Humour and laughter are present in most of human interaction. Interactions inhealth care settings are no exception. Palliative care practitioners know from experiencethat humour and laughter are common in palliative care despite the seriousness of the carecontext. Research establishing the significance of humor in care of the dying is limited
There has been great progress in palliative care in recent years. Clinical expertise has evolved through the learning of experience and an evergrowing body of research that has provided evidence for best practice. Humour and laughter are ubiquitous in palliative care, as in all human interaction. Research evidence supporting the significance of humour in care of the dying, however, is limited. The investigation of humour and laughter in an inpatient palliative care unit is tricky. In particular, the functions of humour was explored. These functions establish the use of humour as an important and valuable component of communication and compassionate care.
Humour “pervades all aspects of human behavior, thinking, and sociocultural reality, no culture has been found without it. Humour has been an object of intrigue for scholars throughout history. There is widespread agreement on its value in maintaining a sense of proportion and enhancing human relationships. Proponents advocating humour for its physiological benefits are increasingly popular despite a recent review which suggests that “attempts to promote the therapeutic use of humour for purposes of improving physical health are premature and unwarranted by the current research evidence”.
Although the positive effects of humour on physical health may not yet be firmly established, there is a wealth of evidence about the significance of humour in health care relationships. Research ranges from general studies of the social functions of humour in various settings to caregiver attitudes about humour and to more focused studies of humour in specific settings such as psychiatry, critical care and medical education.
Despite variability in settings and approaches, findings consistently identify the importance of humour as a means of enabling communication, fostering relationships, easing tension, and managing emotions. Although there is consistency in reporting humour’s positive attributes, many studies suggest that humour appreciation is subjective and that the context in which humour occurs is critical. Research frequently indicates that there are times when humour may be misunderstood or inappropriate. Chief among such circumstances are those involving crisis, serious discussion, and heights of anxiety.
In health care settings such as palliative care where terminal illness is the norm, circumstances of crisis, serious discussion, and heightened anxiety are commonplace. Although several studies indicate that patients in diverse circumstances used humour to introduce their concerns about death, there has been a paucity of research that specifically examines humour in the context of death and dying.
The purpose of the research was to examine the phenomena of humour and laughter in the context of palliative care, developing an extensive description of circumstances where humour and laughter ocurred, determining functions served by humour and laughter, and identifying circumstances where humour and laughter were experienced or observed as inappropriate or offensive. The focus of this article is limited to the functions of humour and laughter in the setting.
The research method was clinical ethnography. Clinical ethnography relies heavily on fieldwork and observation in the cultural context of a health care setting, with the goal of examining the human experience of illness or of caregiving in an interpersonal context. Emphasis is placed on the subjective experience and communication and interaction for both patients and caregivers. Clinical ethnography was selected because of its emphasis on fieldwork and observation. Extended periods of observation were necessary to capture humour’s individualistic, variable, and often elusive nature. Observational data were supported by informal interviews with patients and families, and semistructured interviews with members of the health care team. Ethical approval for the study was granted through the Ethical Review Board and the Institutional Access committee. Fieldwork involved over 200 hours spent accompanying six nurses for all of their daily activities on a 30-bed inpatient palliative care unit. Informal interviews occurred in the context of interactions with staff, patients, and families over the course of the fieldwork. De- tailed fieldnotes were developed with the help of cryptic pocket notes following each observational period. Interviews with representatives from nursing, medicine, social work, and physiotherapy were conducted outside of the research setting in the latter weeks of the study. Interviews were tape recorded and transcribed verbatim. Analysis of the data generated categories that were later collapsed into overarching themes that gave meaning to the findings.
Keep reading in Part 2……..
Part 1 – Introduction, background & Methods
Part 2 – The reseach, Part 1 – Building Relationships
Part 3 – The reseach, Part 2 – Contending with Circumstances
Part 4 – The reseach, Part 3 – Expressing Sensibility
Part 5 – Discussion