Donna Strickland Blog

Overcome Terminal Seriousness

LET GO, LAUGH, AND LIGHTEN UP!

This article examines physiological and psychological benefits of laughter and humor. These are essential tools that can successfully combat the stress and pressure of the preoperative environment. Used in tandem with ‘life balancing skills,’ they can enrich the work arena and help nurses rekindle passion and meaning in their lives.

Copyright © 1999 by W.B. Saunders Company

You turn a corner in the hall only to witness one of the most infamous, degrading, and most cliched scenes in the hospital: an arrogant, self-righteous surgeon is screaming at an OR nurse about something so ridiculous it would be laughable if it were not so infuriating. Your own blood pressure escalates as you walk by, but then something amazing happens. You hear the voice of your colleague, a genteel Southern woman, say in a slow Alabama drawl, “Pardon me for interrupting, doctor.” The neurosurgeon is so stunned by this audacious act that he stops screaming. The nurse then sheepishly crosses her legs and says in her most demure voice, “Excuse me. I’m so sorry; I’ve just got to go to the bathroom.” The nurse then walks off and leaves the physician standing in the hallway, frustrated and thwarted. After waiting about 5 minutes, the neurosurgeon realizes that the nurse is not coming back and that she never had to use the restroom in the first place. The best part is that the OR nurse won both the battle and the war. That neurosurgeon never, ever screamed at her again.

Most of the time, confrontations such as this result in both parties walking away angry, frustrated, and holding onto resentments that can hamper productivity and increase stress long after the initial incident is over. However, this clever, soft-spoken nurse in Birmingham was able to defuse the situation completely and get the outcome she needed. She made her point very effectively without ever getting drawn into a screaming match with the physician. Nor was she a victim. She did not passively accept this inappropriate tongue-lashing as part of the job. She made it abundantly dear to the surgeon that his behavior was unacceptable and she was not going to tolerate it. He got the message. The nurse handled the situation so artfully that she succeeded in permanently changing the surgeon’s behavior. All accomplished without raising her voice or her blood pressure!

GIVE STRESS A REST

The preoperative environment is one of the most stressful in all of nursing. The nature of the work requires a high degree of skill, perfectionism, rigidity, and precision. There is little or no margin for error. As a result, tension and stress can routinely be off the Richter scale. You have been there a hundred times when the whole place has gone mad. Chaos is everywhere: the procedure in Room 3 is running 20 minutes long; Rhonda, the scrub nurse in Room 2, has morning sickness and needs relief; your super-visor says you’re needed in Prep Room 2 for emergency surgery on a trauma patient who just arrived by helicopter. Regardless of your superhuman capabilities, these demands are absurd. You cannot possibly do everything that needs to be done.

You see the absurdity of the situation, and you can choose to get angry or you can get comical. Anger will net you a very long day made worse by wallowing in the misery of being overworked. You probably will go home and yell at your dog, or worse, take it out on your family members, who were excited to see you and welcome you home until you stormed into the house and slammed your purse on the kitchen counter. A humorous approach will lighten your mental load, if not the physical, reduce stress, engender a little camaraderie among the ~ and have you feeling a little invigorated at having survived such a ludicrous day.

In fact, the word humor comes from the Latin umor, meaning to be fluid and flexible; to flow like water. Using humor is a way of flowing with what is happening instead of resisting. It takes a lot less energy to go with the current than to push against it. Integral to being flexible is relinquishing control. That means taking the risk that you will appear foolish, that you will not have a tight hold on things. Being humorous and laughing gives you a chance to feel a little out of control in a safe and healthy manner. It is a chance to experiment. Laughter is the response to humor, which can be experienced in many ways. Cartoons, jokes, toys, costumes, situational absurdities, comic skits, witticisms, and pranks are all forms of humor. Humor is different for each of us because it has to do with a particular perception. What is funny to one person is not necessarily funny to another. However, giving yourself permission to laugh allows you to bend with the wind rather than break in resistance to it. The key to using humor successfully is to recognize and enjoy the comic aspects in the moment, instead of after the fact.

