Although the hope is among our primary emotions, it is very difficult to define it in words. However, we should not confuse hope with optimism, positive thinking, or expectation, as these are attitudes where we believe that things will be in our favor. Optimism and dreaming can be considered the requirements of hope. Hope is different; it does not originate if we think positively. Hope is deeply embedded in pure reality. This is a concept that is extremely important in the parameters of medical science and nursing and thus, there are enough reasons to understand the aspects of hope in treatment.
Hope is an elevated sensation we feel when we can see a better future for ourselves through our mind’s eye. It recognizes the various significant hurdles and unforeseen difficulties of our life and gives us the strength to move forward with confidence.
Doctors and nurses seldom say that their patients help them find hope all the time. Their patients highlight the indefinite nature of hope as they firmly base their future on reality, which acknowledges that there may be obstacles and pitfalls in life. Hope does not grow in a linear manner as it too has moments where we face fear and doubt. Thus, we can define hope as a multidimensional and vibrant life energy that is characterized through our unexpected but positive belief that we can achieve our objectives. This force of an individual makes anything personally, substantial, and practically achievable. Thus, clearly, hope creates in us the courage required to face our circumstances and overcome them. (Koehn, 2006)
Scientists believe that hope has two main components – one is the affective component while the other is the cognitive component. Hope uplifts us bringing about an energizing feeling within us. These energizing experiences have a psychological impact on the hormonal levels in our body. This is the affective part. Hope demands that we thoroughly survey all the things present before difficulties, our pitfalls, life threatening obstacles and us. In addition, after doing so we find a path, which takes us to our better future. This is the cognitive part. Without hope people will be completely lost and without any direction. Hope gives us the chance to survive by instilling resilience and bravery in us. (Cutliff, 2006)
True hope and false hope
Having true hope means that a person has the proper information needed to think rationally about one’s condition along with all of the problems and pitfalls that are their in our way. Again, true hope also differs from optimism. Optimism makes us believe that everything in this world will be all right but the actual truth is that every time not all the things we want will be in our favor and sometimes they may be very bad.
There is absolutely no space for delusion in true hope. It is completely acute and clear-sighted and does not make any assumptions. True hope recognizes all the problems and the difficult situations that are presented before us in our life and tries to find a potential naturalistic path through the obstacles and hurdles for our better future. Having clear visions and information in our mind helps us to make better decisions and choices for ourselves. Scientists have also found that this also starts a number of chemical changes in out mind and bodies, making us feel better. (Henoch, 2009)
When a person misleads into believing that he or she can be cured of their illness even though the doctors and nurses know that they will not, then that is false hope. Blind optimism is a kind of false hope. Patients who are severely ill should not think that everything will be fine for them and thus, they do not have to bother about anything. Those people who have blind optimism in them and pay no attention to minor details have false hope.
Such people are in complete denial of their circumstances and most of them tend to dismiss the changes that take place in their body. False hope does not recognize the perils and risks one must face in life, but true hope considers these difficulties to be a part of life. Thus, people who have instilled true hope in themselves will have to face fear but they will be able to walk past it. They will realize that even though things may not always work in their favor, but by maintaining resilience and bravery in them, they will be able to walk through fire. (Koehn, 2006)
Should a person ever relinquish the right to hope?
People should never relinquish their right to hope and should uphold it even in severe illness. Sometimes hope can actually alter the direction of an illness helping patients to overcome it. Sometimes even the doctors and nurses loose their hope and feel that by asserting his or her right to have hope and holding on to it strongly; a patient is doing a wrong thing. However, this is not so. Even an ounce of hope in the patient can make him or her survive. Again the patients should not have false hope as described earlier. Blind optimism and false hope in a patient places the doctors and nurses at a great deal of disadvantage.
They require the patients to tell them properly what is wrong with them and get enough information to be able to look for a cure for them. If the patients do not communicate with them and only rely on optimism then the doctors and nurses may jump into wrong conclusions making unnecessary changes in their medical status. When people are faced with health issues by having a hopeful attitude in them and believing in their treatment and doctors, will help them recover faster from their illness. Positive and true hope helps our body to fight against sickness and helps the patients to recover faster. Our emotional state makes our mind produce healing effects in our bodies thus, influencing our physical health too. (Milberg, 2007)
Placebo effect of hope
The placebo effect or the placebo response is an extremely remarkable phenomenon, which sometimes helps to improve the patient’s circumstances. A placebo is an innocuous and fake treatment where an inert substance, like saline or distilled water, is given to the patient, without telling them that it is wrong, as a pacifier. Thus, the placebo effect simply describes the healing and remedial effects, which innocuous medicines without any active chemical substances have on patients. Since the patient expects that the treatment they are receiving is going to be helpful, their expectation and hope helps them get better.
Thus, hope has a powerful influence in the placebo response as more the patients hope more will they benefit from the treatment. Hope brings about positive expectation and its power makes the patients experience benefits even from a fake treatment. Thus, the placebo response is merely the positive effect of curing which is completely founded on the influence of suggestion and not due to the working of some chemical substance.
Placebos also have psychological affects on the patients as it speeds up their pulse rate increasing the blood pressure. The patients are told that they have been given a stimulant. Thus, it helps in improving their reaction rate. This makes our body react in a positive manner to a placebo or healer. For example, the use of Band Aid makes a child instantly feel good from its comforting effects event though it has none. This is the power of hope and placebo effect. (Verhaeghe, 2007)
However, simply taking the placebo is not enough. The patients need to be motivated by the doctors and nurses so that their expectation and beliefs grow making them feel competent to be able to recover from their illness. The nurses and doctors should be able to please their patients by giving them a fake treatment but making them believe that the therapy is highly effective. Once the patients believe in the treatment, it may improve their condition.
