Intervenciones de esperanza en la enfermedad crónica: una revisión integrativa a la luz de Nightingale

Laranjeira, Carlos António; Querido, Ana Isabel Fernandes; Charepe, Zaida Borges; Dixe, Maria dos Anjos Coelho Rodrigues

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Revista Brasileira de Enfermagem

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Brasil

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Sumário

REVIEW • Rev. Bras. Enferm. 73 (suppl 5) • 2020 • https://doi.org/10.1590/0034-7167-2020-0283 copiar

Intervenciones de esperanza en la enfermedad crónica: una revisión integrativa a la luz de Nightingale

Autoría SCIMAGO INSTITUTIONS RANKINGS

RESUMEN

Objetivo:

Identificar las evidencias disponibles en la literatura científica sobre las estrategias o intervenciones utilizadas para promover la esperanza en personas con enfermedad crónica.

Método:

Revisión integrativa de la literatura entre 2009 y 2019 realizada en navegadores/bases de datos online: b-On, EBSCO, PubMed, Medline, ISI, SciELO, PsycINFO, Google Scholar. Han encontrados 41 estudios, ocho de los cuales cumplieron los criterios de inclusión.

Resultados:

La mayoría de los estudios utilizó abordaje cuantitativo. Hubo predominancia de estudios de Asia y América, abordando pacientes con esclerosis múltiple, diabetes, insuficiencia cardíaca congestiva y cáncer. Las intervenciones han categorizadas por los atributos de la esperanza: proceso experiencial, proceso espiritual/ trascendente, proceso de pensamiento racional y proceso relacional.

Conclusión:

Las intervenciones basadas en la esperanza, en su esencia, son buenas prácticas clínicas en los dominios físico, psicológico, social y espiritual. Eso es congruente con la perspectiva de la enfermería holística propuesta por Florence Nightingale. Parece haber lagunas en la literatura en relación a las intervenciones específicas de promoción de la esperanza.

Descriptores:
Enfermedad Crónica; Esperanza; Enfermería Holística; Asistencia al Paciente; Revisión

