Humor can also help nurses build relationships with clients and colleagues. After all, it is hard not to like a person who makes you laugh (McGhee, 1989). Analysis of observations of client–nurse interactions in a cancer treatment unit demonstrated the importance of social exchange, trust, and humor (Lotzar and Bottorff, 2001). A study of humor between nurse and client and among staff demonstrated that nurse–client humor helped both nurse and client to cope with unpleasant procedures. Humor among staff facilitated coping with the work environment (Astedt-Kurki and Isola, 2001). From observations and interviews in an intensive care unit and a palliative care unit, Canadian researchers concluded that humor promotes positive team relationships and adds a human dimension to support and care given to seriously ill clients and their families (Dean, 2008). Humor does the following (Green, 1994):

• Invites interaction

• Puts others at ease

• Wins affection

• Helps us cope with stress and fear

If you can laugh at your own shortcomings and learn from your mistakes, you are free to be creative. Being creative means taking the risk to fail. Nurse managers who can tolerate personal mistakes create a safe environment in which staff can dare to be innovative. Healthcare staff whose managers use humor effectively and appropriately are viewed as more effective and report higher job satisfaction (Cansler College, 2008).

Positive versus negative humor

Distinguishing between positive and negative humor is important. Positive humor, “constructive, empathic humor” (Fry and Salameh, 1987), is associated with love, hope, joy, creativity, or a gentle sense of playfulness. Its intent is to bring people closer together. Negative humor puts people on the defensive and makes them feel put down. It may be sarcastic, racist, sexist, or ageist, and it reinforces negative stereotypes about different cultures, age groups, or conditions. Negative humor isolates you and alienates people (Box 15-1).

Box 15-1 Negative Humor Can Build Barriers between People

WIT&Wisdom

A person without a sense of humor is like a wagon without springs—jolted by every pebble in the road.

Henry Ward Beecher

Positive humor communicates that the human condition is shared, that we all have problems, and that no one is perfect. The highest form of humor is the ability to laugh at ourselves. Follow this adage: “Take your work seriously, but yourself lightly.” One nurse who volunteers as a clown in her hospice work relates an example of humor with an elderly man whose movements have slowed with his illness. The nurse and the client often joke about this because she admits to being slow in the mornings, too. The nurse gave her client a button that showed a turtle saying, “I may be slow, but I won the race.” The client loved the gift and wears it whenever the nurse visits. Positive humor adds to your relationships with clients, families, and colleagues by eliciting cooperation (Box 15-2).

Box 15-2 Positive Humor Can Build Bridges between People

• Laugh at yourself.

• Follow the patient’s lead.

• Remark on humorous cards.

• Share cartoons.

• Share jokes.

• Use gentle banter: “Our gowns aren’t skimpy; they’re air-conditioned!”

Your response to another person’s humor says something about who you are. To reinforce positive humor by laughing and sharing your own humorous perspective, but to refuse to laugh at or participate in demeaning humor by remaining quiet or gently commenting, “I don’t think that’s funny,” is an assertive statement of your belief system. Although it may be difficult to make this type of response to demeaning humor, this is a responsible way to deal with such humor and does not encourage or reinforce put-down humor as does nervous laughter. Recognize, however, that humor serves to relieve tension, and negative humor may be a coping mechanism in tough situations. The medical humor, or gallows humor, that staff use to cope is appropriate when kept among staff because it permits sharing of frustration and promotes group cohesion (Simon, 1988).

Negative humor may serve to relieve tension for the sender of the communication, but it can demean others and undermine your credibility if shared inappropriately. When information about acquired immunodeficiency syndrome (AIDS) first became public, several radio stations aired macabre jokes about the illness. It was not uncommon to hear people repeat these jokes. People often make jokes about subjects that cause anxiety, such as sexuality, relationships, and death. AIDS is one issue that touches all three.

National tragedies, such as the space shuttle disaster, can also be the source of jokes. Humor is often used as a catharsis to provide relief. In a study of such jokes, this humor was found to serve as an “antidote to personal tension and pain” and helped “neutralize the pain of a nation” (Green, 1994).

Humor is listed as an adaptive response to terminal illness by the End-of-Life Nursing Education Consortium curriculum (American Association of Colleges of Nursing, 2000). Joy Ufema, a well-known expert on death and dying, tells us that it is right to provide relief from the seriousness of being terminally ill but advises that you take your cue from the client. She writes of the courage of a woman with leukemia who agreed to be interviewed on 60 Minutes while they were discussing funeral preparations; the client wondered if she should ask her friend, the church organist, to play. When the interviewer said she was sure that were their situations reversed, the client would do it for her friend if asked, the client retorted that she didn’t think she would be asked, since she couldn’t play the organ (Ufema, 2002).

Humor is highly individualized. People find different things funny. Pay attention to the subjects of your clients’ jokes or humorous comments. This gives you a clue about their topics of concern. If a preoperative patient lightly says, “Well, I won’t die from it,” it is likely he would benefit from a little extra time to talk about these fears. Be alert for what seems like inappropriate humor in timing or subject. This is a clue that clients or colleagues may benefit from more serious discussion of the issue. Allow your clients the right to hostile or macabre humor but do not participate in it yourself. To listen without using off-putting body language shows your ability to allow for individual coping responses. To build on this negative humor may create problems. Consider a situation in which you are upset with a relative or close friend. You make negative comments or jokes to relieve tension. If a friend or spouse joins in, you may be offended. It’s OK for me to joke about my mother, but not for you to!

