HOPE
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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