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Jul 10, 2007

Healthcare is a serious business, so using humor as a therapeutic tool to assist people may not be in the forefront of your mind. Theresa L. Garnero has prepared a handout to help us overcome our sometimes over serious manners and learn the necessary skills to use humor.


Theresa L. Garnero
Healthcare is a serious business, so using humor as a therapeutic tool to assist people may not be in the forefront of your mind. Healthcare providers are socialized to be serious and typically are not taught the necessary skills to use humor, despite its numerous benefits.


To make matters more challenging, diabetes is a notoriously serious disease that gets plenty of attention to its negative consequences. The fear and denial associated with having diabetes can be a barrier to self-management. As educators, we can emphasize the positive through timely, gentle humor to encourage and support the efforts required to manage diabetes.

What’s the first step? Establish a connection with the individual(s) before using humor. One way is to look at the health assessment questionnaire or healthcare record and comment on their profession by tying that into the world of diabetes. (“You’re an engineer? I can see your plotted out scatter grams of glucose values. You’re going to be OK!”) No matter the profession or pastime, we can do wonders by assuring people they have the advantage since they are one of the few to get diabetes education.

Take the following into consideration when incorporating humor into your practice:


  • Enhances communication and learning
  • Allows for the expression of anger
  • Lowers glucose levels
  • Reduces stress
  • Minimizes professional burnout

Developing Your Sense of Humor:
(reprinted with permission from Kevin Smith, Complimentary/Alternative Therapies in Nursing, 2nd Edition, page 276)
1. Gain an awareness of the benefits of humor.
2. Identify inappropriate humor and avoid it. This is any type of humor that can be perceived as offensive.
3. Get to know what type of humor amuses you. What humor feels comfortable?
4. Do a humor history on yourself. Note favorite comedians, TV shows, humorous situations, etc.
5. Keep a file of humorous anecdotes, stories, jokes, and cartoons.
6. Practice! Using humor is a process, not an event.
7. Allow yourself to be silly.
8. Learn to laugh at yourself.


  • During a crisis, such as high anxiety or serious discussion
    (may be more distracting and aggravating than tension relieving).
    Just after diagnosis, or hypoglycemic event, or hospitalization, use cautiously.
  • During complex tasks
    (important not to stick humor in the middle of a task requiring full attention).
    For example, during an insulin start or glucose monitoring or anything related to needles.


  • Timing, receptiveness, and context
  • Must tie into a point in order to be funny
    (Place a carbohydrate-related cartoon while teaching about carbs. Obvious, no?)

Non-Therapeutic Side Effects:

  • Avoid crossing that fine line between being funny and being offensive
  • Someone can always be offended (apologize immediately if you realize this)
  • Can distract from the message if over used
  • Can promote anger, and increase anxiety
    (by keeping the humor lighthearted and patient-focused, many of the negative consequences can be prevented)

Patient Assessment:

  • During greeting, assess receptiveness to humor
    (This can be accomplished by making a silly comment about parking, or the weather. Example, “I see you found our hidden office. If you can find our office, you can learn to manage diabetes!” Watch their response to your testing the humor waters. Or, “Rainy days and diabetes always get me down,” or “Did you hear the weather report? It’s sunny and normal blood sugars are in the forecast.”)
  • Ask is humor is helpful
  • Watch their eyes—do they look away or are they engaging?
  • Listen to the tonal quality of their laugh (is it heartfelt or just a polite giggle?)
  • If a patient jokes non-stop, it may signal an unstated wish to talk about feelings

Group vs. Individual Approaches

  • Ask the group to share anything funny (related or not related to diabetes)
  • Show a photo and ask “What’s wrong with this picture” (a sugar free advertisement of ice cream with 3 huge scoops)
  • Post cartoons or interject them into the standards of care.
  • Create a caption contest for a cartoon

Age-specific Considerations:

  • All age groups expect nurses to have a sense of humor
  • Children (should look quite different—use body humor, playfulness)
  • Adolescents (use cautiously only after a relationship is established)
  • Older adults (humor often relates to issues of loss)

Cultural Issues:

  • Understand humor preferences within a culture prior to using culturally-specific humor
  • A smile goes a long way and puts most patients at ease

Plastic Food Models

Dietitians have it made. Plastic food models cut across all demographics. Use them! When a patient is approaching your office, pretend to take a sip out of the fake wine glass, or a bite out of the fake chicken leg and say, “Oh I’m sorry, I didn’t see you. I’m the dietitian. We going to have some fun with food today!” Individualize your humor. There are countless ways to incorporate a little tasteful fun (pun intended).

Humor can galvanize your effectiveness as a diabetes educator. It is often the key that promotes a connection between patients and their healthcare providers. Are you sharing your smiles? Have you shared the joy with those under your care? It’s not about signing up for the Glee Club. It’s about using the healing power of humor. Luckily, it is never to late to start.

Theresa L. Garnero got her start as a cartoonist by receiving rejection letters from Walt Disney when she was 8 years old. As the youngest of 7 children, raised in a humorous environment, it’s no wonder she aspired to make people laugh. Even comedians realize the seriousness of making a living, however, so she eventually went to college and found her passion: nursing. She completed her Master of Science in Nursing degree, became a Certified Diabetes Educator and an Advanced Practice Registered Nurse, Board Certified in Advanced Diabetes Management. She is the current President of the California Central Coast Chapter of the American Association of Diabetes Educators. She has 18 years experience as a nurse, is Director of Diabetes Services with Washington Hospital in Fremont, CA

To learn more about her paperback  DIABETease or to have her draw a custom cartoon for you just contact her directly at 1(877)765-4386, or visit her at www.tgarnero.com.