Humor and field energy in older adults.
Abstract: The purpose of this study was to gain an understanding of humor from the perspective of the Science of Unitary Human Beings as described by Martha Rogers. It was proposed that there would be mutual patterning of humor and field energy in older adults who are either institutionalized or non-institutionalized, and that both humor and field energy would be significantly lower in the institutionalized group.

This study used a descriptive correlational design. The sample (N=80) consisted of individuals who were 55 years of age or older. The individuals in the sample were either residents of various nursing homes (n=40) or resided independently and attended activities at one of several different regional senior centers (n=40).

Humor and field energy scores for the entire sample were significantly correlated (p = .000), as well as for institutionalized elders (p = .000) and for noninstitutionalized elders (p = .000). Additionally, when potential influences were controlled, the hypothesized relationship between humor and field energy (p = .000) was further supported regardless of group membership. Field energy was significantly lower (F = 16.93; p = .000) in the institutionalized, older adults than in the non-institutionalized older adults. Humor did not differ significantly between institutionalized and non-institutionalized subjects.

Key Words: Field Energy, Gerontology, Humor, Science of Unitary Human Beings, Martha Rogers
Article Type: Report
Subject: Nursing homes (Management)
Aged (Health aspects)
Aged (Research)
Author: Hindman, Margaret E.
Pub Date: 01/01/2011
Publication: Name: Visions: The Journal of Rogerian Nursing Science Publisher: Society of Rogerian Scholars Audience: Academic Format: Magazine/Journal Subject: Health; Health care industry Copyright: COPYRIGHT 2011 Society of Rogerian Scholars ISSN: 1072-4532
Issue: Date: Jan, 2011 Source Volume: 18 Source Issue: 1
Topic: Event Code: 200 Management dynamics; 310 Science & research Computer Subject: Company business management
Product: Product Code: 8050000 Nursing & Rest Homes; 8366000 Homes for Aged NAICS Code: 623 Nursing and Residential Care Facilities; 623312 Homes for the Elderly SIC Code: 8051 Skilled nursing care facilities; 8052 Intermediate care facilities; 8059 Nursing and personal care, not elsewhere classified
Geographic: Geographic Scope: United States Geographic Code: 1USA United States
Accession Number: 272167867
Full Text: Introduction

During this time of prolific gerontological research (McCormack, 2009) there is a marked deficiency of research on the potential therapeutic value of humor in older adult populations (Merz, et al., 2009). The relationship between humor and the vibrant qualities of the human spirit, i.e., field energy, two quintessential characteristics of human beings has received virtually no attention in the nursing research literature, or in the greater body of available scientific literature. Accordingly, the purpose of this study was to investigate the relationship between humor and field energy in samples of institutionalized and non-institutionalized older adults.

Background

Humor

Recent descriptions of humor suggest that humor is spontaneous and incongruent, involving a change of mind (Bellert, 1989, Southam, 2003). Flugel (1954) described humor as the quality in individuals that mediates the amusing, the comic, the laughable, the ludicrous, the witty, and the funny. Tansey (1988), on the other hand, constructed a definition of humor from a phenomenological study with adolescent males, defining humor as an expression that was produced when an individual cognitively perceives amusement stimulated by an incongruence or absurdity in the ordinary pattern of life. This definition emphasizes the cognitive aspect of humor, the stimulus for humor, and that humor has some type of expression.

In addition to definitions of humor, there are many descriptions of the functions of humor. Robinson (1977) described humor as having four primary functions: (1) physiological, (2) psychological, (3) social, and (4) communicative.

Physiologically, laughter is known to cause: (1) a rise in one half a Fahrenheit degree of body temperature; (2) an increase in pulse and blood pressure, then a drop back to baseline; (3) an elevation of serum oxygen levels; and (4) the contraction with subsequent relaxation of thoracic abdominal musculature (Berk, 1989; Black, 1984). The "twinkle or sparkle in the eye" is postulated to result from the moisture produced by tear glands due to reflex lacrimation during smiling and moderate laughter (Black, 1984).

The positive psychological benefits of humor have not gone unnoticed.

