Karyn Buxman

Catching Up With Karyn

Archive for April, 2011

Understanding Why Patients Use Humor When They Talk To Nurses

I work in a neurologist’s office. We try to get really complete histories from every new patient but the patient I was working with, Mr. K, hadn’t checked anything on his intake paperwork. No history of heart disease, no high blood pressure, no cancer scares – not a thing. That’s so rare among our patients (Average Age 78!) that I had to ask him about it.

“Medical history?” He shrugged. “Can’t say there’s much. Of course, I’ve had amnesia as long as I can remember.”

This little grin pushed up the corners of Mr. K’s mouth, and his eyes suddenly started twinkling. I burst out laughing, and so did he. It turns out he did have a little bit of medical history, and he shared that with me after our laugh.

I was dropping off the file when one of the other nurses stopped me. “What was going on in there?”

I shared Mr. K’s joke. “I hate it when they try to be funny,” she said, rolling her eyes. “But they always feel like they have to.”

While I didn’t share my colleagues’ disdain for a quick quip, I did have to agree that there are some patients who seem to constantly be cracking jokes, making puns, or even doing impressions – one of my favorite patients does a Betty White you wouldn’t believe! – whatever it takes to make the nurse laugh. The question is: Why? Why do patients try to make the nurses laugh?

Reasons Patients Try To Make Nurses Laugh

Humor is a powerful social tool. We draw on the ability to laugh, and to make others laugh, in a number of situations. This is especially true when we’re in a place where we’re not exactly sure of ourselves. It’s important to remember that while we, as nurses, are relatively comfortable and at ease in the medical setting, that’s not necessarily true for our patients. The use of humor by patients allows them to:

Maintain Control

Being a patient means surrendering a lot of personal autonomy, at least temporarily. You’re told where to sit, what to wear, and to gracefully comply with being stuck, poked, and prodded. There’s an uneven power dynamic at play, even in the most aware therapeutic environments. This can make patients uncomfortable. Using humor is a way to exert some personal control in a situation where the patient feels relatively powerless. When Mr. K joked with me, he briefly stopped and changed the rhythm of what had been a fairly routine intake. For that moment, he was in charge.

Alleviate Anxiety

Humor has the power to comfort. Laughter can distract us from the fear we’re feeling. Patients can experience anxiety at any number of points through their time with us, and while we might more intuitively understand that anxiety at certain times – shortly before surgery, for example – the anxiety is equally as powerful w hen it’s triggered by something we perceive as unremarkable. No one really enjoys feeling anxious. Patients use humor in an effort to alleviate those feelings – and as the nurse, we’re the first, best, and often only audience available.

Establish A Bond

One of the first things we learn in this world is that life is easier for us if the people who surround us, especially those people who we’re dependent on them to any degree, like us. We tend to like the people who make us laugh – and our patients know this. Using humor creates a route for a patient to establish a bond with their nurse, creating alliances through the power of laughter.

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My Pain is Not Like Your Pain!

How many times, for example, have you had a patient report Level 14 Pain – when you can get them to take a break from the animated conversation they’re having on one phone and text-fest they’re having on another? That patient is almost inevitably followed by a seriously injured person who protests that they’re “Just fine – can I go home now?” Talking them into having at least a few stitches to keep their innards in the usual places is a job in and of itself.

Humor To Help Keep Perspective

Tragedy is when I cut my finger.  Comedy is when you fall into an open sewer and die.

Mel Brooks My Pain is Not Like Your Pain! made a critical point with this quote. It’s far easier to find humor in the things that happen to other people than it is to laugh at our own circumstances. Humor experts caution us to keep that in mind, both when we want to laugh at someone else’s situation and when people laugh at ours. Anyone of us could slip in a Pool of Unspecified Origin while en route to the call light – hats off to the nurse who can get up laughing!

Sometimes the humor in a situation is immediately apparent to everyone around us, but we, ourselves, are having a hard time finding the funny. Other emotions – embarrassment, irritation, chargrin – are taking up all of our mental energy.  Given time, however, when those emotions fade away and you have a fresh perspective, things can be funny in retrospect.

