Hope in terminal illness: an evolutionary concept analysis

AIMS: to clarify the concept of hope as perceived by patients with a terminal illness, to develop hope as an evidence-based nursing concept, to contribute new knowledge and insights about hope to the relatively new field of palliative care; endeavouring to maximize the quality of life of terminally ill patients in the future. METHOD: utilizing Rodgers' (2000a) evolutionary concept analysis methodology and thematic content analysis, 17 pieces of research-based literature on hope as perceived by adult patients with any terminal illness pathology, from the disciplines of nursing and medicine have been reviewed and analyzed. An exemplary case of the concept in action is presented along with the evolution of the concept hope in terminal illness. RESULTS: Ten essential attributes of the concept were identified: positive expectation; personal qualities; spirituality; goals; comfort; help/caring; interpersonal relationships; control; legacy; and life review. Patients' hopes and goals are scaled down and refocused in order to live in the present and enjoy the time they have left with loved ones. CONCLUSION: By completing all the steps to Rodgers' (2000a) evolutionary view of concept analysis, a working definition and clarification of the concept in its current use has been achieved. This provides a solid conceptual foundation for further study.     

Complications of the myeloproliferative system: Infection and sepsis

Living with cancer has become a more realistic hope for many patients as a result of newer combination-treatment modalities. However, impairment of the immune and inflammatory responses is a serious consequence of both aggressive disease and treatment.

Comprehensive nursing care during periods of granulocytopenia is critical to the survival of myelosuppressed patients. The primary nursing goals for these patients include (1) prevention of infection through promotion of the patient's optimal health status and reduction of environmental factors contributing to infection; and (2) early detection of infection through diligent assessment of the patient's health status, with prompt initiation of medical and nursing interventions.

Sepsis in the compromised cancer patient poses a major challenge in oncology nursing care. The importance of thorough nursing assessment and interventions to minimize exposure of the patient to potential pathogens during granulocytopenic periods cannot be overstated. The patient's life may well depend on it.     

Hope in the older adult with chronic illness: a comparison of tow research methods in theory building

When current theory about a concept of interest is insufficient, the researcher may desire to build or expand theory. Two research methods for building nursing theory are compared by asking the same question using each method. Phenomenology was used to analyze the interviews of six older adults with chronic illness regarding their experience of hope. Eight theme categories depicted the essential structure. Using concept mapping, eight older adults with chronic illness generated statements about hope. Nine clusters resulted. The methods are compared for procedure and outcome. Although differing with regard to time and participant involvement, the similarity of outcomes suggests that qualitative research is robust.     

The elements of wound assessment

Accurate wound assessment is essential to the appropriate and realistic planning of goals and interventions for patients with wounds. However, the assessment process has a number of components that must be systematically considered.     

STAMP: components of observable behaviour that indicate potential for patient violence in emergency departments

AIM: This paper is the report of a study to explicate the components of observable behaviour that indicate a potential for violence in patients, their family and friends when presenting at an emergency department. BACKGROUND: Violence towards nurses is a contemporary, multifaceted problem for the healthcare workforce globally. International literature identifies emergency departments as having high levels of violence. METHOD: A mixed method case study design was adopted, and data were collected by means of 290 hours of participant observation, 16 semi-structured interviews and 13 informal field interviews over a 5-month period in 2005. Thematic analysis of textual data was undertaken using NVivo2. Frequency counts were developed from the numerical data. FINDINGS: Five distinctive elements of observable behaviour indicating potential for violence in patients, their families and friends were identified. These elements can be conceptualized as a potential nursing violence assessment framework and described through the acronym STAMP: Staring and eye contact, Tone and volume of voice, Anxiety, Mumbling and Pacing. CONCLUSION: Staring and eye contact, Tone and volume of voice, Anxiety, Mumbling and Pacing provides a useful, practical nursing violence assessment framework to assist nurses to quickly identify patients, families and friends who have a potential for violence.     

