, Goodman noted. “Not as a replacement for good competent, clinical medical care,” he cautioned, “but as a very powerful ally.” |
