Journal of Nursing Education

The Benefits of Humor in Nursing Education

Joan Kay Ulloth, PhD, RN

Abstract

ABSTRACT

This study was designed to examine the perceived benefits of intentionally using humor in the nursing classroom. A multiple case study of three associate degree nursing instructors and their classes was developed with qualitative methods, which included observations, interviews, and surveys. Data were examined within and across cases for commonality or difference of experience. Strong connections were made between humor and learning. Teachers and students expressed benefits they believed were received from humor. Humor can be an effective, multipurpose teaching tool for nurse educators to convey course content, hold students' attention, relieve anxiety, establish rapport with students, and make learning fun. When combined with other teaching methods, humor can enhance student learning.

Abstract

ABSTRACT

This study was designed to examine the perceived benefits of intentionally using humor in the nursing classroom. A multiple case study of three associate degree nursing instructors and their classes was developed with qualitative methods, which included observations, interviews, and surveys. Data were examined within and across cases for commonality or difference of experience. Strong connections were made between humor and learning. Teachers and students expressed benefits they believed were received from humor. Humor can be an effective, multipurpose teaching tool for nurse educators to convey course content, hold students' attention, relieve anxiety, establish rapport with students, and make learning fun. When combined with other teaching methods, humor can enhance student learning.

Humor has been an integral part of human communication for much of recorded history. The Hellenistic philosophers Socrates and Plato were known for their sophisticated humor. Later, during medieval times, a balance of the four body fluids, known as humors, was considered necessary to maintain health. Humor has continued as a topic of interest in a variety of settings. Cousins (1979) popularized the benefits of humor in Anatomy of an Illness by relating his experience with chronic pain. According to Robinson (1991), health care workers used humor to cope with the daily events of their work, while Loomans and Kolberg (1993) asserted that educators, such as elementary and secondary teachers, have employed humor to create "safe" and conducive learning environments. Scholarly interest in humor has risen dramatically from 1981, when 5 dissertations concerning humor were written, to 1994 when there were more than 150 (Cannella, Missroon, & Opitz, 1995). Out of this body of research, only one quarter of the studies involved education, and none were related to incorporating humor into the art of teaching nursing.

As a nurse educator, I use humor in my classroom and regularly receive positive feedback from students. Therefore, I developed a study to explore how humor was used in other nursing classrooms and how it was perceived to facilitate student learning. This article reveals the findings.

LITERATURE REVIEW

Nurse educators view learning from many perspectives. Currently, some nurse educators have integrated the holistic philosophy of nursing practice into their classrooms. According to this view, people are multidimensional beings who develop to their fullest potential when there is balance among the three major components of being - body, mind, and spirit. In education, these emerge as a focus on the psychomotor, cognitive, and affective development of learners. Listed as a need in nursing's Human Need Theory (Yura-Petro, 1991), humor links cognitive and affective learning.

Benefits of Humor

Appropriate instructional humor can promote five major benefits for both initiators and recipients:

* Relieve stress and anxiety.

* Focus attention.

* Make learning run.

* Aid learning.

* Strengthen social relationships.

Stress and anxiety interfere with the ability to learn, so educators work to keep them at manageable levels (Cannella et al., 1995; Smeltzer & Bare, 1995). In a series of studies published in 1986, Lefcourt and Martin showed that using humor lowered stress levels in college students. Hillman (1995), Nilsen (1994), and Johnson (1990) each described humor as a way to ease tensions about uncomfortable topics or situations. Rosenberg (1989) said humor enhanced the learning process by allowing nursing students to admit their mistakes and learn from them. In addition, Kuhrik (1996) examined nursing students' use of humor and found that traditional students had a greater overall sense of humor but nontraditional students were more likely to use humor to cope with stress.

Because the average adult attention span ranges from 10 to 20 minutes (Peterson, 2000), boredom and loss of concentration commonly afflict students attending prolonged class sessions. In 1980, Bryant, Comisky, Crane, and Zillmann explored claims by college teachers that humor increased learning by stimulating students' interest and attention. Humor was used successfully by Eason and Corbett (1991) to "grab" the attention of their adult education students, and Inman (1991) extolled the benefits of humor in gaining students' attention.

Humor can be used in the classroom to make learning fun and energizing for both students and teachers. Presser (1997) found that 79% of adult educators reported frequently using spontaneous humor in class to energize the students. Role play and games were the strategies White and Lewis (1990) used to engage their students. Shade (1996) found that humor served as a catalyst for cognitive associations that helped students integrate new material with current knowledge. Ziv (1988) conducted a study using students enrolled in a college statistics class, and students who were taught with humor had significantly higher test acores on the final examination than students in the control group. Zillmann, Williams, Bryant, Boynton, and Wolf (1980) noted that after a humorous classroom event students demonstrated increased attention to and retention of accompanying educational content.

