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PubMed1999

Hopefulness and its characteristics in adolescents with cancer.

Hopefulness in adolescents with cancer serves critical functions related to the adolescents' sense of well-being and commitment to treatment. Given these critical functions, it is important to determine the essential characteristics of hopefulness, which include the degree and dynamism of hopefulness and the nature and attributes of hoped-for objects. The purposes of this two-site study were to describe the degree and dynamism of hopefulness at four time points during the first 6 months of adolescents' treatment for newly diagnosed cancer, to identify and describe the adolescents' hoped-for objects, and to evaluate potential relationships between the characteristics of hopefulness and patient gender, age, diagnosis, and time point in treatment. Seventy-eight adolescents completed the Hopefulness Scale for Adolescents, the Hopelessness Scale, and the Hopefulness Interview Question at each time point. Hopefulness scores were higher and hopelessness scores substantially lower than reported in other tested samples. Adolescents identified a total of 57 different hopes. Differences by age, gender, and diagnosis were found.

Adolescent↗

PubMedDate not supplied

The concept of hope in nursing 6: research/education/policy/practice.

This article, the last in the series, focuses on future international research, education, policy and practice issues that centre around the concept of hope. While a growing literature is accumulating, it needs to be acknowledged that the area of hope and hope inspiration remains under-researched and is consequently not well understood. However, this article highlights future research questions around hope which have been grouped under the broad headings of: (1) the structure of hope; (2) the assessment of hope; (3) the enhancement of hope; (4) the potential outcomes of hope. The article also declares how our current body of knowledge relating to hope has had limited visibility outside professional journals, has not received the funding necessary, and has not been reflected in relevant policies within our healthcare and educational institutions. If the goal is to conduct interdisciplinary research across countries and to gain a global understanding of hope, then greater resources are needed. There is a need to prepare nurses and other healthcare professionals to deal with the challenge of enhancing and maintaining hope in those that they care for in their practice, as well as in themselves.

Education, Nursing↗

PubMed1999

[Hope].

This article deals with the phenomenon of hope in seriously ill and dying patients. Uncertainty is seen as a prerequisite for hope, fear as the "negative" side of hope. A scheme involving three particular kinds of hope is introduced: Hope on a daily basis; hope concerning a possible eternity; and hope based upon unrealistic premises. In a clinical setting, the question is: Taking into consideration the issues of how to inform and communicate with patients, how may the physician help the patient to express hope, and how may the physician contribute to reinforcing the patient's hope? Within palliative medicine, treatment may involve many aspects of a patient's life. It should be directed against the physical aspects of the disease, as well as the psychological, social, spiritual and existential dimensions of life. There are two fundamental questions patients with terminal cancer disease almost always ask: "Will the disease eventually cause my death?"; and, "Am I going to experience great pain and suffering?" These questions are clearly marked by hope. The hope that there will be little pain, for example, may not only relate to physical pain but to psychological and social pain as well.

Attitude to Death↗

PubMed2005

Hope in patients hospitalized with heart failure.

BACKGROUND: Hope is seldom described in patients with heart failure, despite high morbidity and mortality for this population. OBJECTIVES: To describe hope in hospitalized patients with heart failure and to evaluate influences of demographic and health-related variables on hope. METHODS: Ninety-three patients with heart failure and 441 healthy control subjects completed questionnaires about sociodemographics, health indices, disease severity, and the Herth Hope Index. RESULTS: The patients with heart failure had a mean age of 75 years; 65% were men, and 47% lived alone. Lung diseases and diabetes were the most common comorbid diseases, with 58% classified as New York Heart Association class III. The mean global hope score among patients with heart failure was 37.69 (SD 5.3). Patients with skin (P = .01) and psychiatric (P = .02) disorders reported lower hope scores. Number of comorbid diseases was the only predictor of hope related to disease-specific variables (P = .01). Mean age of the control subjects was 60 years, and 66 (15%) lived alone. Once demographic variables were controlled for, patients with heart failure had significantly higher global hope scores than did control subjects. CONCLUSIONS: Adaptation to a life-threatening illness may induce a "response shift" that causes such patients to have more hope than the general population. Patients with heart failure may be more concerned with the past than the future. How patients judge their health and satisfaction with life influences their hope. Interventions supporting hope in patients with heart failure may influence treatment goals.

Adaptation, Psychological↗

PubMed1997

How healthcare professionals contribute to hope in patients with cancer.

