Humor in Nursing Case Study Essay

There has been increasing interest in the use of humour in patient care within recent years. However, little research has been conducted to show the natural utilisation of humour, particularly from the participants’ perspective, within the clinical environment. This study uses ethnomethodological ethnography and conversation analysis methods to investigate the use of humour between nurses and patients with renal failure who were learning about, and to, haemodialyse. It is believed that the project is unique in the utilisation of audiovisual video recordings to measure and describe the frequency, distribution and use of humour. Findings indicated that humour rates and the proportion of humour produced by the patients were differentially distributed between patients but, overall, not between the same patients on different occasions. In addition, in one case a significant positive relationship between the rate of humorous instances per session and time was demonstrated and another patient (D) was found to produce a significantly larger proportion of the humour over time. Further exploration of patient D’s increasing use of humour revealed that one important aspect was associated with the patients anxiety and difficulties with regard to ‘needling’. The findings have implications for understanding the role of humour in health care communication, particularly with reference to developing formal ‘humorous intervention  Humor in Nursing Case Study Essay

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Humor has been subject to research and philosophical reflections for centuries and has also been used for interventions in the health sector (Hulse, 1994). Most research has been conducted in pediatrics (review by Sridharan and Sivaramakrishnan, 2016). Apart from the health sector, humor interventions have also been investigated in the field of positive psychology (Ruch and McGhee, 2014; Ruch and Hofmann, 2017). Some studies in medical settings were conducted with older people in nursing homes (Mathieu, 2008; Goodenough et al., 2012; Low et al., 2013), cancer patients (Itami, 2000; Venter et al., 2008), veterans (Steinhauser et al., 2000), and patients suffering from depression (Shahidi et al., 2011). Positive correlations have been reported on humor and laughter in relation to life satisfaction outside the health care setting (Wild et al., 2003; Ruch et al., 2010), and there is some evidence of a relationship between humor and health (Martin, 2001, 2004).Humor in Nursing Case Study Essay

The theoretical model of the effect of humor on health has been described by Martin (2008) and Gremigni (2012) extensively, who concluded that humor as a complex psychological phenomenon needs to be differentiated according to the kind of humor and the setting. Hearty laughter, for example, works through different mechanisms than social and interpersonal aspects of humor and results in different effects. Social and interpersonal aspects of humor, such as enhancing personal connections, influence health and wellbeing by increasing one’s level of social support, while hearty laughter may predominantly affect health by improving the respiratory, musculoskeletal, vocal, and cardiovascular activity. Each kind of humor requires a specific research setting and will produce specific effects (Martin, 2008).Humor in Nursing Case Study Essay

Society perceives humor to have beneficial effects on health and wellbeing (Boyle and Joss-Reid, 2004). Implementation concepts of humor and the scientific evaluation of their effects (Boyle and Joss-Reid, 2004) have been developed over the last century. These different kinds of interventions range from individualized humor therapy visits via the presentation of humorous movies aligned with patients’ humor preferences (Schwartz and Saunders, 2010) to clowns working in the public health sector. Warren and Spitzer (2011) provided a summary of different types of clowns working in health care settings (e.g., elder-clowns and “classical” clowns in hospitals) in various countries and concluded that the application in elder and end-of-life care may not only benefit residents and patients, but health care professionals and family members as well. There are not only different types of clowns in healthcare but also different styles of humor that can be assessed (Craik et al., 1996; Schultes, 1997; Martin et al., 2003; Ruch et al., 2018). One of the few randomized controlled studies on humor interventions with adequate power was carried out in Australia and included 398 residents from nursing homes (Goodenough et al., 2012; Low et al., 2013). The single-blind randomized controlled study evaluated a clown intervention over a period of 9–12 weeks, which showed a significant decrease in agitation in residents compared to the control group receiving usual care. Additionally, so called “LaughterBosses” (staff members in nursing homes) were trained as facilitators with techniques to incorporate humor in between elder-clown visits. Humor also seems to be a relevant coping mechanism in various aspects of patients’ lives. In her analysis of posts in an online patient-to-patient cancer forum, Demjén (2016) found that patients make fun of cancer and its consequences in multiple and creative ways to cope with their physical and psychological distress.Humor in Nursing Case Study Essay

