https://doi.org/10.15218/ejnm.2019.13 Erbil j. nurs. midwifery, Vol. 2, No. (2), May, 2019 Original Article Perception of Undergraduate Nursing Students Regarding Humor’s Using as a Teaching Strategy in the Classroom at College of Nursing in Erbil City ABSTRACT INTRODUCTION Humor is an characteristic that can motivate an individual to accomplish sig- nificant goals in his or her life.[2] Examples Background and objectives: Humor is a necessary teaching strategy tool in nursing edu- cation programs. Nursing students may feel a sense of boredom in class and therefore, it is important for faculty and instructors to incorporate humor in both the class and clinical setting to improve the overall learning environment. The purpose of this study was to ex- plore students’ experiences regarding the use of humor in the classroom. Methods: A qualitative study using a hermeneutic-phenomenological approach was taken as a framework for the study. A volunteer sample of 9 undergraduate nursing students from the fourth stage of college of nursing at Hawler Medical University participated in the study. The data was analyzed using the content analysis method. This method included four stages; interview transcript, open coding, axial coding, and core category. Data was collected using a semi-structured interview utilizing four open-ended interview questions: (a) Did humor improve your relationship with teachers? How? (b) Did humor help you to pay attention to the class? How? (c) Did humor increase your interest in the topic? How? (d) Did you have experiences with humor in the classroom? How? Results: Most of the participants reported and emphasized that using humor in the class- room by nurse educators was helpful in making the learning environment fun. Also, partici- pants mentioned that using humor was helpful in that they were able to ask their teachers questions in class without fear. Students reported that utilizing humor in the classroom encouraged them to enjoy the course content and the teachers. There were two main themes used in this study; a) encourage students for discussion in the classroom with the following sub-themes: enhance the learning process, improve students critical thinking and communication skills, and decrease the students’ stress, fear and anxiety and b) attract students’ attention in the classroom with the following sub-themes: improve stu- dents’ course grade, encourage group discussion, increase students’ attendance in the classroom, and pay attention to the class . Conclusion: The use of humor in the classroom enhances the learning process. All of the students confirmed that using humor in the classroom improved student-teacher’s com- munication skills. Also, students indicated that using humor in the classroom influenced them to pay attention to the class, retain the information, and digest the information very well. Keywords: humor, classroom, nurse educator, nursing students, nursing education Dlzar Sedeeq Anwer; Department of Nursing, College of Nursing, Hawler Medical University, Erbil, Iraq. (Correspondence: dlzar.anwer@hmu.edu.krd) Norhan Zeki Shaker; Department of Nursing, College of Nursing, Hawler Medical University, Erbil, Iraq. Adnan Rasheed Aziz; Department of Nursing, College of Nursing, Hawler Medical University, Erbil, Iraq. 101 Erbil Journal of Nursing & Midwifery Received: 19/11/2018 Accepted: 22/8/2019 Published: 30/11/2019 https://doi.org/10.15218/ejnm.2019.13 Erbil j. nurs. midwifery, Vol. 2, No. (2), May, 2019 Original Article of humor include jokes, cartoons, comedy, laughter, etc. [1] It carries a message of caring, warmth, love, and compassion and enhances positive communication in the learning environment. [3] Humor can assist students in remembering topics and course content particularly if the humor supports the class material. [3] Humor creates a relaxed environment where both teaching and learning can be interesting and improved upon. Humor is used to develop the learning pro- cess and enhances nursing students’ desire to learn and diminishes the “boring” class- room setting. Humor is a concept that can help nursing students feel relaxed through- out lecture. When nursing students are comfortable, thinking becomes productive and important. An anxious atmosphere im- pedes thinking. [2-4] Humor can be an effective, multi-purpose teaching tool for nurse educators to teach course content, keep students’ attention, relieve anxiety, establish relationships, and make learning fun. [5] Humor appropriate- ly used has the potential to humanize, ex- plain, soothe, encourage, reduce anxiety, and keep people thinking. [6] Humor has been said to facilitate the retention of orig- inal information as well. [7] The effective use of humor in the classroom produces loyalty, supports self-esteem, lessens