PURPOSE/OBJECTIVES: To explore whether healthcare professionals influence the level of hope in patients with cancer and, if so, how they influence their hope. DESIGN: Descriptive, qualitative design. SETTING: An adult hematology/oncology unit in the upper midwestern United States. SAMPLE: Thirty-two men and women receiving active or supportive treatment or palliative care for cancer. METHODS: Semistructured interviews conducted in the participants' hospital rooms. Ten investigators and two consultants transcribed and analyzed the interview data using content analysis. They identified themes and subthemes that described healthcare professionals' roles. MAIN RESEARCH VARIABLES: Healthcare professionals' contributions to hope as described by patients with cancer. FINDINGS: Healthcare professionals positively and negatively influenced hope in this sample. Hope was facilitated by being present, giving information, and demonstrating caring behaviors. Negative influences on hope primarily concerned the way in which healthcare professionals gave information. CONCLUSION: Healthcare professionals do influence patients' perceptions of their hope. Although most nursing actions are hope enhancing, nurses can reduce a patient's sense of hope if information provided or attitude toward the patient is insensitive or disrespectful. IMPLICATIONS FOR NURSING PRACTICE: Nurses can increase patients' hope by being present, taking time to talk, and being helpful. They must provide information and answer questions in a compassionate, positive, honest, and respectful manner. Caring behaviors such as thoughtful gestures, showing warmth and genuineness, and being friendly and polite also increase patients' hope.

Adaptation, Psychological↗

PubMed2026

Hope is linked with more favorable tumor molecular signatures in serous ovarian cancer.

INTRODUCTION: Hope has been associated with improved quality of life and lower mortality in cancer, but the underlying biological mechanisms are poorly characterized. We previously reported that hope was associated with less inflammation and more normalized diurnal cortisol pre-treatment among women with ovarian cancer. We also reported associations of socio-environmental factors with pro-metastatic processes. Here, we used genome-wide transcriptional profiling to quantify associations between hope and tumor molecular signatures reflecting invasiveness, inflammation, and cellular immunity. METHOD: Participants were 74 women with serous ovarian cancer who provided demographic information and completed surveys pre-surgery. Hope was assessed using a face-valid item from the Center for Epidemiological Studies Depression Scale (CES-D). Depression was assessed using the full CES-D without the hope item. Illumina HT12 microarrays were used to assay tumor RNA, and associations between hope and tumor gene expression were quantified, adjusting for depression, age, BMI, grade, and stage. RESULTS: Adjusting for covariates, hope was associated with multiple favorable differences in RNA expression, including lower levels of mesenchymal differentiation (p = 0.008) and pro-inflammatory gene regulation (NF-κB: p < 0.001; IRF1: p = 0.024; STAT: p = 0.018), elevated epithelial differentiation (p = 0.011), and elevated activity of the IRF7 transcription factor which promotes cellular immunity (p = 0.016). CONCLUSIONS: These data suggest that hope is associated with an ovarian tumor gene expression profile characterized by reduced epithelial-mesenchymal transition (EMT) and inflammatory activity, and increased activity of a transcription factor promoting cellular immunity. These findings highlight potential biological implications of a resilience factor such as hope, but need replication with more robust assessments of hope.

Epithelial mesenchymal transition↗

PubMed2005

The nature of hope in hospitalized chronically ill patients.

BACKGROUND: Hope as a universal human phenomenon has been studied from various perspectives often conceptualized as having a unified set of attributes. In this study however hope is viewed to be experienced by people in various patterns structured by different orientations and emphases depending upon their life circumstances. There is a paucity of studies in the literature examining patterns of hope experienced by people in chronic illness or in special life circumstances. OBJECTIVES: The aim of this study was to discover patterns of hope in hospitalized chronically ill patients and to identify the major threads that structure various patterns of hope experienced by them. DESIGN: Q-methodology, which is an approach designed to discover patterns in various subjective experiences, was used as the method for data collection and theory generation. Q-methodology involves five steps in its approach, the first two as the first phase and the last three as the second phase. The study was carried out at a general acute-care, tertiary hospital in a New England state in the US. The study obtained data from a convenient sample of 12 chronically ill patients and 16 oncology nurses for the first phase, and a different convenient sample of 20 chronically ill patients for the second phase. RESULTS AND CONCLUSIONS: Five patterns of subjective experiences of hope emerged as: (a) externalism orientation, (b) pragmatism orientation, (c) reality orientation, (d) future orientation, and (e) internalism orientation. This means that chronically ill patients experience hope in various ways by focusing on different dimensions of meaning, suggesting the conceptualization of hope as a unitary construct may not reflect people's experiences of hope accurately. The major implication of the study is to rethink ways to assess patients' hope in terms of pattern differences rather than in terms of quantity.

