The battle between hoping and suffering: a conceptual model of hope within a context of spinal cord injury

A qualitative study on hope in iranian end stage renal disease patients undergoing hemodialysis

BACKGROUND

End Stage Renal Disease (ESRD) patients undergoing hemodialysis are faced with serious problems in their lives. Hope, as a multifaceted factor, plays a critical role in these patients' lives. Given the multifaceted process of hope, this study aimed to describe hope and identify the challenges, strategies, and outcomes of hope in Iranian ESRD patients undergoing hemodialysis.

METHODS

This is a qualitative study using content analysis. The participants were selected using purposive sampling. The data were collected using deep, semi-structured interviews with 14 participants; it continued until reaching data saturation. Graneheim and Lundman content analysis approach was used to analyze the data.

RESULTS

Five main categories and twenty-two subcategories emerged; the categories consisted of (1) Hope described as a particular event to happen, (2) Opportunities and threats to achieve hope, (3) Negative emotions as barriers to achieve hope, (4) Positive coping strategies to achieve hope, and (5) Growth and excellence as the outcomes of hope.

CONCLUSIONS

Based on the findings, ESRD patients undergoing hemodialysis described hope as a positive feeling of expectation and desire for a special thing to happen. They faced threats and opportunities to achieve hope, which exposed them to negative emotions as barriers of hope. Thus, they make use of positive coping strategies to achieve hope. Moreover, hope led to growth and excellence. Through awareness of hope, definition and strategies to achieve it, and teaching them, physicians and nurses working in hemodialysis wards can enhance hope in patients.

Empowerment, Communication, and Navigating Care: The Experience of Persons With Spinal Cord Injury From Acute Hospitalization to Inpatient Rehabilitation

Background

Spinal cord injury (SCI) results in long-term functional impairments that significantly impact participation and role in the community. Newly injured persons are often reintroduced to the community with significant deficits in knowledge, including how to access and navigate community resources and supports. This warrants a better understanding of the patient experience of in-hospital care and discharge planning to ensure individuals with SCI are best supported during transitions in care and while living in the community.

Objective

To explore the lived experience of persons with acute SCI and their perceptions of care, focusing on the initial hospital experiences to inpatient rehabilitation.

Methods

A phenomenological research study was conducted using semi-structured interviews. Eligible participants had differing etiologies of SCI (including non-traumatic and traumatic SCI), were over the age of 18 at the time of initial care, and experienced acute hospital and inpatient rehabilitation at an Alberta-based institution within the last 10 years. One-on-one interviews took place between March and June 2021 over telephone or virtual platforms (Zoom). Interview transcripts, and field notes developed the text, which underwent hermeneutic analysis to develop central themes.

Results

The present study included 10 participants living with an SCI in Alberta, Canada. Most participants (80%) were male. Participants' age ranged from 24 to 69 years. The median years since initial SCI was 3 years. Interviews lasted 45–75 min. Seven participants identified as having a traumatic SCI injury and three identified as having a non-traumatic SCI. The interplay between empowerment and disempowerment emerged as the core theme, permeating participants' meanings and perceptions. Three main themes emerged from the interviews regarding the perceptions of the SCI patient experience. Each theme represents a perception central to their inpatient experience: desire to enhance functional independence to empower confidence and self-management; need for effective communication with healthcare providers to support recovery; and navigating appropriate care supports to enhance preparedness for discharge and returning home.

Conclusion

This study demonstrates the significant need to enhance education of person/family-centered SCI care, foster positive communication between care recipients and care providers, and facilitate better in-hospital access to appropriate navigation and wayfinding supports.

"Hope to See the Soul": The Relationship Between Spirituality and Hope

This research extends recent studies of spirituality and hope from a patient perspective, building on the analysis of an auto-ethnographic self-story of a cancer patient. A connection has been highlighted in the literature that forms a relationship between spirituality and hope. This study suggests that hope is generated through a dynamic and relational process of doing hope together with others. The trauma of illness can cause a dramatic situation of despair in which terrified and worried voices become the norm. Sacred meetings in connection with others can replace these terrified voices with hopeful ones. These meetings are established through people being witnesses to the situation, alleviating the suffering through presence and reflection, for the patient to become reconciled with oneself and experience something beyond the situation as sacred.

