HOPE AND HOPELESSNESS

“A nurse does not only seek to alleviate physical pain or render physical care – she ministers to the whole person. The existence of the suffering whether physical, mental or spiritual is the proper concern of the nurse.”

Nurses have played and will always have a major role in caring for patients at healthcare settings. In my entire experience, physician never indicates in patient’s chart “give this patient a dose of care ”, sounds funny to me but it’s a fact. Truly a physician cannot “order” nursing care any more than a nurse can “order” medical care. Nurses provide expert care throughout life’s continuum from the beginning-to-the-end of life in managing the bio-psychosocial, physical, mental and spiritual needs of patients and families both independently and in collaboration with other members of the interprofessional healthcare team.

 At some point we are trying to find meaning in our profession. Asking ourselves at to what extent we can help this patient alleviate suffering. We do not want the patient to feel hopeless whenever they are in a situation that gives them perception of hopelessness. The question is HOW?.

 Example, A case of 55 years old, with ESRD, uncontrolled DM Type 2, HTN with severe necrosis of right leg. Every time the patient comes in Emergency room, you will find his condition getting worse. The family refused for amputation  and further treatment to lessen the worse scenario. They neglected referrals. After a short span of stay in observation room, monitoring and administering medications, the family and the patient will go home despite poor condition and against the physician’s advice.

 Nurses may face limitations in extending their role. The family refused for surgery and palliative treatment, and eventually the patient. They believed that it’s the God’s Will. In this kind of religious orientation, people will handle crisis by submitting everything to their generous Creator. 

“ support of nurse-role in interpersonal relationship with patient to understand their suffering, in exploring the definition & meaning in the concept of “HOPE” & in the therapeutic use of self…”

 It is the patient’s and family’s decision, and nurses are ought to extend respect. At first, we will consider everything useless and irrelevant. We may ask ourselves “Why they will come to the hospital, take medications, and yet  they will disregard further plan for restoration of health?”  Sympathy towards the patient is the main reason why we ask this to ourselves. 

Hopeless it may seem, nurses are deemed to provide intervention suitable to patient’s beliefs. The code of Ethics reiterates the moral obligation of the nurse to practice ethically and to provide care “in a manner that preserves and protects patient's autonomy, dignity, rights, values, and beliefs” and “assists patient in self determination and informed decision-making” . 

 Hopelessness is a subjective state in which an individual sees limited or unavailable alternatives or personal choices and is unable to mobilize energy on own behalf. According to Joyce Travelbee, Nurses’ job is to maintain hope and avoid hopelessness. Nurses fulfill its purpose as the catalyst of hope, through different intervention including communication. A general goal in the nurse-patient relationship is to assist the patient to communicate logically and verbalise his feelings towards his illness. Listen to all ideas  and feelings without judgement.

 In the given scenario, the patient is showing “hope” believing that this healthcare workers will help him alleviate his suffering, through submitting himself  even for a short span of care in ER. We may perceived it as a hopeless condition, scientifically, but his subtle expression of hope is focused on his faith. That hope is a means of steadfastness. They believed, even after one's death, man’s hope is still present; in fact, it is even more so, because his hope is then for the pleasures of Paradise and other bounties of his Creator.

 Lastly, we may fulfill the therapeutic use of self through providing spiritual support. Spirituality is often identified by clients as a bridge between hopelessness and a sense of meaning (Fryback, Reinert, 1999).While therapeutic use of self means assisting the ill person to consider an alternative means of solving problems. In this case, the nurse supports and respect the patient’s and his family’s means of hope and to bring about peaceful death. The nurse perceives, understands, and assigns meaning to behavior and is therefore part of the theory.  In clinical setting, nurse sustains hope,through holistic nursing interventions either for recovery or acceptance of death.

 

 http://www.islamweb.net/en/article/195973/a-believer-lives-between-hope-and-fear

http://nursinginterventionsrationales.blogspot.com/2013/08/hopelessness_6236.html

https://books.google.com.om/books?Theoretical Nursing: Development and Progress