Types of Hospital Humor Programs
The best known approach to bringing humor and laughter to hospital settings is the use of clowns. Over the past two decades, a steadily increasing number of hospitals have created programs in which volunteer clowns visit patients in their rooms in order to boost their spirits and distract them from their anxieties and concerns. The Big Apple Circus Clown Care Unit was initiated in New York City by Michael Christensen in 1986 and has spawned many comparable clown units across the U.S. and around the world (e.g., the Fondation Théodora, in France).17
The power of clowns is evident in the following example provided by a clown from the Big Apple Circus. An 11-year-old boy had been doused with gasoline and set on fire by an older boy.
"He was conscious, but in terrible pain with major burns over more than half of his body. I went right into emergency with him. When the surgeons began cutting away dead flesh, I began telling funny stories and promising circus tickets and making scarves appear and disappear - anything to keep his mind off the agony. Pretty soon he was rolling his eyes in amazement and finally I got him laughing behind his medical mask. It was incredible. He was staring death in the face - and he was having fun!"18
Like adults, children are generally very anxious prior to any serous surgical procedure. One study suggested that 60% of children suffer anxiety in the preoperative period.19 Since high levels of preoperative anxiety are often associated with postoperative difficulties, efforts are often made to use sedatives or other tools to ease anxiety prior to surgery. There is now evidence from a recent study that the presence of clowns (along with parents) in the preoperative room does reduce the level of anxiety experienced prior to anesthesia induction.20 Interestingly, even though the clowns in this study were very effective in reducing children's anxiety before surgery, the operating room clinical staff still were against the idea of bringing clowns into the preoperative area. They felt that the clowns 1) created a disturbance, 2) delayed clinical procedures and 3) interfered with the quality of the relationship between the medical personnel and the child. So while the movement to "bring in the clowns" continues to grow in connection with patients' rooms, hospitals may not yet be ready to let clowns near the operating room.
Some hospitals have created entire rooms devoted to fun and humor for ambulatory patients. These rooms are given such names as "The Lively Room," "The Living Room," or simply "The Humor Room." For many years, Sunnyview Rehabilitation Hospital, in Schenectady, New York, even had a full-time humor coordinator whose job was to be sure humor is made available to all of those patients who wanted it.
________________________________________________ "After two days in the hospital, I took a turn for the nurse." W. C. Fields
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One of the first humor rooms was established in the early 1980s at St. Joseph's Hospital in Houston. Representatives of this program have expressed their belief that the program leads to shorter hospital stays for many patients. The head nurse observed that some patients are able to reduce their pain and nausea medications following a visit to the humor room.
I know of one hospital in New Jersey which has a humor program built into its pediatrics department. At one point in the 1990s, the hospital was short of beds for adults, so a 70-year-old cancer patient was forced to stay in pediatrics for nearly a week. While he came in depressed, he had such a good time during his stay that when he was later re-admitted to the hospital, he specifically asked for a room in pediatrics.
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Another common approach to building a lighter touch into hospitals is to create a "humor cart." This is a cart which can be wheeled into patients' rooms, and contains funny CDs, DVDs, books of cartoons, games, funny props, silly nose glasses (animal noses as well as the traditional red clown nose), etc. Several hundred hospitals around the country now have humor carts. Volunteers from the community often take responsibility for these programs. They wheel the cart into a patient's room, and the patient can take anything on it to play with for as long as s/he wants. The basic idea here is simple - to take patients' mind off their pain or health concerns by engaging them in humor and the spirit of fun.
Some hospitals even adopt multiple approaches to keeping patients immersed in humor, including the use of satellite feeds of comedy programs (I know of one hospital that issues patients a kind of "TV Guide," listing when the comedy shows will occur on closed circuit TV, when they are first admitted to the hospital), a comedy cart, a humor room and even a lighter style of interaction with patients - at least with those who express interest in such interactions with staff. The latter approach is one of the most effective means of making the therapeutic benefits of humor available to patients. Nurses and other staff members can have a powerful impact on patients' mood by bringing them an occasional opportunity to laugh as they do their jobs. The Humor Skills Training Program discussed at the end of this course helps nurses find their own style of bringing humor to the bedside.
The Integris Baptist Medical Center in Oklahoma City, Oklahoma created a humor program between 1996 and 2000 (funds for the program ran out after four years) in a 20-bed rehabilitation unit within the hospital. The unit was called the MIRTH unit (Medical Institute for Recovery through Humor). The basic idea here was to use humor to create a more patient-centered environment and generate positive emotions in the midst of patients' rehab program. The main focus was on the use of humor in interaction with patients, but the unit also included exposure to cartoons, posters of clowns and videos of classic comedians (like the Marx Brothers, The Three Stooges and Lucille Ball), puns and jokes, etc. Humor was used not just to get patients (all 65 or older, and being treated for a broad range of conditions, including cancer, heart disease, diabetes and stroke, among others) laughing, but to help them escape the role of patient for a while, bring back memories of their healthier youth, generate some positive feelings in the midst of a difficult circumstance and renew a sense of happiness and self-worth.21
This kind of environment was found to produce a contagious effect of humor on patients.
"When one patient appeared to be happy or amused, other patients and staff picked up on these cues and appeared to be happy or amused themselves. This was apparent when one patient would tell a story about his or her youth and chuckle, encouraging others in the room to chuckle reciprocally. Many patients in the room may have perceived a person chuckling as an environmental cue that 'allowed' them to perceive humor as well. Other environmental cues, such as quotations and posters on the walls or the 'joke of the day' also influenced the perception and contagion of humor."22
An observational study of the impact of this hospital humor program by a researcher not involved in the creation of the MIRTH unit led to the conclusion that using humor with patients supports more effective patient-centered care in three ways.
"First, humor provided an informal, positive environment in which providers . . . could gain valuable personal information about patients for the purpose of fulfilling their physical and psychological needs. Second, humor may have liberated patients from the 'bad patient' label by encouraging them to be open and unapologetic about their concerns and requests, leading them to take a more active part in their health care. Finally, humor may have de-emphasized some of the power disparities so often associated with patient-provider relationships."23
