[Hope in tragedy. When action gives meaning to a life]

The experience of illness causes disorientation, a loss of meaning, and a loss of freedom to act. In other words, the entire field of practical possibilities diminishes, resulting in action being viewed as something impossible. In this case, the question is the following: Can the nurse contribute to maintaining hope for a life that is rich in meaning, adjusted to the limits imposed by the patient’s illness? To explore the answer to this question, we propose a humanistic model of accompaniment that enables nurses to restore hope and power to persons in vulnerable situations. In examining the best-case and the worst-case scenarios that a vulnerable person could be faced with, the accompaniment method proposed places emphasis on the exploration of practical interventions that could foster the best-case scenario and reduce the risk and the consequences of the worst-case scenario. By working on certain pragmatic aspects, we find that life becomes meaningful according to the use we can make of it, taking into account what we can actually do.

The effect of a dysfunctional upper limb on community-dwelling stroke survivors and their carers: An interpretative phenomenological analysis

OBJECTIVES

The poststroke upper limb continues to pose a myriad of physical and psychological challenges for patients and caregivers. To optimize existing services, this study firstly aimed to explore the experiences of both stroke survivors and caregivers and secondly identify their ongoing needs.

METHODS

A qualitative approach was utilized for this study. Six participants (three stroke survivors and three caregivers) were purposively sampled from community stroke groups. Semi structured interviews were utilized to collect experiential data, which were analysed using an interpretative phenomenological approach.

RESULTS

Three master themes emerged from data analysis: "Finding a way forwards from a poor start," "The battle with the upper-limb," and "Relationships with self and society." All participants, seemingly affected by disappointing services, expressed negative views of rehabilitation. Misplaced or persistent hope, losses in control, and reduced autonomy may have contributed to poor functional outcomes and perceptions of rehabilitation services. The complex physical and psychological impact of the experience of the dysfunctional upper limb was also associated with ongoing and unmet support needs for stroke survivors and carers.

CONCLUSIONS

Healthcare professionals may consider the varying impact of the dysfunctional upper limb during decision-making and treatment planning, particularly during acute rehabilitation. Future research could explore therapists' perceptions and experiences of upper-limb rehabilitation during this period.

What is unrealistic optimism?

Here we consider the nature of unrealistic optimism and other related positive illusions. We are interested in whether cognitive states that are unrealistically optimistic are belief states, whether they are false, and whether they are epistemically irrational. We also ask to what extent unrealistically optimistic cognitive states are fixed. Based on the classic and recent empirical literature on unrealistic optimism, we offer some preliminary answers to these questions, thereby laying the foundations for answering further questions about unrealistic optimism, such as whether it has biological, psychological, or epistemic benefits.

Solicitude: balancing compassion and empowerment in a relational ethics of hope-an empirical-ethical study in palliative care

The ethics of hope has often been understood as a conflict between duties: do not lie versus do not destroy hope. However, such a way of framing the ethics of hope may easily place healthcare professionals at the side of realism and patients at the side of (false) hope. That leaves unexamined relational dimensions of hope. The objective of this study was to describe a relational ethics of hope based on the perspectives of palliative care patients, their family members and their healthcare professionals. A qualitative longitudinal method based on narrative theories was used. Semi-structured interviews on hope were conducted with twenty-nine palliative care patients, nineteen friends or family members, and fifty-two healthcare professionals, which were recorded and transcribed. Data on hope were thematically analyzed. The researchers wrote memos and did member checking with participants. When participants spoke about hope, they referred to power and empowerment, like the powerful bonding of hope between patients and physicians. They also associated hope with the loss of hope and suffering. Several participating healthcare professionals tried to balance both sides, which involved acknowledgment of hope and suffering. Hope and power were reflected in the ethical concept of empowerment, whereas suffering and the loss of hope were reflected in the ethical concept of compassion. Empowerment and compassion can be balanced in solicitude. In conclusion, a relational ethics of hope requires solicitude, in which healthcare professionals are able to weigh empowerment and compassion within particular relationships.

A singing choir: Understanding the dynamics of hope, hopelessness, and despair in palliative care patients. A longitudinal qualitative study

OBJECTIVE

Hope, despair, and hopelessness are dynamic in nature; however, they have not been explored over time. The objective of the present study was to describe hope, hopelessness, and despair over time, as experienced by palliative care patients.

METHOD

We employed a qualitative longitudinal method based on narrative theories. Semistructured interviews with palliative care patients were prospectively conducted, recorded, and transcribed. Data on hope, hopelessness and despair were thematically analyzed, which led to similarities and differences between these concepts. The concepts were then analyzed over time in each case. During all stages, the researchers took a reflexive stance, wrote memos, and did member checking with participants.

RESULTS

A total of 29 palliative care patients (mean age, 65.9 years; standard deviation, 14.7; 14 females) were included, 11 of whom suffered from incurable cancer, 10 from severe chronic obstructive pulmonary disease, and 8 from severe heart failure. They were interviewed a maximum of three times. Participants associated hope with gains in the past or future, such as physical improvement or spending time with significant others. They associated hopelessness with past losses, like loss of health, income, or significant others, and despair with future losses, which included the possibility of losing the future itself. Over time, the nature of their hope, hopelessness, and despair changed when their condition changed. These dynamics could be understood as voices in a singing choir that can sing together, alternate with each other, or sing their own melody.

SIGNIFICANCE OF RESULTS

Our findings offer insight into hope, hopelessness, and despair over time, and the metaphor of a choir helps to understand the coexistence of these concepts. The findings also help healthcare professionals to address hope, hopelessness, and despair during encounters with patients, which is particularly important when the patients' physical condition has changed.