1. Humor in the Workplace

2. Objectives
Describe uses of humor in healthcare scenarios to lighten up patient and nurse stressors.
Describe psychological effects of laughter.
Describe the benefits and hazards of use of humor.

3. Humor Evoked response to storytelling and shifting expectations
Provide some quality of life
Provide some pain relief
Encourage relaxation
Reduces stress

4. Findings Show that humor
Has a positive effect on the cardiovascular and respiratory system, similar to exercise
• Some studies have shown an increase in endorphin levels - enhances a feeling of well- being and helps in pain reduction.
• The immune system is improved because laughter increases the level of N-K (natural killer) cells,IgA, IgG, IgM and plasma cytokine gamma interferon.

5. Humor Findings show
The levels of the body’s major stress hormone – cortisol – are reduced not only during the time of laughter but for many hours after.
Another study found that neuroendocrine and stress-related hormones decreased during episodes of laughter.
These findings provide support for the claim that humor can relieve stress

6. Laughter Social signal among humans
Laughter stimulates the immune system.
lowers serum cortisol levels
Increases number of helper/suppressor receptors  • increases the number & activity of natural killer cells
Increases the heart rate, BP, Oxygen consumption
Works the muscles in the face & stomach
Lowers stress hormones
Decreases pain – increases endorphins
Like a punctuation mark
Stress causes adrenal glands to release cortiocosteroids and high levels have a immunosuppressive effect. Laughter is the ANTIDOTE

7. Adults Laugh about ___ times per day

8. Children Laugh _____ per day

9. Laughter Based on caring and empathy: Creates bonds between people
Is nourishing
Helps people cope with difficult situations
Is supportive
Gives people control
Is a diversion

10. Nursing is a stressful profession but can be very rewarding
Laughter can be used to dispel tension and accumulate emotion in a socially accountable way
Laughter is a “safety valve”
Laughter can buy us the time needed to safely process stressful events of your shift.

11. Nursing is a stressful profession
Karyn Buxman tells the story of Debbie, the serious uptight nurse who had a horrendous day at work just losing a tiny patient who had so many cards stacked against her. Like Debbie, all the nurses on the shift were on the countdown to when the shift would end so they could go home.
Debbie tripped over a chair in the nurses station falling with a gigantic crash landing on her face.

12. When everyone rushed to help her out Debbie commented –”Well the day can only get better from here.” Because of the way she said it, everyone knew she was moments away from losing it.
She then looked up at everyone and asked: “What I really want to know is what score the Russian Judge gave me.”
All knew that Debbie would be Okay

13. It’s All about Patient Satisfaction
Hospitals have become increasingly competitive.
Preoccupation within upper management with levels of pt. satisfaction related to hospital stay.
Tool for boosting pt satisfaction= Humor + best medical care possible

14. Humor can provide a relationship between pt and staff
Patient’s arrive stressed and anxious.
Placed in strange environment
Subjected to degrading and embarrassing procedures
Humor eases tensions
Most patients welcome the opportunity for humor and laughter
Does not require additional equipment & space; doesn’t cost anything to implement & can be done anywhere

15. A nurse caring for a man from Kentucky asked patient “so how’s your breakfast this morning?
Patient replied: It is very good except for the Kentucky jelly. I cannot get used to it’s taste.
You guessed it – The jelly was KY jelly.

16. Hospital regulations require a wheelchair for patients being discharged. One elderly gentleman already dressed and sitting on the bed with a suitcase at his feet insisted he did Not need any help to leave the hospital as was being requested by the nursing student.
After a chat about the hospital rules, he reluctantly allowed the student to wheel him down the elevator.
On the way down, the student asked “ Is your wife meeting you” His comment “I don’t know. She is upstairs in the bathroom changing out of the hospital gown.

