First You Make Them Laugh: How Humor Helps Patients Establish Relationships

First impressions really matter. The first few moments we spend with someone can set the tone for everything that follows. Yet many times, getting off on the right foot with a new patient is very difficult. We’re meeting them at what may be one of the worst times in their lives, when they’re scared and overwhelmed, in an unfamiliar situation and not feeling their best.

It gets even better! The relationship our patients have with us – as nurses, as part of their treatment team, even as part of the facility we work for – is qualitatively unlike any other relationship they may have. While our patients may actively seek out and enjoy the company of their family, co-workers, neighbors and others, our company is not something they were looking for.

Meanwhile, patients are becoming increasingly familiar with the team approach to health care. They know they get better treatment if they work with us, rather than against us — or at least some of them know this! This can be awkward, because they’re forced into a position of establishing a relationship that in their heart of hearts, they really don’t want to have to have.

More experienced patients know that on-going treatment creates an almost continual requirement to establish new relationships: each day can bring a new doctor, a new PA, and most especially, new nurses. This constant exposure to new health professionals is a stressor in and of itself; a stressor that many patients find more taxing than even the most rigorous treatments.

So where does that leave us? It leaves us with patients who are nervous, who are anxious, and who are often resentful that they’re even in our presence. They’re angry and overwhelmed, and now they have to start yet another relationship with yet another health care provider…can we add some frustration to the mix?

It’s these nervous, scared, angry patients we need to connect with. In order to provide treatment — and more often than not, education and emotional support — we must move past a seemingly insurmountable wall of resistance, all while providing care in a very compressed time frame. Humor, along with empathy and compassion, perhaps the very best tool we have at our disposal.

Nurses Using Humor

As nurses, we know that the strength of the relationship we have with our patients has a direct and positive impact on the effectiveness of treatment. With that in mind, we can use humor right from the first moments with our patients. Humor allows social barriers to drop very quickly — nothing bonds a people as rapidly as sharing a laugh.

Dropping social barriers is good, because social barriers are one of the primary impediments to effective communication. The use of humor between patients and nurses creates a route around those barriers, and makes it easier for patients to discuss difficult issues.

At the same time barriers are being eliminated, bonds are being created. By introducing humor, you’re adding an element of humanity back into what patients see as a de-human, de-humanizing environment. It’s a tangible demonstration of care and concern, above and beyond what the patient expects the nurse to provide.

When using humor to help establish a new relationship, it’s important to keep in mind that the humor used must be therapeutic humor. Therapeutic humor encompasses a wide range of scenarios, from an expression of the absurdity of the situation, a commentary on the conditions you’re both working in at the moment, or using limited self-disclosure to reveal common experiences with your patients. The goal of therapeutic humor is to use humor as a complementary treatment of illness to facilitate healing or coping, whether physical, emotional, cognitive, social or spiritual.

Often, there’s a great deal of education to be done with new patients. They don’t know or understand what’s happening to them — or, more often, their understanding is based in some less-than-reliable sources: family and friends, or late night sessions poring over the message boards on WebMd.

As nurses, we need a way to convey critical information that doesn’t alienate patients who don’t want to be ‘talked down to’. Humor often works well here. As an added benefit, humor makes information memorable: by and large, we’ll remember what makes us laugh far longer than random bits of data we’re supposed to know.

Patients are more likely to engage with and actually read information they find humorous: that’s why increasing numbers of facilities are using cartoons on their discharge instructions. Admittedly, the humor here isn’t side-slapping, fall down on the floor and cry funny, but it will provoke a smile or two. Better yet, patients will actually read the information — a marked improvement from the usual state of affairs.

Patients Using Humor

As nurses, we need to be aware of and responsive to our patient’s attempts to use humor while establishing a relationship. This can be tricky — not every joke is a good one, after all, and many come disguised as odd or even inappropriate comments.

Listening to and assessing a patient’s humor is critical because humor may be the only way the patient feels safe expressing themselves. Anxiety, fear, nervousness, and tension aren’t generally socially acceptable emotions: many people only express them in environments where they feel safe — with family members or close friends. However, in an environment where the patient finds themselves devoid of that safety net, humor may be the only way the patient feels capable of processing those emotions.

In some cultures, it is almost taboo to discuss one’s own pain or suffering. These patients may feel incredibly uncomfortable discussing how they’re feeling, and want to avoid drawing attention to their condition. Patients may use humor in these situations to deflect what’s ‘really’ happening: it’s far more acceptable to make someone laugh than to let someone — even the nurse! — know they’re feeling pain.

Conclusion

Sometimes the only thing we can do is laugh. The beginning of a relationship is a delicate time, yet often, in the go-go-go atmosphere we work in, we don’t have time for delicacy. To save time and import critical information, humor may be the best tool that we have as nurses.

While humor may be our best tool, it may be our patient’s ONLY tool. Those jokes and awkward laughs can mask a lot of emotion: anxiety, fear, and a lack of understanding. Being aware of the message behind the giggles can help us communicate more effectively with our patients and help them receive the care they need.