护理中的笑声和幽默：道德问题？

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No one denies the importance of ‘laughter and humour ' in life. We can hardly imagine life without laughter. A world without humour is a dead world. Even when there is little to laugh at, there is laughter. As a small goodness.1 the positive effects of laughter and humour on human’s health and well-being have been widely documented, especially on physical and psychosocial level.

But is laughter and humour in healthcare acceptable? In times of crisis, such as the Covid-19 pandemic, can we make it to encourage caregivers to pay attention to humour? Can we ethically support using humour in care when being so close to dying people, to patients totally isolated from their loved ones?2 Or is humour perhaps just what is needed to persevere as a caregiver, to survive difficult situations in care? In any case, humour in care is not something to laugh at, it is a very serious topic.

Listening carefully to the patient’s voice makes us think that laughter and also humour may play a more important role in care than we think. For patients, laughing and humour are among the essential qualities needed in the nurse-patient relationship.3 Humour helps maintain dignity, it can help patients feel ‘human’ and not just a recipient of care. Using humour means that you do not underestimate the other (“you are strong enough to deal with this”). Moreover, laughing and humour also possess the property to connect people, to strength the bond between persons, to bring out of isolation; they create a feeling of sharing, of belonging.

And let us also be aware of the transformative power of laughter and humour in caring and care-relations.4 It is remarkable how nurses using humour can make things move in care, between patients and caregivers, between patients and family, but also within the team. Use of humour in care can help interrupt, defrost, relax, disarm and reinforce values, create or strengthen trust in the patient-nurse relationship. Humour is a form of self-compassion and compassion for the other. It is also a way of relating to the other. No matter how different you are, how different the world you and the other person live in, if you can laugh together, there is a lot that connects you both.

The message is clear: laughter and humour do belong in care, they allow the nurses to add value and dignity in patient’s life. Humour can be seen as a virtue: an essential element of virtuous caring and of a flourishing professional life as a nurse.5 The potential of humour in nursing care should not be underestimated.

Why is it then that we feel a certain reluctance among nurses to use humour? Patients who are having a hard time should not be burdened with jokes, right? “There’s just no time to laugh and joke around in healthcare”, a nurse might say. Or “In my organization, humour and laughter are seen as unprofessional and unethical nurse behaviors”.

Laughter takes courage.6 You have to be willing to venture out, sometimes to push the boundaries of the caring relationship. You have to be willing to make yourself vulnerable. If you do venture too far, it takes courage not to give up. After such an experience, it asks courage to not throw the baby out with the bathwater (i.e.: never dare to use humour again). As a virtue, a balance has to be struck between ‘too much’ and a ‘too little’ (the ‘mean’ in Aristotle’s ethics). That balance is different in every situation. If we want to encourage virtuous humour in nursing relations, we need room to also fail in finding the right balance. That also includes space to reflect (ethically).

So, yes, humour is a matter of ethics…

全文翻译（仅供参考）

没有人否认"笑和幽默"在生活中的重要性。我们很难想象没有笑的生活。一个没有幽默的世界是一个死气沉沉的世界。即使没有什么可笑的，也有笑。作为一种小小的美德。1 笑和幽默对人类健康和幸福的积极影响已被广泛记录，特别是在身体和心理社会层面。

但是，医疗保健中的笑声和幽默可以接受吗？在危机时期，比如新冠肺炎大流行时期，我们能否鼓励护理人员注意幽默？在如此接近垂死之人、与亲人完全隔绝的患者时，我们能否在伦理上支持在护理中使用幽默？2 或者幽默也许正是作为一个照顾者坚持下去，在照顾中度过困境所需要的？无论如何，照顾中的幽默不是一件可笑的事情，它是一个非常严肃的话题。

仔细倾听病人的声音使我们想到，笑和幽默在护理中可能比我们想象的更重要。对病人来说，笑和幽默是护患关系中所需的基本素质之一。3 幽默有助于维护尊严，它可以帮助病人感受到“人”的存在，而不仅仅是一个接受护理的人。使用幽默意味着你不低估对方（“你有足够的力量来处理这件事”）。此外，笑和幽默还具有连接人与人、加强人与人之间的联系、走出孤立的属性;它们创造了一种分享和归属感。

让我们也意识到笑声和幽默在照顾和照顾关系中的变革力量。4 值得注意的是，护士如何使用幽默可以使事情在护理中，病人和护理人员之间，病人和家人之间，以及团队内部移动。在护理中使用幽默可以帮助打断，解冻，放松，解除武装和加强价值观，在护患关系中建立或加强信任。幽默是一种自我关怀和对他人关怀的形式，也是一种与他人相处的方式。不管你们有多不同，你们和对方生活的世界有多不同，如果你们能一起笑，你们之间就有很多联系。

信息很明确：笑声和幽默确实属于护理，它们让护士为病人的生活增添价值和尊严。幽默可以被视为一种美德：作为一名护士，这是有道德的关怀和繁荣的职业生活的基本要素。5 幽默在护理中的潜力不应低估。

那么，为什么我们觉得护士们不太愿意使用幽默呢？那些日子不好过的病人不应该被笑话所累，对吗？"在医疗保健行业，没有时间大笑和开玩笑"，一位护士可能会说。或者"在我的组织里，幽默和大笑被视为不专业、不道德的护士行为"。

笑需要勇气。6 你必须愿意冒险，有时候是为了突破关爱关系的界限。你必须愿意让自己变得脆弱。如果你真的冒险太远，那就需要勇气不给予。在这样的经历之后，就需要勇气不把孩子和洗澡水一起倒掉（即：再也不敢使用幽默）。作为一种美德，必须在“太多”和“太少”（亚里士多德伦理学中的“中庸”）之间取得平衡。这种平衡在每种情况下都是不同的。如果我们想在护理关系中鼓励良性幽默，我们也需要在找到正确平衡时失败的空间。这也包括（伦理学上的）反思空间。

所以，是的，幽默是一个道德问题...

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