17. Studies Nurses should laugh more often with pts (80%)
Nurses should try to get their patients to laugh ( 83%)
Laughing helps me get through difficult times (83%)
Children have commented that humor and other light- hearted interactions help them adjust to their hospital stay

18. Trust development
Nurses using humor can develop a sense of trust with patients
One nurse’s approach
“Do you know the name of the person who invented hospital gowns?”

19. HC setting Guidelines Establish competence in pt’s eyes
Be sure nearby pts/family members are not facing a crisis at the moment
Ease into a playful interaction
Be sensitive to how patient is responding
Do not force humor or laughter upon the patient
Remember patients do not always feel like laughing

20. HC setting Guidelines
Many patients do not respond to humor until they have come to accept the fact of their disease
Do not try to use humor to overcome their depression or anger
Avoid joking with other staff in the presence of patients who are about to undergo a test, surgery etc.
Laugh together at unexpected circumstances

21. HC setting Guidelines
Poke fun at yourself, but not in a way to suggest lack of competence
Never joke about staff incompetence
Never Joke at patient’s expense
Never use humor when you are about to deliver bad news (provide compassion and empathy)

22. HC setting Guidelines
Do not use joking to avoid discussion of sensitive issues
Many patients have no history of using humor under stress
Patients may have religious convictions which stress reverence in the midst of serious illness

23. Inappropriate Use of Humor
During acute crisis ( may help after)
When patient needs to cry
When patient needs quiet time
When patient in adjacent bed is very sick or coping with bad news
When patient is trying to communicate something important to you

24. Avoid Ethnic jokes sarcasm mockery Humor at other person’s expense
Joking about any patient or their condition

25. Norman Cousins found humour and laughter relieved the pain of his ankylosing spondylitis.
In 1969 he collaborated with his physician Dr Hitzig and watched funny films and read humorous books and found that 10 minutes of laughter gave him 2 hours of pain free sleep.
There was physiological evidence in his lower ESR . The reduction not only held, but was cumulative.
He popularized the benefits of laughter in his books Anatomy of an Illness and Head First: The Biology of Hope.
ESR – Sedimentation rate – index of degree of infection or inflammation in the body. After bouts of hearty belly laughter while watching comedy films Cousins Sed rate decrease significantly

26. His theory that positive emotions had a positive effect on health lead to modern research. Based at UCLA Medical School, he established the Humour Research Task Force to co-ordinate and support world wide clinical research on humour.
Stories:
urine recycle
Oil cocktail

27. In 1971, Dr. WILLIAM FRY at Stanford University’s Medical School began empirical studies on the effects of humor and laughter.
He went beyond anecdotal stories by objectively testing and measuring physical responses to humor.
He found that the chemical compositions of tears are different when a person is laughing as compared to crying.
Dr. Fry showed that people’s bodies are tense when listening to a joke, but relaxed at the end.

28. William Fry says that hearty laughter is a kind of internal jogging
Exercise to consider

29. In 1928 Dr James Walsh noted in his book Laughter and Health that laughter reduced the pain after surgery and promoted wound healing.
Women with painful muscle disorders got significant pain relief after a course of humour therapy. (L. Ljungdahl in Journal of the American Medical Association 1989)

30. Young girls with burns were shown cartoons during very painful hydrotherapy. Their perception of pain was reduced.
The study was done by ML Kelly and published in the Journal of Applied Behaviour Analysis 1984)

31. Patch Adams is the most famous American supporter of humor and health.
Gesundheit Institute in WV

32. Humor Contribution to Physical Health
Muscle Relaxation
Those muscles not directly participating in the act tend to relax while you are laughing
Lose your strength when you are laughing
Biofeedback shows: relaxed muscles more quickly after watching funny cartoons vs beautiful scenery
Those muscles not directly participating in the act tend to relax while you are laughing (Little kids fall down while laughing)
Lose your strength when you are laughing (Try carrying object across the room when you are laughing hard) When you stop laughing the muscles that had been contracting relax.
In combination these 2 mechanisms produce a general pattern of muscle relaxation

