MSN, RN, NPD-BC
In nursing school, we learn about many nonpharmacological interventions that bring a sense of wellness. I worked in a medical intensive care unit (ICU) in a teaching hospital with state-of-the-art equipment, innovative practices, Magnet® designation, and a diligent focus on evidence-based practice. The experience of a nurse on the medical ICU was one that involved uncertain outcomes and death. For this reason, aside from the pharmacologic interventions, we had to learn compassion and empathy for the patients and their families.
In my time as nurse, I have prayed with my patients, given back and head massages, played the patient’s favorite music during bathtime, sat down with the family just to listen, and many other things. About a year into my career on this unit, I had an encounter with a patient and a coworker that changed my perspective on what healing looks like from a nonpharmacological standpoint.
This helped me add another intervention to my toolkit — humor. I think we can agree that there is nothing funny about being sick. However, when applied appropriately, there is value in humor as a part of patient care and the enrichment of our work environments.
It was time to give my patient a bath and change his linens. One of my favorite patient care technicians turned on the bathtime music playlist to start the process. The majority of my patients in the medical ICU were intubated and sedated. However, this patient was ventilated via tracheostomy, so you could clearly see his facial expressions.
For days, this man had a scowl on his face. It seemed almost permanent. He did not seem too impressed with the playlist either. Once we were finished, the patient care technician left the room to help another nurse. The respiratory therapist came into the room to check the ventilator settings.
She asked what happened to the music. I informed her that the patient care technician took her phone out of the room. She responded that we would just have to make our own musicand began singing an instrumental of an old school song that played in skating rinks in the 1980s. Because we had on slippery shoe covers, our shoes were transformed into pretend skates. We skated around the room humming the song. Some may say that we were being unprofessional and disregarding the patient.
However, when we turned around, we received a pleasant surprise. Our patient with the “permanent” scowl had the biggest smile on his face. I knew at that moment that if anybody argued that we were breaking any rule, my argument would be that humor improved the patient’s sense of well-being.
There are plenty of other examples from my personal experience with patients, their families, my coworkers, and humor. However, we can’t discount what the evidence says about humor.
Laughter affects several body systems in beneficial ways. It stimulates the cardiovascular, respiratory, musculoskeletal, and central nervous systems.
A good laugh has the ability to activate the stress response and also relieve it. When we laugh, we take in a good amount of oxygen, which decreases heart rate and stimulates the parasympathetic nervous system. The increased circulation that is stimulated by laughter can also aid in muscle relaxation. Some experts refer to humor and laughter as a “full-brain workout,” as it activates multiple regions of the brain, including those associated with motor function, emotions, and cognitive processing.
Benefits of this “workout” include the improvement of cognitive function, enhancement of creativity, and even boosting of memory retention. Laughing also increases the endorphins released from the brain, which will be discussed later.
Studies have shown laughter to be helpful in pain management. As mentioned above, laughter releases endorphins. Endorphins are released by the hypothalamus and pituitary gland and act as analgesics. Their role in reducing the perception of pain is the reason why they’re often referred to as our body’s “natural pain killers.” In addition to endorphin release, laughter can aid in muscle relaxation. The reduction in tension can help alleviate pain. Humor, even in thought, can also be a good distraction from pain.
Laughter alters serotonin and dopamine levels to boost our mood and make us feel a sense of well-being and reward. Laughter, or even anticipating a funny scenario, can be instrumental in decreasing stress hormones (e.g. epinephrine/adrenaline and cortisol) to improve mental health. Epinephrine/adrenaline and cortisol can also suppress the immune system. The decrease of these stress hormones also helps with immunity, giving your immune system a boost by increasing the production of T-cells and antibodies.
Years ago, I learned that you cannot pour from an empty vessel. The care our patients receive is only as good as the well-being of the care providers. I was certainly blessed to spend my bedside career with a group of people who understood that it’s totally appropriate to have fun at work.
There is a video floating around that shows me in full protective personal equipment (PPE) dancing at the nurses’ station in the wee hours of the morning. Was I doing it to be obnoxious? No. Was I doing it to disturb the peace of the unit? Absolutely not. I just needed to wake myself up so I could complete morning blood draws. In the process, my coworkers got a good laugh, and I was able to perform my job effectively. The key was that we made sure that we honored “quiet time,” so we didn’t disturb the patients and families.
Research studies have shown that humor can change a caregiver’s perception of challenging situations. Healthcare environments can be high-stress and warrant the need for mental breaks. Participants in select studies reported that humor could “relieve tension, create bonds and strengthen relationships, and enhance both learning and work environments … [and] serve as a coping mechanism to alleviate work stress and prevent burnout.”
Some people who bond over trauma, drama, complaining and gossip. While these bonds can feel like a safe space, if there is no movement toward resolution, there’s a risk of creating environments that are not edifying or fruitful. Flipping the coin and making an effort to bond over a shared laugh and positivity can create fruitful collaboration and mutual support.
These factors can also increase job satisfaction. Healthcare will come with challenges wherever you go. It’s not always the stress of the workload that causes job dissatisfaction. Sometimes it’s the work environment created by ourselves, coworkers, and leadership. There are times where I may not have loved my job, but the people that I worked with made all the difference.
Several recommendations place ownership of creating supportive environments on not only the caregivers, but the leaders as well. Experts are in favor of nurse leaders and educators using humor in nursing school curricula. In addition to that, nurses report that when a leader uses humor, it helps to humanize them in the eyes of nursing staff. This creates an environment where the leader works in partnership with their staff, instead of from an authoritarian approach.
Humor can be helpful in putting your patients, family members, and colleagues at ease. However, it also has the ability to make others uncomfortable. A common recommendation is to avoid dark, cynical, callous, or derogatory humor. Some studies show that healthcare professionals sometimes develop a sense of dark, cynical humor as a coping mechanism for the stress of the job.
A good portion of our jobs as caregivers involves building therapeutic relationships with each other, our patients, and patients’ families. Dark and cynical humor is some cases can undo that work. There’s too much opportunity for misunderstanding. Therefore, it is wise to err on the side of caution and keep the humor light.
Everyone’s sense of humor is different. As with anything else, read the room. Notice both verbal and nonverbal cues. If your humor is not yielding the response you hoped for, reroute the conversation to something else.
If you witness a colleague engaging in callous humor at the expense of a patient, family member, or fellow colleague, feel empowered to address and discourage it. Whether you are staff member or designated leader, it is everyone’s responsibility to hold each other accountable.
Not everyone is a stand-up comedian, but it is possible to insert humor into your practice in your own way. Remember that nursing is not just about administering medications. It is about holistically caring for your patients and their families. Caring for ourselves and our colleagues’ well-being improves the care that our patients receive. Sometimes, the little things can change the trajectory of someone’s day. I wish you all the best as we seek to find evidence-based and creative ways to increase our patients and colleagues’ sense of wellbeing.
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