An Ethnographic Study of the Role of Humor in Health Care Transactions

Author: Lippert, Lance R. and Stephen K. Hunt
Lippert, Lance R. and Stephen K. Hunt
This book examines conversational humor in communicative exchanges during the health care transaction. Our focus is on interactive humor at a specific cultural site as it actually occurs. This study is based on the assumption that the participants at this site routinely engage in some form of humor exchange during interpersonal communication in health care transactions. Given the prevalence of humor use in the health setting, as well as the lack of attention devoted to this important phenomenon in the extant literature, this study set out to explore two fundamental questions. The first question that must be addressed is: If the participants (nurse and resident) in a long term care relationship construct conversational humor or participate in humor exchanges, what are the humorous exchanges accomplishing? What functions do they serve? The second question deals with the humor strategies and their organization by the participants: How are the humor exchanges being accomplished? In other words, what humor strategies and communicative behaviors do the participants apply during health care transactions?

Nursing homes operate as homes for millions in this country's aging population. Because nursing homes more often call for prolonged care rather than a cure, interpersonal communication is even more crucial to this care giving context. Humor use is one way the participants in this study interpersonally confronted the rigors of old age and institutional care. The humor exchanges enhance the communicative climate and multiply the chances for quality care outcomes. This book sheds new light on the role of humor in long term care facilities and offers educators, practitioners, and researchers a powerful tool for better understanding communication in this context.


“ Dr.Lippert and Dr. Hunt's text is one that is at the forefront of taking the initial framework of scholarship and building upon that to account for everyday occurrences and interactions as applied to health. Specifically, Lippert and Hunt's emphasis on the use of humor in long term care highlights the absolute importance and relevance of such exchanges, and the impact these exchanges have on patients, family members, and health care practitioners. The research presented in this book demonstrates that humor exchanges enhance the communicative climate and multiply the chances for quality care outcomes. This book sheds new light on the role of humor in long term care facilities and offers educators, practitioners, and researchers a powerful tool for better understanding communication in this context. What we've learned through our past examples of scholarship is the importance of entering the field and studying real-world examples of health communication exchanges. Research approaches such as ethnography are relatively new to health communication. Hence, studies such as this set a precedent regarding the valuable information we can gain as we seek to determine the health effects of communication exchanges. The focus on humor over the course of long-term treatment highlights how everyday exchanges influence the roles of those administering and receiving health care. Likewise, this type of research emphasis is invaluable in bridging links between communication and overall biological, mental, and social health.” – (from the Commendatory Preface) Dr. Scott T. Paynton, Chair, Department of Communication, Humboldt State University

"I enthusiastically support the publication of this book. It provides a thorough review of humor research as well as unique insights about the way humor functions in a nursing home setting. I especially like the authors’ passion for and engagement in the phenomena under study. In this book, they show themselves to be well versed in humor literature, careful and methodical researchers, and sincerely interested in the challenges and rewards of caring for people at the end of their lives. The combination results in a cogent analysis that is informative and thought-provoking. Readers will be moved by the insights that arise during this ethnographic study of humor in a nursing home. Unforgettable moments include a nurse’s encouragement to help a confused resident experience “a moment of current reality.” The reality depicted in this book is sometimes frightening and sad, but often brave and surprising funny. Humor’s presence in this setting is a reminder of humans’ remarkable capacity and yearning for a sense of human connection. This book is compelling reading for scholars as well as caregivers, patients, and loved ones. End-of-life care is attracting increasing attention as Baby Boomers redefine what it means to flourish in old age. With predictions that 1 in 4 Americans will be over age 85 by 2050, we better start now to understand the dynamics of caring for older adults. This book makes an important contribution to that effort." - Dr. Athena du Pré, Associate Professor of Communication, University of West Florida

"This book studies humorous communication in a long-term care facility. These facilities (also called nursing homes) have been the targets of much public criticism and questioning in recent years, not only for occasional reports of abuse and deplorable conditions but also because of the troubling medical, economic, and sociocultural issues they manifest regarding how as a society we care for the elderly and incapacitated. Lippert and Hunt illuminate the fleeting, often intimate moments of interaction that are central to the fabric of everyday life in a long-term care facility. Such moments, difficult for participants to script or even to notice, typically have received little scholarly investigation ... As Lippert and Hunt demonstrate, humor provides an effective compliance-gaining strategy, useful in getting clients to get up, take medicine, or come to lunch. Humorous talk also provides a way to bring clients into interaction and offer them a moment of levity or pleasure in a context where most clients will remain until death. Humor also helps the practitioners themselves cope with trying circumstances. In addition, this book contributes to scholarly literature on humor, laughter, and play as important components of human communication. This book documents many examples of humorous interchanges, carefully analyzing their structures and functions. In so doing it represents a valuable contribution to scholars concerned with these processes. The book is also important as an example of qualitative research utilizing multiple methods. Based on Lippert’s extensive participant observation and interviews with health care providers, the findings draw on ethnographic analysis of field notes, content analysis of interviews, and discourse analysis of moments of interaction. This is substantive and meaningful research, and the book will be of interest to scholars and practitioners in several fields. I highly recommend it for publication." - Dr. Phillip Glenn, Associate Professor, Emerson College

"The material here is very rich in insights about everyday communication, particularly in this sort of shunted-off setting that most of us would avoid entering. I think the insights apply well beyond the nursing home setting, and I see this study contributing to our knowledge about the forms and functions of humor in maintaining the social fabric. It would be of interest to scholars in health communication, interpersonal communication, organizational communication, ethnography of communication, and language and social interaction, among others. Lippert was very meticulous in his field observations, which took place over an extended period of time so that he could effectively become a fly-on-the-wall in the setting, sometimes participating in interactions and helping out, other times just observing. I think he stayed true to the methodological guidelines for good interpretive research, and the result is a thick description of segments of interaction in which humor or a cheery disposition functioned to make life in the nursing home more tolerable and less institutional for both nurses and residents ... The study is well grounded in the current research literature, with an extensive set of references covering several fields that are not often brought together in one place. The documentation is careful and thorough, though the sources never get in the way of the authors' own narrative voices. The writing style is engaging, and the organizational logic of chapters and sections makes good sense to me ... I think this would be well received in the discipline, and it serves as a good exemplar of participant observation research." - Dr. Bryan K. Crow, Southern Illinois University

Table of Contents

Preface by Scott Paynton
1. Humorous Communication and the Long Term Care Relationship Interpersonal Communication in Health Care
2. Approach to Studying Humorous Communication in the Field Theoretical Framework
3. Understanding the Culture of Long Term Care
4. A Descriptive Look at Humor Exchanges
5. The Functions of Humor Exchanges
6. The Future of Humorous Communication Research and Implications for Practitioners