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By
Anne Federwisch, OTR Joni
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. 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 optional Although 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 response Though 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-to How 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:
Not just fun and games Sultanoff 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." |