Despite these beneficial effects, there has been limited research on humor interventions for patients at the end of life. This might result from the societal perception that death is not supposed to be the object of implementations that included humor (Herth, 1990). Also, certain situations or topics might limit or impede the use of humor; for example, unfamiliarity between the patient and the health care professional (Erdman, 1991) or the fear of ridicule in certain patient groups, such as penile cancer patients (Branney et al., 2014).

However, the limited number of existing studies imply that humor might be beneficial toward the end of life as well (Steinhauser et al., 2000). Cox (1998) explored the effect of humor, art, and music on dying children through a literature review and found that any kind of social support and artistic strategies to process emotions and grief helps children: “[…] to remove the distance to others, find relief for depression, enhance their self-esteem, lower anxiety, fear and other feelings of grief and achieve an improved level of acceptance of reality” (Cox, 1998, p. 416). Cancer patients talk about humor as one of the predominant themes and coping strategies in their lives (Venter et al., 2008). Dean (1997) extrapolated findings from humor research in other health care settings and concluded that humor may be applied in the palliative care setting as well. However, she also noted that in certain situations, like crises and imminent death, humor would not be appropriate. From the perspective of health care professionals, Müller et al. (2012) found that humor is one of the three most powerful resources that protect health care teams from the negative effects of the strain of death and dying.Humor in Nursing Case Study Essay

Kanninen (1998) conducted a review on humor in palliative care, but found only one pilot study that analyzed the effect of humor on 14 patients (Herth, 1990). The remaining articles included in Kanninen’s review were anecdotal personal experiences of individuals. Kanninen concluded that research is needed to establish if humor is effective in medicine, especially in palliative care. The present paper reviews the study of Herth (1990) and the research that has been added in the two decades since Kanninen’s review. It thus lays the foundation for future research on humor interventions in palliative care, assessing the effects on patients, relatives, and health care professionals.

Objectives
The aim of this review is to synthesize humor interventions and assessments that have been applied in palliative care and to derive implications for future research and applications. The investigated patients were diagnosed with an incurable disease and were at the end of their lives. Study designs and outcomes of interventions and assessment are compared and grouped to facilitate cross-study comparisons.Humor in Nursing Case Study Essay

Research Questions
This systematic review evaluates the effectiveness of humor interventions in a palliative care setting. It also outlines which kinds of humor interventions and assessments have been applied in palliative care until now and the methods, results, and limitations of these studies.

Methods
Study Design
A systematic literature review of qualitative and quantitative research was undertaken in July 2017.

Participants and Interventions
The target group in the reviewed studies consisted of patients in a palliative care setting who received a humor intervention. Studies assessing the perspective of family caregivers or health care professionals on humor were also included. Different kinds of interventions and assessments were reviewed in a range of patient groups and institutions. All patients had diagnoses of incurable diseases and received end-of-life care.Humor in Nursing Case Study Essay

Systematic Review Protocol
Overall, 336 abstracts were found and reviewed by two authors (LLD and LR), with an agreement rate of >95% regarding the investigated publications. Screenings resulted in 64 abstracts that were rated as potentially relevant for the review. Lack of consensus about inclusion was discussed with another author (SH). Next, 32 articles were analyzed as full-text versions, from which 13 met the inclusion criteria (see Figure 1), for further information please access the Supplementary Material. The included studies were published between 1990 and 2017. No older studies have been identified in the literature search. The 17 articles which were not included were an opinion paper (Dean, 1997) or articles that investigated patient groups which did not meet the criteria of palliative care (e.g., Low et al., 2015).Humor in Nursing Case Study Essay

FIGURE 1
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Figure 1. Flowchart of the review protocol. 1search terms: {(humor OR humor OR humorous OR clowns OR clown[Title/Abstract]) AND intervention OR training OR coaching OR visit OR practice OR therapy[Title/Abstract]} AND “palliative care” OR “hospice care” OR “end-of-life” OR geriatric OR “life limiting illness” OR death OR dying[Title/Abstract].

