Never Try To Teach A Pig To Sing…

An experience that makes your customers ‘Feel Good’ is an experience that is going to bring those customers back to you.  More than that, “Feel Good” creates word of mouth: customers love to tell their friends, co-workers, and at least some of their relatives about the fantastic time they’ve had, so that their friends, colleagues, and family can enjoy the experience as well.

The problem is that not everyone wants your customers (or patients, if you’re in a health care setting!) to feel good.  In a book I’ve recently written with two of the smartest people I know (T. Scott Gross and Greg Ayers), we examined the three types of people you’ve probably got working for you, and how they feel about creating a “Feel Good” experience for your customers.

Never Teach a Pig to Sing…It Wastes Your Time and Irritates The Pig!

Not everyone is psychologically capable of extending “Feel Good” to perfect strangers.  That’s just a fact of life, and no amount of training, no incentive program, no creative job wrangling or title bestowing is going to change that.  As you strive, as an organization, to provide ‘Feel Good’ experiences for your customers, you want to make sure you have the right people — people who are hard-wired to have fun — participating in the effort!

According to Bill Wagner of Accord Management Systems, about 15 percent of the population can be termed Service Naturals.  These folks just get it: they’re all about having fun and loving on customers. 70 percent (which we like to call the Vast Majority!) are Service Possibles.  They can, and will, with good leadership and training, get with the program and create ‘Feel Good’ experiences for your customers.

That leaves 15 percent.  These folks are what we call Service Hopeless. They’re dour, dire, and have no intention of providing adequate service, much less ‘Feel Good’ experiences.  Now, there may be redemption for everyone, but if you are in business, there is nothing to be gained and much to be lost by wasting time salvaging the unsalvagable.   There’s a job for everyone, but if the job you need done requires great customer service, you need to not have a Service Hopeless person in that spot!

It’s not unlike teaching a pig to sing.  Even if you succeed, you’re not going to get a concert level performance out of Miss Piggy!  Stack the deck in your favor by hiring (whenever possible!) Service Naturals.  Then commit to training your Service Possibles until they too become adept at providing “Feel Good” experiences!

Mind if I Laugh?

Mind If I Laugh?
originally published  2007

Following the events of September 11, 2001 and the terrorism that ensued, I continued traveling around the country, addressing groups about the healing power of humor and laughter.  I heard a variety of comments:
“I really want to laugh, but I just can’t bring myself to do it.”
“I can’t bear to watch another news report—it’s sucking the life right out of me.”
“I feel like laughing, but I’m afraid other people will think I’m being inappropriate.  Is it really okay to laugh yet?”

Abraham Lincoln may have said it best: “With the fearful strain that is on me night and day, if I did not laugh I should die.”

Now more than ever, we, as individuals and as a country, need the healing power of humor and laughter to deal with the tragedies we experience.  Reports showed that the country is in poorer health overall than it was prior to September 11th.  Accompanying the levels of higher anxiety and stress are people suffering from a myriad of stress related illnesses and conditions: Headaches, stomachaches, general malaise, fatigue, difficulty sleeping, muscle aches, difficulty concentrating, depression, and the list goes on.

People find many ways to cope with their stress including unhealthy means, such as abuse of drugs, alcohol, food, sex and work among others.  A healthy person needs a variety of coping mechanisms at his disposal, as there is no single coping mechanism that will be right for every situation.  Humor should be one of the many tools one carries in his repertoire, as it is recognized as one of the healthy coping mechanisms we have available at our disposal.

Humor relieves anxiety and tension, serves as outlet for hostility and anger, and provides a healthy escape from reality.  It lightens heaviness related to critical illness, trauma, disfigurement, and death.  It comes as no surprise that many people are utilizing humor to deal with the trying times.  But is the humor timely?  Is it appropriate?

“When tragedy and death cloud our lives, they darken our humor as well.” (Karyn Buxman, This Won’t Hurt A Bit)

Much of the humor that saw after 9/11 is what has been referred to as gallows humor, dark humor or black humor.  In her book, Humor and the Health Professions, nurse researcher Vera Robinson explains, “(Black humor) is a humor that people have always used when they feel hopeless and helpless, when there is nothing we can do to change what has happened.  Black humor is a defense against the horror against whatever it is we fear and is a way to master it, and give us a sense of control by laughing at it.”

The truth is that we all experience tragedy on a variety of levels.  For some of us, it may be on a personal level.  At times, it may be on a community level.  And periodically we experience tragedy on a national or even global level.