A nurse executive friend of mine recently came home from work after a long day. She pulled her family’s minivan into the garage, cognizant of the new and expensive custom-made bicycle parked at the front end of the garage. Not wanting to hit it, she carefully pulled in and slowed to a stop. She hopped out and pushed the remote to close the garage door. The garage door came crashing down on the van’s rear bumper. Being a very old garage door opener, it did not allow the door to bounce up. It stayed on the bumper, scratching the paint off, and in seconds the motor of the opener was smoking and grinding. There was no way to stop it but to get on top of the van and pull the plug.

My friend had her own smoke coming out of her ears as she climbed on top of the van, still dressed in her business suit and heels. Her precocious, almost-5-year-old daughter Claire had witnessed the situation and was compelled immediately to help. Claire dashed into the house, donned her swimming goggles, put tissue in her nostrils, grabbed her binoculars, and put on her mittens. She came rushing to the rescue. The binoculars, she said, would allow her to investigate what was wrong with the opener, and everything else was “for safety” in the face of smoke. One look at Claire and my friend was howling as she sat on top of the van looking very “UN-executive-like.” Claire’s comical attire and earnest heart completely changed the situation from disastrous to silly.

A plethora of research in recent years documents the benefits of using humor to relieve pain, reduce stress, and enhance wellness. Comedy carts with access to funny movies, comics, and books are becoming more commonplace in hospitals across the country. We have all heard the incredible account of how Norman Cousins used humor to cope with the painful and debilitating disease ankylosing spondylitis.1 The disease was so advanced that he could barely move his joints, and Cousins’ physician told him that recovery was unlikely. Cousins claimed that laughter was an integral part of his miraculous recovery. He also said that just 1.0 minutes of hilarity brought him 2 hours of pain-free sleep. A little humor goes a long way. Just think: 10 minutes of laughter in the workplace might provide 2 hours of stress-free work!

LAUGHTER: A SWEET PILL TO SWALLOW

If you thought laughter was a frivolous, superfluous nicety in your life, think again. Laughter is no lightweight; it weighs in with impressive physiological and psychological benefits that rival the gains of some medicines-with no co-payment or doctor visits required! The actual act of laughing is a complex process that puts your body in high gear for a time. Laughing stimulates your system in several ways. It:

  • Increases breathing. Laughing raises the breathing rate, increases the amount of oxygen circulating in the blood, and dears mucus from the lungs.
  • Stimulates and relaxes muscles. Laughing also provides limited muscle stimulation and relaxation. Even more impressive, it breaks the pain/ spasm cycle of some joint, limb, and muscle discomforts. A hearty laugh causes at least five major muscle groups (face, neck, shoulders, abdomen, and diaphragm) to begin rhythmic movement that stimulates those muscles and results in greater relaxation of all the muscle groups in your body. The laughter muscles relax after their stimulation, which can act to break up the pain/spasm cycle.
  • Elevating the heart rate. A good laugh temporarily increases the heart rate and blood pressure, enhances circulation, and increases the amount of oxygen delivered to cells throughout the body. The increase is directly proportional to how long and hard you laugh. When you finish laughing, your blood pressure and heart rate drop to lower levels than before laughing.2
  • Improves digestion. Laughing has been shown to improve digestion and may stimulate enzymes that act as natural laxatives.

You just have to love laughter. It has zero calories, no fat grams, and does not require expensive new running shoes every 6 months or the use of a treadmill! What else is this good, this cheap, and this easy? Check out this impressive statistic discovered by William Fry, Jr., a psychiatrist at Stanford Medical School. He claims that a measly 20 seconds of laughter provides the cardiovascular benefits of 3 minutes of strenuous rowing.3

Laughing is so good for your body that, among researchers, it has earned the nickname “inner jogging.” It stimulates the sympathetic nervous system, the pituitary gland, and hormones that reduce pain and inflammation. Your metabolism jumps, calories are consumed, and your entire system gets an adrenaline rush. It’s a “runner’s high” without ever having trotted out the door. If you already enjoy the benefits of regular exercise, you know how good that surge of endorphins feels.

For centuries, people have known intuitively that laughter is also good for the soul. In recent years, scientists have gotten serious about laughing and confirmed what has been taken as fact for generations. Jeffrey Goldstein, a psychologist at Temple University, has done research showing that laughter physiologically reduces stress, hypertension, depression, heart attacks, and strokes.4 Furthermore, the tears that are shed as part of a good laugh have the same chemical composition as those that are released when you have a good cry. In both cases, the tears carry away toxins and hormones manufactured during stress.

