The term hope refers to undetectable strength that permits us to overcome our weaknesses, boosts us up when we fall, and continue to motivate us to move forward in any given situation. The theoretical description of hope is not universal but many shared elements are present in the definition of hope (Herth, 2000). According to Cutcliffe and Herth (2002), review of the literature has shown eight distinct key elements that outline and describe hope, such as, multidimensional, dynamic in nature, essential to life, focused on the future, personalized, part of a process, goal oriented, and connected to nursing (Table 8, p.839). The theoretical background for this analysis is grounded on concept of hope as established by Herth, who based her theory on Stress Appraisal & Coping outline by Lazarus and Folkman (Borneman, Stahl, Ferrell & Smith, 2002).
Analysis of concept of hope among caregivers using Walker and Avant approach will expend the understanding of the concept. Clarification of defining attributes of hope, identification of antecedents that affect the insight of hope, discussion of probable consequences of hope, and explanation of the significance of terms will help the author and the reader with sharing of mutual language. Connection of hope to the vital attributes will be shown by the use of model case. Contrary and borderline case will distinguish this concept from other nursing concepts. Review of empirical literature will provide proof of this concept existence.
Aims or Purpose
In general, analysis of specific concept “aims to pull apart an interesting phenomenon with a view to understanding more about what it is and how it works in practice” (Tutton, Seer, & Langstaff, 2009, p. 120). The objective of concept analysis is to comprehend what is the concept about and differentiate it from other concepts. Furthermore, in order to modify and explain concept that originates from nursing research, theory or practice a concept analysis is conducted. Concepts are the building blocks for nursing theories and their examination is vital to active and correct implementation (Maputle & Donavon, 2013).
In nursing, the concept of hope plays significant part in the plan of care. It is assumed that this concept analysis of hope among caregivers will help nurse’s acquire better knowledge of the concept and help them implement gained understanding in patient-centered care settings. Accurate assessment of fading hope among caregivers will allow for implementation of supporting interventions. Application of patient-centered interventions, based on acquired findings, will help with delivery of evidence-based holistic care (Duggleby et al., 2009).
Caregivers of dementia patients face many challenges on a daily basis and their hope is “very much tied to how the person they were carrying for was doing that day” (Duggleby, Williams, Wright, & Bollinger, 2009, p. 517). The experience of carrying for a patient with dementia is perceived to be distinctive and as vital to the experience as the illness itself. The research has shown that physical, psychological, and spiritual stress is part of everyday struggles among caregivers. Furthermore, their physical and mental health is affected by the experience of caregiving. Hope among caregivers of dementia patients’ balances stress and sense of well-being (Duggleby et al., 2009).
According to Herth (2000), hope is “one of the most essential elements in the lives of people with cancer” and has influence on “effective coping, especially during times of loss, suffering, and uncertainty” (p. 1431). Contribution from hope to enhancement of quality of life and impact on the progression of disease, among cancer patients, has been noted. Nursing practice has been known for contributing to support people in enhancing and preserving their hope (Herth, 2000). Terminally ill patients perceive hope as a treatment or cure that can extend their life regardless of their terminal diagnosis. They depend on hope for energy to keep moving forward when promising treatments fail to deliver positive outcomes. Hope can offer the capability to tolerate distress and cope with unbearable situation. Overall, “hope is exactly what is needed to stay engaged in the living while shouldering the burden of an uncertain future” and it “gives life meaning, direction, and an optimistic focus” (Johnson, 2007, p. 451).
Uses of Concept
The concept of hope is vital in terms of disease and health problems. Milne, Moyle, and Cooke (2009) examined the significance of hope for patients diagnosed with chronic disease, such as COPD. The live of individuals and their family members is burden by chronic illness. Dealing with condition that is chronic, on a daily basis, requires constant life modifications and hope is known for contribution to better understanding of illness and enhances future outcomes. Additionally, “hope is an intrinsic part of being human; a basic human response essential for life and to have no hope is to plunge into despair” (Milne, Moyle, &Cooke, 2009).