Because learning is primarily a social activity, any activity that strengthens social relationships can aid learning. Communication becomes more effective when laughter melts away inhibitions (Audette, 1994). Powell and Andresen (1985) found that humor creates studentteacher rapport, enhancing the general learning environment and interactions between students and teachers. In addition, Gorham and Christophel (1990) discovered that humor most effectively aids learning when coupled with interactive teacher behaviors, such as making eye contact and calling students by name.

Summary

Using humor to stimulate mental processes and control fear and anxiety helps students retain the content they have learned. In addition, when anxiety is reduced, students are more likely to open their minds to learning and enjoy the experience. Therefore, humor is a legitimate teaching tool to facilitate learning (Berk, 1998) and engage all levels of the mind (Caine & Caine, 1989).

METHOD

Qualitative Case Study

This study examined the perceived connections between humor and student learning. Qualitative case study was selected as the most appropriate method to examine the use of humor in the classroom. Munhall (1994) maintained that nursing aligns itself with human sciences because it views each individual as an integrated whole that cannot be understood by examining each part separately. In this study, the affective and cognitive components of learning are intricately interconnected through humor.

Humor is an ephemeral experience. Humorous events related by one individual to another often elicit the comment, "You had to be there," from the storyteller who is frustrated by the inability to recreate the context. Qualitative research is designed to study the process and context of a particular situation, retaining this valuable contextual information. Merriam (1988) described case study as a useful design for educational research because "educational processes, problems, and programs can be examined to bring about understanding that in turn can affect and perhaps even improve practice" (p. 32). The use of humor is a relatively recent innovation in nursing education. Therefore, how it is used and the rationale for using it are unclear. Detailed descriptions of successful use of humor in the classroom are needed if humor is to be considered among teaching strategies that most effectively aid students' learning.

Data Collection

Subjects were selected from undergraduate nursing schools in a three-state area during the 1997 to 1998 school year. To be selected:

* The program had to have at least one teacher who intentionally used humor in the classroom.

* The teacher had to be identified by others as a humorist and be available during the study period.

* The class needed to have at least 10 students. When a class met these initial criteria, humor questionnaires were distributed to recent graduates or senior-level students to determine whether students independently identified the same teacher as the one using the most humor in that school. Graduates and students from all three schools exhibited a high degree of agreement in identifying the teacher using the most humor. Cheryl* received 95% of the votes from the Illinois school, Karen received 94% of the possible votes from the Ohio school, and Martha received 100% of the votes from the Indiana school.

Table

TABLE 1Student Interview Questions

TABLE 1

Student Interview Questions

Subjects. The teachers selected for this study taught in associate degree nursing programs. Cheryl was an instructor of medical-surgical nursing for students beginning their second year of nursing; Karen taught a fundamentals of nursing course to new students; and Martha was in charge of a medical-surgical nursing class for students in the final semester before graduation. All three were veteran teachers with at least 15 years of experience, and each was very knowledgeable in and comfortable with her respective subject area. All three demonstrated their commitment to students' learning through their similar use of many effective teaching techniques, Each addressed students by name, interacted with students in a personal way, and maintained availability outside of class.

Student populations varied slightly among classes, but 80% to 90% were White women, with an average age of 28. Men comprised 10% to 15% of each class. Nineteen percent of Cheryl's class had cultural backgrounds other than White (i.e., 8% Asian, 5% Hispanic, 3% Black, 3% other), making it the most ethnically diverse class. Seventy to eighty percent of the students in each class worked part time in health care.

Observations. The teacher named by the most students from each school was asked if she was willing to participate in the study. After she consented, arrangements were made to observe two or three of her classes taught during the week. A video camera was used to record events to be cross-referenced later with field notes. At the end of the observation period, students in each class were asked to complete the same humor questionnaire given to the alumni and senior students.

Table

TABLE 2Teacher Interview Questions

TABLE 2

Teacher Interview Questions

Interviews. Audiotaped interviews were conducted with a purposive sample of students selected to represent the class demographics in gender, age, ethnicity, and selfperception of scholastic ability. At the first school, 11 of the 35 students in the class were interviewed. All 10 of the students who attended the class at the second school participated in the interviews, as did 10 of the 17 students in the nursing class from the third school. All student names have been changed for anonymity purposes. Interviews were held either individually or in groups of two or three, depending on student preference. Student interview questions are listed in Table 1.

