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PubMed2006

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.

Adaptation, Psychological↗
PubMed1999

Hope and deception.

Convinced of hope's therapeutic benefits, physicians routinely support patients' false hopes, often with family collusion and vague, euphemistic diagnoses and prognoses, if not overt lies. Bioethicists charge them with paternalistic violations of Patient Autonomy. There are, I think, too many morally significant exceptions to accept the physician's rationales, or the bioethicist's criticisms, stated sweepingly. Physicians need to take account of the harms caused by loss of hopes, especially false hopes due to deception, as well as of the harms of successfully maintained deceptive hopes. As for autonomy, hopes -- even if based on deception -- can protect and enhance autonomy, understood broadly as the capacity to lead a chosen or embraced life. Deception aside, patients' hopes often rest on beliefs about possible rather than probable outcomes -- beliefs themselves supported by optimism, 'denial', or self-deception. Such 'possibility-hopes' may conflict with physicians' often more fact-sensitive 'probability hopes.' To resolve such conflicts physicians may try to 'down-shift' patients' or parents' hopes to lesser, more realistic hopes. Alternatively, physicians may alter or enlarge their own professional hopes to include the 'vital hopes' that define the lives of patients or parents, as well as 'survival hopes' needed to face and bear the loss of loved ones, especially children. A principle of Hope-giving might help guide such sympathetic hope-accommodations. More generally, it would give Hope a distinct place among Beneficence, Autonomy, and the other moral factors already highlighted by canonical principles of Medical Ethics. To formulate such a principle, however, we will need a collective Project Hope to pursue deeper philosophical and psychological studies.

Altruism↗
PubMed2004

Hope during the first months after acute spinal cord injury.

BACKGROUND: According to the general literature on hope, individuals who are hopeful live more positive lives than those who experience hopelessness. Hope has been defined as a positive orientation toward future improvements, and is associated with health and well-being. AIM: This paper reports a study that explored patients' experiences of hope following spinal cord injury. METHOD: Data were collected by personal interviews (n = 10) at a rehabilitation institution in Norway. A phenomenological-hermeneutic approach was used to extract the meaningful content of patients' experiences. The analysis was performed as a spiral process that included a reading to gain a sense of the whole, followed by identification of meaningful parts and a comprehensive and understandable interpretation of the whole. FINDINGS: Two themes emerged: 'images of the past and future', and 'balancing between inner emotional dichotomies' that were, mainly, related to experiences of courage/uncertainty and patience/restlessness. DISCUSSION: All participants experienced hope. The substance of hope--being able to walk again and hoping for recovery--was a universal experience among participants and was comprehended in terms of positive expectations. The process of hope involved continuous 'ups and downs'. Patients were in need of skilled nursing care to enable and foster hope during the first months following acute spinal cord injury. CONCLUSION: In conclusion, patients hoped for recovery and every improvement stimulated hope. The process of hope was future-oriented, characterized by dichotomies. Nurses need the skills to foster hope and enable recently injured patients to look beyond the immediate situation and direct their energies appropriately.

Adaptation, Psychological↗
PubMed1996

Hope from the perspective of homeless families.

Homeless families represent one-third of the homeless population. These families have few resources and experience multiple stressors. This study explored the meaning of hope and the influence of specific characteristics on hope, and identified strategies that are used to foster hope in homeless families living in four homeless shelters. Using the technique of methodological triangulation (interview, Herth Hope Index, and Background Data Form), the author collected cross-sectional data on 52 homeless families and longitudinal data on 10 families over a 9-month period of time in order to provide a clearer understanding of the hope process. Hope was described as a power within the self that mobilizes one to move beyond the present situation and to envision a better tomorrow for one's self and others. Six hope-engendering strategies and four hope-hindering factors were identified based on the interview responses of adult family members. Overall hope levels in those residing in the homeless shelter were low and remained stable across the background variables with the exception of those receiving nurse-provided health care on the premises. Across time, hope levels were found to be low at interview time one, to rise significantly at time two, and to level off at time three. An understanding of hope from the perspective of the homeless family could provide a basis upon which to develop interventions that engender hope.

Adaptation, Psychological↗
PubMed2000

Exploration of the concept of hope in the Dominican Republic.

An ethnonursing study explored What is the meaning of hope (esperanza/esperar) to the Dominican people? What is the importance of the concept of hope to the people of the Dominican Republic? What are the universals and diversities in the meaning of hope for this cultural group and United States' (US) mainstream culture? Hope has been considered universal and recent research has demonstrated the effect of levels of hope or hopelessness on health. Nurse researchers have explored the meaning of hope to patients in the US and have developed instruments to measure levels of hope. However, little research has explored whether hope has different attributes in various cultural groups. From data gathered in a rural Dominican village, a definition of hope and its attributes were developed: 'Hope is an essential but dynamic life force that grows out of faith in God, is supported by relationships, resources and work, and results in the energy necessary to work for a desired future. Hope gives meaning and happiness'. This definition and its attributes were compared with definitions developed from research among mainstream US populations to propose universals and diversities of hope.

Adolescent↗
PubMedDate not supplied

Nurses' perspectives on the meaning of hope in patients with cancer: a qualitative study.