Cousins (1989), a popular journalist, advocated the power of positive humor in the recovery process and used his own life as an example of these phenomena. Primarily, however, the psychological benefit of humor has been documented as a positive coping strategy for dealing with stress (Martin & Lefcourt, 1983). Martin and Lefcourt (1983) as well as Labott and Martin (1987) indicated that coping by using a sense of humor buffers the effects of negative events on mood states.There is support for humor-coping as a stress moderator by acting as a buffer in college aged subjects (N=334). Humor buffered negative life events upon mood disturbance.

As a social function, humor has been used by health care workers to deal with gory and gruesome situations or situations in which they are emotionally unprepared to cope. Warner (1991) found in a group of student nurses (N=38) that they used humor to cope with stressful person-environment relations of which they were emotionally unequipped to handle.

Humor is also a communication tool (Robinson, 1977). Humor provides an outlet to express oneself about subjects that might otherwise be socially unacceptable. The messages that are conveyed are usually emotionally tinged.

In addition to the functions of humor, humor, as a therapeutic modality, has received considerable attention in the literature. Some examples of techniques that have been recommended are plain laughter, humor as a distracter, rational emotive therapy with humor, and the humorous imagery situation technique (Alligood, 1990; McCaffery, 1990; Prerost, 1989; Shibles, 1991).

Humor, as an indicator of well-being, has been empirically understudied, although the concept of well-being in gerontological studies is more common (Merz, et al., 2009). A study by Tennant (1991) examined the effect of humor on the well-being of older adults (N=31). Defining morale as a means to enhance well-being, Tennant's experimental study, found no statistical significance to support the hypothesis that humor raised morale.

Humor, within the Rogers' conceptual framework, has been studied with phenomenological methodology by both Malinski (1990) and Reeder (1991). Malinski (1990) found in a sample of older adult couples (N=20) that the experience of laughing at oneself facilitates awareness of the harmonious process between a person and their environment. Reeder (1991) discovered that senior citizens (N=24) who have a transcendent life perspective believe that laughing at oneself is "knowing what to care about in life and choosing to trust and live by it, spontaneously and deliberately" (p. 275).

Motion of the Human

Energy Field

Motion of the human energy field is an indicator of "the continuously moving position and flow of the human field pattern" (Barrett, 1986, p. 175), and is manifested by human energy field patterning. Manifested by continuing change from lower to higher frequency waves (Rogers, 1970; Ference, 1979, 1986; Gueldner et al., 1996), motion of energy fields is characterized by an intense absorption and awareness of self without regard to time or space (pandimensional patterning) and illustrates the principle of resonancy. With higher frequency motion, there may be a sense of exuberance, sometimes associated with a relaxed and revitalized feeling (Ference, 1979). Higher field energy, therefore, may reflect an inward sense of well-being or vitality for life, while an individual with lower field energy may seem lackluster.

Environments of Institutionalization and Non-institutionalization

Long term care facilities (institutions) are the environments where many older adults reside (Miller, 1990). The institutional setting is provided for those individuals who need survival assurance due to loss of function (Simms, Jones, & Yoder, 1982). Institutionalization, as a threat to survival, is considered to have profound negative effects on older adults (Simms, Jones, & Yoder, 1982) and has been linked to disturbances in well-being (Reed, 1986).

Humor, Field Energy, and the Environment

The flow of energy, associated with humor, characterized as a harmonious surge of vitality in the human field, creates a feeling of exuberance in the energy field. The exuberance that the individual feels is associated with an enhanced sense of well-being, or change in field energy that is characterized by movement from a lower to higher wave frequency. Human beings who experience humor more frequently are postulated to have higher field energy. In other words, there would be a mutual patterning of the experience of humor and field energy.

Furthermore, the environment provides the context for the experience of humor (Fine, 1977). Since the experience of humor is environmentally conditional (Fine, 1977; Prerost, 1989; Rogers, 1986) and the environmental energy field and the human energy field are integral (Rogers, 1986), an individual's residence or primary environment is proposed to have a significant relationship with the experience of humor as well as field energy. In institutionalized older adults, the stifled environment may be mutually patterned with lower field energy and a decrease in the frequency of the experience of humor. Non-institutionalized older adults may experience humor more frequently and have higher field energy. Therefore, this study proposes that the primary environment or residence of a human being is directly related to the mutual patterning of the experience of humor and field energy.