'Hope as a lighthouse' A meta-synthesis on hope and hoping in different nursing contexts

BACKGROUND

Hope has a contextual dimension and experiences of hope seem to be an important part of everybody's life irrespective of changing and challenging health conditions. However, less focus has been placed on the similarities and differences in the experiences of hope among patients and family caregivers in different contexts of suffering and health, such as the nursing contexts of acute and critical care, rehabilitation and long-term care and prevention and health promotion.

AIM

This paper focuses on experiences of hope and hoping in different clinical nursing contexts, based on a meta-synthesis of seventeen empirical studies on hope and hoping. These studies highlight experiences of hope and advance our theoretical and clinical understanding of the phenomenon.

METHODOLOGICAL FRAMEWORK

This study on hope and hoping from seventeen empirical research studies was based on a meta-synthesis, by clarifying and modifying the essence of hope and hoping, aiming to identify the unique conditions in the different clinical contexts.

RESULTS

A new understanding of the empirical findings emerged from the text: Hope means transformation and hope is indispensable in the acute and critical nursing context, and hope as an inner flame and hope as a lighthouse related to rehabilitation and long-term care. Hope means pushing limits and expanding hope was experienced in the context of prevention and health promotion.

CONCLUSIONS

According to the findings, dimensions of hope and hoping were always present but also influenced by contextual suffering and losses.

IMPLICATIONS FOR PRACTICE

Hope means metaphorically a lighthouse, meaning a bright and shining centre, which must be promoted and protected in patients and their families.

End-of-life conversation from both sides of the bed: voices of family and staff

PURPOSE

Prolonged living with chronic illness and disability expands the discussion of end-of-life conversation because of the complex role of intercommunication among patient, family, and healthcare staff. Little is known about such interaction from participants' different perspectives. This qualitative case study examined end-of-life conversation among patient, family, and staff during long-term hospitalization in a neurological rehabilitation department.

METHODS

After the patient's death, 18 participants responded to in-depth semi-structured interviews: 16 healthcare staff and two family members (the patient's wife and brother). In addition, we used the wife's autoethnographic documentation of her experiences during end-of-life conversation.

RESULTS

Thematic analysis produced three themes: (1) The Rehabilitation Department's Mission - Toward Life or Death? (2) The Staff's Perception of the Patient; (3) Containing Death: End-of-life Conversation from Both Sides of the Bed. These themes represented participants' different perspectives in the intercommunication in overt and covert dialogues, which changed over time. Death's presence-absence was expressed by movement between clinging to life and anticipating death.

CONCLUSION

The study findings emphasize the importance of practitioners' training to accept and openly discuss death as an inseparable part of life-long disability, and the implementation of this stance during end-of-life care via sensitive conversations with patients and their families.IMPLICATIONS FOR REHABILITATIONIt is vital for rehabilitation professionals to be trained to process and accept end-of-life issues as a natural and inseparable part of the life discourse among people with disabilities and their families.Rehabilitation professionals need to acquire tools to grasp the spoken and unspoken issues related to life and death, and to communicate their impressions and understandings with people with disabilities and their families.Rehabilitation professionals need to encourage an open dialogue when communicating with people with disabilities and their families on processes related to parting and death.

Lifetime Active Care: A qualitative study of long-term family carers of people with spinal cord injury in Australia

This study reports the findings of a qualitative, grounded theory study which explored the experiences of partners and other long-term family carers living with and supporting loved ones with spinal cord injury. The study is exploratory in that little was previously known about the experience of long-term care-giving in this context in Australia. Most research in this area has focused on this experience during the first 5 years postinjury. This study focuses on the experiences of family carers beyond that 5-year period. The study aimed to explore the experience of partners and other long-term family carers of people with spinal cord injury, and illuminate their daily lives, interests, concerns and caring approaches in this context. Data collection included in-depth interviews, a focus group and an on-line, password-protected research blog for participant narrative reflections. Findings revealed that the experience of long-term caring is complex, all-encompassing and lifelong. This experience is conceptualised here as lifetime active care which always involves what we describe as protective, negotiated, surreptitious and strategic caring. These dimensions of caring are interdependent and deeply embedded in the daily, active support provided by long-term carers of people with spinal cord injury. We argue that carers in this context are involved in processes that have, in other contexts, been conceptualised as narrative reconstruction and also that the four dimensions of caring identified involve significant emotion work. The social processes of lifetime active care may shed light on the experiences of family carers in other long-term care contexts.

