Concept Analysis of Hope from a Nursing Perspective

Introduction

The concept of hope has been studied and researched by philosophers, theologists, clinicians and nurses. The concept has been found to have different meanings, conceptions and interpretations in various disciplines including nursing. The human-to-human interaction theory by Joyce Travelbee defines hope as an integral concept which is directly linked to good patient health outcomes. Since it is thought to be central to all healing, it triumphs over despair, hopelessness and suffering. Therefore, nurses have an integral role of reducing hopelessness during suffering among patients in clinical settings.

The human-to-human interaction theory also explains how nurses can help families, friends and patients to cope with suffering and illness by finding meaning through hope. This paper discusses the concept of hope from a nursing perspective. It defines hope according to the human-to-human interaction theory by Joyce Travelbee, explores literature, the defining attributes, antecedents, consequences and empirical referents of hope. A model case and alternative cases will also be provided.

Uses of the Concept of Hope

Hope is defined in the Oxford English Dictionary both as a verb and a noun. As a noun, it is “expecting something desired”. The verb form is “entertaining something desired”. According to Tabers Cyclopedic Medical Dictionary, hope is “having a prospect that something desired will happen”. Mosby’s Dictionary of Medicine, Nursing and Health Professions defines hope as a state of optimism which increases personal satisfaction and life-support. This description directly links hope to the science and art of nursing.

Joyce Travelbee discovered hope as a core component on nurse’s roles. Nurses have a professional responsibility to assist patients to find meaning in their lives, find and maintain hope. She defined hope as a form of strong belief/faith that something good and safer can still happen, bringing something better that was strongly desired with it. She linked hope to six major characteristics as follows: is associated with being dependent on other people, is future-oriented, and is connected to numerous escape routes, a strong desire to experience or take part in a task, a lot of confidence on the availability of other people when needed and being courageous to acknowledge personal fears and shortcomings and work towards he attainment of goals. According to Travelbee, both the patient and the nurse must go through a series of steps for this relation to progress. These steps are: observation phase, emerging identities, empathy, sympathy and mutual understanding.

Literature Review

Within the scope of nursing, hope has several definitions. Generally, it is considered to be a future-oriented feeling which involves a psychological process where an individual overcomes an event. Some of the most common themes within the concept of hope include: its definition, control, communication, relational and spiritual aspects. Based on most interviews with patients, hope is described either as a noun or a verb. As a noun, hope involves external forces in fighting an illness. As a verb, hope is a form of inner inspiration, responsibility and solidarity. According to Nweze et al., (2015), hope is multidimensional and healthcare providers are essential to a patient’s experience.

The concept of hope lacks clarity according to Eustache, Jibb & Grossman (2014), and this has influenced qualitative studies on hope and how it is directed to healing. In life and during illness, hope has different levels and meanings. Hope has themes such as the desire to return to prior self being action based with patients have individual reasons to become future oriented and hopeful. The majority start reframing their future within the context of their illness, with the hope of a prolonged life, actively maintaining treatment, self-protection from expectations that are unrealistic and integration of routine activities. Most patients directly relate hope will well-being and compare themselves with survivors and spirituality.

Since hope helps most patients to cope with suffering and illness, it is central to nursing. It also encourages some form of well-being and promotes a positive outlook and a meaning to live. By finding meaning in life, a patient keeps anticipating for the future. Majority of those patients who report of side effects that are poorly controlled or experience pain have low levels of hope and an overall sense of well-being which leads to hopelessness. When hopeless, most patients are eager and wish for a faster death and lead a poor quality of life. Lichwala (2014) insists that, in order to have high levels of hope, positive relations with healthcare providers, friends and family, a strong and well-established support system and positively interacting with others is necessary.

This literature review improved the author’s understanding on how essential the human-to-human interaction theory by Joyce Travelbee is integral in fostering hope among families and patients. If good, interpersonal relationships help to establish a rapport and long-term therapeutic relationship that promotes the ability to foster hope. The existence of a poor relationship influences despair and hopelessness.

Defining attributes are basically characteristics which are directly related to a concept and their use is in reference to a concept. From the literature review, several common themes of hope exist. According to Nweze et al., (2015), a patient has an experience to take part in the future and thus focuses on the future. The patient has to set goals and strive to achieve them and he/she should be actively involved in personal care and the healthcare team does not take the entire control. Lastly, a patient looks forward to enjoying and living a life in the future based on their new reality. Therefore, the key defining attributes include: action-directed, active-involvement, future-directed and future redefinition.

These are mandatory attributes which precede a concept before its actualization. Based on the literature review, common antecedents that were identified include: hopelessness, despair and suffering. So that a patient envisions the future and gets something to strive for, it is important that he/she selects goals. To maintain hope, constant communication with friends, family and healthcare providers is integral. Most patients strive to manage uncertainties through various mechanisms such as: comparing themselves with survivors, spirituality and control, which generally shows that they want control.

Consequences are basically the series of events that follow a concept. As commonly observed among patients with cancer, the consequences of hope are: overall well-being, self-esteem, good quality of life, comfort, happiness and comfort. Similar to the findings by Smith (2014), the literature review also demonstrated that a high level of hope is directly linked to patient knowledge on his/her diagnosis and high levels of satisfaction with the shared information.