Method

Sample

The target population for this study was older adults who reside in either institutions or independent living arrangements. A total sample of exactly 80 participants was obtained (n=80) with half of the subjects (n=40) residing independently in the community and the remaining half (n=40) residing in institutionalized settings.

The total sample ranged in age from 65 to 95 years of age with a mean age of 79.1 years. The institutionalized participants ranged in age from 55 to 95 years of age with a mean age of 82.675 years. The non-institutionalized participants ranged in age from 65 to 92 years of age with a mean age of 75.525 years. The two groups were significantly different in age (p=.000). Participants residing in the institutionalized setting were significantly older than the non-institutionalized participants.

Situational Humor Response Questionnaire (SHRQ)

The SHRQ is a 21 item Guttman-like scale designed to assess the humorousness of an individual based on the frequency of the individual's report of laughter (Lefcourt & Martin, 1986), and is non-particulate and unidimensional. Measuring the propensity for laughter, a phenomenon judged to be a manifestation of human beings, it was evaluated to be conceptually consistent with the theoretical underpinnings of Rogers' conceptual system. Respondents are asked to react to a variety of situations. The first 18 items of the scale describe common situations that ask subjects to recall their reaction to a similar situation or, if they could not remember a similar situation or experience, to imagine what their reaction might be with an experience. Simon (1990) established reliability of the SHRQ in a sample (n=73) of non-institutionalized older adults with a Cronbach's alpha of .81.

Lefcourt and Martin (1986) cited the need to revise the SHRQ for use in populations other than college students. Since the original form of the instrument was developed and normed on college students, the investigator of this study revised the SHRQ to be more sensitive and age appropriate to the older adult population. Minor revisions were made to several questions and new situations were created for 3 questions. Internal consistency reliability of the revised SHRQ was calculated for the total sample (N=80) in this study using a Cronbach alpha. The Cronbach alpha for the 21-item scale was .8045. Additionally, the Cronbach alpha for the 21-item scale was computed for each group in the study: the institutionalized group (n=40) were .8276 and the non-institutionalized group (n=40) was .7639.

Index of Field Energy (IFE)

The IFE (Gueldner et al., l996) is an 18-item pictorial semantic differential scale. It is designed to measure the pandimensional experience of motion of the human energy field (Gueldner et al., 1996; Rogers, 1991). The respondent is asked to mark a point on the scale between pairs of pictures, which corresponds to how they feel at the moment. The scale ranges from 1 to 7. Scoring is summative with a possible range of 18 to 137. Eighteen indicates lower field energy and l37 indicates higher field energy. The IFE has established reliability. Internal consistency was documented by a Cronbach's alpha coefficient of .95 (Gueldner et al., 1996). Internal consistency reliability of the IFE was calculated for the total sample (n=80) in this study using a Cronbach's alpha. The Cronbach alpha for the 18-item scale was .8651. Additionally, the Cronbach's alpha for the 18-item scale for the institutionalized group (n=40) was .8474 while the Cronbach's alpha for the non-institutionalized group (n=40) was .8384.

Results

Correlations between humor as measured by the Situational Humor Response questionnaire (SHRQ) (Lefcourt & Martin ,1986) and field energy, as measured by the Index of Field Energy (IFE) (Gueldner et al., 1996) in the total sample of older adults were computed. Comparing the total score on the SHRQ with the total score on the IFE, the Pearson product-moment correlation (Pearson's r) for the combined group was positively significant (r=.5148, p=.000) as well as for the subsamples, institutionalized (r=.5904, p=.000) and non-institutionalized (r=.3503, p=.027) older adults. Therefore, humor and field energy were significantly and positively correlated in the overall sample and the subsamples of institutionalized and non-institutionalized older adults.

ANOVAs were completed to test the difference between institutionalized and non-institutionalized older adults in humor as measured by the group SHRQ scores. The mean score on the SHRQ for the non-institutionalized participants was 52.80 (n=40) while the mean score for the institutionalized participants was 49.850 (n=40). Consequently, humor was not found to be significantly different between the two groups (F=1.723, p=.193).