Activities of Daily Living↗

PubMed2005

The proper place of hopeful monsters in evolutionary biology.

Hopeful monsters are organisms with a profound mutant phenotype that have the potential to establish a new evolutionary lineage. The Synthetic Theory of evolutionary biology has rejected the evolutionary relevance of hopeful monsters, but could not fully explain the mechanism and mode of macroevolution. On the other hand, several lines of evidence suggest that hopeful monsters played an important role during the origin of key innovations and novel body plans by saltational rather than gradual evolution. Homeotic mutants are identified as an especially promising class of hopeful monsters. Examples for animal and plant lineages that may have originated as hopeful monsters are given. Nevertheless, a brief review of the history of the concept of hopeful monsters reveals that it needs refinements and empirical tests if it is to be a useful addition to evolutionary biology. While evolutionary biology is traditionally zoocentric, hopeful monsters might be more relevant for plant than for animal evolution. Even though during recent years developmental genetics has provided detailed knowledge about how hopeful monsters can originate in the first place, we know almost nothing about their performance in natural populations and thus the ultimate difference between hopeful and hopeless. Studying the fitness of candidate hopeful monsters (suitable mutants with profound phenotype) in natural habitats thus remains a considerable challenge for the future.

Animals↗

PubMed1996

The construction and characteristics of an instrument to measure personal hopefulness.

This paper describes the construction, refinement and implementation of a self-administered measure of personal hopefulness, the Hunter Opinions and Personal Expectations Scale (HOPES). Initial state and trait versions of the HOPES instrument were utilized in three separate studies, comprising a medical student sample (N = 211), an adolescent male sample (N = 280) and a psychiatric hospital staff sample (N = 318). A revised 20-item, two factor, trait version of the scale was then utilized in a prospective, longitudinal investigation (N = 753) of the psychosocial sequelae of the earthquake which struck Newcastle (Australia) in December, 1989. Data from all four studies provide strong support for the HOPES instrument's construct, concurrent and predictive validity. Global personal hopefulness (GPH) was shown to be an enduring characteristic of individuals, with a test-retest correlation of r = + 0.71 (over 64 weeks). The association between GPH and trait anxiety (r = -0.64) raised the possibility of redefining anxiety as hope under threat. The hope subscale (HS) and the despair subscale (DS) were moderately negatively correlated (r = -0.32), suggesting that hope and despair are not simply polar opposites. There were no gender differences in GPH scores, however, there were relatively clear age effects, with those aged 70 years and over reporting the lowest levels of personal hopefulness. GPH was negatively correlated with post-earthquake scores on the General Health Questionnaire (r = -0.33), the Impact of Event Scale (r = -0.33), the Beck Depression Inventory (r = -0.54) and the global symptom index from the SCL-90-R (r = -0.43). Overall, the contribution made by personal hopefulness to post-earthquake morbidity was equal to the contributions made by initial exposure to disruption and threat experiences.

Adaptation, Psychological↗

PubMed1997

Role of hope in academic and sport achievement.

Hope is the sum of goal thoughts as tapped by pathways and agency. Pathways reflect the perceived capability to produce goal routes; agency reflects the perception that one can initiate action along these pathways. Using trait and state hope scales, studies explored hope in college student athletes. In Study 1, male and female athletes were higher in trait hope than nonathletes; moreover, hope significantly predicted semester grade averages beyond cumulative grade point average and overall self-worth. In Study 2, with female cross-country athletes, trait hope predicted athletic outcomes; further, weekly state hope tended to predict athletic outcomes beyond dispositional hope, training, and self-esteem, confidence, and mood. In Study 3, with female track athletes, dispositional hope significantly predicted athletic outcomes beyond variance related to athletic abilities and affectivity; moreover, athletes had higher hope than nonathletes.

Achievement↗

PubMed2001

Hope, despair and hopelessness in living with HIV/AIDS: a grounded theory study.

