Patty Wooten presents ...

A few years ago I became curious about whether the humor training workshop I was teaching had any measurable or lasting effect. More specifically, I wanted to know if the workshop experience could decrease symptoms of burnout. I decided to do a formal research project to look into this and to present the results of that research at the 8th International Conference on Humor in England during the summer of 1990.

Introduction

Increasing attention has been focused on investigating job stress and its consequences among nurses. In the United States today there is a severe nursing shortage in the acute care setting. Enrollment into nursing education programs has also dramatically decreased. Investigators have documented a number of major job stressors that nurses typically encounter, including emotional demands of patients, inadequate staffing, work overload and death. One potentially negative consequence of chronic exposure to such job stressors which has also received increasing attention is burnout (Keane & Ducette), (McCranie & Lambert). Burnout is defined as "a syndrome of emotional exhaustion and cynicism that occurs frequently among individuals who do 'people work' of some kind" (Maslach & Jackson).

A review of the literature on burnout reveals considerable agreement about the effects of this condition, but considerable disagreement about its cause. One theme that is becoming more prominent in the literature is the idea that a causative factor in burnout is a sense of powerlessness. This link between burnout and powerlessness is consistent with several earlier lines of research (Seligmen, 1967; Rotter 1966; Kobassa & Maddi, 1983, 1984). While powerlessness is surely not the only cause of burnout, it is a reasonable hypothesis that it is one of the most important contributing factors.

Assessing a person's belief about the source of control in their lives can reflect their sense of powerlessness. Locus of control can be either internal or external. An internal locus of control refers to the tendency to believe and act as if one can influence the course of events rather than feeling helpless when confronted with adversity. External locus of control implies the belief that sources outside of our influence are responsible for determining the outcome of events in our lives.

The workshop I created and have been presenting for the last five years is called "Jest for the Health of It." It has been presented to over 50,000 health professionals (primarily nurses) in 42 states. During this workshop, the health professional receives permission, validation and techniques for the use of humor with patients and coworkers. The presentation includes didactic lectures about humor theory, a review of recent physiological research and a discussion of the psychological benefits of using humor for both the patient, the nurse and the health care team. In addition there is small group exploration of beliefs, blocks and experiences of humor on the job.

Hypotheses for this research include:

• Does this humor training workshop change the locus of control from external to internal?
• Does this workshop change the appreciation of humor in life?
• Does this workshop change the recognition of humor in situations?
• Does this workshop change the use of humor to cope with stressful events?

Method

Sample:

The target population for this study consisted of health care professionals (N=231) from Pennsylvania, Kentucky and California. Of this group, 58 were in a control group for which no intervention of humor training was provided. Only 89 participants from the experimental group responded to the follow-up survey and 46 participants of the control group.

Instruments:

Locus of control was measured by using the Adult Nowicki-Strickland Scale (Nowicki, 1976). This is a 40 question survey requiring Yes or No responses and has proven validity and reliability studies. Recognition and appreciation of humor was measured using Svebak's Sense of Humor Questionnaire (Svebak, 1974). This is a 21 question survey rated using a 4 point Likert scale. The "Liking" and "Metamessage" subscales have been proven to be valid and reliable, the "Emotional Expressiveness" subscale has not proven reliable so it was not evaluated although it was administered. Use of humor to cope with stressful events was measured using Lefcourt's Coping Humor Scale (Lefcourt, 1986). This is a 7 question survey rated on a 4 point Likert scale and has proven validity and reliability studies.

Administration:

The experimental group were individuals who had preregistered to take the "Jest for the Health of It" humor workshop sponsored by a local community hospital. During the thirty minutes prior to starting the class, participants were asked to voluntarily complete a research survey. These were collected before the class started. The survey cover letter stated that an identical follow-up questionnaire would be mailed in 6 weeks.

Since the experimental group was somewhat preselected due to their existing interest in taking a humor workshop, it was determined that a control group would be necessary to adequately evaluate the effectiveness of the humor workshop. The control group consisted of nurses who worked at a small community hospital. They were contacted at work and asked to voluntarily complete the survey. Assistance with their responsibilities was provided during the 15 minute completion time required. The control group was again contacted at work 6 weeks later for the follow-up survey.

