Hope makes a difference

Hope that provides strength in illness-patients' perspectives: Nursing students' narratives after conversation with patients

BACKGROUND

The aim of this article is to explore sources of hope for patients by using patients' narratives and perspectives on how they find hope when facing illness. Hope enables people to endure suffering and can be critical to how people cope with illness. Hope is not a singular phenomenon, so nurses need to understand how to support the patients' sources of hope.

METHODS

We used a qualitatively descriptive design with qualitative content analysis. We examined reflective notes from 385 first-year nursing students after they had had a conversation with patients with disease experiences following Graneheim and Lundman's description of analysis. The conversation with the patients/persons was related to sources of hope and strength, who they turned to when they needed help, and if they were available. After the conversation, the students had to write a reflective log with a summary of the conversation.

RESULTS

We found four categories that explained how patients found hope: (1) relational hope, (2) spiritual hope, (3) hope in nature and (4) hope in oneself. Most of the patients found hope in more than one of these categories.

CONCLUSION

It is important for nursing to have knowledge about patients' narratives about how they build and sustain hope during times of illness. Nursing can contribute to promoting hope and thus alleviating patients' suffering. The four categories in this study can serve as a guide for nurses to assess and support patients' hope and encourage them to find their strength through different sources.

The Effect of COVID-19 Outbreak on Older Adults' Hopelessness, Loneliness and Spiritual Well-Being in Turkey

The aim of this study was to determine the hopelessness, loneliness and spiritual well-being of older adults and the relationship between these three concepts during the COVID-19 pandemic. This research used a cross-sectional, descriptive approach. Data were collected between October 13 and November 13, 2020, with 476 individuals over 65 years living in three different cities in Turkey. Data were collected using a demographic information form, Beck Hopelessness Scale (BHS), Loneliness Scale (UCLA-LS) and Spiritual Well-being Scale (FACIT-Sp). During the COVID-19 outbreak, it was found that there was a significant negative relationship between hopelessness, loneliness and spiritual well-being of older adults. In this study, it was found that during the COVID-19 pandemic, the level of hopelessness and loneliness among older adults was below the average score, and their spiritual well-being levels were moderate. Based on the findings of the present study, it is recommended that practices which increase hope, strengthen social ties and spiritual support, should be implemented for older individuals during the COVID-19 pandemic period or any other times during which social distancing is mandatory.

"Embracing is the most important thing we can do" - Caring for the family members of patients at risk of suicide

Aim

This study explores mental health personnel’s experiences in the encounter with family members of patients at risk of suicide so as to develop a deeper understanding of the content of caring.

Methodology

Data were collected using semi-structured interviews with 12 participants and were analysed and interpreted using a model inspired by the philosophical hermeneutics of Gadamer. The context was psychiatric wards.

Findings

Through a thematic analysis, four themes emerged: Acknowledgement as a premise for involving family members. Embracing with the family members’ feelings and reactions. Strengthening hope in a situation entailing a serious risk of suicide. Providing reassurance to family members in transitional situations.

Conclusion

Witnessing the family members’ suffering and needs is understood as arousing a sense of responsibility in the participants and triggering various care strategies such as listening, embracing, strengthening hope and providing reassurance.

Professionals' Perspective on Needs of Persons Who Frequently Use Psychiatric Emergency Services

This study explores how professionals experience persons who frequently use psychiatric emergency services (PES) in terms of their needs in Sweden. The data comprise 19 semi-structured individual interviews and one focus group interview with healthcare professionals (i.e., assistant nurses, psychiatric nurses, intern physicians, and resident physicians), which are analyzed using qualitative content analysis. The overall findings suggest that persons who frequently use PES suffer from illness, unfavorable life circumstances, and inadequate care, which together emphasize the need for more sustainable support. The findings indicate that the professionals saw beyond illness-related needs and could also acknowledge patients' needs originating from social, existential, and care- and support-related aspects of life.

The Correlation Between Schizophrenic Patients' Level of Internalized Stigma and Their Level of Hope

AIM

The aim of this study is to determine the correlation between schizophrenic patients' level of internalized stigma and their level of hope.