While the tears cried as part of a hearty laugh carry away stress hormones, the act of laughing actually inhibits stress in the first place. Study results reported in the American Journal of Medical Science stated that “the mirthful laughter experience appears to reduce serum levels of cortisol, dopa, epinephrine, and growth hormones. These biochemical changes have implications for the reversal of the neuroendocrine and classical stress hormone responses.”5 Scientists further theorize that laughing boosts the production of immune enhancers and also sup-presses the production of stress hormones that weaken immunity. Another study reported, “Since increased cortisol and epinephrine levels are immuno-suppressive, decreasing their levels may diminish the suppression of the respective immune components. We have reported that mirthful laughter increased the spontaneous lymphocyte blastogenesis and the natural killer cell activity.”6

Annette Goodheart, Ph.D., put it another way. She said that if you take stress, tension, or pain and add play to it, the result is either laughter or tears. In either case, laughter or tears result in a catharsis, which is an emotional movement that changes the neurochemistry for the better.

So use humor to eradicate overzealous stress hormones that seem to infiltrate the preoperative environment! Working in the preoperative area produces a chronic “flight-or-fight” response because of the severe conditions there: emergencies, tension, anxious families, scheduling dilemmas, more surgeries, managed care constraints, and the relentless necessity for precision. All of these factors can produce brutal levels of stress that can compromise nurses’ abilities to care for themselves. Immediate psychological and physical survival is paramount so the flight- or- fight mechanisms take over, whereas long-term health and human considerations vanish. Although these survival skills create top-notch preoperative nurses, they can diminish overall quality of life if there is no relief. The ability to lighten up, mitigate stress, and take a breather helps to improve long-term health and vitality. It can reshape a perspective that has been skewed by the unrelenting pressures of the preoperative environment.

When the OR Director of a hospital in the Midwest retired, she was replaced by an extremely rigid, controlling director. Her deadlines for tasks were unbelievably tight, and everything had to be done her way. She was closed to every suggestion her staff made. It did not take long for the staff to feel oppressed, angry, hostile, and stressed. A group of OR nurses requested a meeting with the new director to talk with her. They used humor effectively, speaking directly to their supervisor kindly and firmly. They told the director that they wanted to help her succeed, but when she tried to control everything, it made the nurses want to rebel. It made them want to sabotage her efforts. The director listened and made changes because she did not want to be ostracized. When the staff saw that the director was on their side, they brought in the song “Never Gonna Get It” and sang it to her as a joke when she asked them to do something that was too controlling. The director laughed, and the song became a “cue” that they sang every time the director got too controlling. It was a great strategy that worked for everyone. The director did not feel threatened, and the staff felt heard.

At another OR in the West, surgical teams get together a few minutes before surgery and sing and dance to their own theme songs. One group belts out “Girls Just want to Have Fun,” and another does a rendition of “Chicken in the Mood.” This brief ritual promotes a sense of cohesiveness among the team and reduces stress in the OIL They all are a little more relaxed and focused going into the procedure.

I was at a hospital recently where things got really tough. The staff was handling one crisis after another without a moment to rest in between. Suddenly, a nurse reached under the counter and pulled out the “martyr kit,” which consisted of sets of Velcro pieces. She gathered everyone together and expertly attached one Velcro piece to each nurse’s forehead and the other to the back of each person’s hand. Then they all struck a “woe is me” pose with hands to foreheads. Immediately, they burst into laughter, got a little silly, and went back to work with smiles. The beauty of the martyr kit is that everyone knows you are suffering and you do not even get tired while you are doing it. The Velcro does all the work, holding up the arm for you!

EVERYBODY’S A COMEDIAN . . . OR SHOULD BE

There are countless ways to inject humor into the workplace. You do not have to be a stand-up comedian to lighten up the environment. Stamp out terminal seriousness in ways that fit your own style. Humor is about perception, so keep in mind the nature of your relationship and the situation of the person you are about to regale with your wit. Avoid ethnic, gender, and negative humor. Remember, you do not have to be a prankster or quick with a joke to add levity and joy to the workplace.

