SCIENCE PHOTO LIBRARY

Having a laugh can help patients and nurses to bond

Laughter really can be the best medicine

Careful use of humour can be the key that unlocks a productive and meaningful relationship between nurses and patients, says Daniel Allen together they begin to build a therapeutic relationship. The tool that works best on this occasion is one with which not all nurses are comfortable – humour. The tone is set when Jean arrives late and Kay gets off the phone with the quip, ‘Right, I need to go – Jean’s finally turned

SUMMARY

A nurse, a midwife and a client are in a room. Jean, the client, is a former intravenous drug user with a history of violence. She is pregnant for the eighth time, but her attendance at this antenatal clinical is unusual. It is more common for her to miss appointments. Kay, a midwife, and Heather, a nurse specialist in sexual health outreach work with female drug users, must find a way to engage her. This is not easy; Jean is not a ‘good’ patient. But the nurse and the midwife are skilful and although they have never previously met Jean,

Many nurses are reluctant to use humour with patients, possibly because they lack the confidence to take a risk in using it or because they believe it is unprofessional. Used well, however, humour can help build a valuable therapeutic relationship between nurse and patient. Author Daniel Allen is a freelance journalist

up!’ Heather remarks that Jean’s bulky case notes ‘are like War and Peace’, and then pokes fun at a GP’s handwriting in the notes, even mouthing a swear word. At this, Jean laughs. There is some banter about Jean’s drug use; at one point Heather says she would be on speed too, if she had seven children. Through all the laughter a bond is being made, and information gathered on Jean’s non-attendance at antenatal clinics, and the place that drugs have in her life. May McCreaddie is a nurse, academic and former stand-up comedian. A senior lecturer at the University of Stirling, she is

24 april 9 :: vol 28 32 :: 2014 STANDARD Downloaded fromnoRCNi.com by ${individualUser.displayName} on Nov 27, 2015. For personal use only. NoNURSING other uses without permission. Copyright © 2015 RCNi Ltd. All rights reserved.

How to use humour in interactions with patients  Shake off the notion that humour and professionalism are mutually exclusive.  Be aware that humour does not always come with a punchline. It can be more nuanced.  Develop an awareness of humour use. If a patient laughs at the end of a sentence, do not ignore it. Reciprocate with a smile; explore possible meanings.  Understand different types of humour – self-disparaging or gallows humour, for example. Consider what they mean.  ‘Grow older.’ Older nurses seem more sure-footed when using humour, possibly because they are more confident. McCreaddie M, Payne S (2012) Humour in health-care interactions: a risk worth taking. Health Expectations. doi: 10.1111/j.13697625.2011.00758.x

also the author of an academic paper titled Harsh humour: a therapeutic discourse, published in Health and Social Care in the Community in 2010, in which the case study featuring Jean appears. Apart from Jo Brand, nurses do not often appear on the comedy website Chortle but Dr McCreaddie popped up there recently in a news item about her research explaining how many nurses ‘don’t get humour’. Dr McCreaddie has published widely on humour and health care and it was the focus of her doctoral thesis in which she analysed 20 interactions between 12 clinical nurse specialists and some of their patients. ‘The nurses were reluctant to initiate humour,’ she says. In fact, patients were twice as likely as the nurses to use humour. Heather was an exception. Not only did she employ humour, she did so in tandem with Kay, working almost as a comedy duo. Furthermore, she used what Dr McCreaddie calls ‘harsh’

humour – upfront and frank. It might not have worked in a diabetes or stroke clinic but in this situation, with this client, it was effective. In nursing humour can be a minefield. Use it clumsily and your patient may not forgive you. The ‘harsh’ humour expressed in Jean’s case study is high risk, says Dr McCreaddie, although it seems to have particular appeal to disenfranchised patients. Employ humour deftly and it can be the key that unlocks a productive, meaningful relationship. RCN mental health adviser Ian Hulatt acknowledges the value of what he calls ‘backstage’ humour – the kind that nurses use with each other, when away from their patients. ‘Because nurses deal with things that society would rather not see or smell, there is a dark humour that exists in people who work in those situations,’ he says. ‘It is a coping mechanism.’ But he suggests that even backstage humour can become corrosive if it stems from senior nurses whose humour is overly cynical or inappropriate. As for using humour with patients, Mr Hulatt urges caution. ‘It is about being responsive and taking your cue from the client.’

Happy and compliant

A popular pledge for NHS Change Day in March was to ‘smile more’. Derbyshire community nurse Joan Pons Laplana pledged to make his patients smile – something he believes strengthens his connections with them. Many of his patients are in their seventies and eighties, he says. ‘They often live alone and are isolated. In most cases I am the only person they see all day. If I can make them smile, it will make their lives more bearable. Then they are happier and more willing to comply with their treatment.’ But what about situations where the patient initiates humour? Dr McCreaddie argues

that ‘good’ patients want to be seen by nurses as compliant. The humour ‘good’ patients employ may be self-disparaging, which can be problematic if it masks profound concerns or fears. So the nurse needs to decode it. Nurses’ reluctance to use humour reveals a lack of confidence, she suggests. In a paper co-authored with Sheila Payne, an expert in end of life care, Dr MCreaddie says that ‘initiating humour involves risk, and risk-taking requires a degree of self-esteem and confidence. Nurses are, arguably, risk-averse and have low self-esteem’. The potential therapeutic gains can, however, outweigh the risks. ‘Humour might be a risk but, according to patients, it is a risk worth taking,’ says Dr MCreaddie NS

‘COMEDY HELPED ME TO TURN A CORNER’ Heard the one about the nurse who found his way back from mental health problems through stand-up comedy? Albert Smith’s life was on a downward spiral. ‘I was in serious debt. I had no money and no future,’ he says. But a grant from the Cavell Nurses’ Trust helped by allowing him to renew his nursing registration. As he began to restore some of his lost self-esteem and fight back from debilitating depression, he enrolled on a stand-up comedy course. Two years on, life looks different. He performs up to three comedy gigs a week, works as an agency nurse and runs his own artisan bakery. He is surprised by his success as a comedian. ‘Nursing colleagues said, “You were so funny, always so sharp”. But I never saw it in myself.’ Earlier this year, Mr Smith organised a comedy night in his home town of Birmingham in aid of the Cavell Nurses’ Trust. ‘The trust helped me and I wanted to give something back,’ he explains.

NURSING STANDARD aprilNo 9 other :: vol uses 28 no 32 :: permission. 2014 25 Downloaded from RCNi.com by ${individualUser.displayName} on Nov 27, 2015. For personal use only. without Copyright © 2015 RCNi Ltd. All rights reserved.

Laughter really can be the best medicine.

Many nurses are reluctant to use humour with patients, possibly because they lack the confidence to take a risk in using it or because they believe it...
277KB Sizes 0 Downloads 0 Views