Search Strategy
Three search strings on the topics of humor, intervention, and palliative care connected by Boolean operators were used. The search terms were: {(humor OR humor OR humorous OR clowns OR clown[Title/Abstract]) AND (intervention OR training OR coaching OR visit OR practice OR therapy[Title/Abstract]) AND (“palliative care” OR “hospice care” OR “end-of-life” OR geriatric OR “life limiting illness” OR death OR dying[Title/Abstract])}.

Publications were included if they were published in a peer-reviewed journal, contained original qualitative or quantitative data, applied and/or assessed a humor(ous) intervention, evaluated effects on patients or residents in nursing homes receiving palliative care, and were published in English. The year of the publication of the study was not restricted.Humor in Nursing Case Study Essay

Humour can play an essential role in the most serious healthcare settings, even when patients are receiving intensive or end of life care, according to research in the April issue of the UK-based Journal of Clinical Nursing.

Canadian researchers spent nearly 300 hours observing and carrying out interviews with staff, patients and families in an intensive care unit and a palliative care unit for people with terminal illnesses.

They concluded that humour played an essential role in promoting team relationships and adding a human dimension to the care and support that staff provided to seriously ill patients and their families.

The researchers found that staff used humour in a number of ways, including:

To cope with, and sometimes distance themselves, from difficult situations. As one interviewee commented: “When you’ve had the most stressful day and you’re ready to cry, sometimes it’s easier to bring out humour and take it in the other direction instead of bawling on somebody’s shoulder.Humor in Nursing Case Study Essay
To connect with other healthcare professionals and provide mutual support. Shared laughter energised and nurtured a sense of community. “If you have those fun moments and that connectedness even the worst hell can happen” said one healthcare professional who worked with terminally ill patients. “You sail through it as opposed to walking out really wounded”
To reduce tension when things don’t go as well as they could do. A doctor who admitted he had been hasty suggesting that a terminally ill man give up his apartment so soon was greeted with the quip: “Shall I chart that you made a confession or that you made a mistake”Humor in Nursing Case Study Essay
To express frustration at life-prolonging measures that staff disagreed with. Staff in the intensive care unit told researchers how they paralleled what was happening to one patient by using an inflatable dinosaur called Dino and putting him through the same interventions. He became a symbol of their dissatisfaction with the situation.Humor in Nursing Case Study Essay
To connect with patients and make them feel cared for as individuals. When a health care aide took a joke picture of a patient with a bubble bath helmet on his head to put him at ease it became one of his prized possessions. He showed it to everyone who visited as evidence of the special treatment he was receiving. And when he died, it was displayed alongside important family photos.
To reduce patients’ embarrassment with the indignity of needing help with toileting and other highly personal functions. When a patient suffered an episode of incontinence she reported that she found the nurse’s matter of fact humour – “what goes in must come out” – made her feel less distressed.
However, the researchers also found that humour could also create distance and prevent serious discussion. As one nurse commented: “If I’m joking with you, I’m interacting with you. We’re talking but I don’t ask you what’s bugging you…I’m not really finding out why you’re upset.”Humor in Nursing Case Study Essay

It wasn’t just the healthcare staff who used humour to alleviate difficult situations.

One nurse recalled admiring an expensive recliner chair a patient had brought in with her to the palliative care unit. The patient was delighted that she didn’t have to pay a cent for two years and quipped that in that case she would never have to pay for it!Humor in Nursing Case Study Essay

Another recalled how a patient’s monitor kept going off in the intensive care unit. “Don’t worry, if I can hear it I’m still alive” the patient joked.