Author, year, country	Approach	Sample	Type of intervention	Intervention description
Chan et al. (2019) ⁽²²22 Chan K, Wong FKY, Lee PH. A brief hope intervention to increase hope level and improve well-being in rehabilitating cancer patients: a feasibility test. SAGE Open Nurs [Internet]. 2019 [2020 Jan 15];5:1-13. Available from: https://journals.sagepub.com/doi/full/10.1177/2377960819844381 https://journals.sagepub.com/doi/full/10... ⁾ China	Mixed-method study	40 cancer patients living in the community	The Brief Hope Intervention consisted of four one-on-one sessions: two (1-hour) face-to-face sessions and two (30-minute) telephone follow-up sessions in between.	There were three core features in the hope therapy: (a) goal thoughts: finding workable goals, (b) pathway thoughts: finding ways to reach the targets, and (c) agency thoughts: positive self-talk to optimize their motivation to accomplish the set goals⁽²²22 Chan K, Wong FKY, Lee PH. A brief hope intervention to increase hope level and improve well-being in rehabilitating cancer patients: a feasibility test. SAGE Open Nurs [Internet]. 2019 [2020 Jan 15];5:1-13. Available from: https://journals.sagepub.com/doi/full/10.1177/2377960819844381 https://journals.sagepub.com/doi/full/10... ⁾.
Khaledi Sardashti et al. (2018) ⁽²³23 KhalediSardashti F, Ghazavi Z, Keshani F, Smaeilzadeh M. Effect of hope therapy on the mood status of patients with diabetes. Iran J Nurs Midwifery Res [Internet]. 2018 [2020 Jan 15];23(4),281-286. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6034523/ https://www.ncbi.nlm.nih.gov/pmc/article... ⁾ Iran	Quantitative Quasi-experimental	38 diabetic patients	The intervention consisted of eight 2-hour group sessions.	"The content of the sessions consisted of a combination of Snyder's hope therapy and the hope plan in Islam. (…) Hope therapy is a narrative approach based on the life story of individuals. In addition, the life story of each individual is based on that individuals' culture, and individuals retell their life story based on their culture" (p.283)⁽²³23 KhalediSardashti F, Ghazavi Z, Keshani F, Smaeilzadeh M. Effect of hope therapy on the mood status of patients with diabetes. Iran J Nurs Midwifery Res [Internet]. 2018 [2020 Jan 15];23(4),281-286. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6034523/ https://www.ncbi.nlm.nih.gov/pmc/article... ⁾.
Rakhshan, et al. (2018) ⁽²⁴24 Rakhshan M, Ganjalivand S, Zarshenas L, Majdinasab N. The effect of collaborative care model-based intervention on hope in caregivers and patients with multiple sclerosis: a randomized controlled clinical trial. Int J Community Based Nurs Midwifery [Internet]. 2018 [2020 Jan 15];6(3):218-26. Available from: https://www.ncbi.nlm.nih.gov/pubmed/30035138 https://www.ncbi.nlm.nih.gov/pubmed/3003... ⁾ Iran	Quantitative RCT	60 patients with multiple sclerosis and 60 of their family caregivers	The intervention group received an intervention based on the collaborative care model on hope (exclusively for each patient and his/her caregiver) through four stages and eight sessions over a period of 12 weeks.	This model is an educational method based on the patient's participation in the management of chronic disease, including phases of motivation, preparation, involvement, and evaluation⁽²⁴24 Rakhshan M, Ganjalivand S, Zarshenas L, Majdinasab N. The effect of collaborative care model-based intervention on hope in caregivers and patients with multiple sclerosis: a randomized controlled clinical trial. Int J Community Based Nurs Midwifery [Internet]. 2018 [2020 Jan 15];6(3):218-26. Available from: https://www.ncbi.nlm.nih.gov/pubmed/30035138 https://www.ncbi.nlm.nih.gov/pubmed/3003... ⁾.
Duggleby et al. (2016) ⁽²⁵25 Duggleby W, Cooper D, Nekolaichuk C, Cottrell L, Swindle J, Barkway K. The psychosocial experiences of older palliative patients while participating in a Living with Hope Program. Palliat Support Care [Internet]. 2016 [2020 Jan 15];14(6):672-9. Available from: https://www.ncbi.nlm.nih.gov/pubmed/27586308 https://www.ncbi.nlm.nih.gov/pubmed/2758... ⁾ Canada	Qualitative	13 dyads (persons with advanced cancer and their caregivers)	Living with Hope Program (LWHP) is a unique hope-focused intervention, as itis speciﬁcally tailored and designed for older home care patients with advanced cancer.	The LWHP was developed based on the "transforming hope" grounded theory and included some hope activities: (1) acknowledging "life the way it is," (2) searching for meaning, (3) positive reappraisal, (4) spirituality, and (5) positive relationships⁽²⁵25 Duggleby W, Cooper D, Nekolaichuk C, Cottrell L, Swindle J, Barkway K. The psychosocial experiences of older palliative patients while participating in a Living with Hope Program. Palliat Support Care [Internet]. 2016 [2020 Jan 15];14(6):672-9. Available from: https://www.ncbi.nlm.nih.gov/pubmed/27586308 https://www.ncbi.nlm.nih.gov/pubmed/2758... ⁾.