Method and Apparatus for the Automated Delivery of Continuous Neural Stem Cell Trails Into the Spinal Cord of Small and Large Animals

BACKGROUND

Immature neurons can extend processes after transplantation in adult animals. Neuronal relays can form between injected neural stem cells (NSCs) and surviving neurons, possibly improving recovery after spinal cord injury (SCI). Cell delivery methods of single or multiple bolus injections of concentrated cell suspensions thus far tested in preclinical and clinical experiments are suboptimal for new tract formation. Nonuniform injectate dispersal is often seen due to gravitational cell settling and clumping. Multiple injections have additive risks of hemorrhage, parenchymal damage, and cellular reflux and require additional surgical exposure. The deposition of multiply delivered cells boluses may be uneven and discontinuous.

OBJECTIVE

To develop an injection apparatus and methodology to deliver continuous cellular trails bridging spinal cord lesions.

METHODS

We improved the uniformity of cellular trails by formulating NSCs in hyaluronic acid. The TrailmakerTM stereotaxic injection device was automatized to extend a shape memory needle from a single-entry point in the spinal cord longitudinal axis to "pioneer" a new trail space and then retract while depositing an hyaluronic acid-NSC suspension. We conducted testing in a collagen spinal models, and animal testing using human NSCs (hNSCs) in rats and minipigs.

RESULTS

Continuous surviving trails of hNSCs within rat and minipig naive spinal cords were 12 and 40 mm in length. hNSC trails were delivered across semi-acute contusion injuries in rats. Transplanted hNSCs survived and were able to differentiate into neural lineage cells and astrocytes.

CONCLUSION

The TrailmakerTM creates longitudinal cellular trails spanning multiple levels from a single-entry point. This may enhance the ability of therapeutics to promote functional relays after SCI.

The golden year: How functional recovery sets the stage for tendon transfer surgery among patients with tetraplegia-a qualitative analysis

BACKGROUND

Tendon transfer surgery can effectively improve hand function for patients with tetraplegia but remains poorly utilized. Little is known regarding how patients' rehabilitation experiences influence their perception of function, identity, and coping to shape their reconstructive context.

METHODS

We performed a cross-sectional qualitative analysis of 19 participants with C4-C7 cervical spinal injuries: 9 patients had undergone reconstruction; 10 had not. Semistructured interviews were conducted using an interview guide focusing on rehabilitation experience, the relationship between function and identity, and how patient experience evolved. Interview transcripts were analyzed using grounded theory.

RESULTS

The study sample was predominantly male (79%), white (89%), and American Spinal Injury Association grades A-D (grade A: 42%; grade B: 32%; grade C: 16%; grade D: 10%). Recognizing rehabilitation's necessity, functional gains, and constructive patient-therapist relationships promoted engagement in therapy. Poor insurance coverage and financial constraints decreased rehabilitation access. Function affected identity through the degree to which it tied participants to a "patient" role. Early in recovery, patients' function, roles, and attitudes were fluid but solidified over time; how satisfied patients were with these final positions influenced how they coped.

CONCLUSION

The balance of patients' positive and negative coping has been found to influence patients' progression to surgery. This study describes how function and identity contribute to coping. Participants' function and identity evolved during a finite period we call "the golden year," before reaching a fixed point around which they built their lives. The norms patients establish during this time may affect receptiveness to surgery.

A qualitative study of immigrant women on long-term sick leave and their experience of dignity

PURPOSE

The purpose of this study was to explore if and how immigrant women suffering from chronic pain experience and maintain their dignity, during rehabilitation.

