There is considerable evidence that laughter is a valuable human behavior that should be encouraged and promoted, especially in the health field. Although researchers have just scratched the surface, studies indicate that laughter is an effective adjunct for pain control, as well as stress and anxiety reduction (Tooper, 1984, p. 51). Humor may have even more uses. Theories about humor and approaches to it vary widely, from those who view it as frivolous to those who view it as basic as love, belonging, and security (Robinson, 1970, p. 145-146). No one theory is universally accepted, possibly because humor serves mankind in so many ways, its value being unique to each individual.
Historically, nurses have been socialized to maintain a serious demeanor when caring for patients. Many older graduates can remember being reprimanded by head nurses and/or nursing instructors for too much joking or laughter. Now, however, humor is being used constructively, with the patient included, to aid in the healing process. Perhaps by planning, we can take more advantage of its power as another strategy to communicate with patients and each other. We suggest some ways for nursing instructors to use humor in the clinical setting to help students reduce tension and anxiety, and to raise their awareness of humor and its potentially healing effect upon patients.
To expect nursing students to know how to use humor appropriately with patients, and to automatically administer a laugh just because they are told that "humor heals," would be unrealistic. We have all experienced naturally comic people - those whose attitude and behavior always imply the humorous side of life. Most of us, however, have been disciplined to be serious about life.
Even with different ways of appreciating humor and its uses and different "funny bones" of their own, all seem to benefit from the instructors' permission to laugh, and permission to elicit laughs, or at least smiles. Nursing instructors know how frequently students are intimidated by the material to be learned, the procedures to be mastered, the wrath of the instructor if a mistake is made. Some students seem to be terrified of even the patients themselves. Some of this anxiety can be dissipated through encouragement and modeling of positive use of humor.
It is well known that laughter relaxes the person, and relaxed people are more open to learning !Robinson, 1977, p. 91). While, at present, humor seen in the clinical setting and in the classroom is mostly spontaneous and unplanned, it would seem that if it were incorporated into the learning process in a structured manner until it became part of the students' communication skills, it could be used effectively as part of the nursing process. In order for nurses to develop the ability to effectively use humor with patients, the nursing education curriculum must include exercises to increase awareness, modeling of appropriate use of humor, and opportunities to practice.
When humor is planned as part of the teaching strategy, a caring environment is established, there is an attitude of flexibility, and communication between student and teacher is that of freedom and openness. The tone is set allowing for human error with freedom to explore alternatives in the learning situation. This reduces the authoritarian position of the teacher, allowing the teacher to be a facilitator of the learning process. Fear and anxiety, only natural in a new and unknown situation, become less of a threat, as a partnership between student and instructor develops.
In our educational setting, humor is introduced in the clinical course during the students' second semester in the nursing program. During orientation to the course, the value of humor as a basic need, as a strategy for learning, and as a nursing intervention is discussed. Students learn to discriminate between constructive and destructive humor. They raise their awareness of the effective use of constructive humor in the clinical setting; they begin to recognize situations in which it is appropriate to plan humor as an intervention.
To help students to "think" humor, and to "raise the level of consciousness," we use and suggest these activities:
Keep a humor diary: Jot down a note or two throughout the day when something feels humorous. While the activity of writing may seem to take too much effort, it can prove worth the effort when reading the diary. Too often little funny things are quickly forgotten. A tape recorder may substitute for the pad and pencil. We spend some class time sharing parts of these diaries.
Tell a short humorous story or a Joke: Come to class prepared to tell a favorite joke. This assignment helps each of us to start thinking "funny" (Robinson, 1977, p. 95-96).
Share a cartoon: Collect and share cartoons from books, magazines, and newspapers. Class members begin to understand that different things are funny to different people. Since our goal is appropriate use of humor with patients, this helps in recognition of differing humor-causing stimuli.
Caption the picture: Hold a contest in which each person decides on a caption for a picture. The funniest, in the group's opinion, "win." This furthers the learning that each person has a unique "funny bone" and that we can appreciate each other's humor as well as our own.
You turn my button: Wear a smile/frown button. This is a circular pin-on with a face which smiles in one position, but when turned upside-down, shows a frown. The button is turned to frown when something happens that the student or instructor might label "a bummer." For instance, when a student is late, or needs improvement in charting, the button gets turned down.
While the button and the exercise might be dubbed silly by some, it almost always elicits at least a smile from the one being "frowned at." Tensions ease when we smile. We need not be tense in order to improve performance.
Play Dress- Up: Holidays or special days are always an excuse for humor. On St. Patrick's Day, wear a shiny green hat; on Easter, wear a ridiculous Easter bonnet. Halloween calls for witch paraphenalia or a couple of stuffed black cats making rounds, tucked under nurses' arms. Students and patients alike enjoy the silliness.
This is only a beginning list of ways to incorporate play. While some of these activities may sound like something one would do for children, our philosophy is that we all need to use the child within, especially during stressful times, which the clinical experience almost always tends to be for nursing students. Play therapy for adults might be a way to describe it. When we stop taking a moment to "play," we lose our spontaneity, enthusiasm, and the energy we desperately need. As student nurses learn to play, in a constructive, nonharmful way among themselves, they gain the courage to "play" with their patients, where humor helps healing. If humor and laughter lift the weight of excess anxiety, learning can increase, mistakes decrease, and one's chosen profession can be approached with joy and enthusiasm rather than dread.
None of this is intended to replace thorough academic and clinical practice, nor the emphasis on attention to details which eliminates most errors. It is, rather, meant to reduce anxiety, lighten the mood, and make everyone feel better.
In any situation, when one feels good, one does a more effective job. We maintain that the nursing instructor who practices humor in life (and certainly the classroom and clinical setting are a large part of his/ her life!) is a better teacher, a better role model, and a happier person. What other goals do we need?
- Robinson, V. (1970). Humor in nursing, in Carlson, C. Behavioral concepts and nursing intervention. Philadelphia: J.B. Lippincott.
- Robinson, V. (19771. Humor and the Health Professions. Thorofare, New Jersey: Charles B. Slack.
- Tooper. V. (1984). Humor as an adjunct to occupational therapy. Occupational Therapy and Health Core 1,(1).