Binaei et al. (2016) ⁽²⁶26 Binaei N, Moeini M, Sadeghi M, Najafi M, Mohagheghian Z. Effects of hope promoting interventions based on religious beliefs on quality of life of patients with congestive heart failure and their families. Iran J Nurs Midwifery Res [Internet]. 2016 [2020 Jan 15];21(1):77. Available from: https://www.ncbi.nlm.nih.gov/pubmed/26985226 https://www.ncbi.nlm.nih.gov/pubmed/2698... ⁾ Iran	Quantitative RCT	46 adult patients with congestive heart failure	60-min sessions of hope-promoting interventions based on religious beliefs were held twice a week for 3 weeks.	The "hope-promoting intervention was based on the purpose of human creation and its foundation was based on the faith in God. Through this faith, such trust and confidence is achieved in the human psyche that he/she will become patient and resistant against all adversities of life" (p.82)⁽²⁶26 Binaei N, Moeini M, Sadeghi M, Najafi M, Mohagheghian Z. Effects of hope promoting interventions based on religious beliefs on quality of life of patients with congestive heart failure and their families. Iran J Nurs Midwifery Res [Internet]. 2016 [2020 Jan 15];21(1):77. Available from: https://www.ncbi.nlm.nih.gov/pubmed/26985226 https://www.ncbi.nlm.nih.gov/pubmed/2698... ⁾.
Ghazavi et al. (2015)⁽²⁷27 Ghazavi Z, Khaledi-Sardashti F, Kajbaf MB, Esmaielzadeh M. Effect of hope therapy on the hope of diabetic patients. Iran J Nurs Midwifery Res [Internet]. 2015 [2020 Jan 15];20(1):75-80. Available from: http://www.ncbi.nlm.nih.gov/pubmed/25709694 http://www.ncbi.nlm.nih.gov/pubmed/25709... ⁾ Iran	Quantitative Quasi-experimental	38 diabetic patients	Hope therapy in the present study is a combination of Snyder's hope therapy and hope program in Islam. 120-min sessions of hope therapy were held twice a week for 4 weeks.	The hope therapy included four sections: "(1) activities and assignments were discussed; (2) the subjects underwent education of psychological and hope-related skills; (3) the participants were encouraged to go over the problems objectively and clearly and help one another to solve them by use of hope skills; (4) the assignments of the future session were determined" (p.77)⁽²⁷27 Ghazavi Z, Khaledi-Sardashti F, Kajbaf MB, Esmaielzadeh M. Effect of hope therapy on the hope of diabetic patients. Iran J Nurs Midwifery Res [Internet]. 2015 [2020 Jan 15];20(1):75-80. Available from: http://www.ncbi.nlm.nih.gov/pubmed/25709694 http://www.ncbi.nlm.nih.gov/pubmed/25709... ⁾.
Rahimipour et al. (2015) ⁽²⁸28 Rahimipour M, Shahgholian N, Yazdani M. Effect of hope therapy on depression, anxiety, and stress among the patients undergoing hemodialysis. Iran J Nurs Midwifery Res [Internet]. 2015 [2020 Jan 15];20(6):694. Available from: https://www.ncbi.nlm.nih.gov/pubmed/26793255 https://www.ncbi.nlm.nih.gov/pubmed/2679... ⁾ Iran	Quantitative RCT	End-stage chronic renal failure patients were undergoing a 4-h hemodialysis session twice or three times a week.	Hope therapy program was administered for 8 weeks once a week (each session lasted 1-1.5 h)	The hope therapy is based on the development of hope and its effect on stress, anxiety, and depression and its role in the trend of solving the problems and disorders⁽²⁸28 Rahimipour M, Shahgholian N, Yazdani M. Effect of hope therapy on depression, anxiety, and stress among the patients undergoing hemodialysis. Iran J Nurs Midwifery Res [Internet]. 2015 [2020 Jan 15];20(6):694. Available from: https://www.ncbi.nlm.nih.gov/pubmed/26793255 https://www.ncbi.nlm.nih.gov/pubmed/2679... ⁾.
Rustøen, et al. (2011) ⁽²⁹29 Rustøen T, Cooper BA, Miaskowski C. A longitudinal study of the effects of a hope intervention on levels of hope and psychological distress in a community-based sample of oncology patients. Eur J Oncol Nurs [Internet]. 2011 [2020 Jan 15];15(4):351-7. Available from: https://www.ncbi.nlm.nih.gov/pubmed/20870459 https://www.ncbi.nlm.nih.gov/pubmed/2087... ⁾ Norway	Quantitative Single group, longitudinal study	A community-based sample of persons with cancer	The HOPE-IN consisted of eight 2-h sessions conducted over 8 weeks.	"At the first meeting, introductions were made, and the purpose of the HOPE-IN was described. The next six sessions focused on the following content: belief in oneself and in one's own ability, emotional reactions, relationships with others, active involvement, spiritual beliefs and values, and acknowledgement that there is a future. The last session reviewed the key points of the HOPE-IN" (p.352)⁽²⁹29 Rustøen T, Cooper BA, Miaskowski C. A longitudinal study of the effects of a hope intervention on levels of hope and psychological distress in a community-based sample of oncology patients. Eur J Oncol Nurs [Internet]. 2011 [2020 Jan 15];15(4):351-7. Available from: https://www.ncbi.nlm.nih.gov/pubmed/20870459 https://www.ncbi.nlm.nih.gov/pubmed/2087... ⁾.