On a personal scale
None of us will escape experiencing personal tragedy: Illness, accident, loss of job, divorce, or death in the family.  These painful ordeals can sometimes evoke humor that allows us to ventilate our frustrations about such unfair events in life.

Sometimes when we use humor to cope, others discourage us with comments about the inappropriate nature of the humor.  One patient told me that when making a joke about his cancer his daughter admonished him by saying, “Dad, you must not understand just how sick you are or you wouldn’t be cracking jokes about this.”

Author Allen Klein asked terminally ill patients about the use of humor and laughter during their illnesses.  Over three fourths of those surveyed said they wished their care providers and support persons would use more humor and not discourage them (the patients) from using humor.

On a community scale
Communities experience tragedies such as floods, earthquakes, fire, natural disasters, loss of industry or politicians caught in compromising situations.

1993 marked ‘The Flood of 500 Years’ on the Mississippi River. Communities along the entire river experienced flooding, destruction of property, loss of homes and jobs, and sometimes death.  Yet, humor marked the will of people to keep their spirits afloat, not to be oppressed and depressed by the Muddy Mississippi.  In Iowa the Des Moines Register held a contest, “I’m a Floody Mess,” where contestants tried to one-up one another with descriptions of their misery.  When the local water system failed as a result of the flood, and running water for drinking and bathing was no longer an option, one contestant wrote, “I smell so bad that my Sure deodorant is undecided.”

Following the 2007 fires in San Diego, in which almost half a million people were temporarily displaced and thousands lost their homes, healing and recovery once again were marked by signs of humor—sometimes literally. In front of one home which had been reduced to ashes, the owner posted a sign that said, “Fire Sale! Everything Must Go!”

On a national scale
Unfortunately we will witness events that have national ramifications, such as the Shuttle Challenger explosion, and even global ramifications, such as the loss of the World Trade Center in New York. With the technological advances in mass media, events that might once have been local tragedies now impact people near and far: The shootings at Columbine, the Oklahoma City bombing, Hurricane Katrina:  These events hit home through television, radio and print around an entire nation and beyond.

At times, the humor demonstrated after these events was a ‘hoping humor’, a “let’s hang in there together and we’ll get through this together” kind of humor.  The focus of the humor was more situational and unrelated to the tragedy; the humor was used as a relief mechanism from feelings of sadness and feeling overwhelmed.  One survivor of the Oklahoma City Bombing commented, “I laugh because I’m cried out.”

While we certainly see many examples of ‘hoping humor’ related to the tragedies of recent terrorism, we also see ‘coping humor’ or the humor that is used to express anger in a socially acceptable way.  By targeting humor at the ‘enemy’ or the oppressors, we are able to whittle them down in size and feel more powerful, more superior.

Some of the humor after 9/11 was grotesque, such as computer exercises allowing us to shoot Osama bin Laden in virtual games or blow up terrorists with a keystroke from the comfort of our own computer.  Some humor was less violent, yet still targeting our enemies.  An example is an e-mail forwarded to me:

“The nonviolent solution currently being circulated is to say to the Taliban:  Give us Osama bin Laden or we will take all of “your” women and send them to college.”

The Internet provides opportunities galore to express our frustration and disgust through games, cartoons, websites, jokes, discussion boards, chat rooms and e-mail targeting bin Laden, the Taliban and the like.

The challenge: What is stress relieving for some is stress producing for others.  While some find gallows humor to be a positive means of dealing with their stress, others find these expressions of humor to be salt rubbed into an already irritated wound.  What’s appropriate?  What’s not?  There is no clear-cut answer.  Gallows humor can be a positive means of coping with anxiety, but it helps if certain guidelines are followed:

Establish a bond: Gallows humor is less offensive when there is a bond between the initiator and receiver of the humor.  Often this is a type of ‘inside humor’ that is utilized within certain the boundaries of a certain group of people. There is an almost unspoken agreement: “I’ll not be offended by your sick humor if you agree not to be offended by mine.”

Be aware of the environment: The trick is to keep the humor within the confines of said group.  Once the dark humor escapes the confines of the group, it then may become hurtful.  Anyone who hears, sees or experiences the humor is part of the audience, whether you intended them to be or not.  Think twice before hitting the ‘forward’ key on an e-mail or blurting out a joke you just heard.  Will it be hurtful if unintended audience members intercept?

Be sensitive to the timing:  H. G. Wells once said, “The crisis of today is the joke of tomorrow.”  Generally it takes time for people to see any humor derived from pain or discomfort.  Some people never will.  Every person’s situation is unique and determined by their own set of circumstances and life experiences.

