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This site is for student nurses or nurses starting out. Letters to a Young Nurse are blog posts written like letters to help you find your way and make your journey as a nurse less difficult. 


Healing Hope

Updated: Aug 30, 2023

Hope, as defined by Merriam-Webster (n.d.), is “to cherish a desire with anticipation, or a desire accompanied by an expectation of belief or fulfillment.” It was first used in the Old English in the 12th century as the word hopian, connoting trust or confidence in that which is wished for (Merriam-Webster, n.d.). Hope involves a future-orientation with an anticipation of the desire or goal to be met in the future.

In healthcare, hope is defined much the same way as “the expectation that something desired will occur” (Venes & Taber, 2017). Herth (1996) describes hope as a power within oneself to help a person move beyond what is happening in their present situation to a better tomorrow. The healthcare definition implies that something is happening in the current situation that requires a psychological response or reaction. Nweze, et al. (2013) contend that hope requires that a health issue or event is overcome through a process of transcendence making it a psychological phenomenon that is internal and individual.

The defining attributes of hope are those characteristics that enable differentiation and help to clarify its essential meaning. Nweze et al. (2013) report through their literature review that the defining attributes of hope involve three areas. The first is that there is an acknowledgement that a problem exists which is causing the patient ill health. The second is that the patient must want to change their ill health, or the situation causing the ill health, and thirdly, demonstrates a desire to change through a readiness to change and must believe that their behavior and belief can change the outcome (Nweze, et al., 2013).

Macy and Johnstone (2012) further delineate the concept of hope into two areas. There is passive hope where the person is waiting for external circumstances to change to bring about a change in circumstance, situation, or disease. And active hope which occurs when the person becomes an active participant and identifies which direction to go in and then takes those steps to move in that direction. Not only does hope require a psychological change in mindset but it also requires that something is actively done through a clear view of reality.

In the area of chronic disease a defining attribute for hope is not seen in finding a cure but in accepting reality as it is with death being the final outcome. There is a future orientation to hope with a positive outcome being a comfortable and pain free death for many patients. There is usually an active involvement in decision making by the patient, caregivers and family. Nweze, et al., (2013) contend that a defining attribute of hope is that it requires energy that is not passive but active and is future oriented. Hope has also been shown in various research studies to have a protective function against the physical and psychological effects of an illness, especially one that involves a terminal diagnosis (Sharour, Suleiman, & Al-Gahabeesh, 2014).

Those characteristics, events or situations that must occur prior to the concept are antecedents (Walker & Avant, 2019). Suffering, pain and despair that accompany many chronic diseases are the antecedents for hope. A chronic and often terminal disease must be identified and usually all appropriate and specific treatments have been tried and are no longer effective. Per Nweze, et al., (2013), terminal diseases are chronic, debilitating and often have an unpredictable course which can cause antecedents of hopelessness and powerlessness. Yet not all of the antecedents of hope are negative. The positive antecedents that enable hope to help a person cope in the state of a terminal disease are that of a person who was previously able to find meaning in despair or struggle. If a person was able to use their religious or spiritual beliefs in the past to overcome despair then hope can be used in the current situation to meet goals that allow for a person to prevent pain and suffering (Nweze, et al., 2013).

Another consequence of hope is coping and resiliency. Coping is helped by hope in relation to the patient’s quality of life and mental health. Sharour et al., (2014) contend that coping and hope strengthens a person’s health and the eventual course of the disease. Hope positively influences resiliency by giving meaning and purpose to a person’s life amid struggle and pain.

It has been argued that when a patient enters hospice care all hope is left at the door. This notion prevents many patients and family members from seeking to enroll in hospice services. Hope is not just a practice but a change in mindset. Cure is no longer sought but that does not mean that hope is only inherent in the cure of disease. Hope is facilitated by nurses, per Nweze, et al., (2013), when healthcare professionals and nurses use their knowledge and experience to prevent despair and struggle. Forming interpersonal relationships and enabling connections between the nurse and patient are aspects of hope. Hope in any area of nursing does not require a cure but rather uses practices that remove pain and keep a patient comfortable during the exacerbation. Facilitating hope in others by nurses occurs when questions are answered honestly about the things that will happen at the end of a person’s life. Future orientation by the nurse who is hopeful does not see death as an end but as a transition to what is next. Hope is also communicated by the nurse when assurances are made to prevent pain, distress and anxiety at the end of a person’s life.

On a study about hope and giving information about terminal disease in cancer patients, researchers found that a nurse supports hope through multiple ways. Providing quality care, answering questions about end-of-life issues honestly without giving false hope and developing trusting relationships with patients, family and caregivers all contribute to using hope by the nurse. Patients want their nurses to be honest about prognosis while maintaining their own views of hope. Hope is used as a coping mechanism and nurses are a “…unique and independent source of support and hope.” (Reinke, Shannon, Engelberg, Young, & Curtis, 2010, p. 8).

