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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 that 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 in 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 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 and 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 Taber’s Cyclopedic Medical Dictionary, hope is having a prospect that something desired will happen . Mosbys Dictionary of Medicine, Nursing, and Health Professions defines hope as a state of optimism that 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 of nurses roles. Nurses have a professional responsibility to assist patients to find meaning in their lives and 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 in the availability of other people when needed and being courageous to acknowledge personal fears and shortcomings and work towards the attainment of goals. According to Travelbee, both the patient and the nurse must go through a series of steps for this relationship to progress. These steps are the 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 that 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, and relational and spiritual aspects (Nweze et al., 2015). 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 patients 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 on patients having individual reasons to become future-oriented and hopeful (Eustache, Jibb & Grossman, 2014). 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 integrating routine activities. Most patients directly relate hope and well-being and compare themselves with survivors and spirituality (Eustache, Jibb & Grossman, 2014).
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 (Lichwala, 2014). By finding meaning in life, a patient keeps anticipating the future. The majority of those patients who report 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 which leads to a poor quality of life. Lichwala (2014) insists that, in order to have high levels of hope, and positive relations with healthcare providers, friends, and family, a strong and well-established support system and positive interaction with others is necessary.
This literature review improved the authors understanding of how essential the human-to-human interaction theory by Joyce Travelbee is 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
Defining attributes are basically characteristics that 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.
Antecedents
These are mandatory attributes that precede a concept before its actualization. Based on the literature review, common antecedents that were identified include hopelessness, despair, and suffering (Nweze et al., 2015). 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 (Nweze et al., 2015)
Consequences
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 of his/her diagnosis and high levels of satisfaction with the shared information.
Empirical Referents
In theory development, empirical referents simply refer to the categories that 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 (Huangan, Utvaer & Moksnes, 2013). 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 (Huangan, Utvaer & Moksnes, 2013). It is the most preferred since it is based 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 concepts 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 recently diagnosed with throat Ca came to the clinic for her scheduled routine follow-up. She had complained 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 to the 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 daughter’s 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 can 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 nurses active participation in the patients care.
Borderline Case
A borderline case has some of a concepts 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 in the 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 that he was generally tired and overwhelmed with life and didnt 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 Jacks 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 instilled 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 been 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 was 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 explains why John refused to get married, had a vasectomy at 26 years old, and declined to modify his lifestyle. This is clearly a case of what hope is not. John strongly believed that there was no hope of 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 that 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 the aim of helping patients find meaning in life especially during times of suffering and illness by maintaining hope. In advanced 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
- 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.
- Huangan, G., Utvaer, B., & Moksnes, U. (2013). The Herth Hope is a psychometric study among cognitively intact nursing home patients. Journal of Nursing Measurement, 21(3), p.378-400.
- Hope. (n.d.). In Oxford English Dictionary. (2nd. ed.).
- Lichwala, R. (2014). Fostering hope in the patient with cancer. Clinical Journal of Oncology, Nursing 18(3), p.267-269.
- 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.
- Smith, H. (2014). Giving hope to families in palliative care and implications for practice. Nursing Children and Young People 26(5), p21-25.
- Tabers Cyclopedic Medical Dictionary. (Ed.). (2013). Philadelphia, PA: F.A. Davis Company.
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