Title. The purpose and function of humour in health, health care and nursing:
Sally Wiggins MA PhD a narrative review Lecturer Aim. This paper is a report of a review conducted to identify, critically analyse and
Department of Psychology, University of Strathclyde, Glasgow, UK
synthesize the humour literature across a number of fields related to health, health care and nursing. Background. The humour–health hypothesis suggests that there is a positive link between humour and health. Humour has been a focus of much contention and deliberation for centuries, with three theories dominating the field: the superiority or tendentious theory, the incongruity theory and the relief theory.
Data sources. A comprehensive literature search was carried out in January 2007 using a number of databases, keywords, manual recursive searching and journal alerts (January 1980–2007) cross-referenced with the bibliographic databases of the International Society of Humor Studies. An inclusion and exclusion criterion was identified.
Review methods. A narrative review of evidence- and non-evidence-based papers was conducted, using a relevant methodological framework with additional scrutiny of secondary data sources in the latter. Humour theories, incorporating definition, process and impact constituted a significant part of the appraisal process.
Results. A total of 1630 papers were identified, with 220 fully sourced and 88 included in the final review. There is a dearth of humour research within nursing yet, ironically, an abundance of non-evidence-based opinion citing prerequisites and exclusion zones. Examination of physician–patient interaction and the humour– health hypothesis demonstrates that use of humour by patients is both challenging and revealing, particularly with regard to self-deprecating humour.
Conclusion. Nurses and nursing should adopt a circumspect and evidenced-based approach to humour use in their work.
Keywords: health, health care, humour, laughter, literature review, nursing
Shortly before his death in 1995, Kenneth B. Schwartz, a cancer patient at Massachusetts General Hospital (MGH) founded The Kenneth B. Schwartz Center at MGH. The Schwartz Center is a nonprofit organization dedicated to supporting and advancing compassionate health care delivery, which provides hope to the patient and support to caregivers and encourages the healing process. The center sponsors the Schwartz Center Rounds, a monthly multidisciplinary forum where caregivers reflect on important psychosocial issues faced by patients, their families, and their caregivers, and gain insight and sup- port from fellow staff members. The diagnosis of can- cer is incredibly stressful, and treatments are arduous. Humor may help to ease the pain, show the human side of the health care team, and help everyone cope. Whether the patient uses humor to lighten the mood of a difficultconsultation with their physician, or health care work- ers use it to help cheer each other through the day, humor and laughter can be valuable tools. Humor can soften the isolation experienced by both patients and staff. When used sensitively, respecting the gravity of the situation, humor can build the connection among the caregiver, patient, and family. However, insensitive joking is offen- sive and distressing, and experience suggests a variable acceptance of humor by patients with life-threatening ill- nesses, making humor a high-risk strategy, and it can be a pejorative maker of an adversive power differential. The medical literature contains little on humor, and very little research has been conducted on this common aspect of human communication. Through an examination of phy- sician and nurse experiences, the role of humor in medi- cine is reviewed. The Oncologist 2005:651–660
Some drugs yield more than one benefit. For instance, Beta blockers have antihypertensive, antianginal, and antiarrhythmic effects. They also have more than one adverse effect. So we can talk about their benefits and harms. It’s all to do with how you count.
The Danish philologist Otto Jespersen expounded the concept of count and non-count nouns in an unpublished lecture to the Copenhagen Academy of Sciences in 1911. As he explained in The Philosophy of Grammar (1924), you can form plurals if you can collect two things alike. For example, two bananas (two of the same thing). Or two fruits, an apple and an orange (two of the same kind). But we have no plural word for a journal plus a stethoscope, except to call them two objects, and certainly no plural word for a journal plus health care.
Music, traffic, and tact cannot be counted; arm, leg, and eye can—at least in English; in Hungarian the word for any pair of body parts is singular; one eye is referred to as a half eye. Then “you” in English denotes both singular and plural (“ye” having disappeared), while the French have “tu” and “vous.” “Peut-on tutoyer?” a student asked her supervisor; the reply was stony: “Si vous voulez.” Some nouns have it both ways, depending on meaning. Chocolates in a box are countable—two chocolates, a few chocolates, many chocolates (but who’s counting?). Chocolate in a bar is not—much chocolate, little chocolate, less chocolate. Morbidity (sickness) is not countable, but comorbidities means diseases; competency (ability) is not countable, but “competencies” means things people can do. Both plurals are relatively new uses.