This study focused on developing an understanding of the meaning of hope for patients with cancer by eliciting vivid descriptions of hopeful cancer patients from clinical nurse specialists. The qualitative methodology for this study was based on one form of grounded theory. An inductive approach was applied to the development of generalized knowledge about the concept of hope. A conceptual model of hope was derived from critical attributes of hope identified within descriptions of hopeful cancer patients. Six oncology clinical nurse specialists were interviewed about their clinical experience with patients with cancer who were hopeful. Interviews were documented through process recordings. Attributes of hope were isolated and coalesced into six subthemes: goal setting, positive personal attributes, future redefinition, meaning in life, peace, and energy. Thematic analysis was used to develop a conceptual model of hope. Energy emerged as a strand running through each of the six subthemes and served as a focal point in the description and model of hope. Each of the subthemes described a component of the process whereby energy was exchanged, transformed, or moved, resulting in the preservation or loss of hope. This study generates a new way of viewing the patient with cancer and suggests several approaches for fostering hope.

Adult↗
PubMed2004

Exploring how to tell the truth and preserve hope: can a balance between communication and empathy be calculated?

BACKGROUND & AIMS: When told the harsh truth about severe disease, a patient might despair and lose all hope. Without knowing the truth, however, the patient cannot participate in decision making and adjust life according to his illness. The present study aims to analyze the relationships between hope and truth in the decision on how much information to disclose to a patient with severe gastrointestinal disease. METHODS: The decision analysis is based on the economic concepts of indifference curves and utility function. An inverse linear relationship exists between hope and truth; as more truth becomes revealed, the amount of hope declines. The utility function and the corresponding indifference curve of hope plotted versus truth describe the patient's personal choices among different combinations of hope and truth. The optimal choice among various combinations of hope and truth corresponds with the point at which the inverse hope-truth line meets the indifference curve. RESULTS: In situations in which hope drops steeply as more medical facts are being revealed, the utility to the patient is maximized with less truth being told. With a less pronounced truth-related decline in hope, utility is maximized at higher levels of truth, and, occasionally, utility is maximized only after all medical facts have been disclosed. The lesser the impact of truth on hope, the more truth is being tolerated. CONCLUSIONS: A caring gastroenterologist trying to optimize his/her patient's well-being should try to assess the potential influence of truth on the patient's psyche and dispense it accordingly.

Adaptation, Psychological↗
PubMed1993

Hope in the family caregiver of terminally ill people.

This longitudinal study explored the meaning of hope, the influence of specific background characteristics on hope, and identified strategies that are used to foster hope in a convenience sample of 25 family caregivers of terminally ill family members from two hospice programmes using the technique of methodological triangulation (interview, Herth Hope Index and Background Data Form). Hope was defined as a dynamic inner power that enables transcendence of the present situation and fosters a positive new awareness of being. Six hope-fostering categories and three hope-hindering categories were identified based on the interview responses. With the exception of those providing care to a family member diagnosed with AIDS and those caregivers experiencing poor personal health, a high fatigue level, severe sleep deprivation and more than two concurrent losses, overall hope levels among participants were found to remain stable across the background variables. Across time, hope levels were found to be low at interview time one, rise significantly by time two and then level off for the remainder of the time. An understanding of hope from the perspective of the family caregiver could provide a basis upon which to develop interventions that foster hope.

Adaptation, Psychological↗
PubMed2000

Enhancing hope in people with a first recurrence of cancer.

Enhancing hope in people with a first recurrence of cancer Researchers and clinicians have identified the need for well-defined intervention studies to test the efficacy of interventions designed to strengthen hope. This quasi-experimental study sought to determine if a specific nursing intervention program designed to enhance hope would positively influence levels of hope and quality-of-life (QOL) in a convenience sample of 115 people with a first recurrence of cancer who were randomly assigned to one of three groups: treatment group (hope), attention control group (informational), or control group (usual treatment). The Herth Hope Index (HHI) and the Cancer Rehabilitation and Evaluation Systems, Short Form (CARES-SF) were administered prior to intervention, immediately after intervention and at 3, 6, and 9-month intervals. Treatment and control groups differed significantly with regard to level of hope (P=0.02) and QOL (P=0.03). Both the level of hope and QOL were significantly increased (P=0.03) immediately after intervention and across time (3, 6 and 9 months). This study was a preliminary attempt to design, implement, and evaluate a theory-driven hope intervention program. Knowledge about the effectiveness of specific interventions designed to enhance hope is vital if nurses are to significantly influence hope in those whom are in their care.

Adaptation, Psychological↗
PubMedDate not supplied

Hope and related variables in Italian cancer patients.

Hope, long considered an essential element for life, has been shown to be important among cancer patients in coping, perceived control over the illness, and psychologic adjustment to the illness. The purpose of this study was (a) to describe the level of hope in Italian cancer patients; (b) to compare the levels of hope during and after hospitalization; (c) to determine whether hope was correlated with quality of life and several symptoms; and (d) to determine whether the variables from the international literature also pertain to Italian cancer patients. A descriptive correlational design using repeated measures was chosen to study 80 Italian cancer patients during hospitalization and then at home. The following instruments were used: a Sociodemographic Questionnaire, the Hope Related Variable Questionnaire, the Nowotny Hope Scale, the Rotterdam Symptom Checklist, and the Hospital Anxiety and Depression Scale. Overall, patients were moderately hopeful and the level of hopefulness was similar in the hospital and at home. Hope was positively correlated with quality of life, self-esteem, coping, adjustment to the illness, well-being, comfort in the hospital, satisfaction with information received, relationship with, and support from family, healthcare professional, and friends. Hope was negatively correlated with anxiety, depression, and boredom during hospitalization. Time since diagnosis, illness stage, and knowing or not knowing the diagnosis and treatment were not correlated with hope. Similarities and differences with the international literature are discussed, and implications for caring for Italian cancer patients are drawn.

Adaptation, Psychological↗