MATERIAL AND METHOD

The population of the study consisted of patients who had been diagnosed with schizophrenia and also met the study inclusion criteria. The study sample selection from the population was not further divided; the study was conducted with 76 patients. The data of the study were collected using a personal information form, the Internalized Stigma of Mental Illness (ISMI) Scale, and Herth Hope Scale.

FINDINGS

The patients' mean score on the Internalized Stigma Scale was 72.78±16.05. Their score on the Hope Scale is 50.36±11.91. A significant negative correlation was found between the total mean scores of ISMI and the Herth Hope Scale (r=-0.360, p<0.01). A significant positive correlation was found between the stigma resistance subscale mean score of ISMI and the total mean score of the Herth Hope Scale (r=0.510, p<0.01).

CONCLUSION

The internalized stigma levels of schizophrenic patients were found to be high, whereas their hope levels were found to be moderate. A significant negative correlation was found between internalized stigma and hope. This study also found a significant positive correlation between the stigma resistance of patients and their hope levels.

The ICU patient diary-A nursing intervention that is complicated in its simplicity: A qualitative study

BACKGROUND

Writing a diary for intensive care patients has been shown to facilitate patientrecovery and prevent post-traumatic stress following hospitalisation.

AIM

This study aimed to describe the experiences of critical care nurses' (CCNs') in writing personal diaries for ICU patients.

METHOD

The study was conducted with a qualitative design. Ten CCNs from two hospitals participated. Data were collected with semi-structured interviews and analysed using a qualitative thematic content analysis.

FINDINGS

The result consists of a theme: Patient diary: a complex nursing intervention in all its simplicity, as well as four categories: Writing informatively and with awareness shows respect and consideration; The diary is important for both patient and CCN; To jointly create an organisation that facilitates and develops the writing; Relatives' involvement in the diary is a matter of course.

CONCLUSION

CCNs are aware of the diary's importance for the patient and relatives, but experience difficulties in deciding which patients should get this intervention and how to prioritize it. Writing a personal diary for an ICU patient is a nursing intervention that is complicated in its simplicity.

Patients' Experiences After Attempted Suicide: A Literature Review

The aim of this study has been to synthesize research on suicidal patients' experiences of the suicide process. A literature search was performed in CINAHL, PubMed, and PsycINFO, and the analysis of the 15 articles covered was based on meta-synthesis. Patients experience a wide variety of feelings regarding their situation during the suicide process, and these exist on two levels: they relate to the different aspects of care that the patients receive and the patients' need to communicate with others and regain hope. The patients in this study described the struggle to maintain hope when life became too difficult and their suffering despite a sense of security, and they sought to achieve emotional balance. A good understanding of how suicidal individuals live with and manage suicidal ideation, while maintaining hope is important for planning effective nursing care. Further research from the patient perspective is needed to further develop psychiatric care for people at risk of suicide.

Experiences that inspire hope: Perspectives of suicidal patients

Background:

Suffering in a suicidal crisis includes feelings such as despair, loneliness, anxiety, fear, shame, guilt and hopelessness. This study highlights the experiences of patients in the aftermath of suicide attempts. The research question was, what do suicidal patients see as meaningful help in care and treatment situations?

Methodology:

The methodology is inspired by Gadamer’s hermeneutics, where the parts are understood in light of the whole, and the whole is understood in light of the parts. Qualitative interviews were employed.

Participants and research context:

A total of 10 persons, 4 women and 6 men 21–52 years old, were informed and asked to participate by specialists in psychology at two emergency psychiatric wards and by one crisis resolution team. Nine of the participants had experienced one or more suicide attempts using drugs and alcohol. Forced hospitalization prevented one of the 10 participants from attempting suicide.

Ethical considerations:

Before the participants signed an informed consent form, the interviewer met all participants to provide the written information, talking about the interview. A meeting to terminate contact was arranged after the participants had read their own interviews.

Findings:

Three themes were generated by the methodology we applied: (1) experiencing hope through encounters, (2) experiencing hope through the atmosphere of wisdom and (3) experiencing a ray of hope from taking back responsibility.

Discussion:

The findings are discussed in the light of Eriksson’s suffering theory and Lindström’s theory about psychiatric care, as well as earlier research and theories about suicidality.

Conclusion:

The study reinforces possibilities that hope in suicidal patients can be inspired in encounters with healthcare personnel and within caring cultures. Through dialogue and cooperation, patients’ safety and ability to cope with suffering is created and thereby the hope and will to struggle for life.