It can take a while to get to that perspective.  There was one spectacular mishap in the mid 80′s that I’m still trying to find the funny on…but that’s a story for another time.

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How Humor Helps: Pediatric Patients

“You either love working peds or you don’t work peds.” I can’t tell you how many times I’ve heard this nursing ‘wisdom.’ There’s more than a grain of truth to it: generally nurses who specialize in pediatrics tend to love their work passionately.

However, enjoying what you do doesn’t mean that you don’t have challenges on the job – and if you’ve never attempted to make a bed with one hand, while holding a baby in the other and figuring out dosages by weight in your mind, you don’t know challenging! (And if you can master that, try finding scrubs that don’t show formula stains!)

Luckily, humor can help ease some of the challenges of pediatric nursing. Here are three ways humor helps make life with pediatric patients easier:

Humor Help Make The Medical Environment Less Frightening For Our Patients

“Can you make my nose stop running?” Tyler looked up, wide eyed. “Because I’m tired of boogers.” The poor kid was sixty-nine hours into a twenty-four hour bug that had been going around town, and looked it. Being stuck in an ER that was busier than usual – and that’s pretty busy in this part of the city – hadn’t made things any better for the little guy.

“Sure! All you’ve got to do is stick out your foot and trip it!” I demonstrated the technique with a little of my own slapstick style. Tyler burst out laughing. “No problem!”

The hospital isn’t a lot of fun for anyone. Humor is one of the quickest and easiest ways to introduce a note of normalcy into unfamiliar surroundings. A chance to laugh is a welcome respite from tests, waiting rooms, and the sense that something’s wrong. A little humor goes a long way: it’s important to keep things from getting too silly, unless you wind up with a patient who’s not going to listen no matter what you say. Experience levels – both you and your patient’s – can go a long way in helping you find the right balance between silly and serious.

Humor Helps Put Parents At Ease

“You can just put that needle down!” Six year old MattieAnne shook her finger at me with all the authority only a first grader can manage. She thrust a paper in my face. “I already drawed my blood!” There on the paper was a carefully crayoned image of a syringe, filled with red ‘blood’. “So get out of here!”

MattieAnne’s mother looked at me, and I looked at her. We burst out laughing, just in time to cover up the quick flash of tears we were both struggling with. The tension in the room melted away: all of a sudden Mom and I were on the same side. “I wish it worked that way, honey,” Mom said, giving her daughter a squeeze. “I really, really do.” It was the quickest stick I’ve ever managed, thankfully.

Parents are in a complex emotional place when we see them. Depending on the circumstance – which can range from the most routine well child visit to the hushed tension of the intensive care unit – we’re faced with people who feel fear, judged, intimidated, angry, or some combination thereof. The medical setting can cause anxiety in and of itself, and then you have to factor in the other pressures – financial, logistic, and familial – that those parents are under. It’s no wonder that many parents are on edge, sometimes to the point where we see aggressive and combative behavior from the very people we’re there to help. Humor can help nurse and parent find a place where they’re more alike than not. Establishing a common point of connection reduces parent anxiety and makes them more comfortable about what’s happening with their child. Anytime the parent feels calmer and more at ease, there’s a benefit to the child, who has less stress in the healing environment.

Humor Helps Put Us At Ease

“Did I make it eight seconds?” Ronnie was the biggest nurse that worked in our pediatric practice and even she couldn’t compete with Mitchell, a very determined two year old who was needed immunizations. Mitchell wasn’t having any of it and put on a performance worthy of any bucking bronco. We wound up winning that rodeo – but it took Ronnie’s good humor and ability to hang in there that made it happen.

It doesn’t matter how long you’ve been working in pediatrics, there are going to be kids that you just can’t connect with. There may be back story involved: children who have had traumatic medical histories, for example, aren’t going to welcome the sight of anyone in scrubs with open arms. You get wary watchfulness at best, outright screaming from the moment the door opens and full-body flailing at worst. Humor helps us remember that even though we may doing our best as nurses, there are things that are beyond our capacity to change. We laugh and move on…at least until the next rodeo!

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