Hope is defined as a feeling that what is wanted will happen, or as the anticipation of the same. Related concepts are trust, confidence, belief, and assurance. The concept of hope is extremely important to the psychological wellbeing of the elderly in institutional and other settings. When I think of hope I remember practice settings in which there was little hope. A tuberculosis sanitarium in which I did a student rotation, comes to mind, as well as a large mental hospital before the advent of neuroleptic drugs. The one element that made these situations stand out in my mind was the lack of hope. When reading Goffman's discussion of asylums it struck me that the major aspect of asylums which was most stressful was this lack of hope.1
When hope is missing, the future in essence is gone and the present takes on forboding dimensions. When hope is gone, there is a sense of profound loss. Therefore, one element of great importance to the quality of life for the elderly is hope, if not for cure, then for rehabilitation or for day-to-day experiences where one can enjoy some aspect of life.
Hope, when approached from a realistic perspective, takes into account restrictions. Physical and mental conditions that limit one's abilities as well as the possibilities and alternatives in these situations are considered. Confinement to a wheelchair, or even to one's bed, is something that can be overcome in terms of enjoyment of life when there is hope. Nursing homes when they are good homes, support and maintain hope that today will be pleasant, that activities will be meaningful and that there will be aspects of life that one can enjoy. Care that is hopeful takes into account alternatives, choices, and ability as well as disability.
McGee, in an excellent discussion of the concept of hope, describes that hope is seen as a "healer" and that persons in concentration camps who had hope were those who survived.2 McGee points out that a nurturing environment with competent supportive others, leads to hopefulness because a mutuality exists between hope and help. Citing Fromm, she describes hopelessness as loss of the ability to dream and withdrawal from others so as to avoid hurt. She concludes by discussing that nurses should realize that hope can fortify psychological and physiological defenses against illness.
Benner perhaps put it best in terms of nurses fostering hope for their patients.3 She stated that her studies uncovered that nurses often have a shared understanding in that they try to develop a sense of the "possible" for their patients. That is, patients even in the most deprived circumstances may have hope for a less painful afternoon or even for a peaceful death.
Hope thus fostered in the care of the elderly, to be effective, must thus focus on the possibles and the realistic potentials in the situation. Fostering the "possibles" for the disabled elderly may in a sense be synonymous with nursing care.
- 1. Goffman E: Asylums. Garden City, NY: Doubleday- Anchor, 1961.
- 2. McGee R: Hope: A factor influencing crisis resolution. Advances in Nursing Science 1986; 6(4):34-44.
- 3. Benner P: From novice to expert: Excellence and power in clinical nursing practice. Menlo Park, CA: AddisonWfesky, 1984, p. 6.