Despite its multiple benefits, humor is always risky business. Try as you may to be politically correct, there will almost always be someone waiting in the wings to be offended.  The humor or laughter provides an excuse for him to ventilate about an unspoken and deeper issue.  That being said, if you choose to use humor to cope with difficult times and are mindful of the feelings of others then, more than likely, most folks won’t mind if you laugh.  Indeed, they may welcome the respite.

Press Release: 10 Tips for Finding Humor in Turbulent Times

I, along with members of The Association for Applied and Therapeutic Humor, put together a list of fun-filled ideas to help you rise above the current economic turmoil.

It is my gift to you.  Happy Holidays!
10 Tips for Finding Humor in Turbulent Times                                                   

The economy is on its wildest ride in decades.  The line waiting for a government bail-out is almost as long as the line waiting to check-out in stores this holiday shopping season.  And, you’re simply at wits end in trying to deal with it all!

Fear not – there’s humor to be found amidst all of this chaos and confusion.  So says Karyn Buxman, Publisher of The Journal of Nursing Jocularity, from San Diego and incoming president of AATH – the Association for Applied and Therapeutic Humor.  The mission of this growing, international community of professionals, founded in 1987, is to study, practice and promote healthy humor and laughter.

“The great thing about humor is it’s FREE and available to everyone,” says Buxman.  “It’s sugar-free, fat-free, salt-free, and tax-free!  It’s available 24-7 and you don’t need a prescription!  There’s no assembly required and you don’t need batteries!  It’s environmentally friendly, and best of all, it’s socially contagious!”

Healthy, therapeutic humor enhances relationships, is non-hostile, sympathetic, benevolent, tolerant, and often philosophical.  AATH is careful to distinguish it from hurtful, harmful humor that is more aggressive, critical, sarcastic, cruel, often based on put-downs, and involves laughing at someone else’s expense.

AATH has generated the following list of 10 tips to help you lighten up and rise above the current economic turmoil and stress of the holiday season:

1.  Adjust Your Attitude – Stop watching the news and start counting your blessings instead of your money!  The blessings will increase, while the money is…well, you know!

2.   Make Someone Else Happy – Send unexpected ‘thank you’ or greeting cards to a mix of people.  Start with those who aren’t expecting it but deserve it. Then, send a couple to people who aren’t expecting and don’t deserve it.  Then, pick a couple names at random out of the phone book that certainly aren’t expecting it and have no idea who you are!

3.  Signs of the Times – Have some mirthful signs or sayings handy.  For example:
- The rules have changed… there are none!
- Walking on water is in my job description!
- Apparently, not all clowns are in the circus!
- Never wrestle with a pig – you both get dirty, but the pig likes it!
- You don’t have to be crazy to work here…but it sure helps!
- If we’re closed, just slide the money under the door!
- I’m not weird… I’m gifted!

4.  Try Some Random Acts of Silliness and Kindness – Wear mismatched gloves or socks… on purpose!  Page yourself over the intercom!  If and when a store clerk, restaurant server or flight attendant asks matter-of-factly “How are you today?” try replies such as, “Well medicated – and you?” or “At least I’m vertical!”  Instead of them always thanking you, thank them first and watch their reaction!

5.  Fun with Food – Put a bag of cookies or marshmallows in your briefcase.  Then, start your meeting by asking, “Dessert, anyone?”  Have a marshmallow stacking competition!  Put a pack of bubble gum in your coat pocket and, in the elevator, offer some to everyone!

6.  Pop Goes Your Worries – Save your bubble wrap!  It’s a great stress reliever.  Pop it with your fingers, knees and toes!  Dance on it!  Pop it with the help of young children!  Pop it, in unison, to the beat of music!

7.  Use Your Imagination – Think of what would happen if certain companies merged.  For example: Fairchild Semiconductor and Honeywell Corporation would become Fairwell Honeychild.  Grey Poupon and Docker Pants would become Poupon Pants.  If FedEx joined UPS, they might become FedUP.

8.  Rename to Keep Sane – Cash Flow: The movement your money makes as it disappears down the toilet.  Broker: What I am today, after taking the advice of my financial planner.  P/E Ratio: The percentage of investors wetting their pants as the market keeps crashing.

9.  Exaggerate – Comedians overstate things to get a laugh.  You can too!  Our family is so poor these days… we took out a second mortgage on our cardboard box.  Our family is so poor these days… to save on milk, we eat our corn flakes with a fork.  Our family is so poor these days… when someone rings the doorbell, I stick my head out the window and yell, “Ding-Dong.”