ANOVAs were utilized to test the differences in field energy as measured by the IFE between institutionalized and non- institutionalized older adults, comparing the total scores on the IFE for both groups. The mean score on the IFE for the non-institutionalized participants was 91.06 (n=40) while the mean score for the institutionalized participants was 73.76 (n=40). Consequently, field energy was found to be significantly different between the two groups (F=16.925, p=.000). Therefore, field energy is different in institutionalized and non-institutionalized participants. Not only is field energy different, but is significantly higher in the non-institutionalized group.

Supplementary analyses

Power analysis. Post hoc power analysis was performed to corroborate the validity of the statistical conclusions for this study. For the ANOVA tests, the SHRQ was found to have an effect size of .25 while the IFE was found to have an effect size of .98. Applying the power calculation to sample size tables for ANOVA as presented by Cohen (1988), the investigator recalculated the needed sample size for this study. For the SHRQ with an effect size of .25, 250 subjects would be needed in order to obtain 80% power at the .05 level of significance. For the IFE with an effect size of .98, 20 subjects per group would have been needed to conduct this study at 80% power for the .05 level of significance. Therefore, the IFE had sufficient power for this study while the SHRQ did not.

Age humor and field energy.

Supplementary analysis of demographic variables, humor, and field energy revealed additional significant findings. Age was found to be a covariate of both humor (F=4.869, p=.030) and field energy (F=7.786, p=.007). Notwithstanding the fact that age was a covariate of humor, there continued to be no demonstrated differences in SHRQ scores between the two residential groups. However, significant differences between residential groups on the IFE continued to be demonstrated when statistically controlling for age. In conclusion, controlling for age does not change the pattern of results of this study. The two groups still do not differ on humor, but institutionalized individuals continued to score lower than non-institutionalized individuals on field energy.

Discussion

Humor and field energy were correlated in the overall sample as well as within the groups of institutionalization and non-institutionalization. Since there was no evidence as to the direction of the relationship between humor and field energy in the literature, the direction of these findings were not specified in the statistical testing. However, the data indicate a significant positive correlation between humor and field energy in this study sample. Furthermore, in this study sample of institutionalized and non-institutionalized older adults, humor and field energy were found to be significant correlates, regardless of residential location. As humorousness varies from individual to individual, field energy concomitantly varies, i.e., not only is there a positive relationship between humor and field energy, but the relationship suggests that humor and field energy are mutually patterned.

From the perspective of the Rogerian conceptual system, these two variables would have been expected to correlate positively and be mutually patterned. Humor, within the context of the Rogerian conceptual system, is a human energy field manifestation associated with a flow of energy or harmonious surge of vitality in the human field. Field energy is a manifestation of motion in the human and environmental fields, characterized by varying frequencies and pandimensional patterns (Gueldner et al., 1996). The principle of resonancy, which proposes that change occurs in the direction of higher frequencies, provides the base for the prediction that humor would be positively correlated with field energy. Thus, the data supports the theoretical proposition that humor and field energy arc mutually patterned. The data further supports the validity of the Rogerian Science of Unitary Human Beings.

However, the statistical differences in humor between institutionalized and non-institutionalized older adults, was not supported by the data. This seems to be difficult to interpret when examined in relationship to the finding that humor and field energy were significant correlates and that field energy was significantly different in the institutionalized and non-institutionalized groups. Tentative explanations may have to do with the lack of precision of measurement of humor by the SHRQ. Thorson and Powell (1991) found that the SHRQ measures the propensity to laugh. However, this measurement may not be a comprehensive measure of the construct of humor, i.e., the instrument may measure only select manifestations of humor. Even though humor and field energy were found to be significant covariates, their correlation may have been even stronger if the SHRQ had been more precise in measurement (Mishel, 1989).

Additionally, power analysis of the SHRQ revealed an effect size of .25. According to sample size tables (Cohen, 1988), the sample size in this study was not large enough to detect significant differences in the two groups on the variable of humor.

A final possible explanation of these results may rest with the conceptual framework of this study. Derived from available

multidisciplinary literature and the Rogers' Science of Unitary Human Beings, the conceptual propositions upon which this study is based may be inaccurate. Humor may not vary between institutionalized and non-institutionalized elderly.

