Offering Hope in Healthcare: An Important Nursing Reality
Hope is an important nursing reality as most patients need hope to cope with their stressors and improve the quality of life (Hammer, Mogensen, & Hall, 2009; Alidina & Tettero, 2010). Hope is mainly needed for the recovery, health promotion, rehabilitation, and for end of life care of the patients (Tutton, Seers, & Langstaff, 2009). It is an essential psychological resource that helps patients deal with chronic illness. It improves their sense of self, feelings of control, relationships with others, and quality of life (Duggleby et al., 2012).
The importance of hope in nursing practice has been acknowledged by patients, nurses, and the nursing theorists. Patients want the nurses and other healthcare providers to be sensitive to their hope. This belief is consistent with the findings from a meta-synthesis conducted by Chi (2007). Chi reviewed twenty-six research articles published from 1982–2005, and found that most of the cancer patients, regardless of their stage of cancer, recognized that hope is an essential part of their lives and they want help from nurses in increasing their hope.
Many nursing theorists such as Jean Watson and Kubler-Ross agreed and emphasized that hope is essential to nursing. In the caritas process, Watson (2008) viewed hope in context of faith and spirituality. She stated that incorporating love, faith, hope, trust, and spirituality in practice can improve the nursing care. Kubler-Ross (1969) in her theory of death and dying; gave special consideration to hope and noted that hope persists throughout the stages of dying, and maintains the spirit of the individuals.
Hope also enables patients to endure their suffering and strain. These theorists conceptualize hope in relation to spirituality, but the notable point is that their work supports that hope is an important element of nursing practice. The idea that hope is an important nursing reality is further affirmed by a few experimental and longitudinal studies which used various hope interventions to instill hope in patients.
Herth (2000) conducted a quasi-experimental study using a convenient sample of 115 people with a first recurrence of cancer. He used random sampling to assign the participants in one of the three groups: treatment group (hope), attention control group (informational), or control group (usual treatment). It was found that the hope intervention program significantly improved the quality of life of patients.
The hope intervention program consisted of the following four steps:
1. Encouraging the patients to recognize and express their fears, expectations, questions, and hopes of their life. This was followed by assisting them to identify areas of hope and specific threats to a hopeful life.
2. Assisting the participants to recognize the influence and importance of family members and friends in their lives. Followed by, helping the participants to establish a positive connection with them.
3. Helping the participants to reflect and understand the meaning of life, death, and suffering and identify their strengths and limitations to fulfill the meaning.
4. Helping the participants to learn different strategies to engender hope in their lives.
The strategies included positive role of interaction with nature, positive memories, and use of lightheartedness.
Rustøen, Cooper, and Miaskowski (2011) examined the effects of a hope intervention on levels of hope and psychological distress of 195 oncology patients through a longitudinal study. The intervention consisted of eight sessions and focused on helping to participants to work on the capacities; belief in oneself and one’s own ability, emotional reactions, relationships with others, active involvement, spiritual beliefs and values, and acknowledging that there is a future. Rustøen and colleagues reported that 95% of the participants found this hope intervention program useful.
Recently, Ghazavi, Khaledi-Sardashti, Kajbaf, and Esmaielzadeh (2015) measured the effect of hope therapy on 38 diabetic patients in Iran. The hope program comprised a combination of Snyder hope therapy and hope program in Islam. The hope program in Islam involved instilling hope by sharing Hadis, verses, and stories from the Holy Quran to the participants. After listening to the stories, such as those of Jonah and Joseph, the participants framed their own life story and retold that to others (Snyder hope therapy model).
The researchers found that hope therapy significantly increased hope in diabetic patients in the experimental group. These studies support the centrality of hope in nursing to some extent. Therefore, it could be implied that hope is a nursing reality. Although, it is difficult to conceptualize hope and propose practical nursing strategies for the use of this concept in nursing practice, nurses should try to instill hope in their patients’ lives (Tutton et al., 2009; Herrestad, Biong, McCormack, Borg, & Karlsson, 2014).