Exploring hope and healing in patients living with advanced non-small cell lung cancer

PURPOSE/OBJECTIVES

To explore the experience and meaning of hope in relation to the healing process of patients living with stage IIIb or IV non-small cell lung cancer.

RESEARCH APPROACH

Interpretative qualitative study design.

SETTING

Peter Brojde Lung Cancer Centre in the Jewish General Hospital in Montreal, Quebec, Canada.

PARTICIPANTS

12 English- and French-speaking patients, aged 36-78 years.

METHODOLOGIC APPROACH

One 60-90-minute semistructured interview per participant was conducted. An inductive approach to data analysis was taken, involving immersion in the data, coding, classifying, and creating linkages.

FINDINGS

Four main themes emerged: (a) the morass of shattered hope, (b) tentative steps toward a new hope paradigm, (c) reframing hope within the context of a life-threatening illness, and (d) strengthening the link between hope and wellness.

CONCLUSIONS

Patients described a process where hope was diminished or lost entirely, regained, and reshaped as they learned to live and grow following their diagnosis.

INTERPRETATION

This study adds to the literature by describing the dynamic nature of hope as well as factors facilitating or hindering the hope process. It demonstrates how finding meaning, a structural component of healing, can be used to envision a new hopeful future. This study suggests hope and healing cannot exist in isolation, and highlights the importance of understanding the fluctuating nature of hope in patients with advanced lung cancer to foster it, therefore promoting healing.

Hope, hopelessness, and anxiety: a pilot instrument comparison study

BACKGROUND AND PURPOSE

Hope has a powerful influence on living. This pilot study compared three measures of hope and one hopelessness measure, and examined their associations with a measure of anxiety.

METHODS

In this cross-sectional study, 23 adult mental health patients ≥18 years old completed the: Herth Hope Index, Miller Hope Scale, Snyder Hope Scale, Beck Hopelessness Scale, and STAI-S, STAI-T.

RESULTS

Cronbach's alpha from each instrument ranged from 0.85 to 0.96. Correlations ranged from -.802 to .780.

Exploring the experience of nursing home residents participation in a hope-focused group

A qualitative intervention was used to explore how older adults living in a long-term care environment (nursing home) understand hope and experience being participants in a group in which a hope intervention was carried out. A group project in which each session focused intentionally on a hope strategy was carried out with a convenience sample of 10 women (ages 75–99) who were members of an existing group. Data were analyzed using thematic analysis of the interviews (conducted before the group intervention was carried out and again at the end), field notes, and collaborative conversations regarding emerging themes. Findings from this study suggest that hope is not static and that it can change over time in response to one's situations and circumstances. Also evident in this study is the potential for using a group process in long-term care to foster hope in an intentional way to make it more visible in the lives of the residents and their environment suggesting that one is “never too old for hope.”

The experience of hope and aging: a hermeneutic photography study

The purpose of this hermeneutic photography study was to explore how older adults lived hope in their day-to-day lives. A purposive sample of 12 older adults 65 and older was asked to photograph how they experienced and lived hope in their everyday lives. Participants were asked to select four to five photographs that best reflected their "lived hope," and these photographs were used as prompts for subsequent interviews. Data were analyzed using thematic analysis of the interviews and photographs, which revealed that these study participants lived a philosophy of hope in which hope provided a kind of landscape through which these older adults lived and made sense of their life experiences. Implications for helping nurses foster and make hope more visible for their older clients are suggested.

Changes in hope and health-related quality of life in couples following acute myocardial infarction: a quantitative longitudinal study

BACKGROUND

Acute myocardial infarction (AMI) is a life-changing event that affects both the patient and the family and can have an influence on hope as well as HRQoL during the recovery period.

AIMS

To compare self-rated scores of hope and health-related quality of life (HRQoL) 1, 7, 13 and 25 months, after an AMI with regard to (i) differences across time, and (ii) differences between patients and their partners.

DESIGN

Explorative and longitudinal study.

METHODS

In this nonrandomized study, Short Form 36 Health Questionnaire (SF-36) and Herth Hope Index-Swedish (HHI-S) questionnaires were completed by thirteen post-AMI patients and their partners. Data were collected on four occasions.