In humor workshops held for clients who test positive for human immunodeficiency virus, participants suggest that nurses “allow us our own form of humor. We know it is black humor. Don’t take offense at it and please, touch us more; don’t act as if you can’t wait to get out of the room.” Although this may be seen as negative humor by nurses, it is initiated by clients as a way of coping with anxiety. Coping styles vary. What people find funny varies. What is constant is your clients’ need to feel that someone understands and accepts them wherever they are along their own journey of coping with illness.

If humor should become offensive, you can change the subject or tell your clients that you appreciate their need to use humor but that you are embarrassed by it.

WIT&Wisdom

Laughter is the most inexpensive and most effective wonder drug. Laughter is a universal medicine.

Bertrand Russell

Criteria for the appropriate use of humor

Have you heard the adage, “There is a time and place for everything”? Pay attention to timing, receptivity, and content (Leiber, 1986) in the use of intentional humor as an intervention.

Timing: When patients are admitted to an acute care setting such as the emergency department, they and their families want efficient, caring attention and treatment. Humor may be inappropriate unless initiated by patients or family members. You will be able to distinguish between banter among clients and family members to ease tension and the put-down humor or sarcasm that needs intervention. In chronic illness, humor may be a much-needed coping technique. One woman with arthritis refers to her condition as “Old Arthur.”

Receptivity: Some people have been raised to believe that humor is frivolous; thus a humorous intervention would not be appreciated. If you use humor and it offends, apologize and explain that your intentions were to be helpful.

Content: Avoid sexist, racist, or sarcastic humor. Remember, just because someone makes light of an issue such as obesity does not give you permission to joke about these personal issues. Your efforts might be interpreted as ridicule.

Nurse–client relationships may provide occasions for humor that seems less amusing when it is retold and thus taken out of context. Trust your own judgment when relating a story. Observe a colleague whose sense of humor you admire. If you have an idea about how to use humor and question its appropriateness, check it out with a co-worker.

Functions of humor in healthcare

Robinson (1990), dubbed the fairy godmother of humor in nursing, examined the functions of humor used in the hospital setting by studying the jokes that were told. She found that humor serves both social and psychological functions.

Social functions include the following:

• Coping with disruptive acts of hospital custom. Consider the banter about “air-conditioned” hospital gowns.

• Establishing relationships. Clients who are disfigured may have a series of one-liners they use to break the ice when someone seems shocked by their appearance.

• Coping with social conflict. One nurse who has good rapport with a physician was surprised by his irritability one day. Realizing that he was having a bad day but was unaware of the effect of his behavior, she retorted, “Dr. Smith, did you have nails for breakfast this morning?” He laughed and apologized.

• Promoting group solidarity. Two teams of nurses with separate medication carts competed to dress a stuffed animal attached to their carts with a different costume for every holiday.

Psychological functions include the following:

• Relief of tension. One supervisor of a telemetry unit puts on oversized clown sunglasses and strolls down the hall when staff members are irritable.

• Release of hostility and anger. A Nerf basketball and hoop or a Koosh ball to toss in the staff lounge is helpful.

• Denial of reality. Humor in the operating room that would seem offensive elsewhere helps staff diffuse tension.

• Coping with disability and death. Individuals infected with human immunodeficiency virus practice their “death rattle” and laugh about it.

In a study analyzing the use of humor in healthcare among registered nurses in a graduate nursing program (Beck, 1997), five themes emerged about humor:

1. It helped nurses to manage difficult situations and difficult clients.

2. It helped build cohesiveness in nurse–client and nurse–colleague relationships.

3. It helped nurses intervene to address clients’ anxiety, depression, and embarrassment.

4. It could be part of the routine or could be spontaneous.

5. It produced positive effects beyond the moment of humor.

A qualitative research study of personal health resources in elderly women demonstrated the use of humor, beauty, and cultural activities as strategies used to maintain physical health and mental well being. The interviews revealed these women had clear ideas about what helped them feel well even in the face of serious disease. Joking with others helped them cope with low-status jobs, pain, and marital difficulties. The researchers reported that study participants’ lifelong experience as caregivers and homemakers provided special information about what can promote health, a wisdom that we can tap when supporting elders (Forssen, 2007).

Studies have shown that hospitalized children use humor, laughter, and play to deal with stressors that make them feel bad, nervous, or worried; to provide distraction from anxiety and pain; and to reduce fear of injury and chemotherapy, and they respond to clowning, jokes and riddles, puppets, games such as peek-a-boo for young children, music, storytelling, and stickers from staff (Dowling, 2002). Jill Sonke, a dancer-in-residence in the Arts in Medicine program at the University of Florida, Gainesville, uses the energy of dance and movement to raise a child’s spirits. Helping a child create and fly paper airplanes in his room boosted his morale and his energy. Mary Lisa Kitakis, an artist-in-residence in the same program, brought T-shirts and paint for a child on a bone marrow transplant unit. The child would stand at the window waiting for her to come (Samuels and Lane, 1998). A nurse artist offered touch drawing (Koff-Chapin, 2002) to an 89-year-old hospice client, who exclaimed, “I am having FUN!” This occurred 1 week before she died. Play and humor bring us into the present moment (Burkhardt and Nagai-Jacobson, 2002). A review of the research literature on caring revealed that humor was a part of the emotional care of clients (Watson, 1993).

Wit&Wisdom

. . .[R]espectful humor used judiciously can buoy clients’ spirits, bring spoonfuls of levity to a sea of seriousness, show humility that softens the stiff authoritarian semblance of control and increases clients confidence that their proverbial exposed underbellies are in safe hands.

Craig (2009, p. 18)