Understanding and using hope with patients and families
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Understanding and using hope with patients and families. Mr. R Becker Macmillan Senior Lecturer in Palliative Care Staffordshire University & Severn Hospice Shropshire. Online lecture - Feb 3 rd 2009. Learning Outcomes: .

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Understanding and using hope with patients and families

Understanding and using hope with patients and families

Mr. R Becker

Macmillan Senior Lecturer in Palliative Care

Staffordshire University & Severn Hospice Shropshire

Online lecture - Feb 3rd 2009


Learning outcomes
Learning Outcomes:

  • Understand the concept of hope as a lived experience for the dying and their families.

  • To view hope as a core underpinning concept in the practice of palliative care.

  • To explore hope frameworks and their potential in clinical practice


Hope and it's relationship to time

  • I hope this teaching session is worth listening to

  • I hope the lunch is good

  • I hope I will see my children grow up

  • I hope to have a long and happy retirement

  • I hope to learn to drive

  • I hope to win the lottery

  • I hope it doesn't rain

  • I hope I don't die of cancer



“choose hope over fear” train to London tomorrow.”

President Barack Obama 2009


“Abandon hope all who enter here.” train to London tomorrow.”

An image of hell taken from Dante’s Inferno.


Defining hope
Defining Hope train to London tomorrow.”

  • Menninger (1959) - identified hope's relevance to the treatment of patients with psychiatric disorders

  • Menninger (1959) details similar experiences of doctor/prisoners in Buchenwald concentration camp.

  • Frankl V(1963) hope and suffering within the Nazi concentration camps


Defining hope1
Defining Hope train to London tomorrow.”

  • Beck & Weissman (1974) Cutcliffe (1998) & Moore (2005) – hope in a mental health context.

  • Hickey (1986(, Hinds & Martin (1988), Herth (2000) – studied hope as a variable in the occurrence of, and recovery from cancer

  • O'Malley & Menke (1988) ) hope in relation to adaptation to chronic illness

  • Duggleby & Wright 2005 studied hope in relation to the elderly

  • Benzein (2005), Holtslander et al (2005). family members of the terminally ill and informal care givers


Common denominators in hope definitions
Common denominators in hope definitions train to London tomorrow.”

  • the expectation of a better future

  • the strong affective component

  • the desire for something which is good and positive

  • life experience and relationships with others.


Hope from a well persons perspective train to London tomorrow.”

  • Turner (2005) - looked at hope from the perspective of well young Australians and found that relationships, choices, motivation and belonging were the key dimensions to their lives.



Becker R (2009) The teaching of hope and suffering in palliative care education. In Foyle L & Hostad J. Eds (2009) Dimensions in Cancer and Palliative Care Education, Radcliffe Press. (for publication in spring 2009)


Evidence based hope fostering strategies
Evidence based hope fostering strategies encompassing not only earthly goals, actions and relationships, but also eternal spiritual goals, actions and relationships with a divine being, neither of which are mutually exclusive

  • Empathy - Egan 2004

  • Realistic goals – Poncar 1994

  • Laughter – Herth 1990

  • Relationships – Smith 2004


Evidence based hope fostering strategies1
Evidence based hope fostering strategies encompassing not only earthly goals, actions and relationships, but also eternal spiritual goals, actions and relationships with a divine being, neither of which are mutually exclusive

  • Time alone – Herth 1993

  • The value of presence - Benner & Wrubel 1989, Le May 2004

  • Reminiscence work - Duggleby & Wright 2005

  • Maximising life's aesthetic experiences - Becker & Gamlin 2004


Developmental tools inventories
Developmental Tools & Inventories: encompassing not only earthly goals, actions and relationships, but also eternal spiritual goals, actions and relationships with a divine being, neither of which are mutually exclusive

  • Erikson (1975), Hinds (1984), Nowotny (1989) & Miller (1988) – assessment tools for use in clinical practice

  • Herth's Hope Index (1992) conforms to the idea that hope is a multidimensional concept. It is in Likert format ( 1-4 scale) and is based on three factors.

    1. An inner sense of temporality and the future. i.e. having goals or fearing for the future

    2. An inner positive readiness and expectancy. i.e. believing life has value and worth.

    3. An interconnectedness with self and others. i.e. feeling all alone or having a faith that comforts.


The short story or vignette
The Short story or Vignette encompassing not only earthly goals, actions and relationships, but also eternal spiritual goals, actions and relationships with a divine being, neither of which are mutually exclusive

  • Powerful strategy to enhance learning with a high impact as a reflective learning tool for the author, listener or reader (Becker 2005)

  • Emotive language

  • Scenarios are full of professional and ethical dilemmas

  • Hope stories based around Herth’s hope fostering strategies.