The interview process continued until the collected information became repetitive. The student interviews were transcribed from the audiotapes and examined for common experiences and similarities or differences in perspective. The teachers were interviewed individually about classroom humor, and the data was analyzed similarly to student data. Teacher interview questions are listed in Table 2.

Data Interpretation

Data from the various sources (i.e., questionnaires, observations, interviews) were examined for similarities or differences within each class. After patterns emerged for the individual schools, a cross-case analysis was conducted among the schools. A composite description of the intentional classroom humor experience was used to portray students' and teachers' perceptions of its effects. Triangulation showed internally consistent study results, and cross-case analysis produced intercase consistency. Although the teachers implemented different kinds of humor in different settings, it became apparent that their students responded in a similar manner, suggesting that humor can be incorporated effectively in nursing education.

RESULTS

Each data source provided information that consistently supported the many benefits of using humor in the classroom. The teachers and students from all three schools described strikingly similar perceived effects of humor, differing only in the examples used to demonstrate each point.

Humor to Relieve Stress

Whether caused by personal problems at home or work or the subject matter in class, stress can interfere with learning. The teachers used humor to reduce students' stress and anxiety. Karen used humor to make her classroom a comfortable environment where students could release some of their pent-up energy and feelings. In a statement that closely paralleled Cheryl's rationale, Martha summarized the reasons she deliberately used humor in her classes:

The type of content I teach is very threatening to the students sometimes, and if I am really serious about it, they become more intimidated. So I use it [humor] to lower the stress level a little bit, to make it kind of fun, and hopefully make associations for them that will make the material less threatening, more palatable and more memorable.

Students were unanimous in their beliefs that the teachers' humor had positive effects on stress levels. One of Cheryl's students, Julie, said it lightened and relaxed the class, making it easier to pay attention. Other students in all three classes agreed. Another student, Jane, said, "I know that laughing is tremendously beneficial. I think that humor helps a lot in terms of being relaxed and the information comes in easily. I can say that in any situation where there is anxiety, the brain doesn't accept information." Margie liked the way Karen incorporated humor in her teaching tactics because it loosened up the class and made it easier to learn. A senior in Martha's class recalled that "humor in every lecture helps increase the comfort level and reduce stressful learning." One graduate's response on the humor survey extended the value of humor beyond the classroom and into the workplace, reporting:

.. .when humor was used in classes, my test scores were higher because I felt "at ease" with the material and was relaxed and confident while taking the exam. I know, now, that humor is greatly valued in the workplace as well. It helps us to survive the craziest and saddest of situations!

Humor to Focus Attention

Students were aware that humor had a positive effect on their attention levels. Many echoed Julie's comment that use of humor increased learning because it grabbed their attention and made them want to listen. Another student, Gary, was direct in explaining his views on Karen's use of humor:

If I had to sit there and listen to somebody talk on and on mthout breaking the ice, it would get boring. You can get old [sic] if somebody just gives you a bunch of facts. ... But when you [the teacher] start making jokes about it, I want to listen more.

Karen noticed the same results from Cheryl's class.

Because Martha teaches a 6-hour class session, her students were particularly aware of the need to maintain their attention level, reporting that humor helped them focus. One student, Barbara, reported, "If you can use humor and relate it somehow, it makes people more interested and they pay more attention. I think I listen better." Her classmate, Tosha, agreed that a joke could bring back her flagging attention.

Humor to Make Learning Fun

The teachers found benefits of humor for themselves, as well as their students. Martha said humor eases the boredom that comes from repeatedly teaching the same course and content, and at the same time, helps her enjoy teaching more. Cheryl echoed Martha's statement after explaining that she continued to use humor in her classroom because students asked for it and seemed disappointed if she did not use it. Several graduates commented about Cheryl's use of humor when they returned the questionnaires. One graduate said the "use of cartoons was a good visual reinforcement of dry material (kidneys, eyes, and ears). It made learning these subjects a lot more fun." Three of Karen's students reported the same benefits.

Katie thought it was good that Cheryl explained the reasons why she used humor, saying:

She just doesn't use it to entertain us; she is using it to help our learning and our understanding of this material. I think it is great; it makes it [learning] fun. When things are fun, you are going to retain it.... I remember her little jokes as we are going along. It helps me learn. I never really realized how this is really a learning aid.

Martha's gift for spontaneous humor produced uproarious laughter. While demonstrating a point about heart valves, Martha asked the student nearest the door to close it. As Barbara described:

She [the student] did so, nervously, and her knuckles hit the door prior to the slam. Martha was demonstrating that heart valves make their sounds when they close, but it was funny because there was a "murmur." It made me listen harder because I knew what came next might be funny and enjoyable.

