The North Dakota Nurse - July 2022

July, August, September 2022 The North Dakota Nurse Page 3
Instilling Hope
Sheri Gunderson, MS, RN, CNE,
Assistant Professor of Nursing,
University of Jamestown
As a nurse you have seen the dejected look, heard the discouraging
story, and tasted the bitterness of unfairness. In your heart you felt the
person’s sadness and mirrored it in your face. Your empathetic and
supportive touch have been the unspoken words of empathy and
presence. Depression, grief, or fresh disability put a person’s focus on
present circumstances and not the future, or if the person considers the
future it seems bleak without colors of quality and not what the person
wants to happen.
Hope is defined as a verb, “to desire with expectation of obtainment
or fulfillment,” and as a noun, “desire accompanied by expectation of or
belief in fulfillment” per Merriam-Webster. You may experience a patient
who either does not have hope, or is not hoping for a future. But to be
mentally healthy a person needs to stretch their thoughts to hope, so
here are a few steps to accomplish this:
1. Provide an environment of openness: don’t deny the person’s
feelings of sadness, anger, frustration, or grief, but instead encourage
the person to express those emotions. “The outward expression of
positive emotion has been repeatedly associated with better health
outcomes,” (Tuck, Adams, & Consedine, 2017, p. 503) When you hear
and see emotion your nursing active listening response should be to
name the emotion(s) and include the story content. If the person denies
your interpretation, this is beneficial because further clarification and
explanation will occur. Through these interactions the person will often
feel validated and more open to continue discussion. For Christians you
could encourage reading the Psalms which include many emotions
which the person may relate to while also gaining strength from the
author’s faith. “Why, my soul, are you downcast? Why so disturbed within
me? Put your hope in God,“ Psalm 42:11a. Situations may leave your
patient reeling on a roller coaster of emotions and they need to realize
this is normal.
2. Find capabilities and strengths: listen for past interests and look for
remaining abilities so you can assist the person with imagining a future
worth living. Hope is found in discussion of plans for the future. Often
your experience with other patients will assist you in reflecting possibilities
available. It is important to hear the person’s interests and passions so
you can help envision use of these, even if in a modified way related to
disability or loss. When I was a hospice nurse I found that patients would
sometimes paint an unrealistic future based on prognosis, but instead of
challenging these plans I would try to ensure that some shorter term or
modified goals were met. For those with longer futures the realization of
small goals helps with stretching out the horizons of the mind. Children
with disabilities and nursing home residents have taught me that new
accomplishments are to be celebrated no matter the age or speed of
attainment.
3. Offer resources: Usually the person without hope feels alone or that
others don’t understand. “Numerous studies have supported the finding
that being socially excluded is psychologically and physically aversive,”
(Hitlan, 2020, p. 309). While no one can feel exactly what the person is
feeling, often an in-person group or online organization related to the
diagnosis or loss will provide support and ability to talk/chat/blog on
frustrations and adaptations. Comradery may be found by chance
while in the waiting room for medical appointments, but the nurse can
facilitate friendships with like people by making referrals or providing
websites. Beyond emotional support, financial and educational supports
can open doors for using capabilities. You may feel overwhelmed by a
patient’s dreams combined with limitation, but your communication
with the healthcare team may start the ball rolling. Social workers and
physical/occupational therapists have a wealth of knowledge to assist
with finding resources. One resource example is Make-a-wish that
you may think of as just one-time trip givers, but some children receive
adapted equipment to improve quality of life.
4. Support faith: Hope may not be in earthly things, but in a heavenly
future where there won’t be tears or fears. Offering prayer can help a
person see that God is in control and planning for the future. As a
hospice nurse I often saw that despite my best efforts during a visit, it was
not until I offered prayer that I truly saw the person become peaceful as
if a heavy weight was lifted from their shoulders. Allow and encourage
chaplain, pastor, priest, or spiritual faith leader visits as an important
part of holistic health care. Some people will find that an encouraging
phrase, or motto, becomes the spark for glimmers of hope. If the person
is Christian, then Bible verses can be a foundation for building hope: “But
those who hope in the LORD will renew their strength,” Isaiah 40:31a, NIV;
“For I know the plans I have for you declares the Lord, plans to prosper
you and not to harm you, plans to give you hope and a future, Jeremiah
29:11, NIV; “For with God nothing shall be impossible,” Luke 1:37, KJV; and
“May the God of hope fill you with all joy and peace as you trust in him,
so that you may overflow with hope by the power of the Holy Spirit,”
Romans 15:13.
Whether this article made you think of a patient, colleague, nursing
student, or acquaintance, I encourage you to be a Hope Builder!
Hitlan, R. (2020). Social exclusion and health: The buffering effects of perceived
social support. North American Journal of Psychology, 22(3), 309-330.
Tuck, N., Adams, K., & Consedine, N. (2017). Does the ability to express different
emotions predict different indices of physical heath? A skill-based study
of physical symptoms and health rate variability. British Journal of Health
Psychology, 22(3), 502-523.