Results and Statistical Analysis

Examination of the data for changes in locus of control was accomplished using non parametric methods. Using the Wilcoxon Matched Pairs Signed-Ranks Test, we found that there was a significant decrease in the measure for external locus of control in the experimental group with a 2 -tailed P value of .0063 and a Z of -2.7316. Using the same analysis for the control group, we found no significant change. We also examined the potential difference in initial locus of control scores between the experimental and the control groups using the Mann-Whitney U and the Kolmogorov-Smirnov tests and found no significant differences in the two groups.

Analyzing the change in appreciation of humor, we found a slight increase in the Liking of humor in the follow-up experimental group approaching significance with a Wilcoxon (MP, S-R) 2 -tailed P value of .0579. We also found a significant difference in the appreciation of humor score between the initial control group and the initial experimental group. The control group was higher initially but did not change significantly with the follow-up survey. Looking at the changes in recognition of humor in situations, we found that the experimental group actually scored significantly lower during the follow-up survey with a Wilcoxon (M -P, S -R) 2 -tailed P score of .0035 and 2 of -2.9228. The control group also decreased their scores for recognition of humor during follow-up survey with a Wilcoxon (M-P, S-R) 2-tailed P score of .0035 and Z of -2.9228. The control group also decreased their scores for recognition of humor during follow-up, however it was not statistically significant. Using these same nonparametric procedures to analyze difference in Coping Humor scores we found no significant changes in either group or differences between groups on the initial survey. On a more humorous note (that's what jocularity is all about, isn't it?) remember that statistics are like bikinis . . . they reveal what's interesting and conceal what's vital.

Discussion

This study was designed to answer four questions.

• Does a humor training workshop change the locus of control (and therefore affect the sense of powerlessness)?
• Does a workshop change the appreciation of humor in life?
• Does a workshop change the recognition of humor in situations?
• Will a humor training workshop affect an individual's ability to use humor to cope in a stressful situation?

This study has shown that when a humor training workshop provides permission to use humor, validation of the importance for humor in health care, and some techniques and examples for appropriate use of humor in the clinical setting; it is possible to affect the caregivers sense of power and control, and to enhance their appreciation of humor.

We have again, more scientific evidence that appreciating, developing, and using your sense of humor can eliminate some of the symptoms of burnout.

Sharing amusing anecdotes or stories about nursing experiences with coworkers can effectively help us to overcome the potential threat of professional burnout.

Next issue we will ask our readers to complete a survey which will analyze their attitudes, preferences and use of humor on the job. Please offer your comments, desires or concerns about developing and implementing humor techniques at work. Results will be analyzed and published in a future issue.

Bibliography

• Keane, A., et.al.
  "Stress in ICU and non ICU Nurses". Nursing Research, 1985, Vol.34, No.4, pp.231-236.

• Kobassa, S.C., et.al.
  "Personality and social resources in stress resistance". Journal of Personality and Social Psychology, 1983, Vol.45, pp.839.

• Kobassa, S.C., Maddi, S.R.,
  The Hardy Executive: Health and Stress. Dow-Jones Irwin Publishers, Homewood, Illinois, 1984.

• Lefcourt, H.M.
  Locus of Control: Current Trends in Theory and Research. Hillsdale, .J. ,Erlbaum Publisher, 1982.

• Lefcourt, H. and Martin, R.
  Humor and Life Stress. Springer-Verlag, New York, 1986.

• Maslach, C.
  Burnout -- The Cost of Caring. 1982, Prentice-Hall, New Jersey.

• McCranie, E. et.al.:
  "Work stress, hardiness, and burnout among hospital staff nurses". Nursing Research. 1987, Vol.36, No.6, pp.374.

• Nowicki, S.
  "A locus of control scale for college as well as non-college adults", Journal of Personality Assessment, 1974, Vol.38, pp.136 -137.

• Rotter, J.B.
  "Generalized expectancies for internal versus external control of reinforcement", Psychological Monographs, Vol 80, No.609, 1966.

• Seligman, M., Helplessness, W.H. Freeman and Cc. 1975, New York.

• Svebak, S.
  "Revised questionnaire on the sense of humor". Scandinavian Journal of Psychology, 1974, Vol.15, pp.328-331.

This article was originally published in "Jest for the Health of It", a regular feature in the Journal of Nursing Jocularity.

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