Then there was the satisfaction that staff felt when they saw a patient smile. “It makes you feel you’ve done something, if not medically, maybe emotionally” said one nurse.

“Some people feel that humour is trivial and unprofessional in healthcare settings, but this study shows that it is neither” says co-author Dr Ruth Dean, a nurse researcher from the University of Manitoba.

Dr Dean carried out the study in the palliative care unit, spending 200 hours observing and informally interacting with care providers, patients and family members and carrying out semi-structured interviews with 15 healthcare staff, including nurses, doctors, a social worker and physiotherapist.Humor in Nursing Case Study Essay

Her colleague Joanne Major from the Health Sciences Centre in Winnipeg spent 72 hours in an intensive care unit, observing and carrying out semi-structured interviews with 15 nurses.

“Despite major differences between the work of the intensive care and palliative care units, they are both areas where serious illness, high anxiety and patient and family distress are prevalent and staff are placed in emotionally demanding situations” says Dr Dean. “Crises are frequent, death is close by and emotions tend to run high.

The authors conclude that humour was very important in these stressful healthcare settings.

“One member of staff referred to humour as the glue that holds human connections together, a statement that was clearly reinforced by our findings” says Dr Dean.Humor in Nursing Case Study Essay

‘Our research suggests that nurses and other healthcare professional don’t need to suppress humour. They should trust their instincts about when it is appropriate.

“Combined with scientific skill and compassion, humour offers a humanising dimension in healthcare that is too valuable to be overlooked.

Data Sources and Data Extraction
Four key databases (PsycInfo, PubMed, Google Scholar, and Cochrane Library of systematic reviews) were systematically searched to July 16th 2017. Full-text publications were downloaded via the library of the Medical Faculty of the University of Bonn.Humor in Nursing Case Study Essay

Data Analysis
All included articles were reviewed in depth. The selected studies were divided into (a) studies that investigated humor in palliative care as the main goal of the paper and (b) studies in which humor emerged as an important variable from an initial research question that had not focused on this topic, for example assessing end-of-life wishes (Delgado-Guay et al., 2016). Target groups, participant numbers, publication bias, study methodology, and quality of research were also analyzed using a template. However, the wide range of different conceptualizations of humor in the studies as well as methodological weaknesses prevented meaningful comparison between studies. Results are presented according to target groups and study methodology. Effect sizes were analyzed using Cohen’s (1992) guidelines. Potential bias within the studies was identified and discussed.Humor in Nursing Case Study Essay

Results
The 14 included research papers contained data on 13 studies (see Figure 2). One study was published in two separate papers, one describing the qualitative results (Kontos et al., 2016) and the other discussing the quantitative results (Kontos et al., 2015). Ten articles were selected because they presented findings of interventions or assessments of humor as the main goal of the paper. Four other publications were included because they dealt with humor, among other variables, as a secondary outcome. Two publications focused on humor interventions and eight mainly on the assessment of patient’s perception of humor, while three examined the perspective of caregivers and/or health care professionals. Nine publications described qualitative results (Herth, 1990; Langley-Evans and Payne, 1997; Schultes, 1997; Dean and Gregory, 2004; Adamle and Ludwick, 2005; Richman, 2006; Cain, 2012; Bentur et al., 2014; Kontos et al., 2015), and five articles presented quantitative results (Kissane et al., 2004; Ridley et al., 2014; Delgado-Guay et al., 2016; Kontos et al., 2016; Claxton-Oldfield and Bhatt, 2017). Overall, a total of 759 participants were included in the reviewed studies.Humor in Nursing Case Study Essay

FIGURE 2
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Figure 2. Flowchart of included studies.