The differences in field energy between institutionalized and non-institutionalized older adults were supported by the data. In addition to a significant difference between the two groups, findings revealed that this difference was directional. Institutionalized older adults had lower field energy than non-institutionalized older adults. This is consistent with the literature on the negative impact of the environment in institutionalized older adults (Simms, Jones, & Yoder, 1982). However, the finding must be viewed with some caution considering the potential influence of age as a covariate.

Age was found to be a significant covariate. Age was found to be a significant covariate of both humor and field energy with chronologically older participants scoringjower on both the humor and field energy scales than younger participants. This is difficult to interpret within the Rogerian framework that considers chronological age as an artifact that is not necessarily related to the individual's evolutionary development. However, this finding may present an alternative interpretation for non-institutionalized participants who were found to score significantly higher on the IFE than their institutionalized counterparts. As is typical of the institutionalized population-at-large, institutionalized participants in this sample were significantly older than non-institutionalized participants. The Science of Unitary Human Beings does not recognize chronological age as a valid indication of development. Furthermore, if chronological age were considered an indicator of development, the Rogerian conceptual system would predict that older subjects would be characterized by higher field energy. Therefore, one must not overlook the possibility that the theoretical framework itself is in need of revision. In the present study, it is impossible to determine whether the differences in field energy are associated with age, or with environment, or a combination of the two. Further studies with age-matched samples would be necessary to clarify these results.

Supplementary Findings

SHRQ. The reliability of the SHRQ was confirmed in this study. The readability of the SHRQ was 6.8 years of education (Lynn, 1989). This was well within the educational level of the groups of older adults, the institutionalized and non-institutionalized.

IFE. The reliability of the IFE was confirmed in this sample. However, the administration of the IFE was not without problems related to administration.

Institutionalized participants seem to have difficulty grasping the concept of a scale as explained in the directions to the IFE, as did some non-institutionalized participants. Participants made remarks, such as, "I do not feel like either picture or anywhere in between," or "I chose this picture because I like the picture" rather than choosing a picture on the basis of how one felt at the time of questionnaire administration. Perhaps the instructions on the IFE should be reconsidered for clarity, especially if the scale is to be used with elderly populations. Implications for Nursing

There were limitations to this study. Low statistical power of the SHRQ, evaluation apprehension of the research subjects, and limited generalizability since the sample was not random. Another variable, length of residence in an institutionalized setting, may have had a potential impact, but no specific limits were placed on length in the institutional setting, therefore, this impact cannot be evaluated.

Additionally, nursing homes as well as other settings that serve environmentally deprived clients need to be cognizant that field energy may be lower under conditions of such deprivation. Nursing care needs to be planned that allows for as much independence in decision-making as is possible. Also, diverse environmental resources would increase stimulation. Environmental diversity and independence, if coordinated, could increase positive feelings about self, adding energy to an individual's life.

Humor is an important component of every individual's life, despite the type of residence. Nursing homes and all types of institutions where elderly reside need to be cognizant of the use of humor as a communication and support device. Additionally, humor presents a means to add environmental diversity. Structured programs of humor or guided "humor reminiscence" may be indicated. However, further studies need to be conducted to determine efficacy of these ideas prior to any implementation of structured humor programs or guided reminiscence sessions involving humor.

Conclusion

This study was based on the proposition that the energizing nature of humor, employed as a nursing intervention, could facilitate patterning of the individual's field energy. Patterning characterized by a zest for living was proposed to have a strong relationship with enhanced well-being and quality of life for the vast number of older adults, many of whom are confined to institutional settings. The nature of the relationship between humor and field energy has been explored in a sample of older adults, yet questions remain. Field energy was significantly lower in institutionalized than non-institutionalized older adults, whereas the groups did not differ in humor as operationalized in this study. Because there were problems associated with sample size and the measurement of humor, further study needs to be conducted with a larger sample size to determine whether humor is different in the two groups, or whether the measurement of humor as measured by the SHRQ is the substantive problem. Efforts to confirm the relationships predicted by Rogers' Science of Unitary Human Beings were hampered by these problems.