As we will se later that the biology of hope affect our body such that hope elicits neurochemical, reactions in our mind making us feel better. What drives our body is our mind, it expectations and thoughts and the placebo effect has a healing and curing effect on both our mind and body, improving our health conditions. In addition, although placebos cannot cure people of severe medical conditions, like cancer, but by developing hope in the patients and relieving them of psychological suffering, placebos surely provide some level of comfort for them. (Milberg, 2007)
Biology of hope
As we have realized by now that we should not consider hope to be a magic wand which when waved cures us of all our illness. By simply thinking, positively all our pain and suffering will not magically vanish. There are a large number of people who no matter how positive they think still fall sick. In the placebo effect our expectations and beliefs, which are the essential elements of placebo response, ironically and interestingly, gives us a glimpse of the biology of hope. Interesting studies have been carried out all over the world with human pain. Normal volunteers were considered for experiment.
Here a blood cuff was placed about their arm by the researchers and slowly inflated bringing up the pressure level to around 250 mm. This is relatively painful giving them a feeling of quantitative painful stimulation. Before the experiment started, they were given a very small dose of morphine. As they were pre-medicated with a dose of morphine, the level of pain, which they felt, was reduced a lot. After this, a trick is played on them.
The scientists then give them normal saline, which is a placebo, and tell them that they are being given drug. Thus, the volunteers are made to believe that they are receiving morphine and it was observed that in many of them, although not in all of them, there was a remarkable reduction of pain. This happens since placebo effect of pain releases enkephalins and endorphins in our brain reducing our response to pain. This is the biology of pain. (Cutliff, 2006)
Similar studies have also proved that when patients with moderate medical problems, like Parkinson’s disease, are given a small dose of a drug which releases dopamine, they showed an increased amount of voluntary muscle movement. After that, they were given a placebo but made to believe that they were getting the drug. Due to this, a huge number of patients actually became better. Their anticipation and belief made the brain release dopamine and thus, hope improved their condition in a substantial way.
The newly emerging theory on the biology of hope is being pursued by many scientists and although it may not produce magic, it surely will help a number of the patients to live a longer and better life even if they have an incurable disease. This is the reason because of which hope will find a proper position in the huge world of science. (Henoch, 2009)
Value of hope in treatment and its use by caregivers in practice
Hope can provide patients living with severe medical conditions not only comfort but also strength to get better and dream about their future. However, they have a lot of fear in them and sometimes-false expectations from their doctors and treatments. The health care providers, like the doctors and nurses, have immense power to either instill or kill hope in their patients. It is up to them to show their care and affection towards their patients attending to their needs and themselves having hope while treating an ailing patient. They have to earn the patient’s trust by making them believe that they are capable of healing them and also in the medical or therapeutic procedure that they are going to perform.
Pain is a common experience felt by the patients and is such an element, which makes it very hard for the patients to face and withstand their situation with courage. It becomes an obstacle for effective treatments to take place as it diminishes the patient’s resilience. The doctors and nurses by instilling hope in their patients can make it easier for them to bear pain so that they are able to tolerate the various stages of their illness thus, increasing their probability of benefiting from a treatment. (Koehn, 2006)
The caregivers need to know how to express hope through their expressions and gestures but must also be realistic in their approach. They must acknowledge their own restrictions and must never impart false hope to their patients. They should be realistic and balance between relieving pain and inspiring hope in their patients. Experiments have also proved that if they communicate in an interactive and hopeful manner with their patients having severe medical problems then the experience and the outcome of their illness is extremely positive.
Even the patients who have hope and faith have shown an increased and rapid recovery from their illnesses. Only when the doctors and nurses actively involve the patients in their own treatment, they get a feeling that may be something good can be done about their ailments. Thus, these caregivers have the power to provide comfort to their patients even if their ailments are terminal. The caregivers should be able to establish a connection with their patients and make them feel free to talk to them anytime and anything they want to. This also instills hope in them as it makes them feel that they do not have to face their ailments alone. (Verhaeghe, 2007)
Cutliff, J. R; 2006; The principles and processes of inspiring hope in bereavement counselling: a modified grounded theory study; Journal of Psychiatric and Mental Health Nursing; 13, 5, 598-603; University of Texas (Tyler), College of Nursing and Health Sciences, Tyler, TX, USA.
Henoch, Ingela & Ella Danielson; 2009; Existential concerns among patients with cancer and interventions to meet them: an integrative literature review; Psycho-Oncology; 18, 3, 225-236; Karolinska Institutet, Institution of Learning, Informatics, Management and Ethics, Medical Management Centre, Stockholm, Sweden.
Koehn, C. V & Cutliff, J. R; 2006; Hope and interpersonal psychiatric/mental health nursing: a systematic review of the literature; Journal of Psychiatric and Mental Health Nursing; 14, 2, 134-140; University of Northern British Columbia, College of Arts, Social and Health Sciences, Prince George, BC, Canada.
Milberg, A & P. Strang; 2007; What to do when there is nothing more to do? A study within a salutogenic framework of family members’ experience of palliative home care staff; Psycho-Oncology; 16, 8, 741-751; Department of Society and Welfare Studies, Linköping University and Unit of Advanced Palliative Home Care, University Hospital, Linköping, Sweden.
Verhaeghe, Sofie T. L, Florence J. van Zuuren, Tom Defloor, Mia S. H. Duijnstee, Mieke H. F. Grypdonck; 2007; How does information influence hope in family members of traumatic coma patients in intensive care unit?; Journal of Clinical Nursing; 16, 8, 1488-1497; Nursing Science, Ghent University, Ghent, Belgium.