Here are some ways you can lighten up:

  1. Create a humor bulletin board. Post funny cartoons, clippings, outrageous postcards sent from vacationing colleagues, or baby pictures of the staff. Shoot photos of work events and add funny captions.
  2. Ask for a standing ovation!
  3. Use kinesthetic movement-dance, give “high Ss,” make silly faces, make more silly faces.
  4. Give out rewards to employees who create humor that best reflects what’s happening at work.
  5. Serve ice cream, lollipops, or clown noses at the next staff party.
  6. Use props to stimulate creativity or change the mood when things get too serious. Pull out “Groucho glasses,” throw some rubber fish in the water cooler, hang posters, carry a magic wand, don a tiara.
  7. Have a party funded by negative people. Every time someone is caught being negative, she or he throws a dollar in the positive pot. Once a quarter, use the money for a party.
  8. Make sure “FUN” is at the top of the agenda at staff meetings. Start every meeting with a humorous or uplifting story, cartoon, or joke.
  9. Take at least 9-10 healing breaks (30 seconds to a minute each) to rejuvenate yourself.
  10. Acknowledge coworkers for good work or for just being there. Leave a Post-it note on their time cards or workspace that says, “It’s a joy working with you.” People need to hear from their peers and supervisors that they are doing a good job and that their presence matters.
  11. Surround yourself with funny pictures of yourself with friends and family members.
  12. Challenge another department to a “best joke” contest.
  13. Choose creativity over stress. Instead of concentrating on the crisis, step back and focus on the problem to better solve it. Moreover, look at the opportunity it creates and ask yourself, “What can I learn from this?”
  14. Whine out loud-better yet, do a group whine.
  15. Breathe.
  16. Place a mark on your body to show where you’ve had it up to today.
  17. Use signs, posters, and memos as environ-mental reminders to lighten up. for example, “You may know where you’re going. God may know where you’re going. Does your secretary know where you’re going?”
  18. Remember that you are not the Queen of the Universe. Taking yourself too seriously? Whip out the tiara; pull out the Viking helmet.
  19. Give out monthly awards for the most creative use of telephone time, late-to-work excuses, etc.
  20. Pretend that you’re in control.
  21. Answer a highly technical question in your best Donald Duck voice.
  22. Get a grip. Stress is positive or negative, depending on what you say to yourself about it.
  23. Organize a hum-a-long. It’s hard to feel stressed when you’re humming.
  24. Write a memo congratulating yourself for being so wonderful.
  25. Let go.
  26. Celebrate the end of each workday with a little ritual or ceremony.3

Humor is effective because it serves to reconnect us to ourselves, to people we care about, and to the Divine. If you want more spontaneity, more levity, more humor, you must attend to your life. You must clean up old, unresolved resentments and wounds that are lurking in the shadows of your life. Humor cannot be a successful strategy if there is too much unresolved conflict. In such a case, using humor is like putting a Band-Aid on an arterial bleed. Humor cannot bridge the gap created by unresolved tensions, misperceptions, and disagreements. Symptoms of unresolved conflict include apathy, low morale, the presence of cliques, customer complaints, absenteeism, anger, and in-creased errors at work. If people do not feel seen, heard, attended to, or understood, no amount of humor will rectify this. Humor erupts naturally when anxiety is low to moderate and there is trust. Humor backfires when anxiety is high.

Nor can humor overcome unresolved loss due to change. Loss can be dealt with effectively only by working through the stages of grief. When someone makes light of a heart-breaking loss, the person experiencing the loss only feels misunderstood and more alone.

THE PARADOX OF PERFECTION

The great paradox for preoperative nurses is that the skins that are essential for the job- precision, perfection, flawless execution, control, etc.-can be devastating in your personal life. As a rule, the rest of the world does not function like a successful and efficient operating room! The transition from the workplace to home can be a complicated maneuver because it involves loosening the reins a bit, surrendering some control, and smelling the roses along the way. Using humor in the workplace is a good start to melding the personal and the professional so that the transition between the two is smoother.