10.  Let a Smile Be Your Umbrella – This simple choice is yours.  You can frown and be miserable (way too many people readily choose this option), or you can wear a contagious smile.  In your conversations with people, smile and ask to see their smile.  Then say, “I see you’ve been practicing!”

For more information contact AATH and/or Karyn Buxman at 858-456-1874.

On Tour at Cancer Treatment Centers of America

I absolutely love being self-employed. I’ve been my own boss for almost twenty years now. But if I were ever going to punch a clock for someone else ever again, I think I found where I would want to work: Cancer Treatment Centers of America. I had the opportunity to visit their facility outside of Chicago last week—they knocked my socks off!

When you arrive at CTCA you are greeted by a couple of valet attendants, who for no fee (won’t even accept a tip) park your car for you and escort you inside. When you enter, immediately you begin to feel the warm energy emanating from this place. On the wall to your left, a brass tree with leaves baring the names of patients who have celebrated at least 5 years of life since arriving. You then pass a large aquarium with beautiful fish on your left and a beautiful atrium with plants and soothing music to your right. A friendly person at the reception desk greets you and quickly determines how to best suit your needs.

The hospital looks more like a hotel (The Ritz, not the Super8), with heavy wooden doors and molding on all the wings, attractive carpeting beneath your feet and beautiful artwork and heartwarming pictures in all the hallways. Rarely will you hear an overhead page (“It disturbs the sleep of our patients,” I was told.)

CTCA boasts the finest state of the art equipment, but what really makes them special isn’t the high tech—it’s the high touch. The founder, Richard Stevenson, created CTCA based upon what he calls the Mother Standard® of care. In the 1980s his beloved mother developed bladder cancer and he searched across the country for someplace that would give her the care he felt she deserved. Finding none, he determined that he would create a place, himself. Each person would be treated with the same unconditional support, warmth and respect that one would want for their own loved one, because everyone is someone’s mother, father, sister, brother, daughter or son.

Katherine Puckett, PhD and Director of Mind Body Medicine at CTCA is one of the most down-to-earth folks I’ve ever met. She told me of a time when she was seeing a patient in her office. Katherine apologized for the piles of reports and files that lay on her desk. The patient smiled and said that he found her office comforting, then explained, “It’s evident that you place people before paperwork.” That’s the mindset in this place—how comforting!

CTCA offers a comprehensive and integrative approach to fighting cancer. Traditional tools for fighting cancer such as surgery, radiation, chemotherapy and immunotherapy are combined with complementary therapies including nutritional support, physical therapy, pain management, naturopathic medicine, spiritual support and mind-body medicine. This enables patients to better tolerate the treatments which can kill the cancer, but can also be devastating to their physical and mental health.

One of the approaches used in the Mind-Body Department is humor and laughter. Dr. Puckett and several other staff members took training several years ago to become Certified Laughter Leaders (CLLs). Since then, numerous other staff have been trained and now laughter therapy, or Laughter Clubs are offered regularly for patients and their families. Participants come away feeling healthier, happier and more energized.

Kudos to the folks at CTCA. They get it. The patient is the focus of all that is said and done. Like I said, I’m not really looking for a job, but if I were, I hope I could make the cut. It would be a real privilege to work among such great people.

Ha! 5 Ways Laughter Makes You Healthy

“I died laughing!” my friend told me, recounting her evening at the comedy club the night before. She described how she laughed until her sides ached and mascara ran down her face.

Wow—a pretty scary picture. And yet people don’t really die laughing—quite the opposite. Laughter is one of the healthiest tools we have.

Remember when you were a child and everything was oh-so-funny?  When the silliest of remarks would send you and your friends into gales of laughter?  When did that stop?  What does it take now to make you pause long enough in your busy life to process humor?

Do you laugh much, or have you noticed a distinct lack of laughter in you life lately?  If you are not laughing, you are failing to take advantage of one of the healthiest natural activities available.  So in between all the busy-ness with which your days are filled, take some time to laugh – and you may just find yourself healthier in the process.  Here are five ways that laughter can improve your health.

1. Provides aerobic exercise for your cardiovascular system

You can get exercise from laughing. Don’t believe it? Take your pulse for 15 seconds and multiply by 4. (This will give you your resting heart rate for one minute). Now laugh. It doesn’t matter if it’s a real laugh or a fake laugh. Try laughing for as little as 30 seconds or up to 2 minutes if you’re in good shape. Stop and take your pulse again.

