Hope-based interventions in chronic disease: an integrative review in the light of Nightingale

"What Do We Know about Hope in Nursing Care?": A Synthesis of Concept Analysis Studies

Hope is a central concept within the nursing literature, which is crucial towards the development of nursing knowledge. Nursing teams play a crucial role in exploring the meaning of hope and promoting hope among patients and their families. This study aims to synthesize concept analysis studies of hope in the context of nursing care and to propose an evidence-based update of the definition of hope in the International Classification for Nursing Practice (ICNP®). Method: This is a literature review, involving the synthesis of studies concerning the concept analysis of hope in nursing practice. Peer-reviewed articles with fully accessible Portuguese or English text were considered. As we aimed to include a historical perspective of the concept, no restriction upon the time of publication was set. Articles were selected in March 2022 and updated in July 2023 using the Medline, CINAHL, and Scopus databases. The search terms used were "hope" AND "concept" AND "analysis" AND "nurs*". Only articles written in English or Portuguese were included. Two reviewers conducted the research synthesis and report independently to minimize the risk of bias in the included studies. This paper adheres to the PRISMA checklist. To clarify the concept of hope as perceived by patients and develop hope as an evidence-based nursing concept, 13 studies were reviewed. The concept of hope, its attributes, antecedents, and consequences, as well as similar concepts, were studied by nurses and synthesized into a definition. The identified antecedents include pivotal life events, stressful stimuli, and experiencing satisfaction with life. The analysis of its attributes, antecedents, and consequences has contributed to understanding its relevance in nursing care and provided a proposed update of hope in the ICNP®. This review provides conceptual clarity on how hope is defined and used in nursing practice and the potential factors that may impact the promotion of hope to provide opportunities for future nursing research.

SPACEE Protocol: "Spiritual Care Competence" in PAlliative Care Education and PracticE: Mixed-Methods Research in the Development of Iberian Guidelines

Spiritual care requires understanding the spiritual experiences of patients and recognizing their resources and needs. Therefore, educators and practitioners should develop their knowledge and understanding in this regard. Spiritual care helps people overcome their anxieties, worries, and suffering; reduces stress; promotes healing; and encourages patients to find inner peace. To provide comprehensive and appropriate care while upholding human/ethical virtues, the spiritual dimension must be a priority. We aim to develop spiritual care competence guidelines for Palliative Care (PC) education and practice in Portugal and Spain. The study detailed in this protocol paper will include three phases. In phase I, the phenomenon will be characterized and divided into two tasks: (1) a concept analysis of "spiritual care competence"; and (2) a systematic review of interventions or strategies used to integrate spiritual care in PC education and practice. Phase II will entail a sequential explanatory approach (online survey and qualitative interviews) to deepen understanding of the perceptions and experiences of educators, practitioners, and patients/family carers regarding spiritual care in PC education and practice and generate ideas for the next steps. Phase III will comprise a multi-phased, consensus-based approach to identify priority areas of need as decided by a group of experts. Results will be used to produce guidelines for integrating spirituality and spiritual care competence within PC education and practice and synthesized in a white book for PC professionals. The value of this improved examination of spiritual care competence will ultimately depend on whether it can inform the development and implementation of tailored educational and PC services. The project will promote the 'spiritual care' imperative, helping practitioners and patients/family carers in their preparedness for End-of-Life care, as well as improving curricular practices in this domain.

Hope-Based Program for Portuguese Outpatients with Advanced Chronic Illness in a Community Setting: A Randomized Control Trial

Background: Hope is widely considered a subjective phenomenon able to bring beneficial consequences to human health and existence. Maintaining hope amid a life-threatening disease and during palliative care is critical. The study aims to examine the effectiveness of a psychosocial supportive Hope Promotion Program (HPP) in enhancing hope, comfort, and quality of life in Portuguese adult outpatients with advanced and progressive chronic illness. Method: Using a parallel Randomized Control Trial (RCT) with pre-post design, 56 cancer outpatients from two day hospitals. Participants were randomly assigned to either a control group (n = 28) or an intervention group (n = 28). The primary outcome measure was hope. Secondary measures included comfort and quality of life. Participants were assessed at baseline, day 15, and day 30 of follow-up. Results: Baseline characteristics were similar between the two groups. In the intervention group, there was a significant increase in the total hope scores after the HPP (day 15). Significant differences were still present after one month (p < 0.05). There was also a significant increase in comfort and quality of life scores in the intervention group one month after HPP (p = 0.018). Conclusions: The HPP may be an effective intervention to increase hope and improve comfort and quality of life among palliative patients. Future studies should increase sample size, diversify settings, and include longer and more detailed follow-ups.

“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.

The multidimensional model of hope as a recovery-focused practice in mental health nursing

ABSTRACT Objective: To analyze the theoretical dimensions of hope as a recovery-oriented practice in mental health nursing. Method: This is a reflective and discursive study based on theoretical and experiential aspects of hope in the recovery process of people facing mental health disorders. Results: Maintaining hope in adverse situations, especially while facing mental suffering, requires skills to manage the factors that promote and inhibit hope. This balance can be tricky to reach without the presence of high-skilled professionals. The study presents the concept of hope-inspiring competence and its main dimensions. The nurse’s hope-inspiring competence is recognized as a crucial advanced practice that optimizes mental health by providing motivational resources. Final Considerations: Hope-inspiring competence should be a core principle for recovery-oriented mental health professionals. Despite this recognition, the promotion of hope in mental health nursing specialized practice lacks evidence and visibility.