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
This is Part 4 – The Research – Part 3
Humour and laughter were pervasive and persistent in the palliative care setting. Ranging in intensity from warm subtleties to uproarious hilarity, they varied in expression from gentle remarks, witty expressions of incongruity, playfulness, dark humour, and the sharp edge of humour with a bite. In each circumstance, humour generated an outcome, ranging from a momentary flicker of a smile, to a small chuckle, or to uproarious laughter that energized and lightened the atmosphere. Humour served myriad functions. Among these multiple functions, three primary categories emerged: building relationships, contending with circumstances, and expressing sensibility.
The essence of humour is sensibility, warm, tender, fellow-feeling with all forms of existence.
Sensibility refers to the ability to appreciate and respond to complex emotional or aesthetic influences. This function refers to humour that conveys esteem for fellow human beings.
Terminal illness often results in circumstances where patients become dependent on others for care of a sensitive or personal nature. Humour some- times played a role in maintaining a sense of dignity in these situations.
As he deteriorated he really didn’t like to ask for help to be transferred from the commode to the bed… I went in there one day and I said “MayI have this dance, let’s see how you waltz?” … I got him up off the commode and over to the bed with a nice little waltz and I said “Thank you, you know that’s the best dance I ever had.” He had a big grin, and then the daughter started using that, “Can I have a dance Dad?” When he died they remembered it as having dances with dad. . . . The whole thing became a dance just from light- ening up just that little bit. . . .
Losing the ability to toilet oneself independently robs an individual of his or her sense of dignity. Humour served to soften this situation. The sense of life ending as a dance provided a warm and sweet metaphor that transformed the indignity of depen- dence into the beauty of the last dance.
Humour allows you to be a person to be able to connect, and that allows you then to move into those places and be genuinely caring … It’s the joking that I use to connect with everybody, and at a person-to-person level.
One family member reported that when staff took time to share humour with her husband and herself, she felt that meant they were seeing them as persons and not just part of the job to be done. Humour was a means of communicating regard for their human uniqueness. Similarly, several staff participants indicated that they used humour as a means of communicating to patients and families that they were also human beings and were open to relate at a more personal level.
I don’t want them to see me as being somebody so straightlaced and prim and proper and prudish, I want them to see me as a human being. Patients who responded in kind entered the “two way street” that acknowledged personhood, both of the caregiver and the cared-for.
Acknowledging personhood is critical in pallia- tive care, where the needs of the whole person are important and quality of life is the goal. The therapeutic relationship is predicated on communication that conveys regard for the individual. The significance of humour as a means of conveying that regard established its importance as a vital aspect of wholistic care.
Many staff were skilled at using humour and had developed perceptive strategies for assessing whether or not it was appropriate. Several participants identified the importance of relying on intuition but also articulated the importance of being attentive to cues such as expressions in the eyes, timing, and responses to gentle or innocuous lightheartedness. Peaks of emotion involving anger, fear, anxiety, and grief were identified as circumstances inappropriate for humour, as were situations where pain was intense. Circumstances where language barriers impeded communication inhibited humour. At the deathbed, staff did not use humour but noted that families often used gentle, loving humour focused on reminiscences of the loved one.
Keep reading in Part 5 …
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