Typically you’ll notice an increase in your pulse, your face will appear more flushed and your breathing will be faster and deeper than before, as well. While it’s not the same as running for a mile, it has its benefits, nonetheless. As a matter of fact, psychoneuroimmunology (mind-body) expert, Dr. William Fry, noted in one of his studies that (in adults over 50) laughing for 2 minutes provided the equivalent aerobic response as 10 minutes on a rowing machine (also known as an expensive sweater hanger for some of us).

The beauty of laughter as exercise is that it can be done without any special equipment, doesn’t require advanced skills or coordination, and can be done any time of the day in just about any setting, as often as desired.

And laughter begets laughter.  Loosening up those laughter muscles will help make laughter a more regular part of your daily life!

2. Decreases muscle tension

Have you ever doubled over laughing? Have you ever laughed so hard that you had to hang onto a desk or a chair to hold you steady? (This may be accompanied by snorting milk out your nose—but that’s another article.) There’s a physiological reason for this.

When we laugh, our skeletal muscles (the ones that help us move) go into a state of tension. Then they relax. We usually feel this in our abdomens, but it’s actually occurring in muscles all over our bodies. And at times, when taken to extremes, this effect can actually become detrimental. Some of you know where this is going… You can laugh so hard that you lose bladder control (a.k.a laughing until you leak!). But this relaxation can be beneficial to the rest of your body—especially if you’re suffering from a tight neck or tight shoulders from a long day at work.

3. Improves your oxygen levels

When you laugh, the contraction of your diaghram forces air out of your lungs. Then when you inhale you pull fresh air and oxygen down deep into your lungs. This “exercising” of your lungs can cause coughing in someone who has a cold, who has a mild respiratory ailment, who is a smoker—or someone who is so stressed that she just hasn’t had a deep breath in a really long time!

Scientists have measured oxygen levels in people before and after laughter and found that arterial blood gas levels have risen significantly. More oxygen in your lungs means more oxygen to your cells throughout your entire body—definitely a health booster.

4. Laughter Energizes!

It’s mid-afternoon and you’re starting to slump. You could grab a $4.00 cup of coffee for a shot of caffeine. Or you could try laughing for a minute or two.

When we laugh, our sympathetic nervous system responds by producing more catecholamines (a hormone), which increases our levels of alertness and memory, as well as enhancing our learning and creativity. Combine this with the benefit of more oxygen (mentioned above) and you’ve got the formula for an energized and productive day.

5. Strengthens your immune system

We’ve known for years that stress can weaken our immune systems. You put too many items on your schedule and realize your throat is getting scratchy. Then the boss adds another project and you develop bronchitis. Your spouse gets a promotion that requires a move and you develop walking pneumonia. If one more person adds one more item to your overloaded plate, you could wind up on a ventilator!

Scientists now have the technology to examine the cells in our body that comprise our immune system. It’s more complicated than we ever imagined, but we can see that when people incorporate humor and laughter into their routines, their bodies’ immune systems respond positively short term (immediately), mid-range (days to weeks) and even long term (weeks to months). This isn’t to say that laughter will cure anything, but it’s a great adjunct to any medical therapy.

Laughter isn’t the be-all end-all, but it’s easy, it’s abundant, and doesn’t cost you anything. It can improve your health, it’s fun and it feels good. With so much to gain, laugh it up!

Humor, Cancer and Chronic Illness

“I’m not afraid of dying.  I just don’t want to be there when it happens.”  Woody Allen

 
Pat’s hand gripped mine tightly– her eyes glistened with mischief. “I so look forward to your visits. Everyone else around here is so darned serious!  I wish they’d just lighten up a little.”  I looked around the room and she was right. Her 58-year-old husband and 32-year-old daughter sat on the couch, looking as if a smile would shatter their faces into a million pieces.  “Tell me something funny that happened to you this week,” she continued. “What’s that little boy of yours been up to now?”

Pat was one of several patients that I made home visits to as a nurse, following up after her chemo and radiation for a tumor in her neck and jaw. Physically she was doing fine and her outlook was tremendous. However, her family had an attitude that could sink a battle ship. Even though Pat valued laughter, her family felt her condition was much too serious to permit using humor.

 
Despite the tremendous advances in cancer treatment, just the word “cancer” evokes a visceral reaction in many people. This includes family, friends, and even some health care providers. One of my patients shared that when she attempted to make a joke about her condition, her husband reprimanded her: “Honey, you shouldn’t be making jokes.  Don’t you realize how serious your condition is?”  This came as no surprise to me. A survey of terminally ill patients showed that over three fourths of them said they wanted more humor but that their family would not joke with them.

