Humor in the OR: a stitch in time?

AORN Journal, July, 2008 by Karyn Buxman

The use of humor by health care professionals including perioperative nurses is widespread. Humor serves multiple purposes and provides numerous benefits. This article explores the use of humor in the perioperative setting.

WHAT IS HUMOR?

The definition of humor has been a topic of discussion for centuries. The word humor originates from the ancient Greek word umor, a term that referred to bodily fluids that kept the body in balance.' Most people have a general sense of what humor is, but no one definition has been accepted by all people. Both individuals and professional organizations (ie, the International Society of Humor Studies, the Association for Applied and Therapeutic Humor) have sought to define it. Examples of definitions include the following:

   Humor is that which lends itself to
   laughing, smiling, or amusement. It
   is considered a positive emotion and
   may be used synonymously with a
   sense of joy. It has characteristics that
   make it a viable coping mechanism.
   That which appeals to one person's
   sense of humor may be offensive to
   others. Everyone's sense of humor is
   unique. (2(p8))

   Wit is considered a thought-oriented
   experience. Mirth is considered an
   emotionally oriented experience.
   Laughter is a physiologically oriented
   experience. While all of these can be
   experienced independently of the others,
   when experienced together they
   synergistically create the experience
   we refer to simply as humor. (3)

Although laughing with someone is considered a positive use of humor and laughing at someone is considered a negative use of humor, humor is not always that black and white. Humor often falls into a "gray zone," in that it can be misinterpreted despite the humor provider's intention. Gray zone humor may include teasing; tickling; sarcasm; "inside jokes;" practical jokes; stereotypic humor (eg, age-ism, racism, sexism); and gallows humor.

Gallows humor, also referred to as dark humor, black humor, sick humor, medical humor, (4) and Gasbag humor (5) is a type of humor frequently associated with health care. Gallows humor tends to be macabre, grim, or scatological, and when used in health care settings, it frequently involves such topics as body fluids, death, and dismemberment. Freud speculated that this type of joking relieves anxiety or repressed impulses and that laughter transforms negative feelings into pleasant ones. (6) Gallows humor is not used exclusively by health care professionals. The closer a person gets to tragedy and death, the darker his or her humor becomes. Thus, patients also may initiate gallows humor:

"The doctor gave me two weeks to live."

"Goodness, what did you say?"

"I'll take the first two weeks in June." (7(p34))

When nurses encourage the use of humor in the OR, they must ensure that they are encouraging the use of positive or therapeutic humor, which is defined as:

   any intervention that promotes health and
   wellness by stimulating a playful discovery,
   expression or appreciation of the absurdity
   or incongruity of life's situations. This
   intervention may enhance work performance,
   support learning, improve health or be
   used as a complementary treatment of illness
   to facilitate healing or coping, whether
   physical, emotional, cognitive, social or
   spiritual. (8)

According to nurse researcher and humor pioneer Vera Robinson, EdD, RN, humor serves five purposes in health care. It

* establishes relationships,

* relieves anxiety,

* releases anger in a socially acceptable way,

* avoids or denies painful feelings, and

* facilitates learning. (4)

There are also numerous physiological and psychological benefits of humor, including

* the reduction of stress, anxiety, and tension;

* diminished depression, loneliness, and anger;

* mood improvement;

* increased self-esteem; and

* an enhanced sense of empowerment. (9,10)

Research regarding physiological benefits specific to laughter suggest that laughter

* increases pain tolerance;

* improves respiration and breathing;

* improves mental functioning, including alertness, creativity, and memory;

* exercises facial, abdominal, and chest muscle; and

* decreases in muscle tension. (11,12)

PATIENTS' USE OF HUMOR

The nurse who creates a therapeutic milieu in which humor can occur increases the likelihood of a more positive surgical experience. There are purposes for and benefits of using humor specific to patients.

ESTABLISHING RELATIONSHIPS. The use of humor has the ability to strengthen a social bond* When a patient jokes with the nurse, physician, anesthesia care provider, or other OR personnel, it decreases the social distance between them and lessens the hierarchy. Their humor may include a joke or anecdote, it may be in the form of teasing, or it may even use a physical prop. The use of humor between patients and staff members or physicians creates a line of communication that encourages patients to discuss difficult issues. (13) In the following example, an oncology patient used humor to amuse a surgical attendant before going to surgery: