A concept is a general common idea created in the mind and expresses a complex mental envision of an experience. Hope is an essential element in holistic nursing theories, being a common human experience, hope is defined by many disciplines and in different perspectives. The aim of this essay is to provide a brief, yet comprehensive review on the hope concept in nursing practice, defining the concept, formulating defining criteria, and presenting examples of the concept’s model cases and examples of what the concept is not.
Concepts are general common ideas created in the mind and express a complex mental envision of an experience (Kearney-Nunnery, 2008). Enhancing nursing knowledge and acquaintance with nursing practice concepts improves nurses’ intellectual and practical skills needed to meet the demanding nature of nursing work. This includes an understanding of human needs and responses, of which hope is a basic shared element (Stephenson, 2006). The aim of this essay is to provide a brief, yet comprehensive review on the hope concept in nursing practice, defining the concept, formulating defining criteria, and presenting examples of the concept’s model cases and examples of what the concept is not.
Significance of hope concept to nursing practice and health care
The main objective of concept analysis is to explore the present state of science about a concept to plan for coming research with a proper strategic vision (Penrod and Hupcey, 2005). Addressing the significance of the hope concept from a nursing viewpoint, it is one role of a nurse to support an ill person to experience hope to muddle through stresses and sufferings of illness (Kylma and others, 1997). In a meta-analysis study on hope research, Kylma and others (1997) inferred there is a prominence of considering hope as a self-motivated dynamic mental state, in contrast to despair, that is translated into actions to change.
In nursing practice, there are two levels of hope, a specific hope that entails an objective or a wish for an expected event or result. Second is the generalized variant of hope that upcoming days will be better or different. Thus, from nursing and health care perspectives, hope is an important factor for patients to prevail over illness and survive difficult conditions. Hope links to spirituality and positive mood states, in this context; it is a key element of holistic nursing. There are two patients’ factors that influence the nursing hope concept; the first is readiness for hope enhancement that is the blueprint of expectations enough to mobilize energy into actions. Second is the end state imagery, which is the image controlling specific envisaged hopes and aims. In fact hope exists even in grieving people, yet, the nature changes so it can be endorsed and practiced in every nursing setting (Dossey and others, 2005).
Defining hope concept
Being a common lived human experience, hope is defined by many disciplines in different perspectives (Cutcliffe and Herth, 2002).
Hope in health care perspective
Hope in adolescents
Hinds (1984, after Hendricks-Ferguson, 1997, p.75) defined hope in adolescents, using a developmental approach, as the extent to which an adolescent have a relieving self-marinating belief that a better tomorrow exists for them or other. Hinds (after Cutcliffe and Herth, 2002, p. 837) suggested four levels (dimensions) of adolescents’ view of hope orderly graded. These are forced effort (extent of trying to take a positive attitude), personal possibilities (the degree of adolescent’s belief of existing second chances), expectations of a better future (degree of having general hope), and expectation of a personal future.
Hope in critical care nursing perspective
Cutcliffe and Herth (2002 a) examined the available experiential work on hope in critical care setting and inferred, given the nature of clinical illness, there is lack of research on hope in this perspective. They emphasized that although hope is important in this particular setting; yet, nursing role is to keep existing hope rather than providing new hopes. Cutcliffe (1995, after Cutcliffe and Herth, 2002 (a), p.1193) suggested four themes of critical care patients lived experiences of hope namely, patient’s hope relates to nurses’ help, patients’ hope combines to nursing care. In addition, hope in critical care patients has an implication on personal future, and hope is a significant resource for patient’s coping with the condition.
Hope in older adults nursing care
There are two challenges to hope inspiration in this setting, first is the negative views of older adults’ health and social problems that pervade the literature. Second is the degree of professional belief in older adults’ capabilities to change (Koenig and Spano, 2006). Unlike younger age group whose perception of hope has implications to the future, older adults place emphasis on current life situations, hope instillation is still helpful to enhance coping skills or strengthening links with support networks. Therefore, hope in older adults nursing is a multi-dimensional concept composed of behavioural elements (coping), spiritual (inner power), cognitive (developing short-term aims), and environmental (social support) (Koenig and Spano, 2006).
Hope in psychological perspective
In this setting, Erikson (1982) views hope as an asset helping an individual to mature and stems from a positive answer to the first psychological calamity between trust and mistrust. Castledine (2000) stressed the nurses’ role is to enforce hope in patients neither in a passive waiting way nor in an unrealistic forcing of conditions but to weigh accurately hope instillation at the time mostly needed and when the patient is ready.
Nursing in philosophical perspective
From a philosophical viewpoint, Stotland (1969) defines hope as the expectation to achieve future aims, in this context; it influences the future, as hopeful individuals are active and energetic. The author strongly linked hope to action stating that hope is essential for action. Vanhoozer (1990) in his interpretation of the works of Paul Ricoeur, the philosopher of hope, suggested that hope is the passion for the possible, which is the passion to live when hope is enacted.
