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Laughing matter: Why humour in medicine is vital

Lightening the mood with a joke can be a useful therapeutic tool in medicine, as Shelley van der Krogt discovered.

When Shelley van der Krogt was training to be a nurse in the late 1990s, her lecturers told her not to joke with patients. “It was seen as inappropriate and unprofessional.”

But, once she graduated, it didn’t take her long to realise that humour is a useful tool that can help patients feel more comfortable and make it easier for them to cope with difficult and sometimes humiliating situations. During her 16 years of clinical practice, she changed nursing specialities a lot, but one thing that didn’t change was her use of humour. “It’s a very valuable skill that helps nurses connect with people.”

It was good for her, too, helping her to manage emotional and stressful situations and gain a sense of perspective. Now that she is a nursing lecturer – she teaches at Massey University’s school of nursing in Wellington – she actively encourages her students to use humour.

“It’s not about being a comedian, or going in and telling a knock-knock joke. It’s about making a genuine connection. Sometimes just sharing a laugh with someone, or sharing a smile with them, is enough.”

Although humour can help build rapport between nurse and patient, it can also fall flat. Van der Krogt, who has just graduated with a master’s degree in health care from Victoria University of Wellington, says she’s seen situations where the use of humour has created an awkward silence and fractured the nurse-patient relationship.

During her degree, she found that other researchers have looked at the value of humour in nursing practice, but few have looked at how nurses know when they can safely use humour and when they should skip the funny business. To help fill that gap, she interviewed nine nurses working on surgical wards about how – and, more importantly, when – they use humour.

She chose surgical nurses both because there is little research on the use of humour on surgical wards and because having surgery can make patients feel particularly vulnerable. “In that situation, humour is a way to change their perspective. It can help reframe things so they don’t feel so threatened and frightened.”

Shelley van der Krogt. Photo/Robert Cross/Supplied
The type of humour her interviewees used was very gentle. Telling a patient that they look like Marge Simpson after they have taken all their clothes off and put on a skimpy surgical gown and a silly hat won’t have them rolling is the aisles. Nor will quips about wearing Victoria’s Secret underwear. But it can put people at ease.

“It’s a way of helping patients feel less dehumanised in this outfit that we force them to wear.”

As one of the nurses she interviewed observed: “I think using humour relaxes patients; you can see heart rates going down, blood pressures going down. You can use it as a distraction quite a lot.”

As to when to use humour, van der Krogt found it’s all about being able to “read the room” and recognising when a patient is up for a bit of a laugh – and when they’re not.

“If their body is turned towards you, and they’re chatting and joking themselves, that’s usually a good sign that humour will be well received. But if they’re visibly upset or turning away, humour is probably best avoided.”

On the other hand, most of her interviewees were also happy to test the waters and throw in a tentative first joke to see how it went down. If it met with a negative response, they just apologised and moved on. “A quick apology works wonders. Just say, ‘I’m sorry, I misjudged that’, and you can quickly re-establish the underlying therapeutic relationship.”

You may assume there are some situations in which humour is taboo, such as when someone has accidentally urinated or defecated in their bed. But that is not the case. Van der Krogt says such throwaway lines as “Don’t worry – I don’t do the washing” or “Better out than in” can often help ease the situation.

And for some patients, a little bit of gentle humour may even be acceptable after they have been told their condition is terminal. “You wouldn’t joke with some people about it, but others respond in a different way and may even make a small joke themselves.”

This article was first published in the January 11, 2020 issue of the New Zealand Listener.

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