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Humour in healthcare interactions

Humour in healthcare interactions. Dr May McCreaddie Senior Lecturer University of Stirling. Outline of presentation. Introduction to humour Briefly - previous research This research: why it’s different Findings Findings specific to sexual health. Why humour?.

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Humour in healthcare interactions

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  1. Humour in healthcare interactions Dr May McCreaddie Senior Lecturer University of Stirling

  2. Outline of presentation • Introduction to humour • Briefly - previous research • This research: why it’s different • Findings • Findings specific to sexual health

  3. Why humour? • Integral to how we express ourselves, specifically interact with others (communication) • Caring - humanity • Personal experience of humour in: -nursing (patients, peers) -teaching -stand-up comedy

  4. Introduction to humour • ?Stable expression of personality in humans (Foot and McCreaddie 2006) • Humour theories (superiority, incongruity, release) • International Society for Humour Studies (ISHS) • Applied or rehearsed humour e.g. jokes, cartoons, laughter therapy • Spontaneous humour: social e.g. natural, ‘real-world’, healthcare

  5. Previous humour health research • Humour-health hypothesis direct(physiological and emotional mechanisms) indirect(moderate adverse events e.g. stress,coping interpersonal skills/social support) • Rehearsed humour not spontaneous • Methodology healthy, scales, correlational, labs • Positive focus ‘positive psychology’ • ?Nursing ‘exclusion zones’ (McCreaddie and Wiggins 2008)

  6. This study Focus Spontaneous humour in situated interactions and contexts Method Constructivist Grounded Theory approach (Charmaz 2006, Strauss and Corbin 1998) Main problem Humour definition or interpretation?

  7. Humour, laughter…both?What exactly is it I’m looking for and how will I know when I’ve found it….?

  8. Definitions, delimitations and analysis How do you ‘know’ what is humour and what it is not? • What is known (interpret and illustrate) • Humour theories (superiority, incongruity, relief) • Humour support (Hay 2001) • Jefferson lite system (Sacks et al 1974) • What is unknown (open and broad) • Humour may have different or unusual presentations particularly in the settings under study • Broader social context (Martin 2005)

  9. Analysing humour in healthcare interactions What is known Interpretative and • 3 main humour theories (superiority, incongruity, release) • Humour support (Hay 2001) Illustrative framework • Audible laughter, smile, breaths, text (Jefferson 1972) What is unknown • Context: social, emotional, physiological etc e.g. antecedents (adapt: Martin 2005)

  10. Data (18 months) Non-researcher provoked data • 20 audiotaped CNS-patient interactions from 12 CNSs • 10.5 hours of field note observations: the negative case • 1 field note observation of a focus group (Stroke Group) Researcher-provoked data • 20 Pre and post CNS-patient interactions diaries (CNSs only) • 2 Audio-taped interviews: non-consent (CNSs ) • 2 Audio-taped follow-up interviews (CNS plus patient) • 2 Field note follow-up interviews (CNSs) • 3 Audio-taped patient focus groups • (Lung cancer, Breast Cancer, Prostate Cancer)

  11. Findings • In seeking to establish and maintain a meaningful and therapeutic interaction with the CNS, patients enact a good patient persona to varying degrees according to the situated context. • The good patient persona needs to be maintained and is reconciled with potentially problematic and non-problematic humour. • Humour is therefore used to deferentially package concerns (potentially problematic) or affiliate (potentially non-problematic) • The middle-range theory presented differentiates potentially problematic humour from non-problematic humour and suggests that how humour is identified is central to whether patients’ concerns are addressed or not.

  12. The Good Patient (core category) • Compliant - concordance • Sycophantic - superlatives • Positive - coping • Independent - not dependent • Displaced concern - for others, not self Good patient persona reconciled with Potentially problematic Potentially non-problematic Deferentially packaged concerns Affiliative (SDH, Gallows) (Incongruity) (McCreaddie and Wiggins 2009)

  13. Humour: general • Asymmetry (initiation and reciprocation) • Non-recognition of humour (CNSs) • Simple interpretation e.g. ‘nerves’ or ‘positive’ • Different humour ‘preferences’ • CNSs: Superiority, incongruity, Gallows, SDH • Patients: SDH, Gallows/release, incongruity, Superiority

  14. Sexual Health, Drug use, Disenfranchised groups • ?Bad patients (Manos and Braun 2006) e.g. difficult to engage in health services (Bidordinova 2002) • Not ‘good patients’: compliant, positive, sycophantic etc..

