In Western medicine, treatment is typically defined according to surgical, chemical or mechanistic attention toward symptoms and ailment origins. This is an appropriate professional orientation for contending with the wide array of conditions which might afflict the human body. However, there is yet another level of medical attention which is considered in this discussion and which, when properly implemented, may offer compelling results.
Such is to say that the utilization, extension and persistence of hope in the process of treating patients in all manner of treatment context can be shown to have markedly beneficial outcomes to either the health of the patient or the emotional well-being of the patient. Still, there is a need for continued dialogue on the subject, as many perceived benefits remain unproven. To this extent, “nursing literature is pointing towards the importance of having hope for a healthful living.
However, the concept of hope has preliminarily been defined in an abstract and general way and is therefore difficult to grasp. ” (Lohne & Serverinsson, 2006) In consideration of this need for clarity and the potential expansiveness of medical benefits, the literature review conducted here will assess three primary articles which offer both an endorsement for this view on the value of hope-based treatment approaches and an assessment of some of the specific ways in which hope can and should be evaluated and implemented. Review of Literature
The discussion provided by Clark (2002) offers an interesting lead point on the subject of hope in medicine by focusing on its history in research discussion and investigation. Clark’s review accounts for several points of inflection in the developing history of hope as part of an integrated strategy for emotional and medical treatment in concert. The first point addressed by Clark’s review determines that a fundamental change in medical perspective had begun to transpire with the assumption of varying clinical research investigations on the subject.
This would contribute to what Clark identifies as a major shift in the way that physicians had begun to perceive and treat terminal illness. As opposed to a cut and dry preparation of the patient for the certainty of death, Clark points to a juncture in the mid to late 20th century at which medical professionals had begun to adopt “an active rather than a passive approach to the care of dying people was promoted in which the fatalistic resignation of the doctor (‘there is nothing more we can do’) was supplanted by a determination to find new and imaginative ways to continue caring up to the end of life.
” (Clark, 2002) In addition to serving as a fundamental motivation for the continuing investigation of ways to extend life expectancy with or without the presence of supposedly terminal illness, the optimism here reflect serves to improve the quality of life for those in the final phases. The simple expression of optimism—not unrealistic or patronizing but conducive of an assurance that all possible measures will be taken to preserve life—can have the impact of promoting a sense of value and support for one on the cusp of death.
Even where life cannot be preserved, the expression of hope suggests that these moments of life can be made more tolerable by the perspective taken by healthcare providers. This idea speaks to another fundamental inflection point in the way that healthcare professional have begun to treat the emotional orientation of patients. Clark points to a “growing recognition of the interdependency of mental and physical distress created the potential for a more embodied notion of suffering, thus constituting a profound challenge to the body-mind dualism on which so much medical practice of the period was predicated.
” (Clark, 2002) This period, late in the 20th century, leads us to the current consensus that there is indeed a real and tangible value to the emotional fortitude of one enduring a physical breakdown. The presence of hope in the healthcare provider, we can clearly see, is likely to improve the prospect that even a terminally ill or age-advanced patient might adopt a hopefulness as well. A study by Eliott & Olver (2006) likewise provides an important body of insight into the subject of hope’s value in medical proceedings.
Its emphasis on the relationship between hope in the medical context and the object of coping with the end of life reveals the depths and persistence of hope as part of the human condition. The merit of the overarching argument here is especially strengthened by the resolutions of this study, which demonstrate a fundamental value to hope in alleviating the pain, discomfort, fear and loneliness which can otherwise be characteristic of a recognition of the end of life. The functionality of hope in the face of impending death is particularly interesting.
In cases of advanced age or advanced terminal illness, the physician or nurse’s responsibility shifts from curative focus or aggressive treatment methodology to a focus on the alleviation of suffering. In this context, healthcare professionals must be prepared to help ease such patients into death with as little anguish and as great a level of comfort as is possible. This is why such matters as acceptance, realism and a sense of support are all crucial aspects of the treatment process.
Here, the capacity in the patient to summon hope, and the ability of healthcare providers to offer support to the extent of instilling hope, will together be essential to assisting patients in the difficult final phase of the life cycle. Thus, “in the context of discussions about decision-making at the end of a terminal illness, when used as a noun, hope invariably referenced the medical domain—focussing either on the objective probability of medical cure (typically taking the negative form “there is no hope”), or the subjective possession of the patient, needed to fight their disease.
” (Eliot & Olver, 2006) Without positive or negative connotation, this indicates that the concept of hope is a definite presence as individuals face terminal conditions. Whether it is realistic for one to fight or to submit to illness, hope makes a transition from an abstract sentiment to a real and tangible thing which may either be palpable in its absence or powerfully evident in its presence.