Attributes of hope	Hope-based interventions
Experiential process	- Prevent and control the symptoms ⁽²⁷27 Ghazavi Z, Khaledi-Sardashti F, Kajbaf MB, Esmaielzadeh M. Effect of hope therapy on the hope of diabetic patients. Iran J Nurs Midwifery Res [Internet]. 2015 [2020 Jan 15];20(1):75-80. Available from: http://www.ncbi.nlm.nih.gov/pubmed/25709694 http://www.ncbi.nlm.nih.gov/pubmed/25709... ^-²⁸28 Rahimipour M, Shahgholian N, Yazdani M. Effect of hope therapy on depression, anxiety, and stress among the patients undergoing hemodialysis. Iran J Nurs Midwifery Res [Internet]. 2015 [2020 Jan 15];20(6):694. Available from: https://www.ncbi.nlm.nih.gov/pubmed/26793255 https://www.ncbi.nlm.nih.gov/pubmed/2679... ⁾ - Use humor and joviality appropriately ⁽²⁹29 Rustøen T, Cooper BA, Miaskowski C. A longitudinal study of the effects of a hope intervention on levels of hope and psychological distress in a community-based sample of oncology patients. Eur J Oncol Nurs [Internet]. 2011 [2020 Jan 15];15(4):351-7. Available from: https://www.ncbi.nlm.nih.gov/pubmed/20870459 https://www.ncbi.nlm.nih.gov/pubmed/2087... ⁾ - Encourage the patient/ family to transcend the current situation ⁽²⁴24 Rakhshan M, Ganjalivand S, Zarshenas L, Majdinasab N. The effect of collaborative care model-based intervention on hope in caregivers and patients with multiple sclerosis: a randomized controlled clinical trial. Int J Community Based Nurs Midwifery [Internet]. 2018 [2020 Jan 15];6(3):218-26. Available from: https://www.ncbi.nlm.nih.gov/pubmed/30035138 https://www.ncbi.nlm.nih.gov/pubmed/3003... ⁾ - Encourage aesthetic experiences ⁽²²22 Chan K, Wong FKY, Lee PH. A brief hope intervention to increase hope level and improve well-being in rehabilitating cancer patients: a feasibility test. SAGE Open Nurs [Internet]. 2019 [2020 Jan 15];5:1-13. Available from: https://journals.sagepub.com/doi/full/10.1177/2377960819844381 https://journals.sagepub.com/doi/full/10... ⁾ - Encourage involvement in creative and fun activities ⁽²⁵25 Duggleby W, Cooper D, Nekolaichuk C, Cottrell L, Swindle J, Barkway K. The psychosocial experiences of older palliative patients while participating in a Living with Hope Program. Palliat Support Care [Internet]. 2016 [2020 Jan 15];14(6):672-9. Available from: https://www.ncbi.nlm.nih.gov/pubmed/27586308 https://www.ncbi.nlm.nih.gov/pubmed/2758... ⁾ - Encourage reminiscence, an expression of gratitude ⁽²²22 Chan K, Wong FKY, Lee PH. A brief hope intervention to increase hope level and improve well-being in rehabilitating cancer patients: a feasibility test. SAGE Open Nurs [Internet]. 2019 [2020 Jan 15];5:1-13. Available from: https://journals.sagepub.com/doi/full/10.1177/2377960819844381 https://journals.sagepub.com/doi/full/10... ^,²⁵25 Duggleby W, Cooper D, Nekolaichuk C, Cottrell L, Swindle J, Barkway K. The psychosocial experiences of older palliative patients while participating in a Living with Hope Program. Palliat Support Care [Internet]. 2016 [2020 Jan 15];14(6):672-9. Available from: https://www.ncbi.nlm.nih.gov/pubmed/27586308 https://www.ncbi.nlm.nih.gov/pubmed/2758... ⁾ - Assist the patient/ family to focus on the joys of the past and the present ⁽²²22 Chan K, Wong FKY, Lee PH. A brief hope intervention to increase hope level and improve well-being in rehabilitating cancer patients: a feasibility test. SAGE Open Nurs [Internet]. 2019 [2020 Jan 15];5:1-13. Available from: https://journals.sagepub.com/doi/full/10.1177/2377960819844381 https://journals.sagepub.com/doi/full/10... ⁾ - Share positive inspirational stories of hope ⁽²²22 Chan K, Wong FKY, Lee PH. A brief hope intervention to increase hope level and improve well-being in rehabilitating cancer patients: a feasibility test. SAGE Open Nurs [Internet]. 2019 [2020 Jan 15];5:1-13. Available from: https://journals.sagepub.com/doi/full/10.1177/2377960819844381 https://journals.sagepub.com/doi/full/10... ^,²⁵25 Duggleby W, Cooper D, Nekolaichuk C, Cottrell L, Swindle J, Barkway K. The psychosocial experiences of older palliative patients while participating in a Living with Hope Program. Palliat Support Care [Internet]. 2016 [2020 Jan 15];14(6):672-9. Available from: https://www.ncbi.nlm.nih.gov/pubmed/27586308 https://www.ncbi.nlm.nih.gov/pubmed/2758... ⁾ - Support the patient/ family to verbally express positive self-reflection ⁽²²22 Chan K, Wong FKY, Lee PH. A brief hope intervention to increase hope level and improve well-being in rehabilitating cancer patients: a feasibility test. SAGE Open Nurs [Internet]. 2019 [2020 Jan 15];5:1-13. Available from: https://journals.sagepub.com/doi/full/10.1177/2377960819844381 https://journals.sagepub.com/doi/full/10... ^,²⁷27 Ghazavi Z, Khaledi-Sardashti F, Kajbaf MB, Esmaielzadeh M. Effect of hope therapy on the hope of diabetic patients. Iran J Nurs Midwifery Res [Internet]. 2015 [2020 Jan 15];20(1):75-80. Available from: http://www.ncbi.nlm.nih.gov/pubmed/25709694 http://www.ncbi.nlm.nih.gov/pubmed/25709... ⁾
Spiritual/transcendent process	- Facilitate participation in religious rituals and spiritual practices ⁽²³23 KhalediSardashti F, Ghazavi Z, Keshani F, Smaeilzadeh M. Effect of hope therapy on the mood status of patients with diabetes. Iran J Nurs Midwifery Res [Internet]. 2018 [2020 Jan 15];23(4),281-286. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6034523/ https://www.ncbi.nlm.nih.gov/pmc/article... ^,²⁵25 Duggleby W, Cooper D, Nekolaichuk C, Cottrell L, Swindle J, Barkway K. The psychosocial experiences of older palliative patients while participating in a Living with Hope Program. Palliat Support Care [Internet]. 2016 [2020 Jan 15];14(6):672-9. Available from: https://www.ncbi.nlm.nih.gov/pubmed/27586308 https://www.ncbi.nlm.nih.gov/pubmed/2758... ^-²⁶26 Binaei N, Moeini M, Sadeghi M, Najafi M, Mohagheghian Z. Effects of hope promoting interventions based on religious beliefs on quality of life of patients with congestive heart failure and their families. Iran J Nurs Midwifery Res [Internet]. 2016 [2020 Jan 15];21(1):77. Available from: https://www.ncbi.nlm.nih.gov/pubmed/26985226 https://www.ncbi.nlm.nih.gov/pubmed/2698... ^,²⁹29 Rustøen T, Cooper BA, Miaskowski C. A longitudinal study of the effects of a hope intervention on levels of hope and psychological distress in a community-based sample of oncology patients. Eur J Oncol Nurs [Internet]. 2011 [2020 Jan 15];15(4):351-7. Available from: https://www.ncbi.nlm.nih.gov/pubmed/20870459 https://www.ncbi.nlm.nih.gov/pubmed/2087... ⁾ - Referral to the clergy or other spiritual assistant ⁽²⁵25 Duggleby W, Cooper D, Nekolaichuk C, Cottrell L, Swindle J, Barkway K. The psychosocial experiences of older palliative patients while participating in a Living with Hope Program. Palliat Support Care [Internet]. 2016 [2020 Jan 15];14(6):672-9. Available from: https://www.ncbi.nlm.nih.gov/pubmed/27586308 https://www.ncbi.nlm.nih.gov/pubmed/2758... ⁾ - Assist the patient/ family in searching for meaning in the present situation ⁽²³23 KhalediSardashti F, Ghazavi Z, Keshani F, Smaeilzadeh M. Effect of hope therapy on the mood status of patients with diabetes. Iran J Nurs Midwifery Res [Internet]. 2018 [2020 Jan 15];23(4),281-286. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6034523/ https://www.ncbi.nlm.nih.gov/pmc/article... ^,²⁴24 Rakhshan M, Ganjalivand S, Zarshenas L, Majdinasab N. The effect of collaborative care model-based intervention on hope in caregivers and patients with multiple sclerosis: a randomized controlled clinical trial. Int J Community Based Nurs Midwifery [Internet]. 2018 [2020 Jan 15];6(3):218-26. Available from: https://www.ncbi.nlm.nih.gov/pubmed/30035138 https://www.ncbi.nlm.nih.gov/pubmed/3003... ^,²⁷27 Ghazavi Z, Khaledi-Sardashti F, Kajbaf MB, Esmaielzadeh M. Effect of hope therapy on the hope of diabetic patients. Iran J Nurs Midwifery Res [Internet]. 2015 [2020 Jan 15];20(1):75-80. Available from: http://www.ncbi.nlm.nih.gov/pubmed/25709694 http://www.ncbi.nlm.nih.gov/pubmed/25709... ⁾ - Assist the patient/ family to keep a newspaper ⁽²⁵25 Duggleby W, Cooper D, Nekolaichuk C, Cottrell L, Swindle J, Barkway K. The psychosocial experiences of older palliative patients while participating in a Living with Hope Program. Palliat Support Care [Internet]. 2016 [2020 Jan 15];14(6):672-9. Available from: https://www.ncbi.nlm.nih.gov/pubmed/27586308 https://www.ncbi.nlm.nih.gov/pubmed/2758... ⁾ - Suggest literature, films and art that explore the meaning of suffering ⁽²⁵25 Duggleby W, Cooper D, Nekolaichuk C, Cottrell L, Swindle J, Barkway K. The psychosocial experiences of older palliative patients while participating in a Living with Hope Program. Palliat Support Care [Internet]. 2016 [2020 Jan 15];14(6):672-9. Available from: https://www.ncbi.nlm.nih.gov/pubmed/27586308 https://www.ncbi.nlm.nih.gov/pubmed/2758... ⁾