The meaning of hope in nursing research: a meta-synthesis

The aim of this study was to develop a meta-synthesis of nursing research about hope as perceived by people during sickness and by healthy people. A meta-synthesis does not intend to cover all studies about hope; rather it tries to synthesize qualitative findings from different contexts, cultures and times to provide a global picture of the phenomenon under study. Noblit and Hare's meta-ethnographic approach was used. The approach is a systematic comparison of studies where each study is translated into the other. Data were 15 qualitative studies published in nursing or allied health journals and conducted in USA, Great Britain, Canada, Australia, Norway, Sweden and Finland. The meta-synthesis resulted in six metaphors that illustrate dimensions of hope. These metaphors permeated the experiences of hope regardless of whether the human being was healthy, chronically or terminally ill. They comprise the complexity of hope and were: living in hope, hoping for something, hope as a light on the horizon, hope as a human-to-human relationship, hope vs. hopelessness and fear: two sides of the same coin, and hope as weathering a storm. Knowing the multidimensionality of hope and what hope means from the patient's perspective might help nurses and other healthcare professionals to inspire hope as Florence Nightingale did when she walked with the lamp through the dark corridors and spread hope and light to the patients. We suggest that nurses working with patients with serious conditions such as cancer reflect on the meaning of the metaphors.     

基于一对一访谈模式的治疗性沟通在老年脑卒中病人护理干预中的应用

[目的]观察基于一对一访谈模式的治疗性沟通在老年脑卒中病人护理干预中的应用效果。[方法]将94例老年脑卒中病人采用随机数字表法分为观察组和对照组各47例,对照组给予神经内科常规护理,观察组在常规护理的基础上采用基于一对一访谈模式的治疗性沟通护理干预,采用希望水平量表(HHI)和特质应对方式问卷(TCSQ)进行心理评估,比较两组病人的治疗效果。[结果]干预后观察组病人对现实和未来的态度、采取积极的行动的态度、与他人保持亲密关系评分均明显高于对照组(P0.05),积极应对评分明显高于对照组、消极应对评分明显低于对照组(P0.05),总有效率明显高于对照组(P0.05)。[结论]基于一对一访谈模式的治疗性沟通护理干预有助于改善老年脑卒中病人希望水平,优化应对方式,提高治疗效果。     

Patients' experiences of hope and suffering during the first year following acute spinal cord injury

Aims and objectives. The aim of this study was to explore patients’ experiences of hope during the first year suffering from spinal cord injury. Background. There is a lack of substantial precision with regard to the concept of hope. Very few qualitative studies focusing on experiences of hope in spinal cord‐injured patients have been identified in the literature. In this study, ‘hope’ was defined as future oriented towards improvement. Design and methods. Data were collected by means of personal interviews (n = 10) at the participants’ homes in Norway. A phenomenological‐hermeneutic approach, inspired by Ricoeur, was used to extract the meaning of the patients’ experiences. The analysis was performed in several steps, as a hermeneutic process. Results. In this study, the findings revealed two main themes: ‘The Vicious Circle’ and ‘Longing’. The vicious circle constituted aspects of suffering, and the common hope experienced by the subjects was therefore to leave the vicious circle. Experiences of suffering were experienced as feelings of loneliness, impatience, disappointment, bitterness and dependency. The ‘Longing’ was based on the subject's former life and was the source of awaked new hopes, which again was experienced comforting. Conclusions. Experiences of suffering created hope and longing. The meaning of hope was to find a possible way out of the circle and the hoping was experienced as a comfort. Relevance to clinical practice. Implications to nursing practice are listening to the suffering and longing individual and comforting the suffering by pointing towards possible future roads of hope.     

Hope in patients with spinal cord injury: a literature review related to nursing.

Few studies have addressed nursing of patients with spinal cord injury (SCI) related to the phenomenon of hope. Therefore, a systematic computer-based literature review to analyze the phenomenon of hope was conducted, focusing on both empirical and theoretical perspectives, to highlight the potential for further empirical studies. The review examined existing definitions of hope, theories on hope in nursing, and methodological and empirical perspectives on studies of hope in the literature. The findings showed that hope has been defined in a theoretical and general way, which has influenced empirical and theoretical research in this developing area of knowledge. These findings show that the phenomenon of hope can be generalized (the process of hoping) and particularized (the substance of hope). In addition, this analysis demonstrates that hope is a prospective phenomenon because it is future-oriented (according to the process) and has a positive essence (according to the substance).     

District nursing assessment practice: case study findings

Patient assessment is widely acknowledged as a core element of community nursing expertise (Griffiths and Luker, 1994). With the current drive towards evidence-based practice, it is becoming increasingly important to provide sound evidence about this key aspect of community nursing practice. This article describes how district nurses' assessments of a carefully constructed simulated patient have provided new insight into community nursing expertise. The innovative approach used in this study of district nursing assessment practice is outlined. One of the simulated patients developed for the study is then described. A case study of one nurse participant who assessed this simulated patient forms the main focus of the article. The case study (one of four) is based on a synthesis of simulation and interview findings relating to a particular study participant. It reveals some interesting associations between various elements of nursing knowledge and provides important insight into how the quality and effectiveness of patient assessment may be affected by a practitioner's approach and knowledge base. The usefulness of this approach and the relevance of the findings for nursing practice and education are also addressed.     

