Patty Wooten presents ...

Patty Wooten: Terry, I read about your humor program with cancer patients at Fox Chase Cancer Center in Philadelphia. Can you tell us more about what inspired you to create this program?

Terry Bennett: My first introduction to the idea of adding humor to patient care began in nursing school at Westchester College in Pennsylvania. Two of my instructors, Ginette Ferszt, MSN, RN and Susan Slaninka, EdD, RN were doing clowning for hospital patients and encouraged the student nurses to use humor as a tool to enhance our nursing care. They gave us articles from nursing journals that offered guidelines for appropriate use. These included ones by Jolene Simon, Jean Sullivan, Kay Herth and one by my instructor Susan Slaninka on the magic of therapeutic clowning.

PW: So you were inspired in nursing school, but when and how did your current program get started?

TB: Well, first I knew I had to develop my professional skills and confidence as a new graduate. I also noticed that the nurses in our sixteen bed oncology unit were very playful and frequently joked with the patients. Both the patients and their families appreciated this extra attention. It helped them relax and lessened their anxiety about their illnesses and some of the invasive treatments. I remember one winter morning, we brought in snowballs of fresh snow. Some patients were delighted to just sit and play with it. Others, feeling more playful, threw snowballs at the nurses and interns. One angry teen released some of his rage by smashing it against the wall in his room.

I began to realize that though we had no formal program, we were using humor therapeutically. What we lacked was a collection of resources and physical items that would enable us to individualize our therapy to match each patient's unique personality, preference, skill or energy level. I decided to approach administration with my proposal for a humor cart. Sue Smolinski, RN and I gathered articles, brochures and photos of carts already in use in other hospitals. I then made a list of local retailers in our community and drafted a letter requesting donations for the cart. I wrote to video stores, book stores and toy stores requesting specific titles or types of toys. I made a telephone follow-up in about a week to answer questions.

I was surprised by the enthusiasm and generosity of the merchants. Our nursing administration was also very supportive, offering us money to purchase the items we wanted but had not received as donations.

Unfortunately, dealing with the hospital administration was not that simple. There was no formal policy or procedure about implementing new projects, or seeking approval through an established chain of command. They were also concerned about appropriate choice of materials and any obligations the hospital may have in accepting these donations. One person on the board of directors even opposed the use of the name "Humor Cart" and wanted it to be called "Diversional Therapy." We submitted articles and news clips proving that humor had health benefits and was being used by many hospitals in a wide variety of methods.

PW: What kinds of "diversions" do you have on the cart?

TB: We have a wide variety of videos and comedy audio tapes, which can be played with a portable tape player with headphones. We have many toys, like squirt guns, Mr. Potato Head, yo-yos, kaleidoscopes, bubbles, whoopee cushions, Slinkies, backgammon, checkers, crossword puzzles and some playing cards. We also have some funny costume items, like a hat with dreadlocks attached, clown wigs, funny hats, rubber noses. We also received a donation of a Polaroid camera with unlimited supply of discounted film from a local camera shop. This is great, because we can capture the joyful moments on film and these often are real treasures for the family.

PW: Your Humor Cart has been up and running for about two years now. What items do you find most popular or helpful to patients?

TB: One of the most popular videos is by Joe Kogel, called "Life and Depth." He's a cancer survivor and gives a very funny presentation about using humor to preserve your attitude and keep your hopes up. This one is often enjoyed by patients together with their whole family. (See References) Other popular videos include: Big with Tom Hanks, Wayne's World for adolescents, Laurel and Hardy, Charlie Chaplin and Buster Keaton for the seniors, and generally everyone likes Singing in the Rain, Best of Bill Cosby, Comic Relief, Tootsie and Lucille Ball. These are also available through mail order companies. (See References)

We've also included some audio and video tapes of peaceful environments, like seashore or meadow lands. Sometimes people want a distraction but not necessarily a humorous one. (See References)

PW: So tell me how the Humor Cart is introduced to the patients.

TB: Well, first of all, we leave it out in the hallway or in the patient and visitor lounge, so people can see it. It's about six feet high with big clown faces as the cabinet door handles. The doors are glass, so people can see what's inside. We keep it locked to prevent theft, and the key is kept with the narcotics keys. If someone from another floor wants to borrow it, she has to sign it out and then her unit is responsible for replacement of any lost items.

PW: Wow, where did you ever find such a wonderful cart?

TB: At first we just had a small utility cart, and we tried to make it look better with a colorful cloth skirt. Unfortunately, because it wasn't locked, we had many items removed and lost. Luckily, a patient service organization called Friends of American Oncologic Hospitals, offered us financial assistance and convinced our hospital engineering department to create the wonderful cart we have today. I gave the engineers a few design guidelines for shelves and doors, but I never expected a cart this special. The patients just love it.

PW: Any suggestions for nurses who are inspired to create something similar to what you've done?

TB: Just get involved and do it. Involve other staff to help out. Tap into your community resources for donations of supplies or money. Present to your administrative staff articles or lists of hospitals with successful programs. Provide the staff with a list of materials you want to obtain, so they can feel reassured that your choices are tasteful and appeal to a wide variety of interests. Try to find a source of ongoing funding, so you can continue to replenish the cart with new materials. Most of all, don't give up, even when others don't share your enthusiasm or question the validity of your endeavor. For me, seeing the patients smiling and laughing with staff and family and knowing how much that means when you face a life-threatening illness, has made all my efforts worthwhile.

References

Books and Articles

• Bellart, J. L. (1989). "Humor: a therapeutic approach in oncology nursing." Cancer Nursing, 12(2), 65-70.
• Buxman, K. (1991). "Make room for laughter." American Journal of Nursing, December, 46-50.
• Herth, K. (1984). "Laughter: A nursing Rx." American Journal of Nursing, 84(8), 991 992.
• Kogel, J. Life and Depth: Very Funny Stories About Very Scary Things. Available from author: 50 Summit Ave. Providence, RI 02906 Send: $19.95 + $2.00 shipping. Or call:
• Simon, J. M. (1989). "Humor techniques for oncology nurses." Oncology Nursing Forum, (16), 667 670.
• Sullivan, J., et al. (1988) "Humor and Health." Journal of Gerontological Nursing, 14(1), 20.

Audio and Video Tapes

• Time Warner Viewer's Edge
  Collection of wide variety of videos - large comedy selection - many under $10.
  P.O. Box 3925 Milford, CT 06460.
• The Mind's Eye
  Audio and video tapes. Unique comedy selection.

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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