stress, lessens criticism, and increases effective leadership. As college classrooms become more diverse both in student pop- ulation and delivery methods, it becomes increasingly imperative for nurse educators to link with their students on a variety of levels that students perceive as beneficial to their learning process. Nurse educators should be role models for students. Nurse educators who are well-informed about humor and utilize humor in their class- rooms can help students identify their own sense of humor and how it affects others around them, including their patients. [8] Humor is understood to diminish anxiety and worry, build self-confidence, develop productivity, increase interest, reduce boredom and encourage different thinking. [9] It is an ideal teaching aid for creating a classroom atmosphere helpful to learning. When used in the correct way, humor can motivate creative thinking, improve memory of the learners, stimulate learners to learn, gain information, and build a posi- tive learner-teacher relationship. [10] Positive humor, particularly when related to the topic, encourages learning because it establishes a conducive environment for adult learning, memory, unification of or- ganizers and learners, and adopted cohe- siveness. [11] Humor is recognized as a teaching method for increasing a positive learning environment. When a teacher cre- ates a helpful social environment, learners are more likely to be receptive to learning. [12] Learners stated that humor makes teachers more likeable, makes the material easier to learn, decreases stress, and in- creases self-esteem and attention. Humor can also bridge the gap between the teach- er and the students by putting students at ease. [13] Humor has been mentioned as one of the important characteristics of a good instructor and it is a valuable teach- ing method with many benefits for teach- ers, as it could enhance learning by helping comprehension. [14] Nurse educators should use humor effectively in facilitating learning so as to develop the learners’ sense of humor, which is also expected in clinical practice, where a climate of ac- ceptance, support, trust and freedom of expression should be created. [15] It is crucial to the nurse educator to use humor as a teaching strategy in the class- room to promote the learning outcome of the nursing students. This study was con- ducted because there were limited qualita- tive research studies about humor in 102 Erbil Journal of Nursing & Midwifery https://doi.org/10.15218/ejnm.2019.13 Erbil j. nurs. midwifery, Vol. 2, No. (2), May, 2019 Original Article The criteria for sample selection includes: fourth stage nursing students, either male or female, self-reports of being present when humor is being used in the class- room. The criteria for sample exclusion includes: first stage, second stage, and third stage undergraduate nursing stu- dents. Instrument/Measurement The instruments selected for collecting da- ta in this study were: (a) Semi-structured open-ended questions interview and (b) demographic data. Demographic data con- sisted of age, gender, educational level, and the question: Have you ever witnessed humor used in the classroom? The four semi-structured interview question was consisted of; (a) Did humor improve your relationship with teachers? How? (b) Did humor help you to pay attention to the class? How? (c) Did humor increase your interest to the topic? How? (d) Did you have experiences with humor in the class- room? How? Data Collection Procedures Prior to data collection, approval was ob- tained from the Research Ethical Com- mittee and Scientific Committee of College of Nursing at Hawler Medical University. Participants were recruited by explaining the purpose of the study and the qualifying eligibility criteria. The researcher contact- ed participants directly by visiting the classroom after students finished their lec- ture. Prior to the start of the interview, each participant was informed of methods to ensure confidentiality and his/her right to refuse participation at any time. Each participant was also asked to sign an in- formed consent form agreeing to partici- pate in the study. Each participant was asked the same four open-ended ques- tions. The interview took place face-to- face (recording voice) between researcher and participants. Data was collected until data saturation was obtained. education and even fewer on humor in nursing education. The scope is further lim- ited when examining studies reflecting how humor is perceived by students regarding their learning experience. The use of hu- mor is a somewhat recent innovation in nursing education. Therefore, how it is used and the reasoning for using it is un- clear. While educators still remain doubtful to the use of humor in the educational