  15. Heather: the negative case • A case that contradicts emerging findings • Heather: • Aware of humour use (without prompting) • Initiated humour use as an engagement strategy • Noted some humour exclusion zones • Noted that patients rarely initiated humour (Mays and Pope 2000, Lincoln and Guba 1985)

  16. Data (18 months) Non-researcher provoked data • 10.5 hours of field note observations: the negative case Researcher-provoked data • 90 minute follow-up interview Participants; 1 CNS (sexual and reproductive health work with drug users), 1 midwife plus assorted others; doctor, SW, HV, drug workers

  17. Harsh humour; a coarse and candid discourse • A kind of superiority humour (sarcasm) • Topic: A particular target of abuse common to the participants (e.g. drug use, sex, men) • How humour was posited/proferred: upfront, frank, no encoding, unsubtle • Using violent, coarse, profane terms

  18. Harsh Humour • Humour that is unpleasant and exacting to the point of being cruel in action but not necessarily in effect.

  19. Excerpt 2A Field Note Jean: 37 years old, ex-IDU, 8th pregnancy, history of violence • 1. Kay (to telephone) • right , I’ll need to go. £Jean’s finally turned up!£ • 2 → (smiles at Jean who smiles back, daughter laughs) • 3 Heather (brings bulky case note file over onto desk) • 4. → Look at these, they’re like war and peace! • 5 Kay (pointing at case notes) • 6 Who’s writing’s that? That’s the biggest writing ever, • 7 → for f…’s sake (she looks at Jean who laughs) • 8. Kay you’re on baby 8 is that right?! (eyes widen) • 9.→ Jean .hha. Aye. • 10 Heather (who is out of sight in cupboard) • 11 → Well we’ll need to find what’s causing it!! • 12 (comes out, raises eyebrows and looks directly at me and • 13 Jean’s daughter who laughs, Jean smiles)

  20. Excerpt 2B: Jean • 1 Kay This isn’t a new thing that you don’t keep • 3 ante-natal appointments. • 3→ Jean Naw .hha • 4→ Kay Good. £I’m not offended then!£

  21. Excerpt 2C: jean – request for mobile • 1→ Kay (pointing) £just so I can track you down£ (writing) • 2 What about the Health Visitor, does she shout at you? • 3→ Jean Never seen her! hah

  22. Excerpt 2D: Jean Question on Drug history? Answer – ‘Speed’. 1→ Heather Ah’m no surprised. A’hd be on speed with 7 kids!! Hah 2 Kay (What about your partner?) 3 Jean (appears to hesitate then) Dope 4→ Kay Aye, him and the rest of Scotland. (Jean smiles)

  23. Harsh humour: staff • 1 You’ll get ones, you know in front of the male patients ”I need to see • 2 → you because I’ve got a discharge that would kill a horse.” • 3 (laughter on tape) • 4 → We’ll discuss that later maybe ( ) but not over the macaroni cheese • 5 Int: .hh oh no! • 6 .hah

  24. Conclusion: negative case • Humour can be used effectively to engage with difficult to reach groups • Does this type of work attract a specific kind of health worker with particular humour? E.g. hedonists • Irony: bad patients get engagement good patients want • Caution: ?advocating similar uses in other settings

  25. Implications Healthcare professionals/workers should take humour seriously: • an awareness of (spontaneous) humour in healthcare interactions • an understanding of humour use (problematic or non-problematic) • consider the appropriate reciprocation and initiation • look out for the good patient persona/engage with the bad patient • carry out further research (longitudinal) • consider the benefits of using naturally occurring data in research/GTM

  26. Life does not cease to be funny when people die any more than it ceases to be serious when people laugh…. George Bernard Shaw

  27. References/outputs for study (1) McCreaddie, M. (2008). Reconciling the good patient persona with problematic and non-problematic humour: a grounded theory. University of Strathclyde : Strathclyde McCreaddie, M. (2010) Harsh humour: a therapeutic discourse, Health and Social Care in the Community 18(6), 633–642 Foot, H., McCreaddie M. (2006) Humour and Laughter, Chapter 10 pp 293 -322In. Hargie O. (ed) Communication skill in theory and practice. Routledge : London McCreaddie, M., Payne, S, Froggatt, K. (2010) Ensnared by positivity: a constructivist perspective on ‘being positive’ in cancer care. European Journal of Oncology Nursing, 14 283 - 290

  28. References/outputs (2) McCreaddie, M. (2010) Being serious about humour in healthcare. AIDS and Hepatitis Digest. No. 136, March 2010 1 - 5 McCreaddie, M., Payne, S. (2010) Evolving Grounded Theory Methodology: towards a discursive approach. International Journal of Nursing Studies, (47) 781–793 McCreaddie, M., Wiggins, S. (2009) Reconciling the good patient persona with problematic and non-problematic humour: a grounded theoryInternational Journal of Nursing Studies, 46 (8) 1071 - 1091 McCreaddie, M., Wiggins, S. (2008) The purpose and function of humour in health, healthcare and nursing: a narrative review Journal of Advanced Nursing. 61 (6) 584 - 595

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