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The Humor Quotient Newsletter
Vol. 11, No. 1 May, 2009
Assessment of Elder-Care Staff Humor Attitudes
With the last issue of HQN, we began a new series focused primarily on issues of humor in the health care setting, most particularly the elder-care setting. We reported specifically on a mental-humor assessment conducted at Lake Winona Manor (LWM) in Winona, Minnesota. based on responses to the cartoon half of the Humor Quotient Test, (HQT) from 36 residents of the manor, 30 of them women, in their eighth to tenth decades of life. The assessment also included an assessment of staff, a wide range of professionals from nurses to business office personnel, from activities directors and rehabilitation therapists to cooks and housekeepers.
In general, what was found was that residents—again mainly women residents—leaned very strongly to Sympathetic Pain (SP) humor with its typical emotion-thought sense of “That’s okay, friend, I know exactly how you feel.” Residents were much higher in SP response than were staff. Staff in this regard resembled their age cohort in humor preference, whereas residents resembled noninstitutionalized people in their late sixties and seventies but showed an even more pronounced interest in Sympathetic Pain.
It was also found, very dramatically and without the aid of statistical analysis, that very elderly residents face huge challenges in humor. Humor becomes hard work, humor that for college students, for example, seems simply delightful play. Nevertheless, despite the hard work, the elderly in our study had a strong desire to express their sense of humor and worked doggedly to complete the test. These are perhaps the most important findings in attempting to integrate more humor into nursing home situations.
On the basis of this assessment, ITCHS staff worked on a consulting basis with Chaplain William Flesch and other LWM staff to conduct various practical experiments using the results of the assessment to introduce more of the most appropriate kinds of humor into Lake Winona Manor with the least added work load for staff who after all are trained in specialties far away from those of a stand-up comedian.
Consultation with Lake Winona Manor led to an invitation to propose a session on the LWM humor assessment results at the 2009 Aging Services of Minnesota Institute, Changing Lives. Inclusion on the program of this Aging Services conference allowed ITCHS not only to share their findings with a large group of elder-care providers but also to conduct what may easily be the largest study of elder-care staff humor preferences ever undertaken. This issue of HQN takes a first look at these staff findings.
A Broader Survey of Elder-Care Staff
The Aging Services of Minnesota Institute is held in mid-winter at the Hyatt Hotel in downtown Minneapolis, typically drawing over 3,000 attendees. The conference has some of the features of a trade show and some of continuing education for licensure. It is hard to find parking within blocks despite an attached parking ramp, and predictably some of the men’s bathrooms have been temporarily redesignated as women’s rooms in light of the great gender disproportion of attendees. Like the industry itself, conferees represent many different specialty areas, many different education levels, and both in-home and in-residence care backgrounds.
The seminar on humor was attended by over 300 conferees, approaching one tenth of total registration. Included in the presentation on research done at Lake Winona Manor was the administration of the cartoon half of the HQT to these conferees, along with attitudinal surveys about humor as they experienced and understood it as health-care professionals. The testing session yielded 241 usable responses. The large number of respondents and the significant number of attitudinal questions asked as a side test are the basis for a great deal of in-depth analysis which we hope to report in HQN.
The session was introduced by Chaplain William Flesch, who then led an introductory segment seeking interactive feedback from participants about what their home institutions were already doing to introduce humor into elder care. Generally, it was clear from this interaction that we were preaching to the choir, that Minnesota’s elder-care providers have identified laughter’s and humor’s therapeutic importance and are actively engaged in experiments to make humor a reality in elder care. The range of experiments currently taking place in Minnesota elder care is a significant finding in itself and has already been reported in the “Humor and Aging” section of the ITCHS website (Participant Input).
In this HQN, we report on surprisingly unified humor attitudes among Minnesota elder-care providers. We asked nine humor attitude questions, and we were amazed at the regular pattern of response to all nine, crossing all specialty occupational lines and all lines of difference in educational background. This tremendous homogeneity of response is both a strength and a weakness. It is a strength in that health-care providers share amazingly similar attitudes about humor. It is a potential weakness to the extent that this homogeneity reveals blind spots in humor understanding that can perhaps lead to repeated mistakes in implementing a solid humor program.
The large database of 241 respondents allows us to run a great many tests of academic and practical interest about the relationship of humor to occupational specialties, education levels, and the like. We hope to report on these in subsequent HQN’s.
Characteristics of the Participants
It is probably reasonable to assume that the 300 attendees at the humor seminar were generally more favorable to humor and to humor’s inclusion in elder care than the average for all attendees at the conference. It is also reasonable to assume that the 300 attendees had a higher-than-average professional responsibility for inclusion of humor than other conferees. Conferees represented institutions from throughout Minnesota, though the metropolitan counties of Minnesota are now a substantial majority of the population, and their institutions had the most ready access to the convention.
Respondents reported their area of education typically as Health/Medical, though Administrative, Social Work, Psychology/Counseling, and Other were all represented.
Four levels of education were queried from High School through High School plus 2 years and Bachelor’s degree to Post Graduate. On this four point scale, the average response was 2.36 (between High School plus 2 years and Bachelor’s degree).
Five physical areas of work were queried, with most responses being “Nurse/care center.”
Most respondents indicated that their work was directly with residents or in-home patients rather than with staff or the public.
Participants were also asked about their general state of health. To the question, “I consider my health to be ___” on a five point scale from excellent (1) to poor (5), respondents averaged 1.8. Almost all considered themselves in excellent to good health, with a very occasional lower response.
