Using humour in cancer & palliative care Mr R Becker Senior Lecturer in Palliative Care...
Transcript of Using humour in cancer & palliative care Mr R Becker Senior Lecturer in Palliative Care...
Using humour in Using humour in cancer & palliative cancer & palliative
care care
Mr R Becker Senior Lecturer in Palliative Care
Staffordshire University Faculty of Health and Severn Hospice Shropshire, UK
AimsAims To highlight the context of humour in
cancer and palliative care To look at the literature which supports its
use To explore the merits and pitfalls of using
humour in a clinical, managerial and educational setting
“Life does not cease to be funny when people die, any more than it
ceases to be serious when people laugh.”
George Bernard Shaw
The 5 primary functions of humourThe 5 primary functions of humour
As a coping strategy Reframing Communication Expressing hostility Constructing identities
Kahn WA (1989) Towards a sense of organisational humour: implications for organisational diagnosis and change, Journal of Applied behavioural Science. 25: 45-63
The holistic value of humour: -The holistic value of humour: -
Stimulates respiration
Stimulates the immune system
Allows the release of emotion
Stimulates the circulation
Fosters hope
Promotes relaxation
It is a positive coping mechanism Pasquali 1993
The Physiology of HumourThe Physiology of Humour
Laughter increases the levels of hormones such as endorphin and decreases levels of stress hormones,
cortisol and adrenaline.
“It worked! I made the joyous discovery that 10 minutes of genuine belly laughter had an anaesthetic effect and would give me at least
2 hours of pain free sleep.”
Cousins N. Anatomy of an Illness. Bantam Books, New York; 1979.
Klein A (2000) The Courage to Laugh: Humour, Hope, and Healing in the Face of
Death and Dying Pub: Jeremy P Tarcher
ISBN-10: 0874779294
Humour as an aid to good communicationHumour as an aid to good communication
Helps relax people
Helps establishes a rapport
Enables people to talk about difficult situations in safety
Is used as a means of helping people face the taboo of death and dying
Allows recognition that others feel the same way
Alex was a young man who was dying. His family was with him. I went in to see if
anyone wanted a drink and Alex came out with the usual corny joke and some cheeky comment. I answered back
“Any more of that mate and you’re dead meat.” I just wanted the ground to open up
and swallow me.
Alex laughed like a drain and after a moments silence, so did his family.
Harry is a 94 year old Yorkshire man, with a prostate problem. I visit him at home to help with his bath
and change his catheter leg bag.
He said to me “Ron, I’ve been thinking, do I have this problem with my prostate because I over used it when I was younger?” I looked up, “What? You
mean!” “Yes” he said with a wicked grin on his face.
I left the house that day with a smile on my face, a warm feeling in my heart and the sound of Harry
chuckling in my ear
Lilly told me that she wanted to pass urine. I was in a hurry, and misheard her so when I returned
with a kettle she smiled and said.
‘No nurse, I want a pee, not a cup of tea!!!’
Humour is difficult to define. Humour is difficult to define.
What is funny to one person is not to another.
Humour should be sensitive and appropriate to the situation
For example:
What does the research say about humour?What does the research say about humour?
“Humour helps engender hope, create a sense of perspective and establish a sense of connectedness with self and others.” (Herth 1990)
“A few moments of humour may in many instances help to sustain people through difficult life experiences, including terminal illness.” (Kanninen 1998)
A large percentage of the literature and research considers the therapeutic value
of humour when used in the nurse patient relationship.
Simon 1998, Bellert 1989, Schmitt 1990, Fry 1992, Erdman 1993 Holden 1993, Astedt-Kurki & Liukkonen 1994, Mathew
2003, Becker 2003, Herth 1990, Kanninen 1998, Hunt 1993, Klein 1994, Perry 1996
Astedt-Kurki & Liukkonen 1994
“Patients often regard a sense of humour as an essential
characteristic of a good nurse.”
Richards J T, (2003) Caring Clowning as a healing art in palliative care. European Journal of Palliative Care, 10: 5, 206-211
Protocols:
• Observing infection control procedures
• Briefings by nursing staff
• Patients permission
• Debriefing after each round
• Meeting with Social Worker monthlyBenefits: 6 month evaluation.
34 people rated how well they felt the clown doctors met their aims. Overwhelmingly favourable response from , patients, visitors and volunteers. Staff feedback positive.
Constipation:
“When I got up this morning I took 2 Ex Lax in addition to my Prozac. I can’t get off the toilet, but I feel really good about it.”
Becker R & Gamlin R (2004) Ch5 Page 52, Managing Symptoms other than Pain, in Fundamental Aspects of Palliative Care Nursing, Quay Books, Salisbury, UK
Reviewer: “This is an enjoyable and informative read, passionately insisting that the art and science of nursing must be bought together. The material is handled sensitively and holistically including the use of some jokes in the text. Each chapter is well referenced, with diagrams and tables……
Nursing Standard September 29th 2004 Vol 19 P:28
Humour has value in teachingHumour has value in teaching
Reduces audience stress.
Increases audience motivation,
Improves morale in the classroom
Enjoyment equals attention
Helps understanding
Helps group dynamics to be formed
Chan 1993
The dangers of humour used wronglyThe dangers of humour used wrongly
Be sure of your relationship with the patient before using humour
Do not ridicule, belittle or patronise
Do not use sarcasm, racism, or put downs
Do not joke about a patient’s situation unless the patient allows this
One day one of the medical team on my ward was examining a patient and a junior doctor came to the door with information about the
death of another patient on the ward.
Knowing that the word ‘death’ would be taboo in the room and finding it difficult to think of a
substitute, she stood in the doorway and announced. “Guess who won’t be going
shopping anymore.”
“Humour is a survival tool for health professionals who wish to
remain compassionate and caring.”
Wooten 1997
Strategies to promote humourStrategies to promote humour
Give your patient permission to laugh
Know your patient really well
Look for the ludicrous
Don’t take yourself too seriously because if you do others will not
Smile – whenever you can, even to people you dislike and especially when you are under stress.
“Life was a funny thing that occurred on the
way to the grave.”
Quentin Crisp