setting, students voice their support and appreciation of humor as an adjunct to their education. The objective of this study was to explore the perceptions of undergraduate nursing students regarding the use of humor in the classroom as a teaching strategy to pro- mote learning outcomes. Research Design A qualitative study- hermeneutic- phenomenological approach used to ex- plore undergraduate nursing students’ per- ception of humor in the classroom. The hermeneutic-phenomenological approach seeks to describe and analyze phenomena as they are experienced. The content anal- ysis was used as a data analysis method in this study. The focus of this study was to examine undergraduate nursing students’ perception of humor in the classroom who are in their last year of the baccalaureate nursing program. Population, Sample, and Setting The population involves undergraduate nursing students (fourth stage) attending College of Nursing-Hawler Medical Univer- sity- in Erbil-Kurdistan Region-Iraq. The sample for the study was a purposeful sample. This allowed for potential partici- pants who have encountered humor in the classroom to come forward and identify themselves. Once inclusion criteria were met, a random sample of 9 students from the learning institution were interviewed. 103 METHODS Erbil Journal of Nursing & Midwifery https://doi.org/10.15218/ejnm.2019.13 Erbil j. nurs. midwifery, Vol. 2, No. (2), May, 2019 Original Article The data was analyzed by using content analysis method. This method included four stages; interview transcript, open cod- ing, axial coding, and core category. In in- terview transcript, all students’ speech was put in one column. In open coding, all stu- dents’ speech details were summarized into short meaningful phrases. In axial cod- ing, all those phrases were summarized into sub-themes. In core category, all those phrases were summarized into themes. 1– Encourage students for discussion in the classroom A-Enhance learning process Student One: “In third stage, I had a psy- chology course. I love this course because the teacher made this course more inter- esting. The teacher always included funny jokes in the class. It encouraged me to love this course. I was able to love the teacher and be happy in his course. It encouraged me to create questions regarding course content.” Student Seven: “I had a teacher who was like a friend and he spoke to us so nicely in the class. He showed us many pictures on the slides. This teacher did not make me feel down in the classroom and his behav- ior encouraged me to easily understand the content of the course”. Student Four: I paid attention to the con- tents of the course due to the use of cari- catures and emoji pictures that my teacher put on the slides of the PowerPoint. This teacher instead of just giving the basic de- tails of his lecture, he included so many pictures in the slides and it was helpful to understand the content of the course. For me, I was not doing well in this course, but when the teacher put all caricatures and emoji’s in the slides it helped me to under- stand the content very well and I got a good grade in this course; most other stu- dents also well in the course” . Student Eight: “The use of kind and funny language has influenced students’ course grades. It encourages us to love the teach- ers and pay attention to the class. It also influences our examination grades”. B-improve students critical thinking and communication skills Student Three: “During our second stage pharmacology course, there was a teacher that I loved because she had a good rela- tionship with students. Student Seven: “I had many examples re- garding using humor in the class. One thing that I remember and experienced was in my communication skill course when I was in second stage. One night I did not sleep very well as well as my classmate. During the class time, I slept in the class until the end of the class. The teacher knew that I slept in the class but he did not wake me up and he did not feel me down in front of the students. I instead, at the end of the class, the teacher put a picture on the slide that some students slept in the class. This picture on the slide made us laugh in the class and we were waking up with the stu- dents’ laughter. This teacher’s behavior made us love the teacher”. C-Decrease the students stress, fear and anxiety Student Three: The teacher was always used nice words to decrease our anxiety and fear in the class. This teacher’s behav- iors helped me to make questions regard- ing the content of the course and love the course and teacher. Previously, I did not like the pharmacology course but this teacher made me love this course due to being so nice during the class. Certainly, if there was no fear between the teachers and students, it would encourage the stu- dents to learn the topic”. 