As the Eliot & Olver study denotes, lending even greater credence to the strong endorsement of this research for the value of hope in terminal medical contexts, there is an empirically demonstrated relevance to the presence of a strong support system in building upon and maintaining hope. In terms of the relationships which the patient is able engage with those around him—whether these are with healthcare providers, family, friends or some variant upon this combination—there is an unquestionable benefit that bespeaks a determined interest in connecting with the world around the patient.
A symptom of hope, this desire to resist isolation even in the face of likely insurmountable medical conditions is likely to have a positive impact where possible on the physiological experience of the patient and, most certainly, even where a cure is not a reasonable expectation, this connection to the world around the patient demonstrates an interest in comfort upon the approach of death. Accordingly, Eliot & Olver would observe that “hope as a verb emphasised the patient’s active engagement in life, identifying what was good and positive for them.
It was used to assign responsibility to others, to indicate and establish solidarity or agreement between the speaker and others, effectively strengthening interpersonal ties between individuals. Through hoping, patients established connection with others and with the future. ” (Eliot & Olver, 2006) The outcome of a terminal illness aside, there are yet evident benefits in appealing to the virtues of hope in enduring or engaging the experience of the final life cycle phase. Moreover, the Eliot & Olver study concludes something which is generally consistent with the overall findings of this review.
Namely, the value of hope and support as imbued to the patient through a relationship with healthcare providers is inestimable. There is a significant and observable return on the personal investment made by the dedicated and optimistic healthcare provider. As the research discussed here would determine, “in the context of interactions between patients and clinical staff, we conclude that the use of hope-as-a-verb may have benefits, enabling the patient—even when dying—to focus on the positive, to connect to others, and to continue to engage with life.
” (Eliot & Olver, 2006) This is an important distinction which denotes an altogether more positive orientation toward death than that which might cause one become protectively isolated. A surrender of hope, again without connotation positive or negative, might denote a disconnect from life and an incapacity to reflect on the possibility of a future. This symptom of death, as much psychological as physiological, will play a part in defining the final emotional experiences of the dying individual.
And finally, the review addresses the report by Eckholm (1991), which provides the research with some insight into a concrete relationship between hope and medical treatment found in so-called experimental medical procedures. Focusing primarily on the complex of issues relating to bone-marrow transplants in otherwise terminal cancer patients, this discussion refers to hope as the force which encourages individuals not just to battle against weakening symptoms and diminishing statistical odds of survival, but also against the resistance to this optimism of medical insurance companies.
According to the report, at the time of its publishing, opponents to the insurance coverage or pursuit of experimental techniques in extending the lives of terminally ill patients have argued that as a life-saving medical treatment culture, “we have raised the public’s expectations far beyond what is supported by the published data. ” (Eckholm, p. 1) It is thus contended that the medical treatment field has come to almost problematically provide hope as a justification for engaging in all possible manner of treatment to the interests of extending lives even where it may appear otherwise impossible.
From the perspective of the patient, which is something that is due consideration in this review as well, it is hard to image that the determination to attempt all manner of life-saving technique in the interests of defying a terminal verdict would be dissuaded by the insurance company’s incapacity to economically justify such experimentation. In the examples of positive treatment outcome discussed by the Echholm article, it is evident that many terminally ill individuals are driven to survival even by the slim hope that such treatment might have a positive impact.
One can constitute a marginally effective strategy of survival predicated largely on the hopeful pursuit of effective treatment options. Characteristics of Hope: For patients who are suffering from illness or injury, hope constitutes the positive perception of recovery in some capacity, whether this is an aspiration to return to a state previously present before the onset of symptoms or simply to achieve personal milestones of recovery, this orientation toward the future is what distinguishes the presence of hope.
A belief in the prospect of something constituting an improvement of one’s state, whether it is to the extent that some recovery is achieved or to the extent that one concedes to the embrace of death, may be understand as bearing the characteristics of hope as we have evaluated it here. Definition of Hope:
The definition of hope which is produced by this discussion’s findings is as an abstract force existing in human sentiment which shows a desire to some end to attain improvement or cessation of negative conditions and which, when the need for such exists, can become a very concrete and powerful entity availing the beholder with an effective conviction of recovery. This is bolstered by the more simple and straightforward definition found in the Herth (1990) study, within which “hope was defined as an inner power directed toward enrichment of ‘being.