Relational process	- Minimize the isolation of the patient/ family ⁽²⁴24 Rakhshan M, Ganjalivand S, Zarshenas L, Majdinasab N. The effect of collaborative care model-based intervention on hope in caregivers and patients with multiple sclerosis: a randomized controlled clinical trial. Int J Community Based Nurs Midwifery [Internet]. 2018 [2020 Jan 15];6(3):218-26. Available from: https://www.ncbi.nlm.nih.gov/pubmed/30035138 https://www.ncbi.nlm.nih.gov/pubmed/3003... ⁾ - Establish and maintain an open relationship with others ⁽²⁴24 Rakhshan M, Ganjalivand S, Zarshenas L, Majdinasab N. The effect of collaborative care model-based intervention on hope in caregivers and patients with multiple sclerosis: a randomized controlled clinical trial. Int J Community Based Nurs Midwifery [Internet]. 2018 [2020 Jan 15];6(3):218-26. Available from: https://www.ncbi.nlm.nih.gov/pubmed/30035138 https://www.ncbi.nlm.nih.gov/pubmed/3003... ^-²⁵25 Duggleby W, Cooper D, Nekolaichuk C, Cottrell L, Swindle J, Barkway K. The psychosocial experiences of older palliative patients while participating in a Living with Hope Program. Palliat Support Care [Internet]. 2016 [2020 Jan 15];14(6):672-9. Available from: https://www.ncbi.nlm.nih.gov/pubmed/27586308 https://www.ncbi.nlm.nih.gov/pubmed/2758... ^,²⁹29 Rustøen T, Cooper BA, Miaskowski C. A longitudinal study of the effects of a hope intervention on levels of hope and psychological distress in a community-based sample of oncology patients. Eur J Oncol Nurs [Internet]. 2011 [2020 Jan 15];15(4):351-7. Available from: https://www.ncbi.nlm.nih.gov/pubmed/20870459 https://www.ncbi.nlm.nih.gov/pubmed/2087... ⁾ - Strengthen the patient's/ family's self-esteem ⁽²⁵25 Duggleby W, Cooper D, Nekolaichuk C, Cottrell L, Swindle J, Barkway K. The psychosocial experiences of older palliative patients while participating in a Living with Hope Program. Palliat Support Care [Internet]. 2016 [2020 Jan 15];14(6):672-9. Available from: https://www.ncbi.nlm.nih.gov/pubmed/27586308 https://www.ncbi.nlm.nih.gov/pubmed/2758... ^,²⁹29 Rustøen T, Cooper BA, Miaskowski C. A longitudinal study of the effects of a hope intervention on levels of hope and psychological distress in a community-based sample of oncology patients. Eur J Oncol Nurs [Internet]. 2011 [2020 Jan 15];15(4):351-7. Available from: https://www.ncbi.nlm.nih.gov/pubmed/20870459 https://www.ncbi.nlm.nih.gov/pubmed/2087... ⁾ - Recognize the individuality and value of the patient/ family ⁽²²22 Chan K, Wong FKY, Lee PH. A brief hope intervention to increase hope level and improve well-being in rehabilitating cancer patients: a feasibility test. SAGE Open Nurs [Internet]. 2019 [2020 Jan 15];5:1-13. Available from: https://journals.sagepub.com/doi/full/10.1177/2377960819844381 https://journals.sagepub.com/doi/full/10... ^,²⁴24 Rakhshan M, Ganjalivand S, Zarshenas L, Majdinasab N. The effect of collaborative care model-based intervention on hope in caregivers and patients with multiple sclerosis: a randomized controlled clinical trial. Int J Community Based Nurs Midwifery [Internet]. 2018 [2020 Jan 15];6(3):218-26. Available from: https://www.ncbi.nlm.nih.gov/pubmed/30035138 https://www.ncbi.nlm.nih.gov/pubmed/3003... ^-²⁵25 Duggleby W, Cooper D, Nekolaichuk C, Cottrell L, Swindle J, Barkway K. The psychosocial experiences of older palliative patients while participating in a Living with Hope Program. Palliat Support Care [Internet]. 2016 [2020 Jan 15];14(6):672-9. Available from: https://www.ncbi.nlm.nih.gov/pubmed/27586308 https://www.ncbi.nlm.nih.gov/pubmed/2758... ^,²⁷27 Ghazavi Z, Khaledi-Sardashti F, Kajbaf MB, Esmaielzadeh M. Effect of hope therapy on the hope of diabetic patients. Iran J Nurs Midwifery Res [Internet]. 2015 [2020 Jan 15];20(1):75-80. Available from: http://www.ncbi.nlm.nih.gov/pubmed/25709694 http://www.ncbi.nlm.nih.gov/pubmed/25709... ^,²⁹29 Rustøen T, Cooper BA, Miaskowski C. A longitudinal study of the effects of a hope intervention on levels of hope and psychological distress in a community-based sample of oncology patients. Eur J Oncol Nurs [Internet]. 