The results of this study have limited generalizability because of sampling bias that may be present in non-random samples. However, the need for further research has been demonstrated in the area of humor. This research can be extended by developing and testing humor as a therapeutic modality within the theoretical context of Rogers' science of Unitary Human Beings. Due to the success of the IFE in this study, a foundation has been laid for the development of a humor intervention with the IFE as an outcome measure. Consequently, the IFE has a bright future for use in gerontological research.

References

Alligood, M. R. (1990). Nursing care of the elderly: Futuristic projections. In E. A. M. Barrett (Ed.), Visions of Rogers' science-based nursing (pp. 129-141). New York: National League for Nursing.

Barrett, E.A.M.(1986). Investigation of the principle of helicy: The relationship of human field motion and power. In V. M. Malinski (Ed.), Explorations on Martha Rogers' science of unitary human beings (p. 773-787). Norwalk, CT: Appleton-Century-Crofts.

Bellert, J.L. (1989). Humor: a therapeutic approach in oncology nursing. Cancer Nursing, 12(2), 65-70.

Berk, L., Tan, S.A., Fry, W.F., Napier, B.J., Lee, J.W., Hubbard, R.W., Lewis, J. E., & Eby, W.C. (1989). Neuroendocrine and stress hormone changes during mirthful laughter. American Journal of Medical Science, 298(6), 390-396.

Black, D. (1984). Laughter. Journal of the American Medical Association, 252(21), 2995-2998.

Brown, V. (1992, October). The effect of poverty environments on elderly subjective well-being: A conceptual model. Paper presented at the meeting of the American Gerontological Society of America, Washington, DC.

Cohen, J. (1988). Statistical power analysis for the behavioral sciences (3rd ed.). Hillsdale, NJ: Lawrence Erlbaum Associates.

Cousins, N. (1989). Proving the power of laughter. Psychology Today, 23(10), 22-25.

Ference, H. M. (1979). The relationship of time experience, creativity traits, differentiation, and human field motion: An empirical investigation of Rogers' correlates of synergistic human development. Dissertation Abstracts International, 40, 5206B. (University Microfilms No. 80-10, 281)

Ference, H. M.(1986). The relationship of time experience, creativity traits, differentiation, and human field motion. In V. M. Malinski (Ed.), Explorations on Martha Rogers' science of unitary human beings (pp. 95-106). Norwalk, CT: Appleton-Century-Crofts.

Fine, G. A. (1977). Humour in situ: The role of humour in small group culture. In A. J. Chapman, & H. C. Foot (Eds.), It's a Funny Thing Humor (pp. 315-318). Oxford: Pergamon Press.

Flugel, J. C. (1954). Humor and laughter. In G. Lindzey (Ed.), Handbook of Social Psychology (Volume II, pp. 709-734). Reading, MA: Addison Wesley.

Gueldner, S.H., Bramlett, M.H., Johnson, L.W., & Guillory, J.A. (1996). Index of Field Energy. Rogerian Nursing Science News, 8(4), 6.

Gueldner, S.H., & Hanner, M.B. (1989). Methodological issues related to gerontological nursing research. Nursing Research, 38(3), 183-185.

Labott, S.M., & Martin, R. A. (1987). The stress-moderating effects of weeping and humor. Journal of Human Stress, 73(4), 159-164.

Lefcourt, H.M., & Martin, R. A. (1986). Humor and life stress: Antidote to adversity. New York: Springer-Verlag.

Lynn, M. R. (1989). Readability: A critical instrumentation consideration. Journal of Pediatric Nursing, 4(4), 295-297.

McCaffery, M. (1990). Nursing approaches to non pharmacological pain control...distraction, relaxation, and cutaneous stimulation. International Journal of Nursing Studies, 27(7), 1-5.

McCormack, B. (2009). Editorial: Gerontological nursing research-do we have a lifespan approach? The International Journal of Older People Nursing, 4(2), 77-78.

Malinski, V. M. (1990). The experience of laughing at oneself in older couples. Nursing Science Quarterly, 4(2), 69-75.

Martin, R. A., & Lefcourt, H. M. (1983). Sense of humor as a moderator of the relation between stressors and mood. Journal of Personality and Social Psychology, 45(5), 1313-1324.