’” (p. 1250) Instrument Critique and Application: The instrument for evaluation will be the theoretical framework of the Health Belief Model, which denotes that individuals will tend to approach healthcare and treatment according to their own ideas and prejudices herewith. Thus, a research examination designed to support the findings of the literature review here would focus on evaluating comprehensible subjects residing in long-term care facilities such as nursing homes, hospice facilities and other such care contexts.
By engaging in direct conversational discourse with patients and basing this discourse on the dual purposes of instilling realistic hope and posing informal open-ended interview questions. By drawing an association between the apparent belief in a cause for hope and the resulting emotional and physiological characteristics exhibited, the Health Belief Model and the informal, oral survey are used together to effective measure an applied consequence of hope as a healthcare strategy in the most afflicted of patients.
The greatest limitation to this approach is, of course, the incapacity of some of the most afflicted patients to express themselves fully. Another limitation is the pointedly qualitative, observational and therefore non-empirical nature of such a study. By and large, as Stokes & Turner (2006) note on this subject, related “literature is replete with claims that Registered Nurses engage in hope facilitation with their patients. However, these claims are largely conjecture, with few studies empirically identifying the extent to which Registered Nurses use hope interventions with their patients. ” (p.
363) Indeed, the research investigation here follows a similar pattern, generally seeking to draw observations without making distinctions regarding control and experimental groups. More, over there is made no real attempt to disprove or critique the value of hope as counterpoint. Relevance of Hope for the Advanced Practice Nurse: With this in mind, the greatest value of the hope-based strategies which we examine here would be in their application. We may ably suggest at least from the research which has been conducted that hope is not detectably threatening in any way to the process of recovery or coping with mortality.
Moreover, it has already have proven applied success in other clinical contexts. Name, it is already true, according to Moore (2005), that “hope is at the heart of psychiatric nursing practice. ” (p. 100) Therefore, for the APN in particular, we may focus on the sharply humanistic value of bringing hope to patients, especially those who may otherwise lack the proper support system. Moreover, it is valuable for the patient to observe hope in those professionals whom it may be assumed have a greater understanding of the consequences of one’s health outcomes at an empirical and personal level.
To the former, facility and nursing education administration will play an important strategic role, insofar as the effectiveness of the use of hope may well depend on the effectiveness of a cultural facilitation of this approach. To this end, as derived from effective administration oversight, “critical dimensions of hope as well as hope antecedents and threats provide direction for nursing intervention. ” (Miller, 2007) This speaks to the importance, in any context, of the personal acceptance and inducement of hope in recovery or a comfortable passing in the medical professional.
Summary: The findings produced by the review and intended by the research investigation here proposed together indicate that there is a fundamental benefit to the use of hope as a concrete strategy in improving either health outcomes, patient experiences or both. To the latter in particular, the research has found that even in the face of terminal illness or certain demise, the presence of hope in the form of personal faith in a positive transition or in the form of a large and loving support system will have the impact of alleviating anguish or fear.
As the research has also illustrated, there is a distinct need to attempt to recognize where possible the feelings and experiences of the patient. A sense that the patient is listened to, valued and understood can go a long way to preventing the dehumanizing impact of illness and aging. It is to this extent that we may suggest a maintenance of hope is, overall, a connection to that which makes one human.
References
Clark, D. (2002). Between hope and acceptance: the medicalisation of dying. The British Medical Journal, 324, p. 905-907.Eckholm, E. (1991). The price of hope: Medicine’s Disputed Frontier. The New York Times. Retrieved April 8th, 2008 from http://query. nytimes. com/gst/fullpage. html? res=9D0CE6D6173AF93AA2575AC 0A967958260>. Eliott, J. A. & Olver, I. N. (2006). Hope and hoping in the talk of dying cancer patients. Social Science & Medicine, 64(1), p. 138-149. Herth, K. A. (2001). Development and Implementation of a Hope Intervention Program. Ebsco Publishing. Retrieved November 16, 2007 from Ebsco Database. Lohne, V. & Severinsson, E. (2006).
The power of hope: patients experiences of hope a year after acute spinal cord injury. Journal of Clinical Nursing, 15(3), p. 215-223. Miller, J. F. (2007). Hope: A Construct Central to Nursing. Nursing Forum, 42 (1). Retrieved November 16, 2007 from Ebsco Database. Moore, S. L. (2005). Hope makes a difference. Journal of Psychiatric and Mental Health Nursing, 12, 100-105. Retrieved November 16, 2007, from Ebsco Database. Stokes, L. & Turner D. S. (2006). Hope promoting strategies of Registered Nurses. Issues and Innovations in Nursing Practice. Retrieved November 16, 2007 from Ebsco