104 Erbil Journal of Nursing & Midwifery RESULTS https://doi.org/10.15218/ejnm.2019.13 Erbil j. nurs. midwifery, Vol. 2, No. (2), May, 2019 Original Article that happened here. His lecture regarding the earthquake stated that people were praying in every home and the color of their faces changed once it happened. It was so nice that the teacher talked about these things because our psychological sta- tus was not good. We had fear regarding the earthquake and the teacher decreased this fear by with his jokes. Also this joke helped me learn more about the earth- quake which was nice. It also helped me to pay attention to the class and it was so good”. Student Six: “In second stage, I had a phar- macology course. That teacher used funny and nice language in the class and he was so open to us as he listened to the stu- dents. His nice speech in the class made us happy. We were able to pay attention to the class and loved to ask questions. The teacher always used pictures in the slides and it helped us to digest the topic very easily. The teacher was able to give more information in a short period of time. It was useful to the students to learn the content of the course”. C- Increase students’ attendance rates in the classroom Students Eight: “I had teachers in both my Ethics and Psychology courses who used humor very nicely. These teachers were nice and used humor in a reasonable man- ner and in a short period of time. We loved both the teachers and going to class. We would be so worried if we missed the class of these two teachers who used humor. In these two courses, we learned the content of the course and paid attention to the class. We learned a lot while being re- spectful of one another and earned good grades in the course”. D- Pay attention to the class Student Nine: “I was in second stage in my microbiology course. I did not like this 105 Erbil Journal of Nursing & Midwifery 2- Attract Students’ Attention in the Class- room A- Improve students’ course grade Student One: “In third stage, I had a psy- chology course. The teacher in this course had a great influence on us to pay atten- tion to the class and to have a great grade in this course. When you understand the content in the class, it makes the examina- tion very easy. This teacher frequently used funny language in the class and this was helpful in understanding the course”. Student Four: “In my second stage commu- nications skill course, I had a teacher who filled all slides with caricatures and emoji from first lecture until the final lecture. We had a good grade in this course”. Student Five: “I remember last year I had a Biostatistics and a Research course both taught by one teacher. From the first lec- ture until now, we had fear regarding this teacher. The teacher was really serious, did not have smile, and did not use funny language in her class. The teacher did not use humor in the class to make us smile and happy. During the examination, I stud- ied so much yet did not get a good grade. This was strange to me. At the same time, I had a psychology teacher and though it was really hard to understand the content of the course, the teacher made a funny joke in the class. It helped us to learn the content of the course. It encouraged us to pay attention to the class and create ques- tions regarding the content of the course. If a teacher did not use humor like funny jokes and spoke nicely during class time, it will not encourage me to ask questions regarding the topic. It means that the teacher is not open to students”. B- Encourage group discussion Student Two: “Last year in third stage, I had a psychology course. the teacher made a funny joke about an earthquake https://doi.org/10.15218/ejnm.2019.13 Erbil j. nurs. midwifery, Vol. 2, No. (2), May, 2019 Original Article course and though I studied so much, I was not able to get a good grade in this course. I was sitting in the last chair in the class and that day I was so sleepy, my teacher said to me ‘why you do not have voice today?’. All my classmates looked at me and all of them thought that I was a smart student in this class. For the remainder of the class, that teacher told me you have to sit in the front seat of the class. This teacher’s be- havior made me to love this teacher and pay attention to the teacher. I was able to have increase my interest for studying in this course. This teacher’s behavior encour- aged me to have a good grade in the mi- crobiology course”. A quantitative study had been conducted in the United States with students who had taken a psychology course. The purpose of the study was to determine the outcome of using humor on students’ exam perfor- mance. The results showed that students who experienced humor in their courses had higher grades