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Topics About 'Hopelessness'.

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  1. jeastridge

    3 Ways Nurses Dispense Rx: HOPE

    Gathering my thoughts and hospice computer, I climbed the outdoor steps to the second-floor apartment. The gloom in the small room was palpable as I entered. Crowded together on the couch sat a group of relatives and sitting close by in a worn recliner was the patient, a man in his late 60’s, jaundiced skin betraying his terminal diagnosis of advanced pancreatic cancer. On the arm of his chair, arm circled protectively around the top sat what appeared to be a daughter. After the introductions and greetings, we began to talk about what hospice is and does and how our services might be of help during this time. The patient waved his hand weakly to indicate his desire to speak, “This is it, isn’t it? I don’t have any more hope.” It seemed almost as if everyone took a collective breath, held it and turned to me, waiting for some word that would help them through this impossibly difficult moment. What would you say at this point? As professional nurses, we are present to help people wherever they are on their journey. From pediatrics to geriatrics and everywhere in between, we work to help people recover, rehabilitate, or compensate. Sometimes, we find ourselves in situations such as the one describe above which fits the traditional definition of “hopeless,” and yet, we are there to help inspire some degree of hope, however small. What is Hope? The stuff of life... As long as we have some hope, we can keep pushing forward. A thought process... Researcher Brene Brown says, “I was shocked to discover that hope is not an emotion; it's a way of thinking or a cognitive process. Emotions play a supporting role, but hope is really a thought process…” (http://www.bhevolution.org/public/cultivating_hope.page) A tool to face the day... Sometimes we hear ourselves or our colleagues referring to a reluctance to encourage “false hope,” or the possibility of inspiring unrealistic expectations in our patients. Given the definition above, maybe false hope is not such a concern since hope might be more about giving those in our care the tools they need to face the day, so they can manage to wring out a bit of joy even in the midst of terrible trials. Hope fills the balloon of life... We talk about hope all the time: I hope it doesn’t rain; I hope I don’t spill spaghetti on my white blouse; I hope he passes his test; I hope he gets better; I hope I will be forgiven. It is the same word, but holds vastly different meanings! Hope is hard to pin down—it fills the balloon of life and floats, held by a string of desire, tightly wound around our fist of determination and strong will. We won’t let go, for as long as there is hope, there is life. So what is our role as nurses in inspiring hope? Set goals. While it is impossible to foresee the future, with our knowledge base, we can help our patients set goals they have the ability to meet. We can help them set goals for today, e.g. “Let’s focus on getting bathed and dressed and sit in the bedside chair for 20 minutes. Does that sound good to you?” Meeting goals, even small ones, helps us to feel a sense of achievement and success which gives us hope for reaching other, more long-term goals. Focus. When life feels out of control, our patients may need help in focusing their goals and hopes on a more short term accomplishment. After a major stroke, or some other serious health set back, people have a hard time with looking too far ahead. We can help them reframe their thinking and thus give them true hope. By listening carefully and asking questions, we can help guide them to their own goals, zeroing in on what matters most. Reframe. When we get down to the nuts and bolts of life, time on earth is always rather limited. But when our patients and their families face a hospice nurse at the door, the limitations seem rather glaring and hope appears to take its bright light over into a corner where it is hard to reach. By helping our patients reframe their thinking to goals that are achievable in this new setting, we can help them have hope. For example, finding out what really matters to them in terms of pain management, family time, and closure can help leave them with a measure of hope. What to say? As I faced the family, I breathed in too, silently praying for inspiration and desperately asking for wisdom. “This is pretty hard, isn’t it? What is the hardest part for you?” I asked. He went on to talk about his fears of being a burden and of having pain that would be out of control. Once I understood his greatest concerns, I was able to help him and the family make plans for caring for him and was also able to describe some of our pain control plans. As we spoke, I could feel the gentle presence of hope re-enter the room. While the hope of eradicating his pancreatic cancer through treatment appeared to no longer be an option, there were other parts of his story that opened themselves up to hope and plans. Make each day as good as it can be... As I gathered my things two hours later, I touched the patient’s hand and spoke to him and his family, “None of us knows what tomorrow holds. But we will do our very best to care for you and to help make each day as good a day as it can be.”
  2. Our lives are filled with unrest. Unless you live on a secluded island, you are exposed daily to news of economic strife, poverty, disease, natural disasters, violence and the list goes on. It’s enough to cause anyone to lose hope, and nurses are not immune. However, nurses are in a unique position to support hope in those experiencing fear, grief, loss, illness and death. In the book, Hope in the Age of Anxiety, authors Scioli and Miller bring light to the nature of hope. Arguing there are 9 forms of hopelessness, the authors suggest a person can be empowered when knowing the specific form they are facing. Through understanding, hope can be restored and used to face life’s challenges. 1. Alienation Individuals who are “alienated” believe they are somehow “different” from everyone else. As a result, they feel unworthy of love or of supportive relationships. Already feeling forgotten by others, an alienated person may further distance themselves as protection from further pain or rejection. 2. Forsakenness This form of hopelessness is similar to alienation and occurs when a person feels completely abandoned during a time their greatest time of need. 3. Uninspired Hopelessness may be grounded in a lack of inspiration in a job or creative process, such as writer’s block. Underprivileged minorities may have greater difficulties with inspiration if opportunities for growth are limited and valued role models are lacking. 4. Powerlessness Powerlessness occurs when a person perceives that their own actions will not significantly impact a current situation. The sense of powerlessness may be related to a lifelong pattern of helplessness, lack of personal resources and inability to use other resources. 5. Oppression Oppression occurs when a person feels they will never be able to overcome life’s obstacles and challenges. A person may feel “kept down” or “down-trodden” by race, social status, a relationship or any other factor preventing them from having opportunities or freedom. 6. Limitedness This form of hopelessness occurs when someone feels as if their own skills are lacking and they don’t have what it takes to succeed. It may be the person is financially disadvantaged or have a severe disability contributing to the sense of limitedness. 7. Doom People who are diagnosed with serious, life-threatening illness or those worn out from frailty and chronic illness are most vulnerable to this form of hopelessness. The person is weighted with despair that their life is over or death is imminent. 8. Captivity Captivity can lead to two types of hopelessness. The first is when a person is physically or emotionally held captive by an individual or group. Prisoners often fall into this category, as well as victims of a controlling and abusive relationship. The second subtle form is “self-imprisonment”. This form occurs when someone is unable to leave an unhealthy relationship because their sense of self-worth will not allow it. 9. Helplessness This form occurs when someone feels exposed, vulnerable and unable to live safely in the world. Individuals who have experienced trauma or repeated exposures to uncontrolled stressors may have an internally established belief of helplessness. How Can You Overcome? Overcoming Alienation, Forsakenness and Lack of Inspiration Three common cognitive distortions drive alienation, mind reading, over-generalization and all or none thinking. The remedy for alienation is examining emotional evidence by surveying how others experience you. It may help a person feeling forsaken to not overgeneralize to a small sample of experiences, but rather, focus on a more extensive sample. By looking at the bigger picture, it is likely that hope will emerge. For all or none thinking, the antidote is thinking in shades of grey and opening up to the possibilities in one’s life. Overcoming Doom, Helplessness and Captivity Scioli and Biller suggest a strategy of “examining the evidence” when doom is a result of “jumping to conclusions” especially with a medical or psychiatric diagnosis. Examine the facts by researching the diagnosis or situation to avoid drawing conclusions based on fallacy. Overcoming Powerlessness, Oppression and Limitedness Three cognitive distortions are at the root of powerlessness, discounting the positive, personalization and labeling. All three cognitive distortions discount personal accomplishments and successes. Examining the evidence is a good strategy to cope with discounting the positive. The authors suggest making a list making a list of personal, occupational or social successes, especially in the area being discounted. What do you think? Do the author’s 9 forms of hopelessness give you a better understanding of your client’s distress? Resources Hope in the Age of Anxiety: A Guide to Understanding and Strengthening Our Most Important Virtue by Anthony Scioli and Henry B. Biller (Oxford University Press).© 2009 by Oxford University Press. Content from Chapter 13- Overcoming Hopelessness: Escape from the Darkness Cognitive Distortions
  3. kurisuchine08