RESULTS

In general, hope as well as HRQoL scores increased over time. A 2 (groups) × 4 (times) anova for mixed design showed significant changes in mental as well as in physical health over time but no significant effect of group on mental or physical health. Calculation of the minimum detectable change (MDC-index) for HHI-S and SF-36 revealed that scores between data collection points were not stable. conclusion: Our results show that although hope and HRQoL scores increased, only a few of the changes were statistically significant. Neither HHI-S nor SF-36 seems to measure stable states. Changes in hope and HRQoL levels may be due to participants striving to adapt to the current situation.

RELEVANCE TO CLINICAL PRACTICE

These results can be used in the training of nursing staff to enhance their understanding of the significance of a family-centred approach after an AMI.

A Hope Intervention Compared to Friendly Visitors as a Technique to Reduce Depression among Older Nursing Home Residents

Depression is common among older persons. An experimental study was undertaken to test the impact of a four-week hope program on depressed nursing home residents. Residents aged 65 or older, who met the criteria for this pilot study and agreed to participate, were randomly assigned to (a) an intervention group, and provided with weekday hope interventions mainly involving positive messages and pictures or (b) a modified control group, and provided with a friendly weekday greeting. The structured hope intervention was not proven effective for reducing depression or raising hope. Instead, a significant reduction in depression among the control subjects was found, as well as a nonsignificant increase in their level of hope. Although these findings suggest friendly visitors may be a more efficacious nonpharmacological approach for reducing depression, further investigations are needed to confirm this and to explore the impact of other hope interventions.

Moving up the continuum of hope: developing a theory of hope and understanding its influence in couples therapy

For years therapists have suggested that hope is an important catalyst in the process of change. This study takes a grounded theory approach to address the need for a clearer conceptualization of hope, and to place interventions that increase hope within a therapeutic context so that therapists know how and when to use those interventions. Fifteen active and experienced marriage and family therapists from across the United States participated in hour-long phone interviews about hope in couples therapy. Moving Up the Continuum of Hope emerged as the core category from the grounded theory analysis of the data. This category represents a process, with general and specific conditions and consequences that increase a couple's level of hope. This study serves as a foundation for future process research on couples therapy, as well as research on hope in other contexts (e.g., individual and family therapy) and with other perspectives (e.g., clients).

Understanding Hope in the Face of an HIV Diagnosis and High-risk Behaviors

The purpose of this article is to: (a) explore and describe experiences of hope in the context of high-risk behaviors; and (b) identify sources of hope for participants dealing with an HIV diagnosis. Following qualitative case study methodology along with philosophical hermeneutics, 12 people diagnosed with HIV or AIDS were interviewed to understand their experiences of hope. Participants were selected based on self-report for continuing or increasing high-risk behaviors following diagnosis. Results include participant descriptions of hope as well as five higher order categories that highlight sources of hope following an HIV diagnosis. Implications for treatment of those newly diagnosed and engaged in high-risk behaviors are discussed.

Modernity, mental illness and the crisis of meaning

Western civilization has, over its relatively recent past, undergone dramatic, unparalleled changes. The historical period in which these changes have occurred is commonly referred to as 'modernity', and although modernity has had profound repercussions on all aspects of people's lives, what has received less attention in the nursing literature is how modernity has influenced, and continues to influence, the mental health of modern men and women. In an attempt to address this, the following paper, drawing on the work of Szasz, Nietzsche and Frankl, seeks to present an accessible introduction to one of the most salient features of modernity; namely, the erosion of those traditions that gave life a meaning or a purpose, and that provided people with ready answers to the problem of how they ought to live. The paper will then introduce some of the possible consequences of this on the mental health of modern men and women, as well as providing preliminary suggestions as to how mental health nursing might respond. In doing so, the paper also seeks to stimulate further discussion and research into how modernity has influenced, and continues to influence, the mental health of modern men and women, and how psychiatric and mental health nursing might respond.

