Bust stress with humor, yoga inservices

Few jobs are more stressful than home care work these days. In addition to the usual stresses of patients with debilitating physical and sometimes mental ailments, your staff also must cope with increased workloads caused by budget constraints and layoffs. Two education managers have made stress management a priority because their staff need it more than ever.

"Health care today, especially home health care, is one of the most stressful professions to be in, primarily because of the rapid changes in reimbursement and regulations," says Alice Hammel, RN, MS, director of education for Kendallwood Health Care Services in St. Josephs, MO. The freestanding agency’s four offices serve Kansas City and northwestern Missouri.

"Almost on a weekly basis in the last year, many agencies have had to drastically downsize or close, and this creates a tremendous amount of stress for employees and nurses," Hammel adds. She has found that yoga is a good way to help people relax and sleep better, so she’s incorporated some pointers about yoga in her inservice.

Another education coordinator, Pat Lynch, RN, of The Elizabeth Hospice in Escondido, CA, says humor is a great way to relieve stress. She has created an inservice focusing on the topic.

Hammel and Lynch offer these tips on how to create a stress-busting inservice:

1. Choose a focus. Stress workshops or inservices may be designed in dozens of ways. Edu cators may want to choose one type one year and another the next. Lynch selected humor because she was intrigued by the possibility that laughter has some healing power. "And in hospice, you have to keep your sense of humor," she adds.

Hammel teaches yoga at home care conferences and at a local university to members of the public. "I had one incident where, a few weeks after my yoga class [at the university], an elderly gentleman’s wife called me, saying, What did you do to my husband?’" she recalls. "I asked her what she meant, and she said, Last night was the first night in over two years that he totally slept through for eight hours.’" The same man also reported feeling no arthritis pain for two days after class.

Because she has seen some positive stress-reduction results in people she has taught over the years, she adds a little yoga education to her home care stress inservice.

2. Research your topic. Libraries and the Internet have plenty of resources on stress management. The U.S. Department of Health and Human Services and the National Institute of Mental Health have free handouts on stress management and relaxation, for instance.

Lynch found these two publications on humor most useful: Humor in Healing,1 a book by Perry H. Biddle Jr.; and an article by self-proclaimed "Jollytologist" Allen Klein, "Humor and Death: You Got to Be Kidding," in the July/August 1986 American Journal of Hospice Care.2

The best way to learn about yoga is to sign up for a beginner’s class at the local YMCA or community college, Hammel suggests. The added benefit of this experiential research is that the education manager also benefits from yoga’s stress-reducing effects.

3. Create an inservice structure. Lynch follows Biddle’s outline of four points in finding humor:.

• Humor is related to childhood. Laugh ing children at play represent humor at its most basic level. "Children, when they’re being humorous, are being fun," Lynch says. "So in childhood, we reveal humor in its simplest form."

• Adults’ senses of humor vary. That’s why different things are funny to different people.

• People often must be in the mood before they can find the humor in things, Lynch says.

• When adults are in the mood, a shift of values takes place, helping them to appreciate what’s fun and pleasant. Adults also have the ability to see humor even in unpleasant situations and laugh about those situations.

"This happens so much so that everyone starts laughing," Lynch says. "That’s the way it is around hospice sometimes when it’s not the best atmosphere, but someone says something funny at a team meeting, and we all start laughing." (See story on stress relief tips, p. 187.)

She also discusses the healing effects of humor, mirth, and laughter. "It has been proven that a hearty laugh stimulates almost all of the organs of the body and heightens the body’s ability to resist disease," she explains.

The cardiovascular system benefits because the blood circulates faster when a person laughs, for instance; the respiratory system benefits because a good belly laugh produces deep breathing and can give the lungs a good workout, Lynch says.

When Hammel gave a yoga seminar at a state home care meeting, she began by explaining the philosophy of yoga and its health benefits. The primary focus in yoga is to perfect body postures, also called asanas, which may be practiced for 15 minutes every morning and night, Hammel says.

She had the home care group practice basic yoga routines for about 40 minutes. She ended the session with meditation. "The last 15 minutes of yoga are for meditation to help people quiet their minds, relax their muscles after they’ve stretched, and to focus on relaxing with peaceful thoughts through a guided meditation," she says.

Yoga routines in the morning may help a person become focused for the day’s work, while nighttime routines may help a person sleep better. "I have found that yoga helps people relax, sleep better, and it reduces their blood pressure," Hammel says. "People who consider themselves out of shape and do not practice a regular routine of exercise really do enjoy the practice of yoga because it’s very easy on them; it’s not strenuous or tremendously physically demanding."

Acceptance is the answer

Hammel follows a different routine during a stress management inservice for home care staff. While she still discusses yoga and its philosophy, she also covers these topics:

• chronic stress and the problems it causes;

• how to become much more focused and efficient at work through deep-breathing techniques;

• the proper way to do basic yoga postures;

• other stress reducers, including the philosophy that everyone has a circle of concern and a circle of control, which is much smaller than the circle of concern.

"Usually there are many things we’re concerned about, but we have absolutely no control over them," Hammel says. "So I tell people to be concerned about their circle of control only and to let go of things in the circle of concern which they have no control over; accept and let go."


1. Biddle PH. Humor in Healing. Fort Lauderdale, FL: Desert Ministries; 1994.

2. Klein A. Humor and death: you got to be kidding. Am J Hospice Care 1996; July/August.