Does humor serve a purpose for those with terminal or chronic conditions?  Absolutely. Humor serves many purposes, including relieving anxiety, managing painful feelings, and releasing anger in a socially acceptable way. Humor is a wonderful coping mechanism that can help by reframing or seeing situations in a new light.

Distraction serves as another useful purpose. Sometimes humor helps to divert our attention, instead of focusing on what’s stressful to us at the moment. Humor can often provide relief, whether it’s from an uncomfortable needle stick or the unpleasant side effects of a medication. Scientists are collecting more evidence every day that humor, laughter, and positive emotions have numerous physical benefits, including a decrease in muscle tension and an enhanced immune system.

 
Where do you find humor? Fortunately it’s all around you. You just have to be looking for it. It’s a mindset, an attitude. It is not the same thing as joke telling, which may come as a relief to some of you. However, if you want to learn to tell jokes, practice telling a joke out loud to yourself seven times before you attempt it with someone else. (Once you blow the punchline, there’s no saving it.) 

Better than jokes are personal experiences or embarrassing moments. Few adults have not locked their keys in their cars, or found their zippers unzipped, or discovered a colorful piece of food stuck between their teeth when trying to impress someone. When sharing these universal events, we share our vulnerabilities and our willingness to trust others.  If you can see any humor in it at all, try sharing an embarrassing moment with a friend or family member.

Schedule some time for play daily. Many folks this frivolous and their lowest priority, but research now indicates that those who are too serious to allow time for play wind up seriously ill. Make a “list of things you find pleasurable and fun to do (some of these ideas should be of little or no cost). Then when you are most in need of lightening up but unable to think of anything fun to do, pull out your list and make an agreement to do at least one thing. You will feel better afterwards.

 
Get out of your rut. Do something out of the ordinary. It can be something as minor as sleeping on the other side of the bed, listening to a different type of music than you’re accustomed to, leaving for work 20 minutes early to take the scenic route, paying for the toll of the guy behind you, sending a cartoon to a coworker, taking a bubble bath by candle light, calling an old friend from high school— just use your imagination!  I once watched in bewilderment as a friend tossed his loose change into the couch in his hotel room.  “What are you doing?!” I exclaimed.  He smiled and said, “Even though I won’t be here to see it, someday someone’s going to have fun discovering the money in this couch.”

No matter what your physical condition, humor can benefit you.  Plan a daily humor break and reap your profits. Make the most of every day– lighten up!

Today’s Nursing Crisis: A Laughing Matter?

Did you hear the one about…?  According to a recent study, one of every three U.S. nurses surveyed under age 30 plans to leave their jobs within the next year. One in five nurses plans to leave the profession within five years because of unsatisfactory working conditions. According to the Bureau of Labor Statistics, 450,000 additional registered nurses will be needed to fill the present demand.  Experts worry about the year 2020, when the registered nurse shortage is projected to reach 500,000 positions, coinciding with the increasing needs of healthcare in an aging U.S. population.
It is obvious that the state of health care today is no joke.  But it may be a laughing matter, if one understands the premise that humor oftentimes is generated by painful circumstances.  There is nothing funny about unlimited resources, job security or a physician who responds quickly and cheerfully to a nurse’s request. The things that make nurses laugh tend to be the very things that drive nurses crazy.

Whether it’s a picky patient, a cranky coworker, or a demanding doctor, nurses frequently have no control over the stressors that arise in their work setting. They do, however, have a choice in how they respond to those pressures.  No single tactic will be appropriate for every situation, so a healthy nurse needs to have a variety of strategies. Numerous means of coping with stress in a healthy manner are available, and one of those ways is with humor.

There are three primary roles of humor in the healthcare setting: psychological, social, and communication. 

Psychological.   As nurses become more anxious and their focus becomes narrower, they become less creative and are more easily upset. Stress may not come from the event, itself, as much as from the nurse’s perception of that event. Humor provides a perceptual flexibility that can increase one’s sense of control. Learning techniques such as catastrophizing the event, where one takes the situation at hand and looks for the absurdity by asking, “How could this be worse?” may help the nurse put the event into its proper perspective.