Defining Foundational Competence for Prelicensure and Graduate Nursing Students: A Concept Analysis and Conceptual Model

AimTo define the concept of foundational competence as it pertains to prelicensure and graduate nursing students during their educational program, thereby informing pedagogical and assessment practices.BackgroundCompetence has many definitions and uses, however a lack of consensus of a clear and useful definition in nursing persists. Without shared language, competence remains open for interpretation across and among groups and impedes the ability to teach and assess it in a competency-based education framework.MethodUsing the Walker & Avant method of concept analysis, literature was reviewed and synthesized to define and explain the concept of foundational competence in nursing using evidence and practice from various disciplines.FindingsAntecedents, attributes, empirical referents and consequences of foundational competence were identified.DiscussionThe components and uses of the concept of foundational competence are presented to guide pedagogical and assessment practices necessary for competency-based education in nursing.     

基于风险理念的肿瘤护理计划对鼻咽癌放疗患者生命质量及希望水平的影响

目的探讨基于风险理念的肿瘤护理计划对鼻咽癌放疗患者生命质量及希望水平的影响。方法选取2018年1月至2019年12月收治的鼻咽癌放疗患者78例,将其随机分为对照组和观察组,各39例。对照组给予常规护理,观察组在对照组基础上给予基于风险理念的肿瘤护理计划。比较两组并发症发生情况、生命质量及希望水平评分。结果观察组并发症总发生率为15.38%,低于对照组的38.46%(P<0.05)。干预前,两组生活质量各项评分无显著差异(P>0.05);干预1个月后,两组心理领域、生理领域、环境领域、社会关系领域评分均高于干预前,且观察组高于对照组(P<0.05)。干预前,两组希望水平各项评分无显著差异(P>0.05);干预1个月后,两组对现实及未来的积极态度、采取积极行动、保持与他人的亲密关系评分均高于干预前,且观察组高于对照组(P<0.05)。结论对鼻咽癌放疗患者实施基于风险理念的肿瘤护理计划有助于降低并发症发生率,提高生命质量及希望水平。     

Level and direction of hope in cancer patients: an exploratory longitudinal study

Goals

Hope is an important factor to consider when caring for cancer patients as a key component of coping with adversity. The aim of our study was to address the following questions: Is there a difference in level of hope between those patients being curatively and those palliatively treated, and how does this change over time? What are patients’ most important hopes? Better understanding of patients’ hopes may promote more effective patient-centered care.

Materials and methods

Outpatients referred to medical oncology or pain and symptom clinics at the London Regional Cancer Program were surveyed before consultation. The Herth Hope Index (HHI) questionnaire was administered to assess level of hope, and the patients were asked to indicate their highest priority hopes. Qualitative thematic analysis was performed on the responses, and comparison was made between patients treated with curative vs those treated with palliative intent. This survey was repeated 4 months after initial assessment.

Results

Fifty patients were surveyed (29 curative-intent; 21 palliative). Highest priority initial hopes were categorized as follows: cure, other positive health outcomes, emotional well-being, life achievements/return to normalcy, interpersonal goals, other. There was no association noted between treatment intent and choice of highest-priority hope. Follow-up assessments after 4 months revealed no significant differences in the distribution pattern of hopes. There was a statistically significant increase in the HHI over time in curatively treated patients, but none in the combined analysis.

Discussion and conclusion

Our study indicates that patients receiving palliative therapy have a HHI score not significantly different from patients being treated for cure. The hope deemed most important is also similar between groups. Over time, overall hope was maintained or increased even in the presence of a trend towards fewer patients hoping for a cure. These results remind oncologists to explore the experience of hope with all patients to ensure that the subjective needs and goals of the patients are met by the proposed therapies.

