Critically ill people become aware of their need for external help because of their compromised health status. In a study they described how external help made them feel more hopeful. Large (1990) says that hope 'is the interior feeling that there is help on the outside'. Spiritual hope comes from receiving the external help from God. Help implicitly increases hope. This relationship is reciprocal with hope seeking help. One depends on the other.

Cutcliffe (1997) believes that help is the action component of a caring relationship. 'The two are inextricably linked together from central constructs of the nature of nursing.'

Seligman developed the hypothesis (through his 'learned helpless' model) that the depressed person fails to learn adaptive ways of dealing with painful events, learning hopelessness instead. He thought that if a person failed repeatedly to control their environment (as the dogs failed to escape the electric shocks) they would describe themselves as helpless, unable to alter their situation. Believing that their behaviour lacked meaning they become passive, expressing feelings of misery and hopelessness.

2. Creation of a partnership/ sharing control

The essence of this is the control within the nurse-patient relationship. The patient must feel that they have some control over some of their lives. They should be encouraged to make decisions, have their individual concerns addressed and have their desires focused on. Schnider (1980) suggests that hopeless patients become more hopeful as a result of the nurse encouraging the patient to control as many events as his energy and the restrictions of his care allow. Stapleton (1983) believes that unchecked powerlessness leads to a state of hopelessness.

3. Affirmation of worth

In a study into how nurses inspire hope in HIV positive people, Cutcliffe (1995) suggests that hope inspiration 'is a subtle unobtrusive process, interwoven with the same subtle act of caring'. Simply by the presence of another human being who demonstrates continual unconditional acceptance, tolerance and understanding is entering into caring practice. Thus simultaneously inspiring hope. Further research supports this view. Critically ill patients reported that a higher hope level was synonymous with the nurse demonstrating caring practice.

The way individuals are treated ultimately has an influence on how they feel about themselves. If a patient senses that a nurse is disinterested and uncaring, the effect on their feelings of self worth is likely to be a negative one. Such attitudes are likely to convey a message of hopelessness. This will ultimately have an effect on the patient's hope level. Nurses cannot inspire hope in others if they have no hope in the patient themselves.

4. Connecting with others.

Patients are assisted in recognising the interdependent influence of family and friends. They explore ways to establish a sense of sustained connectedness with others and identify resources available for support.

From Wake (1992), hope inspiring strategies include use of interpersonal self (listening, presence, empathy, directing the interaction away from hopelessness themes), involvement and caring for the family, sharing success stories, use of progress reports, empowerment, referral to experts (psychologists, clinical nurse specialists).
Humor has an incredible capacity to heal body, mind and spirit. Carson (1989) notes that humor is 'transcendent- it momentarily removes one from an isolated personal state to join in surprise in the ludicrous situation of human beings.'

5. Spirituality

Carson (1989) suggests coping strategies in chronic illness.

a. Prayer

This can be interpreted as:
* A confession of need, thankfulness and a dependency on a God of infinite strength and resource- when one's own resources are so limited and in need of nurturing.
* A reflection of an intimate relationship with a loving, accepting person in which one can be open and honest with thoughts and feelings.
* An affirmation in the hope that God is reliable.
* An expression of anger, confusion or retaliation toward a supreme seen as the source of pain, suffering and loss.

b. Bibliotherapy.

This is purposeful reading: To assist people to expand their horizons, learn from others or experience catharsis. Religious writings may as well encourage one's faith and courage.

c. Journal keeping.

This can renew the spirit, release pent up emotions, trigger new avenues of thought and build a storehouse of memories.

BACK TO ARTICLES INDEX

Handout of definitions used on the day:

Hope is:

'Not a feeling of certainty that everything ends well but just a feeling that life and work have a meaning'.

'A positive expectation that goes beyond visible facts'

'A motivating force and an inner readiness to reach goals'

'An inner strength that can enrich lives and enable individuals to look beyond their current pain, suffering and turmoil'

'A potentially powerful factor in maintaining and regaining health, accepting illness limitations and achieving quality of life during times of illness and loss'.

People who are hopeful therefore experience improved physical and mental well-being.

There is also evidence that people who are hopeless and 'give up' have reduced chances of survival from cancer ad heart disease

People in a state of hopelessness will make little or no effort towards setting future goals and plans. They will emphasize current failures and verbalize doubts about themselves, their care and their life (and focus on the past).

Many authors agree that it is vital to acknowledge that hope is instrumental in the coping responses of those who are critically or chronically ill.

Brian Keenan's conclusion was: Hope for everything but expect nothing.

'Hope should be restrained by objectivity lest it lead one off to a dance into a fairyland, which is the final delusion'.

i.e. if their hope becomes shattered then the level of despair becomes unbearable.

It may not be realistic to hope a depression will disappear overnight or even that it will disappear at all without considerable effort on their part.

BACK TO ARTICLES INDEX

Discussion: Can Nurses Give Hope to Another Person?

'Fostering hope is part of the process of caring but it is not something we are able to give or prescribe for another person?.

But Herth (2000) believes it is possible for nurses to increase feelings of hope and perceived quality of life in individuals through specifically designed hope interventions.

Hope is not static, it is dynamic. Personal hope levels fluctuate.

In studies of terminally ill cancer patients several months before their death, their hope levels were not consistent. The greatest change was noted after specific hope inspiring strategies had been used.

Certainly there is evidence in literature to suggest that hope can be nurtured in people which will change their personal level of hope.

The healthcare provider must be able to maintain and install hope in order to be affective with these clients.

Hope springs from knowledgeable trust in an available and reliable source of help from outside the self at a time of need.