Now “harm” has two meanings, injury and an injury. And the countable sense has as long a pedigree as the uncountable one. Harms are referred to in a 10th century poem, Genesis, wrongly attributed to Caedmon: “Ealle synt uncre hearmas gewrecene.” Shakespeare uses the noun harm about 90 times, and 14 of those are plural. In The Taming of the Shrew, a messenger tells Christopher Sly that his doctors “thought it good you hear a play / And frame your mind to mirth and merriment, / Which bars a thousand harms and lengthens life.” And Shakespeare knew his count from his non-count: “She hath more hair than wit and more faults than hairs,” says the Veronese clown, Lance, about his sweetheart. However much hair she had, she doesn’t sound like a great catch.
Drugs are prescribed because of their potential benefits, but in every case there are risks of harms; before prescribing, the former should be weighed against the latter. This is commonly called assessing the “benefit to risk ratio.” But benefit and risk are non-comparable: one is an actual outcome, the other a chance of one. Benefits are properly balanced by harms. However, the two are incommensurate and cannot be combined into a ratio. One should therefore talk about the benefit to harm balance, which is a complex function of the seriousness of the problem to be treated, the efficacy and safety of the drug to be used, and the efficacy and safety of other available drugs.
And that is why we have called this special issue of the BMJ “Balancing benefits and harms in health care.”
Jeff Aronson clinical pharmacologist, Oxford
We welcome articles up to 600 words on topics such as
A memorable patient, A paper that changed my practice, My most unfortunate mistake, or any other piece conveying instruction, pathos, or humour. Please submit the article on http://submit.bmj.com Permission is needed from the patient or a relative if an identifiable patient is referred to. We also welcome contributions for “Endpieces,” consisting of quotations of up to 80 words (but most are considerably shorter) from any source, ancient or modern, which have appealed to the reader.
Corriere della Sera
09 marzo 2005
Ricerca Usa: dilata i vasi sanguigni, bastano quindici minuti al giorno
E' scientifico: ridere fa bene al cuore
Uno studio dell’università di Baltimora conferma quanto intuito dal medico clown Patch Adams.
Ridere fa buon sangue, dice un vecchio proverbio. Ridere fa bene al cuore, conferma un’originale ricerca scientifica appena presentata a Orlando, in Florida, all’American College of Cardiology , l’appuntamento più importante dell’anno per i cardiologi di tutto il mondo. La risata è un vero e proprio farmaco, ci suggeriscono i ricercatori, con tanto di indicazioni. Dosaggio: una somministrazione di quindici minuti al giorno. Effetti: miglioramento della circolazione del sangue e prevenzione delle malattie cardiovascolari. Controindicazioni: nessuna. Una medicina che va bene per tutti, grandi e piccoli, uomini e donne. La terapia del sorriso non è una novità: tutti ormai conoscono la storia di Patch Adams, il medico americano con il naso da clown che prima ha intuito, poi trasformato in cura il potere benefico della risata.
SEQUENZE DI FILM - Ora gli studiosi dell’Università del Maryland a Baltimora ci dicono che la risata è capace di stimolare l’espansione dell’endotelio, il rivestimento interno dei vasi sanguigni, favorendo così il passaggio del sangue, esattamente come succede con l’esercizio fisico. E lo dimostrano in un modo originale, ma scientifico: misurando con gli ultrasuoni il flusso sanguigno nell’arteria del braccio di venti volontari, prima e dopo la proiezione di due film, uno allegro e uno drammatico. Il primo, «King Pin», è una commedia dei fratelli Farrelly (quelli di «Tutti pazzi per Mary»), uscito in Italia soltanto in cassetta. E’ bastata una serie di gag fra un ex campione di bowling, senza la mano destra, e un Amish naturalmente portato al gioco, ma contrario per motivi religiosi, perché tutti i partecipanti all’esperimento, tranne uno, mostrassero arterie rilassate e un aumento del flusso di sangue per un tempo che andava dalla mezz’ora ai 45 minuti dopo la visione della pellicola. Esattamente l’opposto succedeva a quelle stesse persone quando assistevano alle sequenze, tanto spettacolari quanto violente, dello sbarco in Normandia con cui si apre il film «Salvate il soldato Ryan» di Spielberg: in quattordici dei venti spettatori volontari le arterie si restringevano e il flusso sanguigno si riduceva.
