Journal of Nursing Jocularity

“I never forget a face, but in your case, I’ll make an exception.” Groucho Marx, target unknown

“He’s a nice guy, but he played too much football with his helmet off.” Lyndon B. Johnson on Gerald Ford

‘”Good taste would likely have the same effect on Howard Stern that daylight has on Dracula.” Ted Koppel

For the past 8 months I have been writing about how humor, laughter, mirth and joy, increases our immune power, improves heart health, increases your sense of well being, improves relationships and ….the list goes on. (more…)

A volunteer at a local hospital who regularly donned clown makeup, sang songs, and told jokes to entertain patients was getting ready to leave one day. She told a patient, “I hope you get better.”

(more…)

CLOWNING AROUND!

Break out the rainbow wigs, the red rubber noses and the huge, floppy shoes: it’s time for us to CLOWN AROUND!  Clowning is one of the most visible manifestations of therapeutic humor.  The world famous Big Apple Circus has a ‘Clown Care Unit’ that visits pediatric patients, bringing smiles, giggles, and joy where ever they go.

They’re also teaching nurses how to do the same thing.  This is just fabulous!  Now, I know what you’re thinking — your facility already has enough clowns. Just look in the administration… (more…)

“You’re here again, Steve?” On this particular oncology unit, we didn’t have many patients who ‘hung around’ for long — but there was Steve. Diagnosed with Pancreatic Cancer, he was well into Stage Four, but Steve had no intention of stepping off this mortal coil just yet. (more…)

May is all about celebration and recognition here at JNJ: with Nurses Week just wrapping up (did you get your Cinnabon?) it’s a good time to take a moment to reflect on the relationship between humor and celebration.

Earlier this month, I had the privilege of speaking with Loretta LaRoche.  One of the things she said that really jumped out at me was the fact that women (and look around:   nursing is still predominantly a female field) are socialized to complain.  That’s how we interact with each other; that’s how we communicate.

Changing that dynamic to incorporate more positive conversations — namely, celebrating and recognizing the good work we do every day — can be difficult.  We’re used to complaining.  We’re good at it.  We know how to carry on about everything that went wrong yesterday, that’s going wrong right now, and that’s likely to go wrong tomorrow.

Celebrating, on the other hand, we’re not used to.  We’ve created the  mindset that celebration and recognition are ‘special’ — so special that they’re reserved for a few awkward moments jammed into a semi-annual celebration.  Looking for and pointing out the positive is not something we’re used to doing.

Humor Can Help!

Humor can help us change the conversation.  Laughter is disruptive: it signals a break in the conversation.  Think about it.  Much of what makes us laugh is sudden, abrupt, unexpected. We chuckle when there’s a change — when we don’t get what we expected, but something different, surprising (and hopefully better — nursing does seem to have more than its fair share of unpleasant surprises!)

The disruptive, conversation altering aspects of laughter can derail a train of negativity — exactly what’s needed to facilitate the change toward a more positive direction.  Consider using humor to ‘break up’ a negative conversation and then switch gears, using the moment to praise or compliment a peer.  It doesn’t need to be over the top — we’re so accustomed to a lack of praise and recognition in our daily life that a simple, “Hey, you did a good job there’ can transform someone’s entire day.

Humor Gives Permission

Humor creates conversational safe spaces: we can say things when we’re joking that we wouldn’t ordinarily say.  Knowing that the result is likely laughter — after all, no one is going to take a joke seriously — provides a format to ‘try out’ sentiments you wouldn’t ordinarily attempt.

For example, it’s easier (and may feel safer) to say, “Hey muscles!  You must have been working out lately!” to the nurse who helped you with a difficult patient transfer than to address the issue directly by saying, “Hey, that lady was too heavy for me to move alone, and I’m glad I had your help.”  This is particularly true when addressing a nurse you don’t know very well: humor can serve as an ice-breaker when meeting new people.

Humor is (Generally) Positively Received

By and large, people love to laugh.  Yes, there will be a few stinkers who wouldn’t crack a grin if you paid them $50 for it.  But overall, humor is well received.  Laughter makes us feel better, physically and emotionally, and the majority of people seek out opportunities to laugh.

Praise and recognition, on the other hand, make many people uncomfortable.  We’re not used to hearing positive things about ourselves, and depending upon our cultural backgrounds, we may have even been socialized to never accept positive commentary.  Considering our overall goal here is to boost the morale of our colleagues and peers and create a more positive working environment, we don’t want to actively pursue a strategy that makes people feel bad.

Wrapping praise and recognition, celebration and cheer into humor takes some of the uncomfortable aspects of hearing positive commentary away.  Additionally, if something does make someone feel awkward, they can easily choose to ‘dismiss’ it as just a joke.

Be Careful!