     

希望理论在维持性血液透析病人中的应用

回顾希望概念和理论,重点介绍希望理论在维持性血液透析病人中的应用研究概况,特别是希望的相关因素及护理措施,为希望护理的应用提供理论依据。     

Refinement of the concept of uncertainty

AIMS: To analyse the conceptual maturity of uncertainty; to develop an expanded theoretical definition of uncertainty; to advance the concept using methods of concept refinement; and to analyse congruency with the conceptualization of uncertainty presented in the theory of hope, enduring, and suffering. BACKGROUND: Uncertainty is of concern in nursing as people experience complex life events surrounding health. In an earlier nursing study that linked the concepts of hope, enduring, and suffering into a single theoretical scheme, a state best described as 'uncertainty' arose. This study was undertaken to explore how this conceptualization fit with the scientific literature on uncertainty and to refine the concept. DESIGN/METHODS: Initially, a concept analysis using advanced methods described by Morse, Hupcey, Mitcham and colleagues was completed. The concept was determined to be partially mature. A theoretical definition was derived and techniques of concept refinement using the literature as data were applied. FINDINGS: The refined concept was found to be congruent with the concept of uncertainty that had emerged in the model of hope, enduring and suffering. CONCLUSIONS: Further investigation is needed to explore the extent of probabilistic reasoning and the effects of confidence and control on feelings of uncertainty and certainty.     

Hoping for the Best While Preparing for the Worst: A Literature Review of the Role of Hope in Palliative Cancer Patients

Palliative care and hope have both been known to improve the quality of life (QoL) of palliative cancer patients. Hope is a complex, multidimensional concept that is influenced by a variety of factors and is considered to be an effective coping strategy when dealing with serious illness. Review of the literature identifies an abundance of hope-fostering strategies that healthcare professionals (HCPs) can use to assist patients to improve their QoL. Ethical issues can arise during HCPs’ struggles to remain truthful while attempting to maintain patients’ hopes. Increased communication regarding realistic treatment outcomes between the multidisciplinary team and the patient and family is essential for maintaining a patient’s hope during the terminal stage of disease. Effective communication with patients demonstrates respect for autonomy and allows for informed decision-making regarding end-of-life interests. This results in the achievement of final end-of-life goals and will increase QoL, which is considered to be the goal of palliative care.     

Nurse-Led Motivational Interviewing for Setting Functional Cancer Pain Goals

PurposePersons with advanced cancers experience high rates of pain. Nursing interventions for pain, which are tailored to the individual patient, may support motivation to engage in self-management and should include setting of realistic functional goals. For patients with advanced cancer, functional pain goals include personally important activities, measurable across clinical encounters. However, limited evidence exists regarding nursing assessment of functional pain goals. To address this gap, we piloted use of a motivational interviewing intervention. Motivational interviewing is a clinical technique for clarifying goals and related impediments, such as cognitive and emotional factors underlying pain management behaviors.DesignPilot feasibility testing.MethodsPalliative care patients with cancer-related pain completed up to four intervention sessions, the Pain Self-Efficacy Questionnaire, and an author-developed acceptability questionnaire. Feasibility success was determined by 60% of participants completing at least two interventions. Fidelity to the intervention was assessed using the Motivational Interviewing Skills for Healthcare Encounters tool.ResultsSixty-seven percent completed two interventions. Participants reported that interventions were helpful, worthwhile, and recommended. Mean pain self-efficacy scores (0-60 possible) rose from 31.5 (SD = 11.2) at intervention 1 to 35.5 (SD = 13) after intervention 4. Intervention fidelity was maintained.ConclusionsParticipants were willing to engage in multiple motivational interviewing conversations focused on pain management behaviors related to functional goals. Based on these findings about motivational interviewing for functional goals and patient willingness to set them, these conversations may have a place in clinical care as an element of pain assessment and intervention tailoring.     

Defining Clinical Assessment Standards for Bachelor's-Prepared Nurses in Switzerland

Purpose: A rigorous process of collaboration among multilingual and multicultural nursing faculties throughout Switzerland to define optimized learning goals for clinical assessment education at the bachelor's level is described in the context of wider European academic harmonization. Formation of a consensus-seeking panel proved a useful strategy for disseminating knowledge among academic nursing faculties in the early years of tertiary nursing education. The process enabled representatives of competing institutions to share scarce resources and articulate the added value of a bachelor's degree in nursing.
Conclusions: A consensus-building strategy has applicability for nursing faculties wishing to increase collaboration, efficiency, and effectiveness early in the process of academic nursing development. Lack of availability of learning materials written in the languages of the local clinical setting is a barrier to teaching advanced assessment skills.
Clinical Relevance: Clinical assessment education that teaches a systematic approach to data collection, analysis, and reporting is central to producing excellent clinical professionals.