STRESS MENTALE - «Mediamente - ha precisato uno dei ricercatori americani, Michael Miller - il flusso aumenta del 22 per cento come conseguenza della risata e diminuisce del 35 per cento durante uno stress mentale. C’è una grande variabilità fra persona e persona, ma tutto quello che condiziona lo stato emozionale di un individuo ha un impatto importante sul cuore». L’endotelio è il punto di partenza dei processi che portano all’aterosclerosi, cioè all’indurimento delle arterie e al loro restringimento, situazioni che aumentano il rischio di infarto e di ictus. E se è vero che la risata aiuta a mantenere un endotelio sano, è immaginabile che possa ridurre il rischio di malattie cardiovascolari. «La risata, come l’esercizio fisico - ha continuato Miller - stimola la produzione di endorfine, sostanze chimiche che hanno un effetto benefico sul sistema cardiovascolare. Le modificazioni che noi abbiamo visto nell’endotelio sono simili a quelle che si osservano come conseguenza dell’attività aerobica, ma senza i dolori, gli indolenzimenti e le tensioni muscolari associate a quest’ultima».
SENZA ASCENSORE - Se la risata appare efficace quanto l’esercizio fisico nello stimolare la salute dei vasi, questo non significa che si debba rinunciare all’attività fisica come sistema di prevenzione delle malattie cardiovascolari. «L’esercizio fisico - commenta Calogero Calcullo, coordinatore nazionale per la prevenzione dell’Associazione dei cardiologi del territorio - provoca una dilatazione diretta dei vasi sanguigni, a differenza della risata, dove sono i mediatori chimici, come le endorfine, ad avere l’effetto dilatante. A questo si aggiunge la funzione di allenamento sul muscolo e sulla capacità dell’emoglobina di trasportare ossigeno ai tessuti. L’esercizio fisico ha dunque un effetto più completo su tutto l’organismo». Una buona ricetta pratica per uno stile di vita salutare, suggeriscono i ricercatori, dovrebbe prevedere trenta minuti di attività fisica tre volte alla settimana e un quarto d’ora di risate al giorno. «E’ dimostrato che un’attività fisica regolare come il salire e scendere tre o quattro piani di scale al giorno - conclude Calcullo - riduce l’incidenza di malattie cardiovascolari del 10-15 per cento. Basterebbe, dunque, rinunciare all’ascensore per rischiare meno l’infarto».
Questo è un estratto dall'articolo originale pubblicato sulla rivista statunitense Pediatrics e l'intero articolo è leggibile qui
Laura Vagnoli, Simona Caprilli, Arianna Robiglio and Andrea Messeri
Background. The induction of anesthesia is one of the most stressful moments for a child who must undergo surgery: it is estimated that 60% of children suffer anxiety in the preoperative period. Preoperative anxiety is characterized by subjective feelings of tension, apprehension, nervousness, and worry. These reactions reflect the child’s fear of separation from parents and home environment, as well as of loss of control, unfamiliar routines, surgical instruments, and hospital procedures. High levels of anxiety have been identified as predictors of postoperative troubles that can persist for 6 months after the procedure. Both behavioral and pharmacologic interventions are available to treat preoperative anxiety in children.
Objective. The aim of this study was to investigate the effects of the presence of clowns on a child’s preoperative anxiety during the induction of anesthesia and on the parent who accompanies him/her until he/she is asleep.
Methods. The sample was composed of 40 subjects (5–12 years of age) who had to undergo minor day surgery and were assigned randomly to the clown group (N = 20), in which the children were accompanied in the preoperative room by the clowns and a parent, or the control group (N = 20), in which the children were accompanied by only 1 of his/her parents. The anxiety of the children in the preoperative period was measured through the Modified Yale Preoperative Anxiety Scale instrument (observational behavioral checklist to measure the state anxiety of young children), and the anxiety of the parents was measured with the State-Trait Anxiety Inventory (Y-1/Y-2) instrument (self-report anxiety behavioral instrument that measures trait/baseline and state/situational anxiety in adults). In addition, a questionnaire for health professionals was developed to obtain their opinion about the presence of clowns during the induction of anesthesia, and a self-evaluation form was developed to be filled out by the clowns themselves about their interactions with the child.
Results. The clown group was significantly less anxious during the induction of anesthesia compared with the control group. In the control group there was an increased level of anxiety in the induction room in comparison to in the waiting room; in the clown group anxiety was not significantly different in the 2 locations. The questionnaire for health professionals indicated that the clowns were a benefit to the child, but the majority of the staff was opposed to continuing the program because of perceived interference with the procedures of the operating room. The correlation between the scores of the form to self-evaluate the effectiveness of the clowns and of the Modified Yale Preoperative Anxiety Scale is significant for both the waiting room and induction room.
Conclusions. This study shows that the presence of clowns during the induction of anesthesia, together with the child’s parents, was an effective intervention for managing children’s and parents’ anxiety during the preoperative period. We would encourage the promotion of this form of distraction therapy in the treatment of children requiring surgery, but the resistance of medical personnel make it very difficult to insert this program in the activity of the operating room.