Using humor to deliver praise and recognition to your peers is a powerful, effective strategy.  However, humor can bite you if you’re not careful: make a point to focus on therapeutic humor.  This is humor that lifts up and makes people feel better.  Sarcasm and snark are very popular forms of humor — and they can certainly address some of the bleaker moments of nursing — but they’re not ideal delivery vehicles for positive messages!

It had been a rough delivery. Even though it wasn’t a high-risk pregnancy, things –  as things often do — had gotten complicated along the way.  Nine grueling hours later, we had a tiny but tenacious little girl in an incubator, and Mom still in surgery.

The new Dad, standing with his wife’s sister, stood outside the nursery, staring at his infant daughter.  They were both overwrought and tense, nervous and overwhelmed.  Somehow they’d gotten on the topic of diapers and poop (perhaps not surprising!) and were joking about the million of pounds of poop that the new baby would generate.  You can imagine the conversation — and if you work in or around the nursery, I’m sure you’ve heard this conversation a million times before!

The Mom’s mother (and new Grandmother) came up to join them at the window, overheard the conversation, and went ballistic.  “How can you joke at a time like this? Don’t you know how serious things are?”

How often do our patients hear that question?  Using humor to address stress, terror, anxiety, fear, overwhelm — all experiences that new Dad and his wife’s sister were going through –is often a natural, instinctive reaction.  Deflecting some attention away from the things that are scaring us allows us to function.  Therapeutic humor — even if it’s jokes about a million pounds of baby poop — is a coping mechanism that almost anyone can access.

Yet there are a lot of times when the family and friends of our patients try to keep therapeutic humor out of the conversation.  Serious times, the logic seems to be, call for a serious demeanor.  And if our patients aren’t serious enough, well, these ‘well-wishers’ will make sure to make them stop laughing and get with the program.

Our patients need safe spaces, in which to express what they’re feeling.  If they’re using humor to manifest that expression, GREAT! There’s no rule that says you have to be funny while pondering pancreatic cancer, but if you can, you might as well laugh.

How do we provide safe spaces for our patients? Specifically, how do we let them know it’s okay to laugh, even when other people in thier lives are telling them this is the last time they should even be thinking about laughing?

There are three ways:

One: Provide an Example

The best way to let patients know that therapeutic humor is acceptable in any given setting is to use therapeutic humor yourself.  A simple joke can ‘give permission’ to your patients to share their own joke or funny thoughts.  Additionally, you’re self-identifying as a non-judgmental person who will understand if your patient needs to laugh to keep from crying.

Two: Frame it as Stress Relief

While relatively few patients or their family members will have heard of therapeutic humor, almost everyone has heard of stress relief.  Let the most critical, demanding family members know that reducing stress can help improve the outcome of the situation.  Add to that the fact that laughter is one of the easiest ways to reduce stress.  Since everyone wants a positive outcome here, they should surely be supportive of stress reduction efforts.

Three: Shoo, Shoo, Shoo

Creating safe spaces may mean physically removing negative people from your patient’s surroundings.  Send them home, if possible, or at least out for a coffee while you check vitals/perform a test/prep the patient for a procedure/ready the room for a roommate.  Depending on your facilities rules, this can be easier in some places than in others.  However, a few minutes ‘away’ can do a world of good for your patients.

It’s April, and no fooling, here we are with another issue of JNJ!

April is National Humor Month, a time to celebrate what makes us laugh: at work, at home, and everywhere in between.

This is easier said than done, especially for nurses. The work we do puts us in a unique position: so much of what we do deals with people in intimate, life-changing moments. It’s grave, and dark, and serious — so much so that when we identify the funny moments, one of the most often heard reactions is “You can’t laugh about THAT!” It’s as if the serious nature of nursing precludes us from the human need to deal with stress, diffuse tension, and regain our composure by using one of the most natural and readily available tools: laughter. (more…)

When you’re a student nurse, there’s a lot of emphasis on the “whys”.  Why each vital sign is critically important.  Why you double-check the order before dispensing medications.  Why, when a patient who has been NPO for 24 hours tells you he’s going to lose his lunch, you believe him!

Why, then, is it important to laugh with our patients? (more…)

Let me tell you a story.

Once upon a time, not so long ago, I was a nursing instructor.  And like all nursing instructors, I had students.  And like all nursing students everywhere, my class was stressed out, overwhelmed, and ready to crack.

So I decided we were going to have a little break from the hard-core, heavy-duty studying and have a tiny bit of fun.  Not bring in Bozo the Clown and amusement park fun, but a few chuckles.

On the way to class, I stopped and bought 17 boxes of crayons.

In class, I gave each student a box of crayons and a sheet of paper.  “Draw me a picture,” I said, “that tells me how you’re feeling right now.”

Creativity is always fun, right?  Self expression is a route to joy, yes?