Merz, E.L., Malcarne, V.L., Ingunn, H., Furst, D. E., Clements. P. J., & Weisman, M. H. (2009). A longitudinal analysis of humor coping and quality of life in systemic sclerosis. Psychology, Health & Medicine, 14(5), 553-556.

Miller, C. A. (1990). Understanding the psychosocial challenges of older adulthood. IMPRINT, 37(4), 67-69.

Mishel, M. H. (1989). Methodological studies: Instrument development. In P. J. Brink & M. J. Wood (Eds.), Advanced design in nursing research, (p. 238-284). Newbury Park, CA: Sage.

Pfeiffer, E. (1975). A short portable mental status questionnaire for the assessment of organic brain deficit in elderly patients. Journal of the American Geriatrics Society, 23(70), 433-441.

Pfeiffer, E. (1980). The psychosocial evaluation of the elderly patient. In E. W.

Busse & D. G. Blazer (Eds.), Handbook of Geriatric Psychiatry, (p. 275-284). New York: Van Nostrand Reinhold.

Polit, D.F., & Hungler, B. P. (2008). Nursing research (8th ed.). Philadelphia: J.

B. Lippincott.

Prerost, F.J. (1989). Intervening during crises of life transitions: Promoting a sense of humor as a stress moderator. Counseling Psychology Quarterly, 2(4), 475-480.

Reed, P. G. (1986). Developmental resources and depression in the elderly. Nursing Research, 35(6), 358-374.

Reeder, F. (1991). The importance of knowing what to care about: A phenomenological inquiry using laughing at oneself as a clue. In P. L. Chinn (Ed.), Anthology on Caring. New York: National League for Nursing.

Robinson, V. (1977). Humor and the health professions. Thorofare, NJ: Slack, Inc. Rogers, M. E. (1970). An introduction to the theoretical basis of nursing. Philadelphia: F.A. Davis.

Rogers, M. E. (1986). Science of unitary human beings. In V. M. Malinski (Ed.), Explorations on Martha Rogers' science of unitary human beings (pp. 3-8). Norwalk, CT: Appleton-Century-Crofts.

Rogers, M. E. (1990). Nursing: Science of unitary, irreducible, human beings: Update 1990. In E. A. M. Barrett (Ed.), Visions of Rogers' Science-Based Nursing (pp. 5-11). New York: National League for Nursing.

Rogers, M. E. (1991). Glossary. Rogerian Nursing Science News, 4(2), 6-7.

Shibles, W.(1991). Feminism and the cognitive theory of emotion: Anger, blame, and humor. Women and Health, 17(1), 57-69.

Simms, L. M., Jones, S.J., & Yoder, K. K. (1982). Adjustment of older persons in nursing homes. Journal of Gerontological Nursing, 8(7), 383-386.

Simon, J. M. (1990). Humor and its relationship to perceived health, life satisfaction, and morale in older adults. Issues in Mental Health Nursing, 11 (1), 17-31.

Southam, M. (2003). Therapeutic humor: Attitudes and actions by occupational Therapists. Occupational Therapy in Health Care, 17(1), 23-41.

Tansey, M. K. (1988). Male adolescents' perceptions of humor: A phenomenological study. (Doctoral dissertation, Texas Woman's University, 1988). Dissertation Abstracts International, 49, 3110B.

Tennant, K. F. (1991). Laugh it off: the effect of humor on the well-being of the older adult. Journal of Gerontological Nursing, 16(12), 11-17.

Thorson, J. A., & Powell, F. C. (1991). Measurement of sense of humor. Psychological Reports, 69, 691-702.

Warner, S. L. (1991). Humor: A coping response for student nurses. Archives of Psychiatric

Nursing, 5(1), 10-16. Wolk, S., & Telleen, S. (1976). Psychological and social correlates of life satisfaction as a function of residential constraint. Journal of Gerontology, 31, 89-98.

Margaret E. Hindman, PhD, APRN-BC, FNP

Assistant Professor and Director of the Joint Center for Nursing Research and Scholarship University of South Carolina Upstate
Gale Copyright: Copyright 2011 Gale, Cengage Learning. All rights reserved.