Hope as a concept has influenced my daily practice by allowing for connections to be made that foster helpfulness and hopefulness. Hope allows for an acceptance of where the patient is in their disease without trying to change their outcome or circumstances or becoming overwhelmed by the futility of the terminal state of the patient. Medicine seeks to cure and often physicians end their relationships with patients when they choose hospice instead of home health or rehabilitation services. If the physician has nothing left to give in the area of treatments, procedures or medications then relationships are severed between the doctor and the patient. That endpoint is the beginning of the relationship for a hospice nurse.

Nursing theories of caring like Watson’s Theory of Human Caring fit well in hospice nursing through the interpersonal connections that are formed. For hope to become a fundamental focus in the mind of the patient and the nurse there must be an authentic presence and a trust that is established. Watson says, “hope becomes being authentically present and enabling and sustaining the deep belief system and subjective life world of self and one being cared for.” (Smith & Parker, 2015, p.325). Caring and hope become synonymous in the goal of providing effective care that is hopeful and not hopeless. Because a patient is dying does not mean all hope is gone. Care allows for hope to flourish in both the patient and the nurse. The hope is that death will be peaceful and pain free and that family members and loved ones will have their issues, concerns and questions answered in a kind and compassionate way.

“Hope is the thing with feathers that perches in the soul and signs the song without the words and never stops at all.” Emily Dickinson penned those words over 150 years ago and yet the message is still pertinent today. Hope is a fundamental psychological intention that is exhibited in behaviors to increase and support it. Without hope patients suffer and struggle and in hospice those patients without hope can die painful and horrendous deaths. Hope brings meaning to struggle and pain and is used by nurses to bring healing without cure in difficult situations involving patients with terminal diseases and conditions. Hope brings transcendence and acceptance which reduces stress and suffering. When there are no treatments, procedures, medications, or tasks left to cure a patient the hospice nurse finds hope to help, and the patient foresees a death of peace and comfort in the future.

Before I end this blog on Hope I want to share a few words from two of my favorite authors, Kelly Corrigan and Anna Deavere Smith. Kelly hosts a podcast called Kelly Corrigan Wonders. And she also has a TV series on PBS called Tell Me More where she interviews writers, actors, activists, and others. Anna Deavere Smith is an actress, writer, playwright, and activist. If you watched Nurse Jackie she was the brilliant Gloria Ackalitus, the administrator for the unit. I came to know of her work when she brought her one woman shows to Berkeley Repertory Theater. During her interview with Kelly she talks about the difference between hope and optimism. Anna says "optimism says, huh, it looks pretty good out there. Things are going to be better. We can go sailing." But hope, she says, "looks at the evidence and says, it doesn't look good at all. I'm going to make a leap of faith, go beyond the evidence to attempt to create new possibilities." She goes on to say that hope is held against all odds, with no guarantee of the future. It is an act of imagination.

That is a perfect picture of hope. No guarantees, no end game in sight but the hope is that it will work out well. When we, as nurses, take away a patient's hope by preventing them from thinking of a future without pain, without goals, without more life to live, then we are failing at our jobs. I believe it is our job to help our patients achieve the goals they think are best without judgement and without criticism. As Kelly ends the conversation she says, "We have to have hope, otherwise why keep trying?" (Corrigan, 2022)

Corrigan, Kelly. “Tell Me More with Kelly Corrigan | Anna Deavere Smith | Season 3 | Episode 1 | PBS.”, 5 Apr. 2022,

Macy, J., & Johnstone, C. (2012). Active Hope: how to face the mess were in without going crazy. Novato, CA: New World Library.

Merriam-Webster. (n.d.). Hope. In dictionary. Retrieved April 25, 2020, from

Nweze, O. J., Agom, A. D., Agom, J. D., & Nwankwo, A. C. (2013). A Critical Analysis of the Concept of Hope: The Nursing Perspective. International Journal on Science and Research, 6(14), 1027–1030.

Reinke, L. F., Shannon, S. E., Engelberg, R. A., Young, J. P., & Curtis, J. R. (2010). Supporting Hope and Prognostic Information: Nurses Perspectives on Their Role When Patients Have Life-Limiting Prognoses. Journal of Pain and Symptom Management, 39(6), 982–992. doi:10.1016/j.jpainsymman.2009.11.315

Sharour, L. A., Suleiman, K., & Al-Gahabeesh, S. (2014). Hope in Cancer: Concept analysis. International Journal of Cancer Research, 48(1), 224–230.

Smith, M. C., & Parker, M. E. (2015). Nursing theories and nursing practice. Philadelphia: F.A. Davis Company.

Venes, D., & Taber, C. W. (2017). Taber’s cyclopedic medical dictionary (23rd ed.). Philadelphia: F.A. Davis Company.

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