PART I: THE HUMOR-IN-HOSPITALS MOVEMENT
Chances are that you have never worked in a hospital with a "humor program." The very idea of humor in hospitals strikes most patients as an oxymoron (like "giant shrimp," "smart bombs," "military intelligence," etc.). If ever there were two things that don't go together in most people's minds, it is humor and hospitals. After all, hospitals are places for the very sick.
The last decade or two, however, has witnessed a (slowly building) revolution in health care, as more and more hospitals become convinced of the therapeutic power of humor. The humor-in-hospitals movement has also gained support because of the growing trend toward depersonalization and shorter stays in hospitals in recent years, as focus has shifted away from the person and toward application of the latest technology. Many patients now crave a more personalized and human relationship with care providers, and humor helps establish it. Also, hospitals are increasingly recognizing the importance of providing care that supports patients' emotional, as well as physical needs. Humor is increasingly being viewed as a means of filling the need for such "patient-centered care."1
Hospitals within the United States have become increasingly competitive in recent years. This has led to a greater preoccupation within upper management with levels of patient satisfaction related to their hospital stay. Humor - in combination with providing the best medical care possible - is being seen by some hospitals as a tool for boosting patient satisfaction scores.2
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Most patients arrive at the hospital in a state of stress and anxiety. They are then placed in a strange environment, submitted to degrading and embarrassing procedures by people they don't know and have their independence and sense of control removed - and they don't always get the kind of explanations for procedures or tests that they would like. Humor provides a means of establishing a more personal relationship between patients and hospital staff, easing tensions and anxiety and helping patients cope. The nurse who maintains a high level of competence, but also has a "light touch," has an extra means of saying, "I care."
Children are especially vulnerable to anxiety upon admission to the hospital. The importance of addressing these anxieties is evident in the fact that more than three million children will require hospital care in a typical year these days. In addition to the emotional demands of having to struggle with the illness itself, children have little understanding of the hospital environment and the procedures they must submit to - not to mention a complete lack of control over what they must go through.3 Additional stress comes from separation from their family and the pain resulting from very intrusive procedures. In fact, there is some evidence that children report pain to be the most upsetting part of being in the hospital and that any kind of diversional activity to counter this is very much appreciated.4
Build Your Humor Skills 1. A man long known to be a heavy drinker hears from his doctor, "Even with all our tests, I can't find any cause for your illness; but frankly, I think it's due to drinking." "In that case," said the patient, "I'll come back when _________." Clue: The patient thinks the doctor has been drinking. 2. A woman kept going to the eye doctor because here eye hurt her all the time. The doctor finally discovered the cause of the problem and told her to stop drinking tea. The patient protested, "But I love my morning tea." "OK," said the doctor, "as long as you _____________." Clue: The problem is not the tea itself, but the way she drinks it.
[Work on both jokes before checking the answers on the next page.]
Many nurses and hospital administrators are concerned that patients will perceive them as unprofessional and unconcerned about their health problems if they show a sense of humor while interacting with patients. There is evidence, however, that most patients welcome the opportunity for humor and laughter during their hospital stay. The figures in brackets indicate the percentage of patients in one study who agreed with the following statements:
- "Nurses should laugh more often with patients." [80%]
- "Nurses should try to get their patients to laugh." [83%]
- "Laughing helps me get through difficult times." [83%]
The following statements generated strong disagreement by the same patients:
- "Nurses who laugh with patients are unprofessional." [94%]
- "Nurses who laugh are insensitive to patients who are suffering." [91%]
- "Laughter does not belong in a rehabilitation hospital." [89%]5
In another study, almost half of the hospitalized children studied said that humor and other light-hearted interactions with nurses were important in adjusting to their hospital stay.6
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As a result of the steadily mounting evidence of humor's importance for both physical and mental health, physicians have finally begun discussing among themselves just what the role of humor in healthcare should be. They are finally asking questions like "when is it okay to joke with patients? When is it not okay . . . When is it okay to laugh about cancer?"7 The biggest problem faced by doctors and nurses who may want to use humor in healthcare settings (either for their own or for their patients' benefit) is lack of awareness of what is going on with other patients who may be nearby. A nurse may want to share a laugh with a patient during a routine visit to the patient's room, but there is always the possibility that a patient sharing the room has just gotten some very bad news - which would make any nearby laughter inappropriate. And, of course, clinical staff must constantly keep in mind that the "sick" or "dark" humor they share with each other (see below for a discussion of this) is almost always not to be shared with patients.