2011 [2020 Jan 15];15(4):351-7. Available from: https://www.ncbi.nlm.nih.gov/pubmed/20870459 https://www.ncbi.nlm.nih.gov/pubmed/2087... ⁾ - Recognize and reinforce the reciprocity of hope between the patient/ health system ⁽²⁴24 Rakhshan M, Ganjalivand S, Zarshenas L, Majdinasab N. The effect of collaborative care model-based intervention on hope in caregivers and patients with multiple sclerosis: a randomized controlled clinical trial. Int J Community Based Nurs Midwifery [Internet]. 2018 [2020 Jan 15];6(3):218-26. Available from: https://www.ncbi.nlm.nih.gov/pubmed/30035138 https://www.ncbi.nlm.nih.gov/pubmed/3003... ^,²⁵25 Duggleby W, Cooper D, Nekolaichuk C, Cottrell L, Swindle J, Barkway K. The psychosocial experiences of older palliative patients while participating in a Living with Hope Program. Palliat Support Care [Internet]. 2016 [2020 Jan 15];14(6):672-9. Available from: https://www.ncbi.nlm.nih.gov/pubmed/27586308 https://www.ncbi.nlm.nih.gov/pubmed/2758... ⁾ - Provide time for relationships (especially in institutions) ⁽²⁴24 Rakhshan M, Ganjalivand S, Zarshenas L, Majdinasab N. The effect of collaborative care model-based intervention on hope in caregivers and patients with multiple sclerosis: a randomized controlled clinical trial. Int J Community Based Nurs Midwifery [Internet]. 2018 [2020 Jan 15];6(3):218-26. Available from: https://www.ncbi.nlm.nih.gov/pubmed/30035138 https://www.ncbi.nlm.nih.gov/pubmed/3003... ^-²⁵25 Duggleby W, Cooper D, Nekolaichuk C, Cottrell L, Swindle J, Barkway K. The psychosocial experiences of older palliative patients while participating in a Living with Hope Program. Palliat Support Care [Internet]. 2016 [2020 Jan 15];14(6):672-9. Available from: https://www.ncbi.nlm.nih.gov/pubmed/27586308 https://www.ncbi.nlm.nih.gov/pubmed/2758... ⁾ - Assist the patient to identify significant people/ objects ⁽²⁵25 Duggleby W, Cooper D, Nekolaichuk C, Cottrell L, Swindle J, Barkway K. The psychosocial experiences of older palliative patients while participating in a Living with Hope Program. Palliat Support Care [Internet]. 2016 [2020 Jan 15];14(6):672-9. Available from: https://www.ncbi.nlm.nih.gov/pubmed/27586308 https://www.ncbi.nlm.nih.gov/pubmed/2758... ⁾ - Reflect with the patient on the characteristics and experiences that connect others to the patient ⁽²⁶26 Binaei N, Moeini M, Sadeghi M, Najafi M, Mohagheghian Z. Effects of hope promoting interventions based on religious beliefs on quality of life of patients with congestive heart failure and their families. Iran J Nurs Midwifery Res [Internet]. 2016 [2020 Jan 15];21(1):77. Available from: https://www.ncbi.nlm.nih.gov/pubmed/26985226 https://www.ncbi.nlm.nih.gov/pubmed/2698... ⁾ - Communicate the proper sense of hope ⁽²²22 Chan K, Wong FKY, Lee PH. A brief hope intervention to increase hope level and improve well-being in rehabilitating cancer patients: a feasibility test. SAGE Open Nurs [Internet]. 2019 [2020 Jan 15];5:1-13. Available from: https://journals.sagepub.com/doi/full/10.1177/2377960819844381 https://journals.sagepub.com/doi/full/10... ^,²⁷27 Ghazavi Z, Khaledi-Sardashti F, Kajbaf MB, Esmaielzadeh M. Effect of hope therapy on the hope of diabetic patients. Iran J Nurs Midwifery Res [Internet]. 2015 [2020 Jan 15];20(1):75-80. Available from: http://www.ncbi.nlm.nih.gov/pubmed/25709694 http://www.ncbi.nlm.nih.gov/pubmed/25709... ⁾
Rational thought process	- Assist the patient/ family to establish, obtain, and review the objectives without imposing an agenda ⁽²⁴24 Rakhshan M, Ganjalivand S, Zarshenas L, Majdinasab N. The effect of collaborative care model-based intervention on hope in caregivers and patients with multiple sclerosis: a randomized controlled clinical trial. Int J Community Based Nurs Midwifery [Internet]. 2018 [2020 Jan 15];6(3):218-26. Available from: https://www.ncbi.nlm.nih.gov/pubmed/30035138 https://www.ncbi.nlm.nih.gov/pubmed/3003... ⁾ - Assist in the identification of available and necessary resources for the achievement of objectives ⁽²²22 Chan K, Wong FKY, Lee PH. A brief hope intervention to increase hope level and improve well-being in rehabilitating cancer patients: a feasibility test. SAGE Open Nurs [Internet]. 