Well, no. (more…)

First impressions really matter. The first few moments we spend with someone can set the tone for everything that follows. Yet many times, getting off on the right foot with a new patient is very difficult. We’re meeting them at what may be one of the worst times in their lives, when they’re scared and overwhelmed, in an unfamiliar situation and not feeling their best.

It gets even better! The relationship our patients have with us – as nurses, as part of their treatment team, even as part of the facility we work for – is qualitatively unlike any other relationship they may have. While our patients may actively seek out and enjoy the company of their family, co-workers, neighbors and others, our company is not something they were looking for.

Meanwhile, patients are becoming increasingly familiar with the team approach to health care. They know they get better treatment if they work with us, rather than against us — or at least some of them know this! This can be awkward, because they’re forced into a position of establishing a relationship that in their heart of hearts, they really don’t want to have to have.

More experienced patients know that on-going treatment creates an almost continual requirement to establish new relationships: each day can bring a new doctor, a new PA, and most especially, new nurses. This constant exposure to new health professionals is a stressor in and of itself; a stressor that many patients find more taxing than even the most rigorous treatments.

So where does that leave us? It leaves us with patients who are nervous, who are anxious, and who are often resentful that they’re even in our presence. They’re angry and overwhelmed, and now they have to start yet another relationship with yet another health care provider…can we add some frustration to the mix?

It’s these nervous, scared, angry patients we need to connect with. In order to provide treatment — and more often than not, education and emotional support — we must move past a seemingly insurmountable wall of resistance, all while providing care in a very compressed time frame. Humor, along with empathy and compassion, perhaps the very best tool we have at our disposal.

Nurses Using Humor

As nurses, we know that the strength of the relationship we have with our patients has a direct and positive impact on the effectiveness of treatment. With that in mind, we can use humor right from the first moments with our patients. Humor allows social barriers to drop very quickly — nothing bonds a people as rapidly as sharing a laugh.

Dropping social barriers is good, because social barriers are one of the primary impediments to effective communication. The use of humor between patients and nurses creates a route around those barriers, and makes it easier for patients to discuss difficult issues.

At the same time barriers are being eliminated, bonds are being created. By introducing humor, you’re adding an element of humanity back into what patients see as a de-human, de-humanizing environment. It’s a tangible demonstration of care and concern, above and beyond what the patient expects the nurse to provide.

When using humor to help establish a new relationship, it’s important to keep in mind that the humor used must be therapeutic humor. Therapeutic humor encompasses a wide range of scenarios, from an expression of the absurdity of the situation, a commentary on the conditions you’re both working in at the moment, or using limited self-disclosure to reveal common experiences with your patients. The goal of therapeutic humor is to use humor as a complementary treatment of illness to facilitate healing or coping, whether physical, emotional, cognitive, social or spiritual.

Often, there’s a great deal of education to be done with new patients. They don’t know or understand what’s happening to them — or, more often, their understanding is based in some less-than-reliable sources: family and friends, or late night sessions poring over the message boards on WebMd.

As nurses, we need a way to convey critical information that doesn’t alienate patients who don’t want to be ‘talked down to’. Humor often works well here. As an added benefit, humor makes information memorable: by and large, we’ll remember what makes us laugh far longer than random bits of data we’re supposed to know.

Patients are more likely to engage with and actually read information they find humorous: that’s why increasing numbers of facilities are using cartoons on their discharge instructions. Admittedly, the humor here isn’t side-slapping, fall down on the floor and cry funny, but it will provoke a smile or two. Better yet, patients will actually read the information — a marked improvement from the usual state of affairs.

Patients Using Humor

As nurses, we need to be aware of and responsive to our patient’s attempts to use humor while establishing a relationship. This can be tricky — not every joke is a good one, after all, and many come disguised as odd or even inappropriate comments.

Listening to and assessing a patient’s humor is critical because humor may be the only way the patient feels safe expressing themselves. Anxiety, fear, nervousness, and tension aren’t generally socially acceptable emotions: many people only express them in environments where they feel safe — with family members or close friends. However, in an environment where the patient finds themselves devoid of that safety net, humor may be the only way the patient feels capable of processing those emotions.

In some cultures, it is almost taboo to discuss one’s own pain or suffering. These patients may feel incredibly uncomfortable discussing how they’re feeling, and want to avoid drawing attention to their condition. Patients may use humor in these situations to deflect what’s ‘really’ happening: it’s far more acceptable to make someone laugh than to let someone — even the nurse! — know they’re feeling pain.

Conclusion

Sometimes the only thing we can do is laugh. The beginning of a relationship is a delicate time, yet often, in the go-go-go atmosphere we work in, we don’t have time for delicacy. To save time and import critical information, humor may be the best tool that we have as nurses.

While humor may be our best tool, it may be our patient’s ONLY tool. Those jokes and awkward laughs can mask a lot of emotion: anxiety, fear, and a lack of understanding. Being aware of the message behind the giggles can help us communicate more effectively with our patients and help them receive the care they need.