Theories of hope: are they relevant for palliative care nurses and their practice?

''While There's Life There's Hope'' Hope in Palliative Care: A Qualitative Study

Hope is a critically important concept in palliative care that enables coping and increases quality of life. This qualitative study was conducted to determine how palliative care patients describe hope and the factors that increase or decrease hope after a hope intervention. Data were collected through semi-structural interviews with 10 palliative care patients. The analysis followed a thematic analysis approach. The participants defined hope as the joy of living in general, and the strength to cope with difficulties and stated that spending time with loved ones increased their hopes, the worsening of their diseases reduced their hopes, hope made them feel good psychologically, and health workers had an important role in increasing hope. It is recommended that hope interventions be person-centric in palliative care settings and that care should be structured by considering the factors that maintain and prevent hope.

Developing a meta-understanding of 'human aspects' of providing palliative care

Objectives:

Our intention was to develop a meta-understanding of the ‘human aspects’ of providing palliative care. Integral to developing this meta-understanding was recognising the individuality of people, their varied involvements, situations, understandings, and responses, and the difficulty in stepping back to get a whole view of this while being in the midst of providing palliative care. We intended for this meta-understanding to inform reflections and sense-making conversations related to people’s changing situations and diverse needs.

Methods:

Using collaborative inquiry, this qualitative research was undertaken ‘with’ clinicians rather than ‘on’ them. Our team (n = 7) was composed of palliative care clinicians and researchers from a co-located rural health service and university. We explored our personal perceptions and experiences through a series of 12 meetings over 8 months. In addition, through five focus groups, we acccessed perceptions and experiences of 13 purposively sampled participants with a range of roles as carers and/or healthcare providers. Data were dialogically and iteratively interpreted.

Findings:

Our meta-understanding of ‘human aspects’ of providing palliative care, represented diagrammatically in a model, is composed of ATTRIBUTES OF HUMANITY and ACTIONS OF CARING. ATTRIBUTES OF HUMANITY are death’s inevitability, suffering’s variability, compassion’s dynamic nature, and hope’s precariousness. ACTIONS OF CARING include recognising and responding, aligning expectations, valuing relationships, and using resources wisely. The meta-understanding is a framework to keep multiple complex concepts ‘in view’ as they interrelate with each other.

Significance of findings:

Our meta-understanding, highlighting ‘human aspects’ of providing palliative care, has scope to embrace complexity, uncertainty, and the interrelatedness of people in the midst of resourcing, requiring, and engaging in palliative care. Questions are posed for this purpose. The non-linear diagrammatic representation of ATTRIBUTES OF HUMANITY and ACTIONS OF CARING facilitates multiple ways of engaging and revisiting palliative care situations or navigating changes within and across them.

“Keeping the Light On”: A Qualitative Study on Hope Perceptions at the End of Life in Portuguese Family Dyads

Hope performs an important role in how patients and their families cope with suffering and stressful events. To better inform practice and theory on hope, palliative care research should include both patients and their family carers, given their strong interdependence. The aim of this study was to explore how hope is experienced in dyads formed by end-of-life patients and their family carers. In this qualitative study, data were collected by in-depth interviews with seven Portuguese family dyads. Analysis followed a thematic analysis approach. The analysis of the interviews shed light on the importance of hope for all participants, and the challenges involved. Family dyads noted several barriers and facilitators to perceptions of hope. Barriers to hope included limitations imposed by illness, feelings of anguish and helplessness, and poor communication with clinicians. Hope facilitators included supportive others, positive thinking and sense of humour, connection with nature, faith in religion and science, and a sense of compassion with others and altruism. Given the multidimensional scope of hope, the main challenge for family dyads is to look beyond the disease itself. Thus, palliative care teams should be encouraged to support and foster realistic hope, helping families prepare for death, in the context of advanced cancer.

Barriers to palliative care in people with chronic obstructive pulmonary disease in home care: A qualitative study of the perspective of professional caregivers

AIMS AND OBJECTIVES

To examine the experiences with palliative care in people with chronic obstructive pulmonary disease among professional caregivers in a Danish home care setting.

BACKGROUND

Many patients with advanced chronic obstructive pulmonary disease depend on professional caregivers in the primary sector to provide assistance and care. However, chronic obstructive pulmonary disease patients receive no or only very little palliative care compared to patients with cancer although they may have many burdensome symptoms.

DESIGN

Qualitative explorative study.

METHODS

In 2013-2014, ten professional caregivers from three districts in a Danish municipality were followed during home visits to patients with chronic obstructive pulmonary disease and individual interviews about palliative care were subsequently conducted. In 2014, 66 professional caregivers, representing eleven home care districts, participated in ten group discussions about palliative care needs in this group of patients. Data were analysed using qualitative descriptive analysis.

RESULTS

The study revealed a nonawareness of palliative care for patients with chronic obstructive pulmonary disease among the professional caregivers who expressed vague understanding of palliative care and lack of knowledge about the disease. Organisational barriers, such as lack of time and continuity in patient care, lack of opportunity to discuss palliative care and lack of peer learning were experienced as challenging in the provision of palliative care. Nonawareness and organisational barriers led to difficulties in identifying palliative care needs and reluctance to initiate conversations about palliative care.

CONCLUSION

The findings indicate a need for education, training and reflection among professional caregivers in home care. Also, organisational changes may be needed to reduce the barriers to palliative care.