Social.  As Victor Borge, a well-known comedian, said so eloquently, “Laughter is the shortest distance between two people.” When two or more can share in amusement, there is a commonality experienced among them, thus creating a bond. Some types of shared humor, such as self-effacing humor, reveal one’s own flaws, ‘humanness’ and vulnerability. This ‘revelation’ creates an environment where the listener feels that it’s safe to share, helping to develop rapport and establish or strengthen relationships. For that moment, the humor helps to diminish the perceived hierarchy, such as nurse/patient, doctor/nurse, or teacher/student while all involved participate in the fun.

Communication.  Sometimes a joke is just a joke.  But often, true words are spoken in jest. It may be helpful for the nurse to know that frequently people will present a serious concern in the guise of a joke. A patient may joke about an embarrassing or frightening situation. If her nurse responds in the manner that she had hoped, she has achieved her desired outcome. However, if the nurse doesn’t recognize the serious nature of her comment, then she has the ability to “save face” with the rationale that she was “only joking.” The skill for nurses is in learning to listen beyond the laughter, whether the person addressing them is a peer, patient, family member, or doctor.

 Physiological effect.  In addition to the functions of humor, the physiological effect of humor is identified as a benefit.  Most nurses have experienced at least one negative physiological effect of stress: Muscle tension, cold hands, headaches, gastrointestinal disturbances, among others. While researchers have spent years identifying the negative effects of stress on body systems, they are now looking at the therapeutic effects of humor and laughter on the human body.  These include decreased muscle tension, deeper respirations, and positive increases in the immune system.

As nurses practice to improve their abilities to use and appreciate humor, they also enhance their skills.  “Humor appreciation involves responding to humor produced by others or being a good audience. On the other hand, humor production involves thinking of things on your own to amuse yourself or others,” says Michelle Newman, PhD. When using humor as a coping mechanism, one cannot always count on being able to find an external locus of amusement.  “Of the two, humor production is the more portable skill,” says Newman and adds, “From the standpoint of coping, it seems to me to be less important whether you can amuse other people than whether you can amuse yourself.”  The implication for nurses is that while they may gain benefits from humor when enjoying it passively, there are even more benefits in being active participants by producing a humorous state of mind for themselves. 

Some nurses have shown themselves to be highly creative. One nurse carried a marker to decorate disposable gloves and masks on isolation carts.  A critical care nurse took a couple of adhesive EKG patches, attached them to the bottom of her shoes and “tap danced” her stress away during her break.  At a medical-surgical nurses station, whenever someone would shout “Massage Train!” everyone on hand would line up, put their hands gently on the shoulders of the person in front of them and soothingly massage. Before disbanding, they would switch directions of the line so the person on the end wouldn’t be left out. The whole procedure lasted only a minute or two, but everyone proceeded to their next task with a big smile.

Unfortunately, there is no “one size fits all” list of fun things for nurses to do. Because everyone’s sense of humor is unique, the techniques used to create humor must be highly individualized. The methods need not be flamboyant to be effective. For example, some nurses might be comfortable wearing a small decorative pin with an amusing picture or statement on it, particularly at seasonal times. Colorful clothing with festive accents might be an option if dress codes do not forbid. Some nurses are subtle, wearing Looney Tunes socks or Mickey Mouse jewelry while others walk the halls wearing a red sponge nose or carrying a rubber chicken! Posting cartoons and illustrations can brighten up any nursing unit.  Sharing jokes, stories, or embarrassing moments are other ways to generate laughter.  Humor baskets, carts and humor rooms are means of creating a more humorous environment.

Nurse researcher Vera Robinson once said that a sign of a profession’s maturity is its ability to laugh at itself. The profession of nursing is surely mature enough to be able to laugh at itself, and yet many nurses still refrain from using the skill of humor on the grounds that it is not “professional.”  Humor is not the equivalent of “goofing off.”  Indeed, it is important for nurses to maintain high standards and high expectations on their units and to take their work seriously. It is also important for nurses to be able to take themselves lightly. Sad is the nurse who cannot learn to separate the two– and that is no joke.

Stress Busters

There’s no one coping mechanism that will work for every stressful occasions. People need a variety of skills to stay healthy. These could include deep breathing exercises, progressive muscle relaxation, and meditation just to name a few.  But the benefits of humor and laughter are so plentiful, so convenient, and so cost-effective that people would be foolish to leave these awesome coping tools out of their coping toolbox. 

Here are a few quick stress busters. Try one the next time your energy level drops and your attitude is sagging:
 
Call your own answering machine or voice mail to leave a humorous message that you can enjoy later. Bonus—you get to laugh twice: Once when you leave the message and again when you play it back.  (For example: “Just calling to remind you to be careful when you go by the post office to pick up stamps and be sure to wear clean underwear because you never know when you might be in an accident!”)