Hope and interpersonal psychiatric/mental health nursing: a systematic review of the literature--part two

This is the second of a two-part article which reports on a systematic review of the literature that focuses on hope (inspiring hope) within interpersonal (counselling) focused psychiatric/mental health (P/MH) nursing. Part one focused on the first three substantive areas, whereas this article focuses on the remaining areas and the discussion points arising out of the review. The discussion points arising are: (1) despite the increasing attention to hope over the last three decades, there remains a distinct paucity of research pertaining to P/MH nurses and hope, hoping and hopelessness; (2) the research that has been undertaken thus far lacks a cumulative, sequential progressive focus and has more of a sporadic, disparate look to it; (3) there is a dearth of empirical work to underpin specific interventions; (4) this relative absence of empirical work means that P/MH nurses often have to look to allied and/or related disciplines for their hope-related research; (5) there appears to be a disparity between the alleged importance of hope and the subsequent research activity; and (6) the research that does exist across different substantive areas appears to indicate that there might be common or shared basic psychosocial processes of hope inspiration, and thus the probability of a formal grounded theory; and this allows for idiosyncratic psychosocial processes for each substantive area. As a result of this review, the authors tentatively suggest that the inspiration of hope in P/MH nursing is grounded in the relationship established between nurse and person in need of hope, an emerging empirical finding that has obvious congruence and synchronicity with the philosophy and theory of a Peplauvian-based approach to P/MH nursing.

Hope and schizophrenia: an integrative review

The purpose of this article is to describe the current status of research on hope and schizophrenia. The CINAHL database was used to identify the articles that met the criteria. The searches were conducted using the terms 'hope', 'hope instillation (IOWA NIC)', 'hope (IOWA NOC)', 'schizophrenia' and their combinations. The findings were limited to research articles. In addition, Pub Medical database was used by searching the words 'hope' and 'schizophrenia' from the fields 'title' or 'abstract'. Four new articles were found. The data consist of 17 articles on hope and schizophrenia published in peer-reviewed journals, which were analysed using content analysis. Existing research has focused on people with schizophrenia (n = 8), significant others (n = 4), staff (n = 2), hope-engendering interventions (n = 2) and treatment evaluation related to hope (n = 2) in the care of people with schizophrenia. Different data collection methods have been used in these studies. The most common method was interview (n = 9), followed by questionnaires (n = 8) and observation (n = 1). Most studies used quantitative methods (n = 9). Hope is considered a positive factor in the life of a person living with schizophrenia, in significant others as well as in staff members. Existing research provides evidence of the following themes: factors associated with hope and factors contributing to hope in people with schizophrenia; hope from the perspective of significant others of people with schizophrenia; staff hopefulness and factors contributing to their hope, hope-engendering interventions and treatment evaluation in regard to hope. Based on this review, research evidence of hope in the context of schizophrenia is quite scant and limited, even though the importance of hope in schizophrenia has been underlined in research reports and the literature. It is clear that hope is important to people with schizophrenia, their significant others and the healthcare personnel caring for them. It is therefore also important to study hope among these people.

Factors Related to Meaning of Life in Taiwanese Women Treated with In Vitro Fertilization

BACKGROUND/PURPOSE

The meaning of life can be defined as a sense of a clear aim in life and a belief that one's daily activities are meaningful. Pregnancy is clearly an important aim of women who undergo in vitro fertilization (IVF) treatment. The purpose of this study was to evaluate the meaning of life and its related factors among women who underwent IVF treatment throughout the first treatment cycle until either pregnancy was achieved or when the attempt was abandoned.

METHODS

This cross-sectional study was performed in a single medical center in Taiwan. A total of 149 subjects were recruited from women receiving IVF (n = 69) and women who had experienced IVF failure within the previous 1 year (n = 80). These women were classified into four subgroups according to their treatment stages: beginning of first IVF (n = 39); pregnancy/delivery (n = 22); continuing treatment (n = 64); and discontinuing treatment (n = 24). The Purpose in Life (PIL) test, a previously developed instrument designed to measure meaning of life, was administered to all patients at their follow-up IVF visit.

RESULTS

The mean PIL score was 99.1 +/- 19.5, which indicated that all subjects had some degree of uncertainty regarding the meaning of life; however, no significant difference in PIL score was found among the four groups. Four factors were extracted from PIL by factor analysis, among which "existential frustration" (factor 4) was highest in the continuing group and those with a lower level of education; whereas "being in control" (factor 2 ) was lowest in women whose infertility had a female etiology.

CONCLUSION

Treatment stage, educational level, and etiology of infertility were found to be factors influencing the meaning of life in women undergoing IVF.