BACKGROUND: Hope, despair or hopelessness have been detected in several research reports as important elements of the lives of persons living with human immunodeficiency virus (HIV) (PLWH) or acquired immunodeficiency syndrome (AIDS) (PLWA). However, there is an obvious gap in the literature suggesting a need to study the overall dynamics of hope (including both hope and despair or hopelessness) along the HIV spectrum from PLWHs' and PLWAs' perspective. AIM: The purpose of this study was to describe the dynamics of hope in living with HIV/AIDS. METHODS: The data were collected through interviewing 10 PLWHs/PLWAs and analysed using a grounded theory method. FINDINGS: The dynamics of hope is a multifaceted and complex combination of 'hope', 'despair' and 'hopelessness'. It comprises balancing between 'believing life to be worth living at the present and in the future', 'losing one's grip and sinking into narrowing existence vs. fighting against sinking' and 'giving up in the face of belief in nonexisting future'. A dynamic alternation between hope, despair and hopelessness takes place in the presence of factors that contribute to the 'folding' and 'unfolding' possibilities in everyday life. Factors contributing to the folding possibilities include 'losing', 'fear', 'uncertainty', 'problems in care', 'HIV/AIDS in close ones', 'difficulties in relationships' and 'negative public images and attitudes concerning HIV'. Factors contributing to the unfolding possibilities are 'constructive life experiences', 'wishing not to have HIV while uncertain', 'constructive relationships', 'ability to control one's life', 'finding the meaning of life and zest for life', 'caring', 'noticing one's improved health and the continuance of life', 'increasingly positive attitudes concerning HIV-positive people' and 'protection by law'. CONCLUSIONS: The dynamics of hope discovered in this study present new conceptualization, where hope, despair and hopelessness are viewed in relation to each other. The emerged definitions may be used in clinical practice to identify these phenomena in individuals with HIV/AIDS. The discovered factors contributing to the folding and unfolding possibilities can be used in clinical practice to help the individuals along the dynamics of hope.

Acquired Immunodeficiency Syndrome↗

PubMed2001

Hope in patients with spinal cord injury: a literature review related to nursing.

Few studies have addressed nursing of patients with spinal cord injury (SCI) related to the phenomenon of hope. Therefore, a systematic computer-based literature review to analyze the phenomenon of hope was conducted, focusing on both empirical and theoretical perspectives, to highlight the potential for further empirical studies. The review examined existing definitions of hope, theories on hope in nursing, and methodological and empirical perspectives on studies of hope in the literature. The findings showed that hope has been defined in a theoretical and general way, which has influenced empirical and theoretical research in this developing area of knowledge. These findings show that the phenomenon of hope can be generalized (the process of hoping) and particularized (the substance of hope). In addition, this analysis demonstrates that hope is a prospective phenomenon because it is future-oriented (according to the process) and has a positive essence (according to the substance).

Attitude to Health↗

PubMed2005

Patients' experiences of hope and suffering during the first year following acute spinal cord injury.

AIMS AND OBJECTIVES: The aim of this study was to explore patients' experiences of hope during the first year suffering from spinal cord injury. BACKGROUND: There is a lack of substantial precision with regard to the concept of hope. Very few qualitative studies focusing on experiences of hope in spinal cord-injured patients have been identified in the literature. In this study, "hope" was defined as future oriented towards improvement. DESIGN AND METHODS: Data were collected by means of personal interviews (n = 10) at the participants' homes in Norway. A phenomenological-hermeneutic approach, inspired by Ricoeur, was used to extract the meaning of the patients' experiences. The analysis was performed in several steps, as a hermeneutic process. RESULTS: In this study, the findings revealed two main themes: "The Vicious Circle" and "Longing". The vicious circle constituted aspects of suffering, and the common hope experienced by the subjects was therefore to leave the vicious circle. Experiences of suffering were experienced as feelings of loneliness, impatience, disappointment, bitterness and dependency. The "Longing" was based on the subject's former life and was the source of awakened new hopes, which again was experienced comforting. CONCLUSIONS: Experiences of suffering created hope and longing. The meaning of hope was to find a possible way out of the circle and the hoping was experienced as a comfort. RELEVANCE TO CLINICAL PRACTICE: Implications to nursing practice are listening to the suffering and longing individual and comforting the suffering by pointing towards possible future roads of hope.

Acute Disease↗

PubMed2000

Quality of life in spina bifida: importance of parental hope.

BACKGROUND AND AIMS: Prognosis in spina bifida (SB) is often based only on neurological deficits present at birth. We hypothesised that both parental hope and the neurophysical examination predict quality of life in children and adolescents with SB. METHODS: A previously validated disease and age specific health related quality of life (HRQL) instrument was posted to families of children (aged 5-12 years) and adolescents (aged 13-20 years) with SB. We measured parental hope, determined the child's current physical function, and obtained retrospective data on the neonatal neurophysical examination (NPE). Regression analysis modelled HRQL firstly as a dependent variable on parental hope and NPE ("birth status"); and secondly on parental hope and current physical function ("current function"). RESULTS: Response rates were 71% (137 of 194) for families of children, and 54% (74 of 138) for families of adolescents. NPE data were available for 121 children and 60 adolescents. In children, the birth status model predicted 26% of the variability (R(2) hope 21%) compared with 23% of the variability (R(2) hope 23%)in the adolescents. The current function model explained 47% of the variability (R(2) hope 19%) in children compared with 31% of the variability (R(2) hope 24%) in the adolescents. CONCLUSIONS: In both age groups, parental hope was more strongly associated with the HRQL than neonatal or current physical deficits. A prospective study is required to determine whether a causal relation exists between parental hope and HRQL of children and adolescents with SB.

