By Candace Talmadge
posted 8/23/96
In 1973 Patty Wooten, RN, was a neurosurgery ICU nurse in San Diego. Not long out of nursing school, she had high hopes for alleviating patients' suffering. Instead, Wooten was confronted by the painful reality of the limitations of health care.
She witnessed lives impaired by serious head injuries and patients whose brain tumor surgeries saved their lives but altered their personalities. These patients often wanted to talk to her about their problems, Wooten says, but she did not know how to respond. In addition to professional challenges, Wooten went through a divorce and became a single mother of a 3-year-old. She says she was overwhelmed to the point of feeling without hope. "I felt a broken spirit," she said.
Then, while in her car one day, she heard a radio ad for a course in clowning at a local community college. The class was inexpensive, so she enrolled. To her surprise, she loved to clown and had a knack for it. Clowning became a healthy refuge for her discouragement about her work as a nurse.
Wooten noticed that after she performed at a children's birthday party, she had more energy. Clowning lifted her spirits and helped her become more accepting of that which she could not change. "Through the metaphor of the clown, I learned to accept what is," Wooten said. After she performed at a nursing home and watched the residents respond, Wooten began researching clowns' effect on patients. She found a book, Laugh After Laugh, by Raymond A. Moody Jr., MD, that detailed anecdotal evidence of patients coming out of withdrawn states in the presence of a clown. Around the same time, Norman Cousins published his groundbreaking book, Anatomy of an Illness. "I began to get very stoked about the possibilities," Wooten said.
As she started clowning at hospitals and talked to student nurses about using humor as part of self-care, her life as a clown merged with her work as a healthcare professional. Medical researchers were beginning to take a greater interest in psychoneuroimmunology, the study of how psychological states affect physical health, also known as the mind-body connection. Wooten followed their work with interest.
Today, Wooten is the president of her own healthcare consulting firm, Jest for the Health of It! in Davis, Calif. She travels frequently to speak at hospitals and to professional organizations across the country. She has developed two clown characters, Nancy Nurse and Nurse Kindheart, to help convey her message of the importance of laughter for patients and healthcare professionals alike.
Wooten also has just published a book, Compassionate Laughter: Jest for Your Health (Commune-a-Key Publishing; $12.95). She wrote it to pull together diverse sources of information on humor and healing.
In the book Wooten examines academic studies on the subject, which she lists in an appendix. She explores definitions of stress, research studies that show a relationship between long-term stress and physical ailments, and the role of humor in healing through stress reduction. Humor, Wooten says, can be a holistic approach to healing that speaks to a patient's body, mind, and spirit. She said that while the physical body experiences the sensation of laughter, the mind experiences a shift in perception and perspective. As a result, the patient's spirit replaces frustration and hostility with moments of joy and acceptance.
"It's not enough to treat just the physical person," said Mary Jane White, MS, MSW, wellness facilitator at The Mind/Body Medical Institute at Memorial Health System in Houston. The institute is affiliated with the Mind/Body Institute founded by Herbert Benson, MD, a cardiologist at Harvard University Medical School in Cambridge, Mass., and Deaconess Hospital in Boston, and author of the best-selling book The Relaxation Response.
White says patients' social, psychological, and even spiritual condition must be addressed as part of the treatment. Humor is one approach the institute uses to help teach patients with chronic health problems, such as heart disease or diabetes, to lower their stress. The institute also uses humor in a course for clients who simply want to learn a healthier lifestyle.
"Humor and optimism seem to be characteristic of people who are stress-hardy," or more resistant to stress, White said. "We teach people to learn to recognize the humor in what we say, to pay attention to the things we say that are absurd or don't make sense. It's about taking your work seriously but yourself lightly." Both White and Wooten point out that humor allows patients and healthcare professionals to take control of any situation by choosing how they respond to it.
Wooten's new book provides practical suggestions on how healthcare professionals can bring humor to their work to help patients heal and to reduce their own stress and burnout. Her suggestions for integrating humor into the hospital include a therapeutic humor program, humor rooms for patients and their families, comedy carts, humor baskets, joke book libraries, joke jars, and clown visits. What some people find funny is not humorous to others, so any humor program must mix a wide range of humor styles, Wooten said.
In one of Wooten's favorite humor interventions, healthcare professionals hide comic buttons inside their jackets or lab coats. These buttons say silly things, such as "No whining" or "With friends like you, who needs enemas?" At the right moment, the button can be flashed to a patient in need of comic relief. Wooten says it may take time to develop a sense of when it is appropriate to use humor, but it can be done with practice. Healthcare professionals also need their own humor interventions, especially as the entire healthcare industry undergoes profound transformation. "Nurses are being challenged to be creative and flexible with all the changes going on in health care," she said. "And humor is a key to helping them cope successfully."
For healthcare professionals to use humor in the workplace, they have to give themselves and their colleagues permission to do so. "Sometimes we think we don't have time for laughter in our work," Wooten said. "The job of nursing has a lot of heartbreak and struggle, but it also has a lot of joyful moments." Wooten recommends humor bulletin boards, provided nothing is posted that is offensive or disparaging of individuals. Her book also cites examples of humorous refrigerator magnets and bumper stickers, such as "My karma ran over my dogma" and "Never eat more than you can lift."
Wooten said that management must support attempts to lighten the
load through humor. "If management ain't laughing, no one's
laughing," she said. The bottom-line reward for supporting
humor is increased staff morale, and Wooten says behavioral psychology
studies have shown that higher morale leads to greater productivity.
"Humor can pull a team together," she said.