The results are presented in the following order: the two studies that included humor interventions (Schultes, 1997; Kontos et al., 2015, 2016), three studies exploring perception and appropriateness of humor in hospice settings (Herth, 1990; Ridley et al., 2014; Claxton-Oldfield and Bhatt, 2017), followed by five publications that assessed functions and results of humor applications on patients in hospice care (Langley-Evans and Payne, 1997; Dean and Gregory, 2004; Adamle and Ludwick, 2005; Cain, 2012; Delgado-Guay et al., 2016) and one on patients in an oncology ward (Bentur et al., 2014), followed by two studies presenting results from psychotherapists’ observations (Kissane et al., 2004; Richman, 2006). Within each of the subsections of the results, the studies are presented in the order of their publication date beginning with the most recent one. At the end of each section, the main information is condensed in a table.

Studies That Included Humor Interventions
Two studies investigated the effects of humor interventions in a palliative care setting (Schultes, 1997; Kontos et al., 2015, 2016), one for patients with advanced dementia in nursing homes, and one for patients being treated by a hospice service at home. Both studies applied humor interventions in a palliative care setting. While one study used clowns (Kontos et al., 2015, 2016), the other study involved nurses using humor with the patient (Schultes, 1997). The outcome measures and the study participants varied strongly, limiting comparability between studies (see Table 1).Humor in Nursing Case Study Essay

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TABLE 1
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Table 1. Studies including humor interventions.

A Canadian study using so called “elder-clowns” (with a red nose, but minimal make-up and clothing from an earlier era) applied approximately 10 min humor interventions twice a week over a period of 12 weeks to nursing home residents in an advanced stage of dementia (Kontos et al., 2016). No control group was investigated, so bias cannot be ruled out. The qualitative results of the study were published separately (Kontos et al., 2015). The clowns used improvisations, humor, empathy, song, musical instruments, and dance. Data collection involved video recording the interventions, and the clowns were interviewed afterwards. Several researchers screened and transcribed the videos to assure interrater reliability. The aim of the intervention was to achieve “relational presence,” a term that Kontos et al. define as: “[…] the reciprocal nature of engagement during plays, and the capacity of residents to initiate as well as respond to […] creative engagement” (p. 5). To facilitate an appropriately tailored intervention for each participant, so called “census information”—personal preferences, history of the patient and personality—was informally collected from staff or family. With a small number of participants (N = 23) a significant improvement was found between the baseline and the end of intervention scores in “behavioral and psychological symptoms of dementia” (from M = 24.4; SD = 12.9 baseline to M = 18.6; SD = 13.1 after 12 weeks; scale from 0 to 144; t = −2.68, p = 0.01; Cohen’s d = −0.45), quality-of-life (from M = 0.04; SD = 0.51 baseline to M = 1.05; SD = 0.29; scale from −5 to 5; after 12 weeks; F = 23.09, p < 0.001; Cohen’s d = 2.44) and “occupational disruptiveness” (from M = 8.09; SD = 7.1 baseline to M = 4.9; SD = 5.2 after 12 weeks; scale from 0 to 60; t = −2.58, p = 0.02; Cohen’s d = −0.51) using questionnaires completed by the nursing staff and family members. Use of psychiatric medication and nursing burden did not change significantly. There was a tendency for decreased agitation/aggression, but this did not reach statistical significance (from M = 3.3; SD = 3.3 baseline to M = 2.1; SD = 2.0; scale from 0 to 12; t = −1.86, p = 0.07; Cohen’s d = −0.44). The authors report that persons diagnosed with dementia could engage in the humor interventions in different ways even though they were in their last stage of life. This engagement ranged from sharing their sadness to reciprocal play, joy, imaginative exploration, and from recognizing humor to even creating humor on their own initiative.Humor in Nursing Case Study Essay

