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A little levity goes a long way: Therapeutic humor is an effective tool in easing RNs' stress

Monday May 13, 2013
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Karyn Buxman, RN, MSN, CSP, CPAE, a San Diego entrepreneur, uses podiums, blogs and books to promote the use of therapeutic humor as a magic charm for putting a smile on a worried patient’s face or inspire a grumpy nurse to lighten up and be happier in the workplace.

A certified speaking professional, Buxman, has spent most of her 22-year speaking career advising nurses and others on how to relieve stress and enjoy more positive, productive and satisfying lives. She has helped thousands of nurses learn to inject therapeutic humor into their daily routines through her presentations on the power of laughter at some 100 hospitals and for clients, including the Mayo Clinic. “What I love about humor is how it offers nurses in the workplace a therapeutic lift,” said Buxman, who earned her MSN in mental health in 1990 at the University of Missouri-Columbia and helped set up “laughter clinics” for nurses at various hospitals. “Nurses constantly tell me they work hard and aren’t appreciated. Many of us have a sense of humor, but the profession can be brutal.”

A serious early researcher into the applications of humor, Buxman joined the Association for Applied Therapeutic Humor and the International Society for Humor Studies and said research in psychoneuroimmunology shows laughter and positive emotions enhance the immune and respiratory systems, while a good sense of humor contributes to a healthier heart.

Hearty laughter, she said —

• Relieves physical tensions, relaxing the entire body.
• Reduces stress hormones.
• Boosts the immune system.
• Releases endorphins that decrease pain.
• Promotes a sense of well-being.
• Improves blood vessel flow to prevent heart disease.

Humor relieves anxieties

Mark Clarke, RN, said he was inspired by Buxman’s view of therapeutic humor during a 2002 Nurse’s Day presentation in Chico, Calif., where he and his wife, Pam Avery, RN, have worked at Enloe Medical Center for 15 years. He joined the AATH the same year, attended the association’s session on “laughter yoga,” and began showing up as a clown at an annual health fair.

“When Karyn was invited to the hospital to speak on Nurse’s Day, she gave three presentations, and I attended all three,” said Clarke, who studied nursing at the University of Oklahoma. “She was animated and funny and knew what worked.”
He later started telling humorous stories in the cardiac unit to surgery patients who usually were scared and quiet and was able to make them laugh and relieve their anxiety. “It’s clear that humor is a great tool that helps people relax, reduces their fear, and physically helps the body feel better,” Clarke said.

One night he asked an anxious patient how he felt about going into surgery the next day. “I told him all they’re going to do is cut your chest open, stop your heart and then put everything back together — just think about the fame? He laughed and laughed and went to sleep.”

1 in 5 nurses depressed

Susan Letvak, RN, PhD, FAAN, an associate professor of nursing, was lead researcher of a University of North Carolina at Greensboro study that found 18%, or about one out of every five hospital-employed nurses experience depressive symptoms that confidential interventions, including strategic use of humor, could help alleviate.

In the study, which was published in the May/June 2012 issue of Clinical Nurse Specialist, Letvak and colleagues did a random cross-sectional survey of 1,171 nurses around the country to gauge their individual and workplace characteristics, productivity and depression levels. Analysis of health questionnaire scores found hospital-employed nurses had significantly higher rates of depressive symptoms, than national norms, associated with body mass index, job satisfaction, number of health problems, mental well-being and health-related productivity.

The study said nurses employed by hospitals reported higher rates of depressive symptoms than other nurses, indicating hospitals should do more to preserve the health and happiness of nurses through staffing solutions and proactive wellness initiatives, the researchers noted. “Depressive symptoms affect enough nurses to warrant concern and intervention, and high-stress environments are likely to contribute to more health problems for nurses, including mental health issues,” Letvak said. “Advanced practice nurses can assist with educating nurses on recognizing depression and confidential interventions, including the use of computerized cognitive-based therapy.”

Laughter exercises the lungs

A study of 300 people by a team of University of Maryland School of Medicine researchers found that 150 participants who had heart disease were 40% less likely to laugh in humorous situations than the control group of a similar size, age and background with healthy hearts. The study said laughter may enhance the healthy function of blood vessels by causing the tissue in the inner lining of blood vessels to dilate or expand in order to increase blood flow.