Keep a file folder at your desk with clippings, cartoons, and e-mails you find entertaining. Pull it out and refer to it when you’re put on hold or when you feel those shoulders tightening.
 
Keep a book of word games, crossword puzzles, or cards at your desk. Re-spark your creativity and energy by taking a daily 10-minute ‘play break’ and you’ll recognize how important it is not to wait until you feel better to play. Play and then you’ll feel better.
 
Got a problem that’s bugging you?  Practice playing with your pain by asking yourself “how could this be worse?” Exaggerate the situation until you can make it absurd enough to put things in their proper perspective.
 
Smiles and laughs can diminish muscle tension. They’re also contagious. Practice wearing a smile to share with others and notice how their responses make you feel better, too.
 
Gain maximum benefits by proactively seeking humor every day.

Humor Appreciation: Taking It to The Next Level

I sipped my coffee and listened to my friend vent about her company’s merger. “I was so stressed out about the new changes being implemented at work,” Susan explained while rolling her eyes. “Then someone said something silly and I just lost it.  I laughed and laughed until I was limp as a dishrag.  Nothing had changed, but I just felt better for having laughed!”

It’s becoming accepted knowledge that positive benefits can be acquired from appreciating humor and laughter. Psychologist Michele Newman supported previous studies that found humor has a buffering effect and reduces the negative effects of stress. This study extended previous findings by demonstrating that humor is beneficial even for people who do not typically choose to use it to cope with stress. This finding was consistent with the belief that the ability to use humor to cope can be acquired rather than being a fixed, unchangeable trait.”

“Humor appreciation involves responding to humor produced by others or being a good audience,” reports Newman. “On the other hand, humor production involves thinking of things on your own to amuse yourself or others.” When using humor as a coping mechanism, one cannot always count on being able to find an external reason to be amused.  “Of the two, humor production is the more portable skill,” says Newman and adds, “From the standpoint of coping, it seems to me to be less important whether you can amuse other people than whether you can amuse yourself.”

Through my years of studying humor and laughter, I’ve observed three basic levels of humor appreciation:

Passive humor appreciation: At this most basic level, we appreciate humor that happens vicariously: A coworker says something funny, we observe a child’s comical action or expression, or we experience some absurdity that happens by chance. With this most basic level of humor we enjoy many of the functions of humor and the basic physical benefits, although the humor may occur infrequently and is purely unintentional.

Active humor appreciation: At this level, our awareness level is raised and we intentionally seek humor opportunities. We make it a point to read the daily comics, we ask others to share a joke or story, we become aware of humor we might have otherwise missed if we had made the assumption: Nothing funny happens here. We incur benefits more frequently, although not necessarily on a regular basis.

Proactive humor creation: At this advanced level, conscious effort is involved.  We attempt to create humor opportunities. We schedule time for play and entertainment in our daily schedules. We purposely create situations to amuse others or ourselves. We establish goals to utilize humor on a regular basis and attempt to make humor a habit. We enjoy the positive functions and benefits of humor on a regular basis.
While we may gain benefits from humor and laughter when enjoying it passively, there are even more advantages in being active participants by producing a humorous state of mind for ourselves. By incorporating a ‘humor habit’, we gain maximum profit from the wide and wonderful range of benefits at our disposal. Why not get the most bang for your yuck? Make humor a habit!

Humor: The Heart of the Matter

Scientists continue to support what we’ve known to be true since Biblical times: “A merry heart doeth good like a medicine.”  Studies in psychoneuroimmunology (PNI) have demonstrated that humor, laughter and positive emotions have a positive effect on the immune system, the respiratory system and now evidence shows a link between a healthy heart and a sense of humor.

A team of Maryland medical researchers found in a study of 300 people (half of whom had histories of heart problems) that people with heart disease were 40 percent less likely to laugh in humorous situations than those with healthy hearts.  “The old saying that laughter is the best medicine definitely appears to be true when it comes to protecting your heart,” said Michael Miller, director of the Center for Preventative Cardiology at the University of Maryland Medical Center.

The people with heart disease were much less likely to even recognize humor. They also laughed less, even in positive situations, and generally displayed more anger and hostility than people with healthy hearts.  The question remains: Does humor help prevent heart problems or do people with heart problems tend to lose their senses of humor?  “The ability to laugh — either naturally or as learned behavior — may have important implications in societies such as the U.S., where heart disease remains the No. 1 killer,” Miller said.

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