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Kübler-Ross maintained that hope persisted across every stage of terminal illness, noting that “even the most accepting, the most realistic patients left the possibility open for some cure, for the discovery of a new drug, or the ‘last-minute success in a research project’ ”. Viktor Frankl (1984), a survivor of the Holocaust, described a human capacity for optimism that can be maintained in spite of the possibility or even certainty of pain and death. In terminal illness, hope represents patients’ imagined fu-ture, forming the basis of a positive, accepting attitude and pro-viding their lives with meaning, direction and optimism (Hickey, 1986). When hope is viewed this way, it is not limited to cure of the disease, and instead focuses on what is achievable in the time remaining. Many patients find hope in working on important re-lationships and creating legacies. The terminally ill patient can be extremely resilient, reconceptualizing hope repeatedly as he or she approaches the end of life.
The concept of hope has been delineated and studied by nu-merous nurse researchers, and its presence has been related to concepts such as spirituality, quality of life, and transcendence. Morse and Doberneck (1995) defined hope as a multidimen-sional construct that provides comfort to the individual as he or she endures life threats and personal challenges. These authors identified seven universal components of hope from their study of patients who had survived serious illness:
• Realistic initial assessment of the threat
• Envisioning alternatives and setting goals
• Bracing for negative outcomes
• Realistic assessment of resources
• Solicitation of mutually supportive relationships
• Continuous evaluation for signs reinforcing the goals
• Determination to endure
The nurse can support the patient and family by using effec-tive listening and communication skills and encouraging realistic hope that is specific to the patient’s and family’s needs for infor-mation, expectations for the future, and values and preferences concerning the end of life. It is important for the nurse to engage in self-reflection and identify her or his own biases and fears con-cerning illness, life, and death. As nurses become more skilled in working with seriously ill patients, they can become less deter-mined to “fix” and more willing to listen, more comfortable with silence, grief, anger, and sadness, and more fully present with pa-tients and their families.
Nursing interventions for enabling and supporting hope include:
· Listening attentively
· Encouraging sharing of feelings
· Providing accurate information
· Encouraging and supporting patient control over his or her circumstances, choices, and environment whenever possible
· Assisting the patient to explore ways for finding meaning in his or her life
· Encouraging realistic goals
· Facilitating effective communication within the family
· Making referrals for psychosocial and spiritual counseling
· Assisting with the development of supports in the home or community when none exist
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