The second intervention was developed after an analysis of the existing literature on humor in health care. Schultes (1997) evaluated a humor intervention for patients treated by hospice home care nurses. The intervention was guided by humor assessment questions to explore the preferred style of humor (e.g., incongruity, nonsense, ridicule, or slapstick) and instructions for nurses on how to observe humorous behavior. After the assessment procedure, humorous cassettes and movies were shown to the patient according to the preferred humor style. The intervention was tested in a clinical case study with a 65-year-old woman suffering from metastatic colon cancer. Data collection on the intervention effects was based on observations of the patient by nurses and informal interviews with the patient’s relatives. The results of the case study indicated that humorous interactions and listening to humorous cassettes or watching funny movies made the patient feel better, that she demanded less pain medication and smiled more, and that it also improved the quality of her remaining life. Even after the patient’s death, her family reported that they continued to watch the movies, which helped them to feel relieved and to cope better with their grief, and which gave them a sense of power in a situation where they felt weak. However, the authors did not follow up the case report with a humor intervention trial and the lack of an independent researcher in the data collection could have led to biases.Humor in Nursing Case Study Essay

Studies Assessing or Observing Humor in an Explorative Way
Exploring Perception and Appropriateness in Hospice Settings
Three studies assessed the appropriateness of humor as an intervention in hospice settings using qualitative data (Herth, 1990), quantitative data in general (Ridley et al., 2014), and quantitative data on volunteer-patient interactions (Claxton-Oldfield and Bhatt, 2017). Humor was perceived as appropriate or even essential in those settings, though the authors mentioned limitations regarding the use of humor, such as impending death or absence of a sense of humor (see Table 2).

TABLE 2
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Table 2. Studies exploring perceptions and appropriateness in hospice settings.

Herth’s (1990) small study on 14 terminally ill adults receiving hospice care at home explored patients’ perceptions of and experiences with humor in structured interviews. Patients explained that humor incorporated the following improvements: connectedness, change of perspective, hope, joy and relaxation including physiological improvements. Also, the majority (12 of the 14 participants) of the interviewees stated a need for humor, indicated by quotes such as “Everyone is so sad,” “It just makes it harder, I wish we could lighten up,” and “If I ever needed humor it is now” (Herth, 1990, p. 38). The author concluded that terminally ill people appeared to be the ones who benefitted the most from humor interventions. As a coping mechanism, humor becomes essential due to deteriorating body functions, unfamiliar procedures, and physical and emotional suffering. Humor was also described as one of the most powerful coping mechanisms. However, the strong conclusions that the authors drew may be questioned in relation to the small sample size of the study.Humor in Nursing Case Study Essay

Ridley et al. (2014) analyzed whether humor is appropriate in a palliative care setting. They interviewed 100 patients in palliative care units and residential hospices. A standardized questionnaire captured patients’ perception toward humor therapy prior to and during their illness (Ridley et al., 2014). Ridley et al. reported a potential “bias inherent to retrospective self-reporting” (2014, p. 474). Most participants valued humor as important prior to (77%) and during (76%) their illness. However, the frequency of laughter in patients who laughed 16 or more times a day declined from 65% prior to the illness to 22% during the illness. Patients who rated humor to be more important than other patients were more likely to consider themselves as funny before (p < 0.001) and during (p = 0.014) their illness.Humor in Nursing Case Study Essay

The perception of appropriateness, types, frequency, and results of humorous interactions in hospice and palliative care patients during their interaction with volunteers was analyzed by Claxton-Oldfield and Bhatt (2017) from a volunteers’ (N = 32) point of view. A quantitative questionnaire was developed on the basis of an informal discussion with four volunteers. The first part of the questionnaire examined the frequency of humor in patient-volunteer interactions (for example “How often do your patients initiate humor with you during your interactions with them?”). The second part examined the acceptability of humor in interactions. The volunteers visited patients in a range of different settings (hospital, client’s home, nursing home, and residential hospice). The authors report a potential bias from nonresponse. More than half of the volunteers rated humor as very or extremely important in interactions with patients. In most cases humor was applied (a) after getting to know the patient and following the patients’ lead (n = 11; 40.7%) and (b) depending on his/her stage of illness (n = 12; 41.4%). Impending death was perceived as a very inappropriate moment for the use of humor. All in all, 96% (n = 31) of the volunteers believed that there was a place for humor in palliative care, and 88.9% (n = 24) stated that humor helped them to cope with the demands of their voluntary work.Humor in Nursing Case Study Essay