To the question “Today I’m feeling ___” on a five-point scale from “perky” (1) to “dull” (5), respondents averaged 2.22. From our own attendance at conferences, we would have accepted as normal a considerably larger drop toward dull by the late afternoon of a heavy conference schedule.
Altogether then, we would characterize this respondent group as cheerful, quite buoyant, happy with their own state of health, and generally happily inquisitive going into the HQT.
Attitudes toward Humor
Participants given nine assertions about humor and asked to indicate their level of agreement as “strongly agree,” “agree,” “don't know,” “disagree,” or “strongly disagree.” In compiling the data, we coded levels of agreement on a scale of 1 to 5, with 1 representing “strongly agree” and 5 representing “strongly disagree.” Thus lower numbers represent agreement, higher numbers represent disagreement with the assertion.
To the idea “Laughter can improve people’s health,” on this five point scale from “strongly agree” to “strongly disagree,” respondents averaged 1.25, the most positive humor-attitude response we found. It should be noted that Chaplain Flesch had already reviewed established medical findings in this area. Nevertheless, it is clear that elder-care professionals coming into a discussion of humor were strongly convinced already of the therapeutic benefits of laughter.
To the idea “Some jokes are ‘sick’ and can hurt one’s health,” respondents averaged 2.35, thus somewhat favoring on average “agree” over “don’t know.” No evidence had been adduced in the seminar on this issue. It is interesting, however, that occasionally elder-care staff do object to specific jokes in the HQT as inappropriate for elder-care settings even though the jokes were chosen to be reasonably tame and uncontroversial. While ITCHS staff did not take a stand on this issue in the session, it is clear to us that we cannot assume that all humor is healthy humor for elder-care settings. The challenge, of course, is to establish principles for choice of healthy humor.
To the idea “I’d appreciate more humor in my work place,” respondents averaged 1.51. They averaged 1.39 in response to the idea “I look forward to a light, funny movie.” Both responses indicate a strong conviction that lightening up with humor is a good idea.
To the idea “Humor is often hurtful,’ respondents averaged 3.38, about half way between “don’t know” and “disagree.” This strikes us as ITCHS staff as remarkably unaware of the hurtfulness that can accompany humor, and it certainly is strongly at odds with respondents who then took professional offense at jokes that are by most definitions fairly tame. We suspect that the discrepancy here is somewhat accounted for by the fact that professionals as institutional representatives will often feel professional threats which as individuals they ignore. For example, what about a Far Side joke that features two bulls, one blowing up an inflatable heifer and the other exclaiming that the half-inflated rubber heifer is “looking good”? It is also possible that in answering the attitude survey, which participants did before taking the HQT, many participants assumed that the humor in question was, of course, “appropriate” humor and not “that kind” of humor. If we have already precluded “inappropriate” humor from discussion, we don’t’ have to consider it. Perhaps one of the great challenges in introducing humor in nursing homes is that the residents have been around the track a good deal more than once. But when they are now the objects of professional judgment, there may be many tensions over what humor is indeed appropriate and what humor is indeed hurtful.
To the idea “Humor at work gets me in trouble,” the respondent average was 3.59, between “don’t know” and “disagree.” Considering the group’s enthusiastically positive attitude toward humor, this respondent average strikes us as indicating very little confidence that humor won’t get you in trouble. Again, we suggest that professional considerations preclude a hearty sense that humor can be engaged in without danger in a professional setting.
To the idea “Humor makes things at work go more smoothly,” respondents averaged 1.54, about midway between “agree” and “strongly agree.” So while they weren’t that sure that humor wouldn’t get them in trouble, respondents were very confident that humor would make things go more smoothly at work. This tension between the desirability of humor and its possible professionally problematic practice is perhaps key to future improvements in humor use in elder-care settings.
To the idea “Humor at work slows things down,” respondents averaged 3.95, the second-highest disagreement to our attitudinal questions. For these participants, humor might have some risk, but it would make things go more smoothly and wouldn’t slow things down at work. This result also probably indicates that respondents did not see their attempts to include humor as sloughing off or as down time but rather as integral to the provision of quality care.
To the idea “Humor is usually used to put people down,” respondents had their highest average disagreement 4.14. This finding is of course strongly at odds with, say, the theory of Sigmund Freud that jokes always combine a wit worker and an authenticating audience against a butt of the joke and with aggression, hostility, and superiority theories of humor in general. The finding is then consistent with a sense that elder-care staff with responsibilities for introducing humor into elder-care situations are not aware of very negative senses of humor that have been well-studied and discussed in the academic community. From a practical perspective, we are not suggesting that staff need an education in hurtful, put-down humor. Rather, it appears that such humor is almost beneath the radar of humor discussion within the elder-care industry.
Unanimity and Positive Perceptions of Humor
Everything about the Aging Services Institute humor seminar thus suggests that the Minnesota elder-care industry is well aware of the relevance of humor to providing quality elder care. Experienced professionals are coming together to share practical experiments that have already succeeded in home institutions. And academic discussion of humor and reports of assessment in nursing home environments are treated with interest and respect. Moreover, industry professionals share very similar attitudes toward humor in general. It is very rare for the pattern of any individual’s responses to nine humor attitude questions to vary significantly from the pattern established overall for all 241 participants. And this is true whatever the individual participant’s education, educational level, work area, or occupational specialty. Sometimes, to those academically trained in humor issues, it may seem that this unanimity of opinion is a bit too sanguine about humor, a little naïve perhaps about some of the dangers involved in working with humor. But on the whole, the pattern of humor attitude responses is remarkably positive, unjaundiced, and hopeful for the future of healthy humor inclusion in quality elder care.
Paul and Robin Grawe
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