In theory development, empirical referents simply refer to the categories which demonstrate a concept and how it can be measured. Hope is considered to be a force that only exists internally and thus, it is differently experienced by people. This explains why currently, there are no valid tools or scales that can be used to measure hope among patients. However, the Herth Hope Index has proven to be the most effective and used scale in hospices and palliative care among patients who are terminally ill. The development of the Herth Hope Index used the same subscales found in the HH scale namely: temporality and future, positive readiness and expectancy, and interconnectedness. It the most preferred since it bases on a universal concept of hope and was designed to be used in clinical settings. This scale is made up of twelve items which use a 4-point Likert scale where high scores are indicative of greater hope.

Cases

Model Case

A model case is that which is real, actual and has all the defining attributes within a concept’s context. A perfect example of a model case which illustrates the concept of hope is as follows:

Mrs. Johnson, a 60 year old female who was lately diagnosed with throat Ca came to the clinic for her scheduled routine follow-up. She had complains of shortness of breath, a persistent cough and difficulty walking. According to her past history, she had 40-pack years of tobacco smoking, uncontrolled type 2 DM and hypertension. She however explained that she was feeling great since she was alive and at home rather than being admitted in hospital. Besides, she also explained how she was able to perform some of her activities of daily life with very minimal or no assistance and was thus looking forward to attending her daughters graduation.

In this model case, the most outstanding defining attributes are as follows. Future directed; Mrs. Johnson looked forward to attending an upcoming activity. She is action directed and actively involved since she could perform activities of daily life such as attending scheduled visits. Mrs. Johnson also had some feelings of uncertainty since she clearly stated that despite her condition, she was not admitted. Besides, the interpersonal relationship that was created by the nurse and directed her to find out how the patient was feeling illustrates the nurse’s active participation in the patient’s care.

Borderline Case

A borderline case has some of a concept’s defining attributes but when closely analyzed, it lacks these defining attributes.

Jack is a 36 year old Caucasian male who was diagnosed with bacterial endocarditis which resulted to replacement of the aortic valve and heart failure. Jack observed his routine visits and close follow-up for INR. When asked why he was down in spirit, Jack replied how he was generally tired and overwhelmed with life and didn’t want to live any longer. Jack confessed how every night, when he heard the constant ticking of his valve reminded him how a single visit to the dentist destroyed his life. His condition directly interfered with how he lived and interacted with friends and family. His career with the Army ended and could only perform lighter duties. When asked about his previous relationship with his wife and children, Jack had a wide smile and his face gleamed, an indication that he still loved his family. However, based on the follow-up notes, it was evident that a week prior Jack stopped taking his medications and tried to kill himself despite showing up for follow-up days later.

This case is a perfect illustration of how Jack’s relationship was used to not only overcome but also envisage a future. Although Jack was full of despair, he had some hope but urgently needed assistance to remind himself of some of the outcomes that instill hope and a future life.

Contrary Case

A contrary case is that which illustrates how the concept has totally been defied.

John is a 30 year old African American male who has recently diagnosed with decompensated heart failure, atrial fibrillation and abnormal levels of oxygen saturation. He is obese and a well-known smoker. He was convinced that it is not necessary for him to reduce his weight, quit smoking or take drugs. He clearly explained that his father died at 45 years of age from heart failure, was initially obese, a heavy smoker and an alcoholic before modifying his lifestyle. Besides, he insisted that since he resembled his father as everyone told him, he was ready to die the same way his father died. This explained why John refused to get married, had vasectomy at 26 years and was declined to modify his lifestyle. This is clearly a case of what hope is not. John strongly believed that there was no hope in modifying his lifestyle or taking drugs to live longer past the age that his father died. He was hopeless and not future oriented.

Conclusion

As discussed, the concept of hope provides a clear understanding of its dynamics and how it can be applied by nurses in nursing practice. The fact that it is a phenomenon which exists in all humans makes it universal. Clients who are hopeful are actively involved, action-directed and future oriented. The human-to-human interaction theory by Joyce Travelbee explains the stages that a nurse-patient relationship can be established with an aim of helping patients find meaning in life especially during times of suffering and illness by maintaining hope. In advance nursing practice, the major implications are directly associated with the development of interpersonal relationships and how they can be maintained in the long term.

References

1. Eustache, C., Jibb, E., & Grossman, M. (2014). Exploring hope and healing in patients living with advanced non-small cell lung cancer. Oncology Nursing Forums, 41(5), 497-508.
2. Huangan, G., Utvaer, B., & Moksnes, U. (2013). The Herth hope index-a psychometric study among cognitively intact nursing home patients. Journal of Nursing Measurement, 21(3), p.378-400.
3. Hope. (n.d.). In Oxford English Dictionary.(2nd. ed.).
4. Lichwala, R. (2014). Fostering hope in the patient with cancer. Clinical Journal of Oncology, Nursing 18(3), p.267-269.
5. Nweze, O., Agom, D., Agom, J., & Nwankwo, A. (2015).A critical analysis of the concept of hope: The nursing perspective. International Journal of Science and Research, 4(3), 1027-1030.
6. Smith, H. (2014). Giving hope to families in palliative care and implications for practice. Nursing Children and Young People 26(5), p21-25.
7. Tabers Cyclopedic Medical Dictionary. (Ed.). (2013). Philadelphia, PA: F.A. Davis Company.