Perfection in the OR is rewarded with positive outcomes. Demanding perfection else-where is a recipe for disaster. If you have kids and light-colored carpet, you probably already know that. No matter how much you remind them, no matter how many rules you have about drinking, eating, and slipping off shoes, you know that carpet is going to get stained! The lesson for perfectionist adults is that the amount of suffering that each of us feels is, to some extent, related to the degree to which we try to control events and others. Trying to be the “master of the universe” is not only impossible, it will make you crazy. Instead, the goal is to achieve balance in our lives by having clarity about our own personal vision.

When we are clear about our vision, we can set a course to realize it If we are busy control-ling everything around us, there is no time to focus on obtaining our own goals. As difficult as it is, extricate yourself from distractions and energy-draining activities that take you away from creating the life you want. We nurses are famous for taking care of everyone but our-selves. I know because it has taken me years of practice to learn how to care for myself in the same devoted way I cared about my patients and my colleagues. I suggest that you step back and pretend you’re someone else and take care of that someone else! You can start by doing small things for yourself first and gradually working up to the bigger challenges. Here are some ideas to get you started:

  1. Slow down by adding the word “no” to your vocabulary. Saying “no” is a way of setting limits and imposing boundaries. If you find this a difficult task, start with small “no’s. Say, “No thanks” to things that you don’t want to do in the first place. Decline to chair a committee, turn down a dinner invitation that doesn’t sound fun, opt out of organizing the neighborhood garage sale. Gradually, learn to say “no” to things that are attractive, but leave you chronically busy.
  2. Create open spaces of down time so that you can restore. Hint: don’t fill up all those free moments that you just created by learning to say “no.” Get decadent; take a long bath by candlelight, drink lemonade and read a book at the park in the afternoon, take a nap, listen to some favorite music, talk to an old friend on the phone, go for coffee with someone you love.
  3. Let go of perfection. Yikes! This is a tough one. So, your checkbook is off by 6 ce0ts-does that change your long-term financial planning? Is 6 cents worth a 60-minute review of your entire check- book? You forgot the capers for the salmon-does that make the meal inedible? Save your quota of perfection for where it really counts- the OR.
  4. Make time for meals and eat a balanced diet. Stop the urge to eat on the run and savor the social experience of sharing a bite with family, friends, and colleagues. Give your body every advantage by choosing nutritious foods.
  5. Be gentle with yourself. There are no mistakes, only opportunities to learn. Those who can let themselves be “wrong” have higher self- esteem and lower stress levels.
  6. Live every day with intention. Do not wander aimlessly through your life as though it is just happening of its own accord. You are responsible for your life. Be judicious. Choose friends carefully. Make conscious choices. Recognize that every day is new with possibility; you get to choose how you live every moment.
  7. Help yourself. If you are regularly getting in your own way and getting on your own nerves, get help. Join a support group; find a therapist or counselor or employee assistance program to assist you in making the changes you need to live a full and meaningful life.
  8. Make humor a cornerstone of your life. Let go and laugh. It’s good for the body and the spirit.
  9. Humor does not make problems disappear, but it makes them easier to bear. Flexibility and resilience are essential in a world gone mad. The tonic for the high-speed, high-tech pace of health care and life in general is a steady infusion of humor, merrymaking, and laughter. The joke is on stress, shame, fear, and pain as mirth assuages what ails us all and gives us the strength to face tomorrow. My granny, Nola May-belle, said it best when she declared, “If you have no sense of humor, then you have no sense at all.”

REFERENCES

  1. Cousins N: Anatomy of an Illness: Reflections on Healing and Regeneration. New York, NY, Norton, 1979
  2. Laughter-Can it help keep you healthy?” Mayo Clinic Health Letter, March: 6, 1993
  3. Metcalf CW, Felible R: Lighten Up: Survival Skills for People Under Pressure. Reading, MA, Addison- Wesley, 1992, pp. 11-12
  4. Hafen B, Karren K: The Healing Power of Humor and Laughter: Mind/Body Health. Boston, MA, A1-lyn & Bacon, 1996, pp. 541-561
  5. Berk LS: Neuroendocrine and stress hormone changes during mirthful laughter. Am J Med Sci 298:390-396, 1989
  6. Berk LS, Tan SA, Fry WA, et al: Humor associated laughter decreases cortisol and increases spontaneous lymphocyte blastogenesis. Clin Res 36:435A, 1988

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