METHODS

The study was designed as a field study, with participant observation and in-depth interviews. Participant observations were carried out during a rehabilitation course for 14 immigrant women on an outpatient clinic at a rehabilitation hospital in southern Norway. In-depth interviews were performed after the rehabilitation period. Hermeneutic analysis was applied to interpret the data.

RESULTS

Findings show that the immigrant women experienced dignity by being seen, respected and believed by family-members, healthcare personnel and other patients at the outpatient clinic. Moreover, they maintained their dignity through a sense of their own value, integrity, religious faith and hope for the future.

CONCLUSIONS

The immigrant women maintained and protected their dignity by finding strength, pride, and self-worth in their religion and through their family-members' affection. Taking responsibility for themselves and others and experiencing fellowship and equality with other women, they enhanced their dignity during their rehabilitation process. The caring attitudes and behavior of some healthcare personnel promoted patient dignity. They also gained hope and dignity by experiencing goodness, cultural competence, and sensitivity from healthcare personnel. Implications for rehabilitation This study shows that the family role is more important for the immigrant women than the role as an employee, although financial independence and being able to help relatives financially also were central. Fellowship and equality with other patients, together with a rehabilitation program, which is facilitated for different language levels, were understood as important factors for an effective recovery. Enough time to get to know the patients and cultural competence seems to be central components for the health care personnel to give efficient help to immigrants in rehabilitation. Immigrants from low/middle-income countries appear to apply their religiousness as a resource in their lives to a greater extent than native Norwegians do, and should be taken into consideration when planning and implementing rehabilitation programs for immigrants.

Finding a Way to Cope: A Qualitative Study of the Experiences of Persons With Spinal Cord Injury

PURPOSE

Spinal cord injury (SCI) is a catastrophe that causes disabilities and permanently changes people's lives. The people have to adapt to the loss of self-care ability and may need long-term rehabilitation. The recovery can be problematic, affecting physiological, psychological, and financial aspects of life. The purpose of this study was to explore the lived experiences of persons with SCI living in Taiwan.

METHODS

In 2009, we conducted a qualitative study on 10 participants with SCI recruited from the Association of Spinal Cord Injury Persons in Taiwan. Open-ended interviews were conducted using a guide and tape recorder for subsequent transcription. A phenomenological method was used to collect data by interviews.

RESULTS

The core experience of persons with SCI was "finding a way to cope," which was a process from despair to self-acceptance and composed of four categories: (a) shock and unpreparedness for the injury: the catastrophe of the injury itself and the underrecognition of physiological disabilities; (b) panic and fear: denying the injury and yearning for a miracle; (c) abyss of despair: imprinting of life, bearing the agony alone, and chaos of life; and (d) reflection on the meaning of life: adaptation to physical disabilities, self-acceptance, and growth.

CONCLUSIONS

Our research was descriptive and focused on the structure of the lived experiences of persons with SCI. Many issues of inequality also revealed physical disabilities, such as difficulty looking professional, resulting in burden of stress and frustration. These results highlight persons with SCI should be classified as case management and integration of social welfare resources to facilitate care for persons with SCI after discharge.

"Hoping to see the future I prefer": an element of life-world for older women living alone

We interact with Dorcy's earlier work in Advances in Nursing Science on hope, noting that scholars have emphasized hope in suffering rather than exploring hoping in everyday life. We did a secondary analysis of 4 descriptive phenomenological studies with older women (N = 81, aged 75-98). Findings included a 4-level taxonomy of life-world. Four future-related subelements (such as, having a future I cannot see, down the road) intersected with the element hoping to see the future I prefer. Five of its subelements were common across the sample, including hoping that I do not get to that point. Findings have implications for expanding scholarship pertaining to hoping.

Adjustment and support needs of glioma patients and their relatives: serial interviews

OBJECTIVE

To understand factors influencing the process of adjustment to a diagnosis of glioma.

METHODS

Twenty-six patients and 23 relatives took part in 80 in-depth qualitative interviews conducted at five key stages: before formal diagnosis, at start of treatment, on completion of treatment, 6 months post treatment, and post bereavement.

