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HOSPITAL nursing

Humor in health care: Irreverent or invaluable?

Facente, Alice RN, MSN

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Abstract

Laughter's the best medicine. Sure, laughter is wonderful, but shouldn't you get serious when treating illness and pain? Aren't laughing and joking, especially in the presence of someone who's seriously ill, irreverent and disrespectful? I don't think so, and I'll tell you why.

I learned about the therapeutic value of humor while caring for Randall, a patient who was dying and well aware of it. With advanced lymphoma, he had metastatic bone disease that caused almost constant pain despite the health care team's best efforts to control it. In spite of the pain, he struggled to remain independent in his home.

As he got progressively weaker, Randall reluctantly accepted the services of a home health care assistant to help with his personal care and give his wife a break. We home health care nurses and assistants soon learned that Randall would welcome us with a joke, a cartoon, or a funny story. It was his way of saying, “I know I'm dying but I still need to laugh and enjoy what time I have left.”

Starting each visit with humor gave Randall a measure of control over the situation and taught us that humor had to be a key component of his care plan. Randall's choice not to dwell on his illness 24 hours a day gave him a respite from focusing on his grave condition and influenced the care-giving and care-receiving dynamic.

Gauging the benefits of belly laughs

Scientists are investigating and proving what Randall knew intuitively. Exploring whether laughter has physiologic benefits, researchers at Loma Linda (Calif.) University have discovered these effects:

  • Laughter decreases levels of epinephrine, a “stress hormone.” Test groups had lower epinephrine levels both when the subjects anticipated humor and after a humorous experience.
  • Laughter activates the immune system. The researchers found that subjects had an increase in the number of activated T lymphocytes, which attack virus-infected cells and some types of cancer and tumor cells. Subjects also had an increase in levels of the antibody IgA (immunoglobulin A), which fights infection in the respiratory and gastrointestinal tracts.

Loma Linda University now has programs to inject humor into patient care, including the Laughter Library at the university's cancer institute. (To learn more about the research, visit Humor Therapy at Holistic Online.com at http://www.holistic-online.com/Humor_Therapy/humor_therapy_benefits.htm.

Another humor researcher, psychologist Paul McGhee, has written articles and books on how humor affects stress and coping. On his Web site, http://www.LaughterRemedy.com, McGhee discusses additional therapeutic benefits to laughter:

  • Belly laughs relax the muscles. They make the muscles in the belly contract, then relax.
  • Laughter increases the pain threshold. During laughter and for a short while afterward, pain is minimized. This effect may be partially due to distraction. Laughter also triggers the release of endorphins, the body's natural painkillers.
  • Laughter exercises the heart. A belly laugh is comparable to “jogging internally” because it increases the heart's activity and stimulates circulation.
  • Laughter exercises the respiratory system. Many postoperative patients have trouble breathing deeply and coughing. A few belly laughs make deep breathing easier, more effective, and fun! Repeated belly laughter also cleanses the lungs by forcing deep inspiration and full exhalation.

You don't have to be a natural-born comedian to exercise your funny bone. (For tips, see Developing your humor style.)

Although humor can aid healing, it isn't appropriate in all care situations. If a patient himself uses humor, as Randall did, he'll probably welcome funny stories, but time them carefully and make sure they're appropriate. Balance your use of humor with sensitive listening and validation so he understands that you take his fears and concerns seriously. Stay away from sarcasm and ethnic jokes. Also keep in mind that humor is personal and that people from other cultures can take some kinds the wrong way. In some cultures, people expect only reverence in the presence of a seriously ill person or a dead body.

Adding “humor therapy” to the care plan

I'm sure Randall would chuckle if he knew how much he contributed to my appreciation of humor's positive effects on my patients. Perhaps someday, while assessing the need for physical, occupational, and speech therapy, nurses will be able to add “humor therapy” to every patient's care plan.

Developing your humor style

You don't need to do a comedy routine to have fun with patients. Simply telling a joke or encouraging the patient to tell a funny story may have a therapeutic effect. With time and experience, you'll become more comfortable taking a lighthearted approach.

I've accumulated a “funny folder” that I regularly stuff with medically related jokes, cartoons, puns, and anecdotes to share with patients or to inject interest into teaching materials. Resources for a funny folder include the Sunday comics and cartoons or jokes I find on the Internet by searching with the words “humor” and “health care.”

Funny videos are a wonderful way to ensure laughter for 60 to 90 minutes. I usually carry a few favorites in my car to lend patients who need a lift. I call the videos my “nurse's prescription for humor therapy.”

Alice Facente injects humor into her work as a home health care nurse for Ledyard (Conn.) Public Health Nursing Service.

SELECTED REFERENCES

Bennett J. Humor in medicine. Southern Medical Journal. 96(12):1257–1261, December 2003.
Berk L, et al. Modulation of neuroimmune parameters during the eustress of humor-associated mirthful laughter. Alternative Therapies in Health and Medicine. 7(2):62–76, March 2001.
Pattillo C, and Itano J. Laughter is the best medicine: And it's a great adjunct in the treatment of patients with cancer. American Journal of Nursing. 101(Suppl., 1):40–43, April 2001.
    © 2006 Lippincott Williams & Wilkins, Inc.