    The Broken Man

    When I went to work that day, it was with a heavy heart. I was preoccupied with my own thoughts and was just wishing that I could just go through with my shift as peacefully as I can. Little did I know that I was about to receive a wake-up call from reality. Little did I know that I was about to be slapped with the cold truth that I really was living a sheltered life. My problems were so little compared to what others are going through. This, I was about to find out that day. Hopeless- that's the first word that came to mind when I met him. I've seen many people who suffered from all types of illness and go through such excruciating pain, but none exhibited the same look of hopelessness that I saw in that man's face. It was the look of a man who has accepted that his life has come to an end. It's the expression of a man whose spirit has been broken. It's the look that would later haunt my dreams. What do I know about drug mules? Nothing much, I guess. I see them in the news all the time. Desperate people who, in exchange of food in their bellies, chose to be drug couriers. At that time, I would just shake my head, and say, "such a pity." Then life goes on for me. But now, I doubt I could just dismiss this as easily as I did back then. This man had tears in his eyes while trying to push out all the drug capsules he was forced to swallow. These capsules were as thick and long as your average man's thumbs. Imagine being forced to swallow 97 of these and again being forced to squeeze all of these out of your body. It was pure torture to witness this. It makes one wonder what drove this man to do such thing. But then again, the answer comes back to mind. It's the same thing that made me work away from my family. It's the same driving force behind every expatriate worker: to be able to provide a better future for one's own family; to be able to keep food in their growling bellies; to be able to provide roofs over their loved ones' heads. It's for his and his family's survival. But being without means to do it the legal way, he subjected himself to be used by drug syndicates, those vultures which prey on desperate victims. He allowed them to defile his own body, risking his own life and his family's safety. Who is to say, he did the wrong thing when it was the only option he was dealt with? Yes. He, too, is a victim. As a nurse, I was trained to provide care and comfort to our clients. It is my job to make sure that I ease my patient's suffering and help him make the transition from sickness to optimum health. But how do you nurse a wounded soul? How do you help him when he has lost the will to help himself? It destroys me to know that no matter how much care I give him, he will still be sentenced to die. I am my patient's advocate but I, too, am bound by the rules that govern the land. Someone callously remarked, "Why do you care that he should sleep peacefully tonight, when we all know he is going to die anyway?" I really wanted to rush at him and rip out his tongue. It was all I could do to rein back all emotions I felt. i went home that day carrying with me those terrible pictures in my head. Despite the exhaustion, I slept fitfully. I kept seeing that face of hopelessness. How do I go through these experiences unscathed?

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