Hope has been known as a significant part of patients’ existential needs, especially among patients that are terminally ill. Maintaining hope among home-bounded palliative patients was analyzed by the use of social and psychological approach by Olsson, Östlund, Strang, Grassman, and Friedrichsen (2010). Considering that hope “is a dynamic experience that is central to attaining both a meaningful life and dignified death”, terminally ill patients, uphold it by conversing about their future and by getting emotional and practical support (Olsson et al., 2010, p. 607). Elements that nurture hope among terminally ill patients include: family support, faith, short-term goal attainment, and presence of symbols that are associated with hope (Olsson, 2010). Defining Attributes
The defining attributes of hope are relief of burden and inner strength. Carrying for a loved one, who has chronic or terminal illness, can influence negatively quality-of-life and overall health. The negative consequences, such as physical, social, and economic stress can be defined as burden of caregiving. Caregivers have many roles and responsibilities that can affect that burden. Some of the negative outcomes experienced by caregivers are: “stress, anxiety, depression, sleep deprivation, physical pain, and other chronic health conditions” (Williams et al., 2013).
Additionally, fear of unknown and loneliness are included in the caregivers’ experience. In order to manage every day challenges, caregivers rely on hope as a psychosocial and spiritual source (Williams et al., 2013). Hope as a psychosocial and spiritual source provides support to caregivers during challenging transitions and provides support to improve their quality of life. It is part of the experience of caregiving, especially the uncertainty of the future. In many situations, hope serves as an inner strength to keep going and having an optimistic view of the future. Many caregivers refer to hope as an inner source for coping with given situation (Williams et al., 2013).
Caregivers of chronically or terminally sick patients rely on hope during everyday struggles. The following model cases are presented to portray how caregivers experience hope when their loved ones suffer from chronic or terminal illness. A caregiver of a person suffering from Alzheimer’s disease states: “I think hope is the future, hope is what we do every day of our lives…I think hope is to overcome any obstacles that come in our way” (Duggleby et al., 2009, p. 517). “Hope is what happens to me every day….It is what drives us and gets us up in the morning” (Duggleby et al., 2009, p.517).
It is the inner strength that helps us to overcome obstacles on a daily basis. Everyday challenges faced by caregivers can be managed by incorporation of hope into finding some relief of the burden of caregiving. “The initial cancer diagnosis was just over a year ago…A few weeks ago we received bad news that was hard to take in…My partner is not showing any emotion and says he accepts it, but I am feeling anger, sadness, and fear. I am still shocked with the soberness…I try to be the best person I can be, but sometimes it is hard to find the strength to do that…I guess I need to look for hope every day because it is the one part of disease that I can control, unlike how the cancer progresses…But I can chose to hope. There may be light at the back of the tunnel yet – every once in a while it sneaks in when I’m not looking” (Williams et al., 2013).
Additional cases provide an example of what the concept is not and deliver supplementary clarification (Walker & Avant, 2011). Two additional cases, contrary and borderline, are discussed to provide clarification of the concept of hope.
“Mr. B is a 62-year-old Caucasian who is carrying for 72-year-old Filipino wife with stage IV non-small cell lung cancer (NSCLC). Mrs. B has completed several lines of chemotherapy with disease progression. Mr. B is in excellent health with no chronic health problems, and he works full time as a manager. They have two children and five grandchildren…Mr. B and his wife do not see eye to eye on important issues and they have different styles of coping. Mr. B was raised as a Protestant but does not subscribe to any religion as an adult. Mrs. B is a Catholic and gains support from her faith and church community. Mr. B finds meaning and purpose in life from his family and providing for their needs. He also derives meaning from his work while experiencing the stress of multiple demands on his time. Mr. B has great difficulty coping with his wife’s disease and treatment…Mr. B describes waves of emotion and an inability to control his feeling of helplessness, anger, and fear.