One of Martha's students summarized the class feeling when he said, "If all teachers used humor, class would be more fun and you would learn more."

Humor to Aid Learning

Students in Cheryl's class were the most vocal about the effects of humor on their learning. Although less expansive on the topic, students from Karen's and Martha's classes expressed similar views. Most of the class representatives reported that humor helped them learn in some way. Some used it as a memory device. Others believed it reduced stress, clearing their minds to learn and make connections with more familiar concepts. The connection between humor and learning was stated clearly by one graduate who said, "Use of cartoons in course handout materials and overheads injected a note of levity, leading to relaxation, leading to enhanced ability to learn/remember."

Table

TABLE 3Percentage of Responses on the Humor Questionnaire From all Students and Graduates

TABLE 3

Percentage of Responses on the Humor Questionnaire From all Students and Graduates

Most students reported that humor enhanced their recall of the course material. One graduate explained her view of humor's effects, "Laughter relaxes you, increases oxygen consumption, which increases concentration. You remember what you've been taught!" Students appreciated how the teachers connected the humor with content they were learning. Cheryl wrote rap songs as memory devices, which produced a lot of laughter when reviewed in class. One student's concise comment speaks for many: "Humor keeps me interested in the lecture, keeps me awake, and helps me remember."

Humor to Strengthen Social Relationships

Humor breaks down the barriers between students and teachers. Students who mentioned issues of rapport provided similar descriptions of how humor helped them feel more comfortable with the teacher. Cheryl strives to be a good role model for her students. Although she is in a mentor's role, she believes students should be allowed to laugh at the teacher once in a while. After she had finished performing the "renal cheer," some students laughingly remarked that Cheryl should have done the splits at the end. Later, when Cheryl heard this, she laughed and said, "When you do something like that, it really surprises them, because it is so out of what they think is character for you. It affects them, hopefully, to make them more comfortable." Cheryl also felt that because a lot of teachers do not plan for much interaction with students in class they often do not have good rapport with students.

Most of the students interviewed from Cheryl's class believed humor helped them feel more comfortable with her. One student, Katie, said:

Cheryl is approachable. I feel I could ask a question easily of her and not feel intimidated. I just right away felt at ease with her. I thought, "Well, this is somebody who is going to maybe nurture us a little bit instead of just preaching at us.

All of her current students said Karen was more approachable than teachers who simply lecture. Three students said Karen made them feel comfortable enough to ask questions they thought may be stupid. Cheryl said:

Nobody is afraid to make a mistake. I'm usually pretty shy around people I don't know. But in this class, I have been able to talk to the teacher like one of us. I don't get all tongue-tied and confused when I try to ask a question.

Another student, Keith, expressed this collective thought from his class when he said:

At first, we felt intimidated because Martha's real smart and she knows everything - that's how it comes across - then she used humor and we relaxed. It brings us to the same plane. She's the instructor, but we're working together like colleagues.

CONCLUSION

Results from classroom observations, interviews, and questionnaires strongly indicate that students enjoy humor in the classroom (Table 3). The teachers described several benefits gained by using humor, which the students echoed. Cheryl was the most scientific in her explanation of the benefits of humor. She described the physiological effects of increased oxygenation, enhanced blood flow, the release of endorphins, and the psychological effects of positive attitude, increased attention, and greater recall. Karen used humor to help students relax, feel comfortable, and learn. The benefits Martha's students derived from classroom humor included reduced stress, development of a collégial relationship between teacher and students, and making learning fun by removing the drudgery.

No students responded negatively to the effects of humor in their respective nursing classroom experiences. Some cautioned that teachers should keep the humor focused on class. They described a few non-nursing teachers who used humor inappropriately. Students overwhelmingly supported using humor as another tool in a teacher's repertoire.

The results of this study clearly are aligned with those of previous research on use of humor in education and concur with the conclusions of Bryant and Zilhnann (1989):

Many of the claims by teachers for direct benefits from using humor in the classroom have been evaluated in the crucible of empirical evidence. Clear evidence supporting several of these claims has been discovered. For example, the judicious use of humor has been found to facilitate students' attention to educational messages, to make learning more enjoyable, to promote students' creativity, and under some conditions, to improve information acquisition and retention (p. 74).

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TABLE 1

Student Interview Questions

TABLE 2

Teacher Interview Questions

TABLE 3

Percentage of Responses on the Humor Questionnaire From all Students and Graduates

10.3928/0148-4834-20021101-06

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