RELEVANCE TO CLINICAL PRACTICE

The findings uncovered barriers to palliative care that must be addressed. Targeted educational programmes and organisational changes may increase the ability to identify palliative care needs and initiate and evaluate palliative interventions.

A Kaleidoscope of Hope: Exploring Experiences of Hope Among Service Users and Informal Carers in Health Care Contexts

Background: There is a large and diverse literature on the concept of hope in health care. This literature covers a broad spectrum of perspectives, from philosophical, conceptual, and theoretical analysis through to attempts at measuring the concept of hope with differing health care users. Aims: To explore the concept of hope through the secondary analysis of existing data sets, with the intention of understanding hope in the context of person-centeredness. Research Question: What is the experience of hope among service users and informal carers in different health care contexts? Method: Secondary analysis of data derived from three research studies. Findings: We identified four key themes that together illustrate what we describe as a kaleidoscope of hope, reinforcing the view that there is no one presentation of hope and that practitioners must engage authentically with service users to determine the most effective and appropriate intervention strategies. Conclusions: Hope is not a singular phenomenon, and in the context of person-centered practice there is a need for practitioners to engage authentically with service users and listen carefully to what may bring hope for them.

Hope of patient recovery in the ICU from the viewpoint of Iranian nurses: concept analysis

Nurses’ care quality for patients in the ICU depends on their degree/level of hope to improving patient, but there is no consensus on the concept “hoping to improve patient.” The purpose of the present study is to analyze the concept nurses hoping to improving patient in the ICU. To analyze this concept, hybrid model is used which consists of theoretical phase, field work phase, and final analytical phase. In field phase work, semi-structured, face to face and individual interviews were done for nurses working in the ICU, and the data gathered from the interviews were analyzed using inductive content analysis. In theoretical phase, the concept hoping to improve patient was characterized by being available, being professional, expecting positively, and being future- oriented. The scientific definition of this concept was explained through properties which are necessary for qualified nursing care. In field work phase, the categories include nursing care, inner feeling, belief and consequences. In final analytical phase, final definition of the concept was explained through properties such as dynamic expectation, being realistic, and being goal- oriented which is a better function and attitude in effective nursing care accompanying peace of mind for nurses. Concept analysis showed that nurse’s awareness of hoping to improve patient helps the nurse do his job in the best way and with peace of mind.

Should palliative care patients' hope be truthful, helpful or valuable? An interpretative synthesis of literature describing healthcare professionals' perspectives on hope of palliative care patients

BACKGROUND

Healthcare professionals' perspectives on palliative care patients' hope influence communication. However, these perspectives have hardly been examined.

AIM

To describe healthcare professionals' perspectives on palliative care patients' hope found in the literature.

DESIGN

The interpretative synthesis consisted of a quality assessment and thematic analysis of included articles.

DATA SOURCES

Literature search of articles between January 1980 and July 2011 in PubMed, CINAHL, PsycINFO and EMBASE and references of included studies.

SEARCH STRATEGY

(palliat* or hospice or terminal* in title/abstract or as subject heading) AND (hope* or hoping or desir* or optimis* in title or as subject heading).

RESULTS

Of the 37 articles, 31 articles were of sufficient quality. The majority of these 31 articles described perspectives of nurses or physicians. Three perspectives on hope of palliative care patients were found: (1) realistic perspective - hope as an expectation should be truthful, and healthcare professionals focused on adjusting hope to truth, (2) functional perspective - hope as coping mechanism should help patients, and professionals focused on fostering hope, and (3) narrative perspective - hope as meaning should be valuable for patients, and healthcare professionals focused on interpreting it.

CONCLUSIONS

Healthcare professionals who are able to work with three perspectives on hope may improve their communication with their palliative care patients, which leads to a better quality of care.

Supporting hope and prognostic information: nurses' perspectives on their role when patients have life-limiting prognoses

CONTEXT

Clinicians often feel challenged by the need to deliver difficult prognostic information to patients with a life-limiting illness while, at the same time, support their hopes. Few studies have examined nurses' perspectives on their roles in meeting these patient and family needs.

OBJECTIVES

Our objectives were to 1) describe nurses' perspectives on meeting patients' needs for hope and illness information and 2) offer insights for interventions designed to improve communication about end-of-life care for patients and their families.

METHODS

Using experienced interviewers, we conducted one-on-one, semistructured interviews with 22 nurses caring for patients with advanced chronic obstructive pulmonary disease or cancer. Interviews were analyzed using a limited application of grounded theory.

RESULTS

Three themes emerged: 1) Nurses support patients' hopes by understanding individual aspects of these hopes, focusing on patient's quality of life, and building trust with patients; 2) Nurses provide prognostic information by assessing what the patient knows and following their lead. Nurses report doing these two activities independently; and 3) Nurses identify activities associated with the provision of prognostic information that required collaboration with physicians. Important barriers that complicate effective discussion of prognosis with patients and families were identified.

CONCLUSIONS

Nurses describe behaviors that are useful when meeting patients' and families' needs for hope and which they are comfortable implementing in practice, without collaboration with other clinicians. By contrast, most behaviors related to meeting patients' and families' needs regarding prognostic information are completed collaboratively with physicians. These findings provide insight for the development of interdisciplinary interventions targeting communication around end-of-life care.