2019 [2020 Jan 15];5:1-13. Available from: https://journals.sagepub.com/doi/full/10.1177/2377960819844381 https://journals.sagepub.com/doi/full/10... ^,²⁷27 Ghazavi Z, Khaledi-Sardashti F, Kajbaf MB, Esmaielzadeh M. Effect of hope therapy on the hope of diabetic patients. Iran J Nurs Midwifery Res [Internet]. 2015 [2020 Jan 15];20(1):75-80. Available from: http://www.ncbi.nlm.nih.gov/pubmed/25709694 http://www.ncbi.nlm.nih.gov/pubmed/25709... ⁾ - Assist in the search for necessary resources ⁽²²22 Chan K, Wong FKY, Lee PH. A brief hope intervention to increase hope level and improve well-being in rehabilitating cancer patients: a feasibility test. SAGE Open Nurs [Internet]. 2019 [2020 Jan 15];5:1-13. Available from: https://journals.sagepub.com/doi/full/10.1177/2377960819844381 https://journals.sagepub.com/doi/full/10... ⁾ - Assist in fragmenting broader objectives into small steps (to increase the feeling of success) ⁽²²22 Chan K, Wong FKY, Lee PH. A brief hope intervention to increase hope level and improve well-being in rehabilitating cancer patients: a feasibility test. SAGE Open Nurs [Internet]. 2019 [2020 Jan 15];5:1-13. Available from: https://journals.sagepub.com/doi/full/10.1177/2377960819844381 https://journals.sagepub.com/doi/full/10... ⁾ - Help to live one day at a time ⁽²⁵25 Duggleby W, Cooper D, Nekolaichuk C, Cottrell L, Swindle J, Barkway K. The psychosocial experiences of older palliative patients while participating in a Living with Hope Program. Palliat Support Care [Internet]. 2016 [2020 Jan 15];14(6):672-9. Available from: https://www.ncbi.nlm.nih.gov/pubmed/27586308 https://www.ncbi.nlm.nih.gov/pubmed/2758... ⁾ - Provide adequate information according to the patient's condition ⁽²⁴24 Rakhshan M, Ganjalivand S, Zarshenas L, Majdinasab N. The effect of collaborative care model-based intervention on hope in caregivers and patients with multiple sclerosis: a randomized controlled clinical trial. Int J Community Based Nurs Midwifery [Internet]. 2018 [2020 Jan 15];6(3):218-26. Available from: https://www.ncbi.nlm.nih.gov/pubmed/30035138 https://www.ncbi.nlm.nih.gov/pubmed/3003... ^,²⁷27 Ghazavi Z, Khaledi-Sardashti F, Kajbaf MB, Esmaielzadeh M. Effect of hope therapy on the hope of diabetic patients. Iran J Nurs Midwifery Res [Internet]. 2015 [2020 Jan 15];20(1):75-80. Available from: http://www.ncbi.nlm.nih.gov/pubmed/25709694 http://www.ncbi.nlm.nih.gov/pubmed/25709... ⁾ - Facilitate the surveillance of the current condition/ reality ⁽²⁷27 Ghazavi Z, Khaledi-Sardashti F, Kajbaf MB, Esmaielzadeh M. Effect of hope therapy on the hope of diabetic patients. Iran J Nurs Midwifery Res [Internet]. 2015 [2020 Jan 15];20(1):75-80. Available from: http://www.ncbi.nlm.nih.gov/pubmed/25709694 http://www.ncbi.nlm.nih.gov/pubmed/25709... ⁾ - Help in identifying past (previous) successes ⁽²²22 Chan K, Wong FKY, Lee PH. A brief hope intervention to increase hope level and improve well-being in rehabilitating cancer patients: a feasibility test. SAGE Open Nurs [Internet]. 2019 [2020 Jan 15];5:1-13. Available from: https://journals.sagepub.com/doi/full/10.1177/2377960819844381 https://journals.sagepub.com/doi/full/10... ^,²⁷27 Ghazavi Z, Khaledi-Sardashti F, Kajbaf MB, Esmaielzadeh M. Effect of hope therapy on the hope of diabetic patients. Iran J Nurs Midwifery Res [Internet]. 2015 [2020 Jan 15];20(1):75-80. Available from: http://www.ncbi.nlm.nih.gov/pubmed/25709694 http://www.ncbi.nlm.nih.gov/pubmed/25709... ⁾ - Increase the sense of control of patients/ families ⁽²⁴24 Rakhshan M, Ganjalivand S, Zarshenas L, Majdinasab N. The effect of collaborative care model-based intervention on hope in caregivers and patients with multiple sclerosis: a randomized controlled clinical trial. Int J Community Based Nurs Midwifery [Internet]. 2018 [2020 Jan 15];6(3):218-26. Available from: https://www.ncbi.nlm.nih.gov/pubmed/30035138 https://www.ncbi.nlm.nih.gov/pubmed/3003... ^,²⁷27 Ghazavi Z, Khaledi-Sardashti F, Kajbaf MB, Esmaielzadeh M. Effect of hope therapy on the hope of diabetic patients. Iran J Nurs Midwifery Res [Internet]. 2015 [2020 Jan 15];20(1):75-80. Available from: http://www.ncbi.nlm.nih.gov/pubmed/25709694 http://www.ncbi.nlm.nih.gov/pubmed/25709... ⁾

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[1] Corresponding author: Carlos António Laranjeira. E-mail: carlos.laranjeira@ipleiria.pt