33. Relaxation helps alleviate
stress
heart disease
Headaches
Chronic anxiety
Reduced muscle tension from laughter effective in patients with spasm-pain-spasm cycle ( rheumatism, neuralgia)

34. Reduction of Stress Hormones
Laughter reduces at least four neuroendocrine hormones associated with the stress response
Various relaxation procedures reduce stress hormones

35. Immune System Enhancement
Stress weakens the immune system
Research shows individuals with a better sense of humor have stronger immune systems

36. Immunoglobulin A (IgA)
Protects against upper respiratory problems
Saliva contains IgA which is referred to as the body’s first line of defense against upper respiratory viral and bacterial infections
Watching as little as 30 or 60 minutes of a comedy is enough to increase the IgA of saliva and blood

37. Patient’s blood was analysed before, during and after watching a humorous video.
The test found ´significant´ boost to immune function, including higher levels of anti-bodies and natural killer cells which are the body´s defense against aberrant cells such as cancer.
This study was done by  Barry Bittman, neurologist & pioneer in psychoneuroimmunology (how emotions effect the immune system)

38. levels of Plasma Immunoglobulin Plasma Cytokine Gamma Interferon
The positive effects of laughter on the immune system continued the next day while killer cells remained high 12 hours later
levels of Plasma Immunoglobulin
Plasma Cytokine Gamma Interferon
Study published by Berk /Tan in Laughter & The Immune System: a Serious approach

39. Psychological effects of Laughter
Stimulates alertness & memory
Emphasizes learning & creativity
Promotes relaxation
Promotes shifts from Negative to positive
Outlet for expressing feelings
Effective mode of commitment

40. Social effects of laughter
“Laughter is the shortest distance between two people.” Victor Borge
Self-effacing humor reveals one’s own flaws, humanness and vulnerability . Listener feels it is safe to share, rapport and nursing relationship can be established.

41. Communication Sometimes a joke is a joke
Often true words are spoken in jest.
Important to “Listen” beyond the laughter
Example:
While taking care of a patient scheduled for an orchiectomy patient stated when asked about what was planned:
“Sounds like the doc is going to change me from a rooster to a hen.”
Did the guy really find this as funny as he let on?

42. Add Laughter to Your Life
Smile
Count your blessings
When you hear laughter, move towards it
Spend time with fun playful people
Bring humor into conversations

44. Seniors
Most seniors never get enough exercise. In his wisdom God decreed that seniors become forgetful so you search for your glasses, keys and other things.
Seniors lose coordination so you would drop things requiring you to bend reach & stretch.
More trips are taken to the bathroom due to “nature calls” providing more exercise.

45. 9 important things to remember as we age
#9: Death is the number 1 killer in the world
#8: Life is sexually transmitted
#7: Good health is merely the slowest possible rate at which one can die
#6: Men have 2 motivations: hunger and hanky panky & they can’t tell them apart. If you see a gleam in his eyes, make him a sandwich

46. 9 important things to remember as we age
#5: give a person a fish and you feed them for a day. Teach a person to use the internet and they won’t bother you for weeks, months & maybe years.
#4: Health nuts are going to feel stupid someday, lyin in the hospital, dying of nothing
#3: All of us could take a lesson from the weather. It pays No attention to criticism.

47. 9 important things to remember as we age
#2: In the 60’s people took acid to make the world weird. Now the world Is weird and people take Prozac to make it normal.
#1 Life is like a jar of jalapeno peppers. What you do today may be a burning issue tomorrow.

48. “Do something you love and You will never have to work a day in your life.”
George Burns

49. Your Stories

50. THANK YOU
Lois Schick MN, MBA, RN, CPAN, CAPA, FASPAN W. 3rd Place Lakewood, CO Home: Cell:

51. ASPAN’S 38th National Conference
See YOU in Nashville
May 5-9, 2019