Adolescent↗

PubMed1995

The use of hope as a coping mechanism in abused women.

The purpose of this study was to identify how abused women use hope and to determine whether hope is a coping mechanism in their relationship with the abusers. Four focus group sessions were conducted with a sample of 24 women using a phenomenological methodology. The data analysis indicated that abused women maintain hope in four major dimensions: hope for change in their partner's behavior, hope for survival, hope as something to cling to, and hope for control of the situation. The subjects stated that hope was used as a coping mechanism to help them keep their sanity; but in this context, the subjects often saw hope as false or unreal. Thus some abused women used hope as a mechanism to attempt to resolve cognitive dissonance between their internal beliefs and the external reality of physical violence.

Adaptation, Psychological↗

PubMedDate not supplied

Critically ill patients' perspectives of hope.

This study examines critical care patients' perspectives of hope. It focuses on the patients' expression of their experience of hope while being critically ill on a coronary care unit. Using a phenomenological methodology, the data were coded and underwent a thematic analysis. The resulting theory of the critical care patients' perspectives of hope comprised four key themes: hope relative to help; hope interwoven with caring; the presence of hope as synonymous with a personal future; and hope as coping resource. The researcher believes that hope is of great therapeutic benefit for these critically ill individuals, and that the nurse's role is pivotal in inspiring this hope. Furthermore, due to the often subtle, unobtrusive nature of hope inspiration, these interventions may enhance the more visible, tangible nursing interventions.

Adaptation, Psychological↗

PubMedDate not supplied

The concept of hope in nursing 1: its origins, background and nature.

Hope has been described in theoretical terms for many years but the recognition of the importance of hope within the practice of nursing is a more recent phenomenon. Despite the recent growth of references to hope within contemporary nursing literature, it is reasonable to suggest that there remain gaps in the substantive knowledge base and that there appears to be room for both additional research and further discursive literature. Accordingly, this series of six articles will explore the nature of hope, review the existing theoretical and empirical work in several discrete areas of nursing, and provide case studies to illustrate the role that hope plays in clinical situations. This article focuses on the origins, background and definitions of hope. The next article will examine hope within mental health nursing, and further articles will focus on hope within palliative care nursing, hope in gerontological nursing and hope in critical and acute care nursing.

Cross-Cultural Comparison↗

PubMed1997

A comparison of the level of hope in patients with newly diagnosed and recurrent cancer.

PURPOSE/OBJECTIVES: To compare levels of hope in patients with newly diagnosed and recurrent cancer. DESIGN: Descriptive study. SETTING: Three oncology practices in two urban areas of the southern United States. SAMPLE: Convenience sample of 20 newly diagnosed patients with cancer and 16 patients with recurrent cancer (mean age = 56 years). The majority of the patients were Caucasian, female, and married; had a high school degree; and had a religious affiliation. METHODS: Subjects completed the Herth Hope Scale and answered the open-ended question "What gives you the most hope at the present time?" Analysis included descriptive statistics (i.e., frequency, means, standard deviations, percents), t-tests, Chi-square, and analysis of variance. MAIN RESEARCH VARIABLES: Level of hope each subject had in relation to the stage of the cancer at the time of diagnosis. FINDINGS: Contrary to expectations, patients with newly diagnosed and recurrent cancer did not differ in regard to their level of hope. However, significant differences were found related to the type of hope utilized. Married patients and male patients experienced higher levels of hope. Recurrent themes in response to the open-ended question were family support, nonfamily support, faith, outlook, and health professionals/care. CONCLUSIONS: Patients with newly diagnosed cancer use their treatment and nurses, physicians, and other healthcare professionals as sources of hope and support. Patients with recurrent cancer reported drawing hope from faith. IMPLICATIONS AND NURSING PRACTICE: Heightened awareness of the patient-healthcare professional relationship will enable healthcare professionals to provide care that is more sensitive to one congruent with patients' needs. Healthcare professionals need to assess the meaning of faith for each individual patient and offer services to foster this source of hope.

Female↗