From critical care to comfort care: the sustaining value of humour

He who has laughter on his side has no need of proof. ~ Theodor Adorno, Minima moralia

(Plagiarized from a UPI news item) A study by a Winnipeg researcher shows that humour can play an essential role in intensive or end-of-life care. Continuing research begun in her 2003 dissertation, Ruth Dean of the University of Manitoba Faculty of Nursing, with her colleague Joanne Major, a nurse at the Health Sciences Centre, spent hundreds of hours observing and carrying out interviews with staff, patients and families in an intensive care unit and a palliative care unit.

Their paper, published in the Journal of Clinical Nursing, demonstrates how health care staff use humour not only to reduce tension and express frustration, but to connect with patients, making them feel cared for as individuals and alleviating their embarrassment. They conclude that humour plays an essential role in promoting team relationships and adding a human dimension to the care and support of seriously ill patients and their families. "Our research suggests that nurses and other health care professionals don't need to suppress humour," Dean said in a statement.

The researchers found that staff used humour in a number of ways:

• To cope with, and sometimes distance themselves, from difficult situations. As one person commented: "When you've had the most stressful day and you're ready to cry, sometimes it's easier to bring out humour and take it in the other direction instead of bawling on somebody's shoulder."

• To connect with other health care professionals and provide mutual support. Shared laughter energized and nurtured a sense of community. "If you have those fun moments and that connectedness even the worst hell can happen," said one person who worked with terminally ill patients. "You sail through it as opposed to walking out really wounded."

• To reduce tension when things don't go as well as they could do. A doctor who admitted he had been hasty suggesting that a terminally ill man give up his apartment so soon was greeted with the quip: "Shall I chart that you made a confession or that you made a mistake?"

• To express frustration at life-prolonging measures that staff disagreed with. Staff in the intensive care unit told researchers how they paralleled what was happening to one patient by using an inflatable dinosaur called Dino and putting him through the same interventions. He became a symbol of their dissatisfaction with the situation.

• To connect with patients and make them feel cared for as individuals. When a health care aide took a joke picture of a patient with a bubble bath helmet on his head to put him at ease, it became one of his prized possessions. He showed it to everyone who visited as evidence of the special treatment he was receiving. And when he died, it was displayed alongside important family photos.

• To reduce patients' embarrassment with the indignity of needing help with toileting and other highly personal functions. When a patient suffered an episode of incontinence she reported that she found the nurse's matter-of-fact humour — "what goes in must come out" — made her feel less distressed.

It wasn't just the staff who used humour to alleviate difficult situations. One nurse recalled how a patient's monitor kept going off in the intensive care unit. "Don't worry, if I can hear it I'm still alive," the patient joked.

"Some people feel that humour is trivial and unprofessional in health care settings, but this study shows that it is neither," said Dr. Dean. "Despite major differences between the work of the intensive care and palliative care units, they are both areas where serious illness, high anxiety and patient and family distress are prevalent and staff are placed in emotionally demanding situations. Crises are frequent, death is close by, and emotions tend to run high."

The authors conclude that humour was very important in these stressful health care settings. "One member of staff referred to humour as the glue that holds human connections together, a statement that was clearly reinforced by our findings," said Dr. Dean. "Our research suggests that nurses and other health care professionals don't need to suppress humour. They should trust their instincts about when it is appropriate. Combined with scientific skill and compassion, humour offers a humanizing dimension in health care that is too valuable to be overlooked."

Reference:

Dean RA, Major J E. From critical care to comfort care: the sustaining value of humour. J Clin Nurs. 2008 Apr;17(8):1088-95.