on the final exam. [4] A qualitative study had been conducted in Iran which mentioned that understanding nurses’ perceptions and experiences of hu- mor helps identify its contributing factors and provides valuable guidelines for en- hancing nurses and patients’ mental, emo- tional and physical health. Spreading a cul- ture of humor through teaching methods can improve workplace cheerfulness and highlights the importance of humor in pa- tient care in nurses and nursing students. [16] A qualitative study using the phenomeno- logical approach was conducted in the United States. The focus of this study was to examine undergraduate nursing stu- dents’ experience with humor in the class- room. The results of the study support the principles that emotions can influences the learning process and that interpersonal relationships are a concern for nursing stu- dents. Students expressed their desire to have classroom experiences that help them perceive, create, feel, and wonder and to have a classroom atmosphere where environmental conditions facilitate learning. [17] There are several potential limitations to the study: (a) small sample size, (b) geo- graphical area consisting only of College of Nursing-Hawler Medical University, (c) de- pendence on students’ recall of nurse edu- cators’ uses of humor, and (d) the inexperi- ence of the researcher could introduce re- searcher bias. Interview technique and questions facili- tated participant disclosure and the discov- ery of common experiences. The following conclusions are based on the results of this study: 1) Nursing students in the college of nurs- ing believed that humor in the classroom encourages students to pay attention to the class, retain the information, and di- gest the topic very well; 2) students be- lieved that humor should be incorporated more often into the nursing curriculum; 3) students believed that humor improves student-teacher communication skills; 4) students indicated that using humor in the classroom influenced them to increase their interest in the content of the course. we declared that there is no conflict of in- terest with this study. [1] Olsson H, Kook M, Sorenson S, Koch M. Nursing and humor: An exploratory study in Sweden. Vard I Norden 2000; 1: 42-45. [2] Chabeli M. Humor: A pedagogical tool to promote learning. Curationis September 2008. 106 Erbil Journal of Nursing & Midwifery COUNCLUSION DISCUSSION CONFLICT OF INTEREST REFERENCE https://doi.org/10.15218/ejnm.2019.13 Erbil j. nurs. midwifery, Vol. 2, No. (2), May, 2019 Original Article [17] Athern T. Undergraduate nursing students’ experience of humor in the classroom. 2008 Dissertation. [3] Ron D. The use of humor as a teaching tool in the college classroom. NACTA Journal 2000. [4] Ziv A. Teaching and learning with humor: Experiment and replication. Journal of Experimental Education 1988; 57(1): 5–11. [5] Ulloth J. The benefits of humor in nursing education. Journal of Nursing Education 2002; 41, 476-481. [6] Torok E, McMorris F, Lin C. Is humor an ap- preciated teaching tool? Perceptions of pro- fessors’ teaching styles and use of humor. JournalCollege Teaching .2004; 52, 14-20. [7] Cornett E. Why get serious about humor? In Learning through laughter; humor in the classroom. Bloomington, IN; Phi Delta Kappa Educational Foundation; 1986. [8] Pierson P, Bredeson V. It’s not just a laughing matter: school principals’ use of humor in interpersonal communications with teenag- ers. Journal of School Leadership 1993; 3, 522. [9] Ziegler B. Use of humour in medical teach- ing. Medical Teacher .1998; 20(4):341-348. [10] Goudinho J, Jacob M. .Humor as a teaching strategy in medical education. European Journal of Pharmaceutical and Medical Re- search 2016; 3(7): 419-422. [11] Baid H. Lambert N. Enjoyable learning: The role of humour, games, and fun activities in nursing and midwifery education. Nurse Edu- cation Today .2010; 30, 548–552. [12] Nadeem M. Teaching with humor: a benevo- lent teaching technique for second language learners in teacher education. International Journal of English and Literature. 2012; 2(4): 89-96. [13] Huss J, Eastep S .The attitudes of university faculty toward humor as a pedagogical tool: can we take a joke?. Journal of Inquiry & Action in Education .2016; 8 (1):39-65. [14] Nasiri F, Mafakheri F. Higher education lec- turing and humor: from perspectives to strategies. Higher Education Studies 2015; 5 (5): 26-31. [15] Chabeli M, Malesela J, Rasepae M. Humour to facilitate meaningful learning in nursing education as experienced by learner nurses. Journal of Education. 2014; 59, 90-113. [16] Ghaffari1G, Nayeri N, Shali M. Nurses’ expe- riences of humour in clinical settings. Medi- cal Journal of the Islamic Republic of Iran. 2015; 29 (182): 2-11. 107 Erbil Journal of Nursing & Midwifery