RESULTS

High levels of distress were reported, particularly preceding and following diagnosis. Many participants described lack of specific information in the early part of their illness and a lack of clarity about what was wrong and what was going to happen next. They often desired more procedural information, as well as information about their condition and treatments available, although there was variation in the timing of when people were ready to hear this. Receiving reassurance and support was essential to patients and their relatives to help them come to terms with their illness. This need was particularly acute during the early phase of the illness when distress and uncertainty were at a peak and lessened over time as people adjusted to their illness.

CONCLUSIONS

Offering suitable information about what to expect early and frequently in a supportive way is much appreciated by patients. There is an important balance between ensuring that patients and their families are fully informed and fostering adaptive coping that allows for hope.

Staff and patient views of the concept of hope on a stroke unit: a qualitative study

AIM

This study explores the experience of hope for patients and staff in the context of a British stroke unit.

BACKGROUND

Hope is identified as a useful concept for exploring how people find meaning in recovery from illness. Uncovering the experience of hope in acute stroke care has provided evidence that can be used to facilitate rehabilitation.

METHODS

The methodology drew on the principles of ethnography, undertaking unstructured qualitative interviews with ten patients, ten multidisciplinary staff and 21 hours of participant observation including informal discussions with staff and patients. Data collection took place between November 2007 and November 2008.

FINDINGS

Four themes were identified: suffering, struggling with no hope and despair, hope for recovery and realistic hopefulness. Hope was experienced in the context of suffering a stroke demonstrated as loss of function, loss of mental capacity and dependency. Patients struggled to maintain a sense of hopefulness while feeling close to a slippery slope towards despair and death. Hope was expressed as a strong desire to recover, get back to normal and a time to reflect on their lives so far. Staff identified realistic hopefulness as focused on keeping things real while balancing giving hope and avoiding false hope.

CONCLUSION

Hope is placed within the emotional challenges of suffering and struggle inherent in recovery from stroke. The staff work with patients' hopes but offer realistic hopefulness as a practical strategy for recovery. Further interventions are required for working with feelings of despair or no hope.

Coping strategies used by people with spinal cord injury: a qualitative study

STUDY DESIGN

Qualitative.

OBJECTIVES

Although using coping strategies have an important role in the adaptation process and quality of life following spinal cord injury (SCI), there is still trivial information about this issue in the world and especially in Iran. The purpose of this study was to explore coping strategies used by Iranian patients with spinal cord injuries.

SETTING

The Brain and Spinal injury Repair Research Center of Tehran University of Medical Sciences and the Protection Center of spinal cord disables, Iran.

METHOD

Eighteen patients with SCI were interviewed deeply. Data were concurrently analyzed, using the content analysis method.

RESULTS

During the data analysis, three coping strategies, including seeking help from religious beliefs (understanding the disease as a divine fate and as a spiritual combat), hope and making efforts towards independence/self-care appeared.

CONCLUSION

Understanding strategies that influence the patients' coping with the SCI will contribute to the nursing body of knowledge. It also helps nurses and other health-care professionals as well as the families in reinforcing the most effective coping strategies and promoting the quality of care. Such coping strategies also can help patients to achieve a greater sense of empowerment.

The productive partnerships framework: harnessing health consumer knowledge and autonomy to create and predict successful rehabilitation outcomes

PURPOSE

This article examines the role of power distribution in partnerships between health consumers and professionals in determining successful desired outcomes, and the contributing role of consumer knowledge and autonomy. Recognition is given to the lack of practical tools, from both consumer and professional perspectives, to assist in the creation of productive partnerships.

METHOD

A conceptual analysis of the notions of consumer knowledge and autonomy in the context of outcomes, followed by the development of a prototype framework that aims to facilitate productive health partnerships.

RESULTS

The authors present prototype tools, which are shared between health consumer and professional, for identifying the strength of their cumulative power relative to their alignment to a common desired outcome (goal). The tools provide a choice of power contexts for the partnership to operate within, and a simple method for testing alignment to a common goal.

CONCLUSION

Increased health consumer knowledge and autonomy is associated with improved outcomes and these can in turn be influenced through productive health partnerships. The P2 framework is one approach to establishing robust working relationships between health professionals and consumers.