The value of relationships
The Value of relationships encompassing not only earthly goals, actions and relationships, but also eternal spiritual goals, actions and relationships with a divine being, neither of which are mutually exclusive

There she was, hidden nearly by the crisp white sheet pulled up to her nose. Two withered hands gripped tightly to the edge of the sheet. Two soft bright eyes appeared from the abyss looking at me. “Got a minute nurse?”. Hold my hand please?” she said. I asked her “Are you frightened?” “No” she replied, then silence. After about a minute she looked at me and said “I had forgotten what life felt like.”


Humour and pathos
Humour and pathos encompassing not only earthly goals, actions and relationships, but also eternal spiritual goals, actions and relationships with a divine being, neither of which are mutually exclusive

Alex was a young man who was dying and he knew the score. His family was with him. I went in to see if anyone wanted a drink. Alex came out with the usual corny joke and some cheeky comment. I answered back “Any more of that mate and you’re dead meat”. I just wanted the ground to open up and swallow me, but Alex laughed like a drain and after a few seconds so did his family.


Hope for the end
Hope for the end encompassing not only earthly goals, actions and relationships, but also eternal spiritual goals, actions and relationships with a divine being, neither of which are mutually exclusive

Dawn is breaking. My guardian angels will soon arrive with my tablets washed down with gods wine. Same vibes, different voices, another day. “So this is why the cream curdles and the flowers never smell sweet in this room”. I sleep, then wake up and the pain is there gain. Head, heart, stomach everywhere. My family look on, bemused, worried and unsure what to do. More tablets and gods wine. A kiss, a prayer – maybe tonight?


Pain and suffering
Pain and Suffering encompassing not only earthly goals, actions and relationships, but also eternal spiritual goals, actions and relationships with a divine being, neither of which are mutually exclusive

Three years, that’s how long it took. Tiredness, concentration gone, the headaches – Oh the headaches, intense, powerful, for days on end. My balance went next and the swollen legs got worse. Unsteady on my feet, eyes weaker, hearing poor. Just a day to day existence - you call that living? Doctors and consultants visit – they really want to help but….


Abandonment
Abandonment encompassing not only earthly goals, actions and relationships, but also eternal spiritual goals, actions and relationships with a divine being, neither of which are mutually exclusive

The doctor visited and now I am in the car being driven somewhere. My husband looks stern, tired and talks to me as if I am a naughty child. Why does he do that? We go to this strange place with an odd smell and unfamiliar faces smiling, giving me tablets and asking me to lie down on a bed. Those eyes across the bay are following me. Where is my husband, what am I doing here and it smells awful. There’s nobody I know.


Personhood
Personhood encompassing not only earthly goals, actions and relationships, but also eternal spiritual goals, actions and relationships with a divine being, neither of which are mutually exclusive

John had a degenerate illness and still had all his mental faculties, though could not communicate well. His love of music shone through this and he loved to play his 70’s and 80’s music, much to frustration of his family. He knew this, but he said to me one day “This is my way of saying I am still here….reach out and touch me, hug me, and kiss me if you dare. I’m still here.


Evidence based helping strategies to promote hope
Evidence based helping strategies to promote hope encompassing not only earthly goals, actions and relationships, but also eternal spiritual goals, actions and relationships with a divine being, neither of which are mutually exclusive

  • Use the skill of empathy to develop an understanding of patients and families worries, fears and doubts. Help them build upon their strengths (Egan 2004).

  • Realistic attainable goals is important to our patients and is closely linked to a person’s emotional state Poncar (1994).

  • Laughter – as a healthy emotion and when culturally and contextually acceptable, helps to foster positive attitudes, comforts relatives and more significantly is normality based (Becker 2003). Herth (1990)

  • Relationships underpin the very essence of good palliative care. By working directly with families a close therapeutic rapport can be developed with the patient (Smith 2004).


Evidence based helping strategies to promote hope1
Evidence based helping strategies to promote hope encompassing not only earthly goals, actions and relationships, but also eternal spiritual goals, actions and relationships with a divine being, neither of which are mutually exclusive

  • Opportunities to be alone (Herth 1993)

  • A willingness to share part of yourself through your reassuring presence, encouragement, willingness to listen attentively, to touch and to share hopes and feelings that makes all the difference (Le May 2004& Benner & Wrubel (1989)

  • The relevance and importance of maximising life's aesthetic experiences Miller (1985), Herth (1990) Poncar (1994) & Becker & Gamlin (2004)

  • Other strategies can include, distraction activities, confronting the problem, redefining the problem, reminiscence work and helping the person renew his or her spiritual beliefs.


“If you lose hope, somehow you lose the vitality that keeps life moving, you lose that courage to be, that quality that helps you go on in spite of it all. And so today I still have a dream”.

Martin Luther King


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