Practising with a smile

Humour is thought to serve a wide range of positive functions in health care. This includes providing comfort to patients and reducing anxiety in difficult situations, serving as a means of raising difficult topics that might otherwise be taboo, offering an outlet for negative emotions such as frustration and anger, enhancing working relationships by relieving interpersonal tension and challenging and maintaining the structure of professional relationships. There is also a widespread belief in the beneficial effects of humour on health and wellbeing, hence the saying ‘laughter is the best medicine’. The proposed positive relationship, either direct or indirect, between humour and various health outcomes, such as pain and stress, is captured more formally in the ‘humour–health hypothesis’. Reviews of the literature in this area, however, suggest that much of the early evidence, particularly in relation to the direct effect of humour on health, was anecdotal, based on small sample sizes or on studies that had a number of methodological flaws. There was also found to be very limited research relating to nurses. The early evidence for an indirect impact of humour on health, for example as a coping mechanism that reduces stress, was also found to be limited and inconsistent. This was thought to be because early research failed to fully acknowledge the complexity of the concept of humour, such as its different components (eg behavioural, emotional, social, cognitive and perceptual) and that some forms of humour may be detrimental to psychological and physical health, such as aggressive or excessively self-disparaging humour. With this recognition, and the development of measures of humour that included potentially maladaptive as well as adaptive qualities of humour (e.g. the humour styles questionnaire), a greater understanding of the nature of the relationships between humour, health and other factors began to develop. In addition, a more robust evidence base for the positive indirect effects of humour on health, particularly stress, began to develop