Hope in research perspective
Multi-disciplinary research literature suggests that hope is a build up, which can be evaluated, measured, and directed to work across health-illness scale. Hope is a human experience rather than being a coping strategy that motivates nurses to support patients instead of waiting for a measurable evidence of hope (Herth and Cutcliffe, 2002). Herth and Cutcliffe (2002) in their review identified the need for research centred on how to maintain, initiate differences made by hope, they also pointed to the need for multi-centre and multi-national studies.
Hope in the perspective of Christian belief
In Christian belief, hope is one the three religious virtues besides faith and love. Hope is an undividable part of Christian belief and is rooted in the bible; Adam’s reconciliation with the creator is an example to hope in the bible. Man promised a future with God in Heaven, but commanded to work seeking this hope in the future; thus, hope is as many think is an inspirational motivation (Cutcliffe and Herth, 2002).
Attributes of hope concept
Morse and Doberneck (1995) outline seven common components of hope based on qualitative concept analysis. These attributes of hope are
- a preliminary assessment of the quandary or threat,
- creating choices in one’s mind and establishing goals,
- a healthy revitalizing attitude for negative outcomes.
The remaining attributes are
- a realistic evaluation of one’s capabilities and external conditions and sources of help,
- looking for reciprocal supportive relationships,
- the persistent assessment for indication that reinforce the established goals, and
- the will to tolerate and carry on.
O’Connor (1996) identified four general essential defining criteria for hope;
- existence of an inside human energy,
- positive envision of the future,
- the incentive for action, and
- envision of expressive and realistic future aims.
A model case for the concept of hope
A model is a realistic image of a phenomenon; concept or theory providing a description of what it represents (Kearney-Nunnery, 2008). The following model case shows the attributes of hope in Morse and Doberneck components of hope (1995), adapted from Benzein and Saveman (1998). Last winter a 25 years old male involved in a car accident and had multiple fractures of both legs. After surgery, rehabilitation physiotherapy was slow.
The patient remained optimistic believing that he will ski again. He learned from his doctors that fractures are healing properly. He trusted his physiotherapist, he then decided that he will not only ski but will compete in his favourite sport that is downhill skiing. The patient sets his goal consulting his physiotherapist to whom he is grateful for encouragement. He trains with great motivation, patience and endurance, although some people around him doubted his endurance. This goal helped him to feel well and he is sure that he will achieve it. His friends keep regular contact and the patient is very motivated.
Three model cases of hope concept is not Benzein and Saveman (1998) suggested three model cases of what hope concept is not, the first is a contrary where none of the attributes exists.
Carl was a painter, a good one. But this summer he ran out of inspiration. He felt trapped boxed in. He felt a great loss at not being able to paint. His smile was gone, he felt empty dead inside and very alone. He retreated into himself and didn’t want to see or to talk to other people. He felt imprisoned in his inactivity and he couldn’t find a way out of it (Benzein and Saveman, 1998, p. 327).
It is clear the Carl, in this model, is helpless, moreover, he moved to despair.
The second model is a related case, where the hope concept attributes are not represented. Instead a related model (trust in the following case) is represented.
Mr Cliff is 86 years old and in hospital. Recently the staffs have thought that he has become shut in on himself and silent. He has not wanted to talk to them as he did before. A trainee nurse, Maria, who has been working on the ward for two weeks, has spent a lot of time with Mr Cliff. She has helped him with things he has asked for. Mr Cliff himself thinks he has got much worse and is afraid he is going to die. He thinks about it a lot and decides to talk to Maria about it (Benzein and Saveman, 1998, p. 326).
Benzein and Saveman (1998) explained that although the concepts of hope and trust are occasionally used interchangeably, yet, there are key differences in attributes. Contrary to trust, hope is a future-orientation; developing trust is a timely process and is interpersonal which are all present in this case. The third case presented is a borderline case where it contains some of hope concept attributes but not all.
Linda looked in the jeweller’s window. She caught sight of a diamond necklace which was very, very expensive. She loved jewellery but as she was unem -ployed she could not afford to buy any – especially not that necklace. Linda was excited by the thought of the necklace and wished she could buy it so that she could show it off to all her friends at her sister’s wedding (Benzein and Saveman, 1998, p. 326).
This case lacks the realism attribute of hope and an illustration of the desire concept where goals are neither realistic nor essential ((Benzein and Saveman, 1998).
Hope concept is an important component of the holistic nursing theory, it is important in nursing practice to induce specific and general hope as they translate into patient’s actions. Generating hope has its implications on health care; future research is needed to explore how internal patient’s factors and external factors interact and how the nurse can encourage the patient’s experience of hope.
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