Assessment of Functions and Results of Humor Application
Patients in hospice care
Five studies examined the functions and results of humor applications (see Table 3). All of them used observations and interviews as methods of data collection. The results demonstrated that humor was crucial for hospice professionals to cope with the demands of their jobs (Cain, 2012), that it was primarily initiated by patients (Adamle and Ludwick, 2005), and that it helped health care professionals and patients to build relationships and to bear difficult situations. Humor was, moreover, a means to express sensibility (Dean and Gregory, 2004), it represented an important end-of-life wish (Delgado-Guay et al., 2016), and it helped patients to distance themselves from their own death (Langley-Evans and Payne, 1997).

TABLE 3
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Table 3. Studies assessing functions and results of humor application.Humor in Nursing Case Study Essay

Delgado-Guay et al. (2016) compared four different tools developed to rate end-of-life wishes in a randomized controlled trial (RCT). Hundred patients with advanced cancer in an inpatient palliative care unit in South Texas rated “to keep my sense of humor” as one of the ten most important end-of-life wishes (45% of all participants).

Cain (2012) analyzed “front” and “back region” personalities of health care professionals; that is, the personality shown in front of patients and relatives on the one hand, and the personality presented in team meetings and with colleagues on the other hand. Data was collected through observations over 1 year by a researcher at the ward and 51 interviews with staff-members. Bias was possible because only one researcher collected the data, so no inter-rater checks were conducted. Among the dynamic and complex interactions of staff and patients, she found that humor fulfilled an important role, predominantly in the “back region” of the hospice staff. It was not only an instrument to distance oneself from negative emotions, but also a resource of strength, which enabled professionals to deal with emotionally difficult times.Humor in Nursing Case Study Essay

Adamle and Ludwick (2005) observed 132 interactions between nurse, patient, and primary caregivers in hospice settings (home care hospice services, inpatient hospice, and hospice care in nursing homes) including 160 participants. They counted the number of occurrences of humor and who initiated them. Potential bias was reported in the selection process of participants. In three different settings, humor was observed in 85% of the 132 observed interactions. In about 70% of the cases, humor was initiated by the patient, and the average number of humor occurrences per visit was three. The lack of humorous occurrences in 15% (n = 20) of the observed interactions was due to the cognitive inability or impending death of the patient (nine patients were either in a coma or did not respond physically or mentally to verbal cues, and five patients were dying).

In another study, Dean and Gregory (2004) focused on the circumstances, functions, and appropriateness of humor in an inpatient palliative care unit using participant observation plus informal and structured interviews with 15 health care professionals. Detailed field notes and transcribed interviews were analyzed. Humor was reported to be “pervasive and persistent” (p. 140) and had the following key functions: (a) building relationships (making connections, humor as attraction, discovering hidden verbal messages, energizing, nurturing community, neutralizing status differences), (b) bearing the situation (humor as respite, humor as survival, humor as tension relief/lightening the heaviness, maintaining perspective/providing support), and (c) expressing sensibility (preserving dignity, acknowledging personhood).Humor in Nursing Case Study Essay

In their ethnographic investigation, Langley-Evans and Payne (1997) studied how patients in a palliative day care unit think and talk about their condition and death, using participant observation over a period of 7 weeks and evaluating field notes and documentary information from health care professionals. One theme that emerged from the qualitative data analyses was the rather nonverbal humorous nature of this “death talk,” which enabled patients to distance themselves from their own deaths.

Patients in Other Settings
Three studies examined patients in other settings (see Table 4). Bentur et al. (2014) analyzed coping strategies at the end of life in 22 advanced cancer patients in an Israeli daycare oncology clinic. The interviews were transcribed verbatim and analyzed afterwards. Humor was described as one of the five applied coping strategies. One participant stated on the use of humor “maybe it helped me ease the burden Humor in Nursing Case Study Essay