Strategies for instilling hope in patients based on the above discussion, the nurses can use the following practical strategies to maintain hope of the patients.
1. Relish their communication with their patients with the use of “light heartedness and humor, encouraging creative activities, using reminiscing, and communicating their own hopefulness” (Miller, 2007; p.16).
2. Engage in an open communication with their patients in order to identify their needs and expectations of life. Based on the assessment, help them in developing capacities to fulfill their needs and expectations pertaining to hopeful life (Herth, 2000).
3. Actively listen to the patients and their life stories and then plan accordingly to help them in dealing with the situations.
4. Involve the family members of the patients where needed, to help the patients in realizing their potential and capacity, to fulfil their needs and engage them in a positive interdependent relation with the family.
5. Involve themselves in physical, psychological, and emotional support of the patients and be present to them in an authentic manner (Clayton, Butow, Arnold, & Tattersall, 2005).
This discussion clearly highlights that hope is a nursing reality and patients need hope in order to deal with their illnesses and stressors. Therefore, the nurses can use various hope intervention programs or strategies to increase their hope.
1 .Alidina, K., & Tettero, I. (2010). Exploring the therapeutic value of hope in palliative nursing. Palliative and Supportive Care, 8(3), 353-358.
2. Clayton, J. M., Butow, P. N., Arnold, R. M., & Tattersall, M. H. (2005). Fostering coping and nurturing hope when discussing the future with terminally ill cancer patients and their caregivers. Cancer, 103(9), 1965-1975.
3. Dufault, K., & Martocchio, B. C. (1985). Symposium on compassionate care and the dying experience. Hope: its spheres and dimensions. The Nursing Clinics of North America, 20(2), 379-391.
4. Duggleby, W., Hicks, D., Nekolaichuk, C., Holtslander, L., Williams, A., Chambers, T., & Eby, J. (2012). Hope, older adults, and chronic illness: A meta-synthesis of qualitative research. Journal of Advanced Nursing, 68(6), 1211-1223.
5. Ghazavi, Z., Khaledi-Sardashti, F., Kajbaf, M. B., & Esmaielzadeh, M. (2015). Effect of hope therapy on the hope of diabetic patients. Iranian Journal of Nursing and Midwifery Research, 20(1), 75-80.
6. Hammer, K., Mogensen, O., & Hall, E. O. C. (2009). The meaning of hope in nursing research: A meta-synthesis. Scandinavian Journal of Caring Sciences, 23, 549-557.
7. Herrestad, H., Biong, S., McCormack, B., Borg, M., & Karlsson, B. (2014). A pragmatist approach to the hope discourse in health care research. Nursing Philosophy, 15(3), 211-220.
8. Herth, K. (2000). Enhancing hope in people with a first recurrence of cancer. Journal of Advanced Nursing, 32(6), 1431-1441.
9. Klotz, L. K. (2010). Hope in relation to nursing interventions for HIV-infected patients and their significant others. Journal of the Association of Nurses in AIDS Care, 21(4), 345-355.
10. Kubler-Ross, E. (1969). On death and dying. New York, NY: Macmillan Publishers
11. Miller, J. F. (2007). Hope: A construct central to nursing. Nursing Forum, 42(1), 12-19. doi: 10.1111/j.1744-6198.2007.00061.x
12. Rustøen, T., Cooper, B. A., & Miaskowski, C. (2011). A longitudinal study of the effects of a hope intervention on levels of hope and psychological distress in a community-based sample of oncology patients. European Journal of Oncology Nursing, 15(4), 351-357.
13. Tutton, E., Seers, K., & Langstaff, D. (2009). An exploration of hope as a concept for nursing. Journal of Orthopaedic Nursing, 13(3), 119-127.
14. Watson, J. (2008). Nursing: The philosophy and science of caring. Boulder, CO: University Press of Colorado.
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