Buxman said hearty laughter contracts your diaphragm, forcing you to exhale and increasing the capacity for fresh air and oxygen to be pulled deep in the lungs with each breath. This exercising of the lungs allows more oxygen to reach cells throughout the body, which contributes to better health.

A minute or two of laughter also produces catecholamine hormones in the sympathetic nervous system that boosts our alertness and creativity better than a jolt of coffee, she said.

Researchers at Loma Linda University School of Medicine in central California found that people who watched a funny 60-minute video experienced a significant drop in cortisol and adrenaline levels. Scientists say these hormones can contribute to a wide range of stress-related illnesses including depression and heart disease.

Other research suggests regular doses of humor and laughter can enhance breathing and circulation, ease pain and even stimulate T-cells that guard the immune system.

Avoid hurtful humor

There may be days when being funny and light-hearted doesn’t work in the healthcare setting. If jokes flop in the nurse’s lounge or a distressed patient isn’t amused by an ill-timed quip, apologize if necessary and take time to assess your humor strategy and sensitivity to serious situations, Buxman said. Eventually, you’ll find a happy solution for lightening people’s moods.

And while Buxman enjoys sarcasm, silliness and sick jokes, she views pranks as problematic and often perilous humor that should be avoided because they prey on someone else’s fear, pain or discomfort. “Pranking is a type of bullying with the potential for extreme physical or emotional harm,” Buxman said. “Healthy humor seeks to strengthen the bonds between people, instead of targeting someone for the amusement of others.”

A funny thing happened …

Buxman earned her nursing diploma in 1979 and either practiced nursing or worked as an instructor through the 1980s, earning her BSN and MSN along the way. After a short stint as an air ambulance nurse and instructor for an associate nursing program, Buxman left in 1991 to focus on a speaking career. Her decision came after a successful presentation on therapeutic humor at a major Nurse’s Day event in Albuquerque, N.M., in May 1990 triggered demand for her as a speaker.

Buxman said she was tutored in professional speaking by Melodie Chenevert, RN, BSN, MN, MA, an author and circuit speaker who saw her potential, and she sought advice from others in the field, including Zig Ziglar, a marketing guru who inspired her to develop a strong business strategy and set solid goals. “I was relentless and learned to entertain as well as inform,” said Buxman, who now is founder and president of “What’s So Funny About …” a book series focusing on diabetes and other chronic diseases. Buxman also launched a book series on nursing specialties. The first book, “What’s So Funny About ... School Nursing,” debuted at the National Association of School Nurses meeting in San Francisco in June 2012.

Her latest book, “What’s So Funny About … OR Nursing?” is part of an ongoing series about the benefits of humor for coping with health issues that includes books focusing on Alzheimer’s disease, cancer, depression, Parkinson’s disease, aging and dialysis.

The book lists eight ways OR nurses can employ humor to enhance care of patients facing surgery, including:

• Decrease fear by increasing frivolity.
• Lower patients’ stress levels with delight and diversion.
• Equip yourself for life’s most embarrassing moments.
• Listen beyond the laughter.
• Get them laughing, get them learning.
• Use high-touch, not just high-tech.
• Empower your patients through humor.
• Build resiliency with humor.

The “What’s So Funny ...” books discuss how sharing humor helps build solidarity and teamwork among colleagues and leads to top nursing performance in a high-stress environment. Buxman also is a contributing author for “Chicken Soup for the Nurse’s Soul” and for eight years helped publish the Journal of Nursing Jocularity, which now is an online blog forum.

Buxman said a plethora of perplexing problems face the healthcare community — more pressures, sicker patients, fewer resources — giving the impression there’s not much to laugh about. “Nothing could be further from the truth. Healthcare needs humor,” she said. “Humor has incredible benefits for our patients, our healthcare providers and for the healthcare organizations and systems.”


John Leighty is a freelance writer. Post a comment below or email specialty@nurse.com.
HUMOR RESOURCES FOR NURSES

• Association for Applied and Therapeutic Humor —
AATH.org
• International Society for Humor Studies —
www.HNU.edu/ishs
• “Depression in hospital-employed nurses” —
PubMed abstract on University of North Carolina nursing depression and solutions study — ncbi.nlm.nih.gov/pubmed/22504476
• Share nursing humor online at the blog: Facebook.com/JournalofNursingJocularity or see the magazine’s archives, at JournalofNursingJocularity.com