He chooses not to share his feelings with his wife for fear that he may cause her more distress. While struggling with many unknowns, Mr. B anticipates being alone in the home the couple has shared for more than 40 years. He perceives that his responsibility as a caregiver is to protect Mrs. B from suffering and negativity (Fujinami, Otis-Green, Klein, Sidhu, & Ferrell (2012), p. E213). This case study presents a scenario of struggling with burden of caregiving. Mr. B has no inner strength to cope with his situation. He feels hopeless and decides not to inform his wife about struggles with his role as caregiver and fading hope. Open communication with his wife about struggles with many unknowns could bring Mr. B some hope and relief from burden of his wife’s disease.
Some of the critical attributes of the concept of hope are present in a borderline case (Walker & Avant, 2011). The next case offers similar attributes to the main concept . “A 46-year-old woman, incompletely injured at C5, moving around with the aid of crutches and a wheelchair, described her personal experiences of faith, hope and will power: ‘I really have hope, you always have hope, you just hope to manage a new, little thing, and then you hope to succeed…and if you have faith, then you hope and then…and all the time you have this (hope) within you, and to keep it (the hope) you need the will as well as the belief that you will make it…And she summarized her years’ experience as follows: ‘I really need to have hope. I need both faith and hope to cope with this. And willpower. Because if I give up, I will end up sitting here (in a wheelchair) and nothing can help me” ( Lohne, & Severinsson, (2005), p. 319). According to this case, faith, hope and will power are relentlessly related. Patients who suffer from traumatic injuries depend on on hope to cope with a new situation. They also need willpower, faith to hope and effectively cope with lifestyle changes.
Antecedents and Consequences
The circumstances or instances occurring prior to main concept are the antecedents (Walker & Avant, 2011). Antecedent to hope can be related to crisis. The examples of crisis include: terminal or chronic illness, hardship, harm, a life frightening condition, or a change. Tough decision that needs to be made or a challenge in one’s life could also be an antecedent to hope. Overall, antecedent to hope can be anything that is crucial in persons’ life since hope is exceptionally linked to persons’ life experiences (Stephenson, 1991). “The consequences or outcomes of hope can be a new perspective” (Stephenson, 1991, p. 1459). Hope provide inner strength, empower and energy in ones’ life experience. Fulfillment of hope delivers encouragement, purpose for ones’ actions, calmness, and relief (Stephenson, 1991).
The theoretical framework offers different structure for understanding the concept of hope. Herth (2000) pursued to establish if theory driven interventions enhance hope and quality-of-life among participants with an initial relapse of cancer. Groundwork for this study was constructed on The Hope Process Framework. Implementation of nursing interventions during group session intended to focus on diverse attributes of hope, such as experimental (searching for hope), spiritual or transcendent (expending the boundaries), relational (connecting with others), and rational thought (building the hopeful veneer) (Herth, 2000, p. 1434).
This study has shown that by focusing on the four attributes of hope, patient-centered nursing interventions enhance the level of hope and increase patient’s quality of life. Suitable research instruments are mandatory to assess the concept of hope. In order to measure the level of hope Herth Hope Index (HHI) can be used. HHI is a valuable instrument that is used to measures hope using 12-item Likert-type scale. The level of hope among terminally ill patients was assessed by the use of HHI and Background Data Form (BDF). The BDF delivered information on age, sex, diagnosis, and level of education, activity and fatigue. The results have shown no influence on the level of hope by those variables, moreover, reveling that hope remained stable (Herth, 1990).
This paper sought to deliver concept analysis of hope. The understanding of this concept analysis was based on literature, attributes, and empirical evidence. The critical attributes, antecedents, and consequences were identified and empirical reference was provided for better understanding. Hope as a concept is multidimensional and the understanding of hope among caregivers of chronically or terminally ill patients is significant. Hope gives inner strength and relief of burden of caregiving daily and should be nurtured and cherished before it fades.
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