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Hope-based interventions in chronic disease: an integrative review in the light of Nightingale

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

ABSTRACT

Objective:

To identify the available evidence in the scientific literature about the strategies or interventions used to promote hope in people with chronic diseases.

Method:

An integrative literature review of literature published between 2009-2019, which was conducted in online browsers/databases: b-On, EBSCO, PubMed, Medline, ISI, SciELO, PsycINFO, Google Scholar. Forty-one studies were found, of which eight met the inclusion criteria.

Results:

Most studies used a quantitative approach. There was a predominance of studies from Asia and America, addressing patients with multiple sclerosis, diabetes, congestive heart failure, and cancer. Hope-based interventions were categorized by the hope attributes: experiential process, spiritual/transcendence process, rational thought process, and relational process.

Conclusion:

Hope-based interventions, in its essence, are good clinical practices in the physical, psychological, social and spiritual domains. This is congruent with the vision of nursing, first proposed by Florence Nightingale. There seem to be gaps in the literature regarding specific hope promoting interventions.

Descriptors:
Chronic Disease; Hope; Holistic Nursing; Patient Care; Review

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

INTRODUCTION

Nursing, as an organized profession, appeared with Florence Nightingale, in the second half of the 19th century, in a period of great need to improve the living conditions of populations, namely in the control of infectious diseases, given that medicine had very limited resources(11 Collière M. Promover a vida: da prática das mulheres de virtude aos cuidados de enfermagem. Lisboa: Lidel; 2000. 388 p.). Searching for Florence Nightingale’s current events, in her thinking and in her work, is an interesting exercise that takes us to the hygienist concerns “clean air, pure water, efficient drainage, cleanliness and light” - five essential points in the observation of a healthy home. Nightingale knew the germ theory, and before its wide publicity, she had deduced that cleanliness, fresh air, sanitary aspects, comfort and socialization were necessary for the cure. Besides, Nightingale’s message of health and healing, anticipated the holism perspective as recognized from today’s point of view.

After Nightingale, with the advent of modern nursing, caring became considered an end of the nursing profession, responding to the social demands of each age. At the beginning, it was based on essentially practical knowledge, characterized by a solicitude associated with a spirit of fraternal help and charitable dedication, having been influenced by technical-scientific developments, and by increasingly complex and diversified socio-cultural contexts, giving rise to a practice based on scientific knowledge, professional competence and the adoption of scientific methods of work(22 Kerouac S, Pepin J, Ducharme F. La pensée infirmière. 4th ed. Paris: Beauchemin; 2017. 224 p.). Conceptual foreknowing’s of hope(33 Parse R. The human becoming concept inventing model: a reprise and more. Nurs Sci Q [Internet]. 2018 [2020 Feb 13];31(2):157-9. Available from: https://journals.sagepub.com/doi/abs/10.1177/0894318418755740
https://journals.sagepub.com/doi/abs/10....
-44 Doe MJ. Conceptual Foreknowings: an integrative review of hope. Nurs Sci Q. 2020;33(1):55-64. doi: 10.1177/0894318419881805
https://doi.org/10.1177/0894318419881805...
) assume that is a universal human universe living experience characterized by some patterns: a) hope hides in veiled shades of obscurity; b) strengthens dreams; c) hope-no-hope illuminates connections and hope keeps perseverance in fighting; d) linking the present to the future; and e) expands the horizon of possibilities.

This openness makes it possible to work on hope in the context of the nurse-patient relationship from a perspective that does not cure but it heals. The nurses’ commitment to the practice of promoting hope as a duty of care and a criterion for good clinical practice, led to the need to investigate the concept, and look for new ways to better inspire hope in patients and families. In Cutcliffe’s view(55 Cutcliffe JR, Herth K. The concept of hope in nursing 1: its origins, background and nature. Br J Nurs. 2002;11(12):832-40. doi: 10.12968/bjon.2002.11.12.10307
https://doi.org/10.12968/bjon.2002.11.12...
), hope is interconnected with care and help, and is intrinsically related to the effectiveness of nursing practice. Nurses inspire hope by taking care of the person in a holistic way, considering their well-being in the context of a therapeutic relation of partnership, based on the recognition of the person being cared for and the affirmation of their value.

The scholars are unanimous in defining hope as a dynamic and multidimensional process that is central to life, oriented towards the future, intentional and highly personalized in each individual(44 Doe MJ. Conceptual Foreknowings: an integrative review of hope. Nurs Sci Q. 2020;33(1):55-64. doi: 10.1177/0894318419881805
https://doi.org/10.1177/0894318419881805...

5 Cutcliffe JR, Herth K. The concept of hope in nursing 1: its origins, background and nature. Br J Nurs. 2002;11(12):832-40. doi: 10.12968/bjon.2002.11.12.10307
https://doi.org/10.12968/bjon.2002.11.12...
-66 Duggleby W, Holtslander L, Kylma J, Duncan V, Hammond C, Williams A. Metasynthesis of the hope experience of family caregivers of persons with chronic illness. Qual Health Res [Internet]. 2010 [2020 Mar 18];20(2):148-58. Available from: https://www.ncbi.nlm.nih.gov/pubmed/20065303
https://www.ncbi.nlm.nih.gov/pubmed/2006...
). It also involves the presence of significant objects that are desirable and realistically possible to achieve and the willingness and capacity to make decisions and make choices(77 Duggleby W, Hicks D, Nekolaichuk C, Holtslander L, Williams A, Chambers T, et al. Hope, older adults, and chronic illness: a metasynthesis of qualitative research. J Adv Nurs [Internet]. 2012 [2020 Apr 2];68(6):1211-23. Available from: https://www.ncbi.nlm.nih.gov/pubmed/22221185
https://www.ncbi.nlm.nih.gov/pubmed/2222...
). Hope emerges as a process of anticipation that involves the interaction of thought, action, feeling and relationship, directed towards a future achievement that is personally meaningful. It provides comfort in the face of life’s threats and challenges(88 Sachse D. Hope: more than a refuge in a storm. A concept analysis using the Wilson method and the Norris method. Int J Psychiatr Nurs Res [Internet]. 2007 [2020 Apr 2];13(1):1546-53. Available from: https://europepmc.org/article/med/17927022
https://europepmc.org/article/med/179270...
), saving people from the agony of despair(88 Sachse D. Hope: more than a refuge in a storm. A concept analysis using the Wilson method and the Norris method. Int J Psychiatr Nurs Res [Internet]. 2007 [2020 Apr 2];13(1):1546-53. Available from: https://europepmc.org/article/med/17927022
https://europepmc.org/article/med/179270...
-99 Miller JF. Hope: a construct central to nursing. Nurs Forum [Internet]. 2007 [2020 Mar 15];42(1):12-9. Available from: https://www.ncbi.nlm.nih.gov/pubmed/17257391
https://www.ncbi.nlm.nih.gov/pubmed/1725...
), it is an integral and determining part in the existence of sick people, a process that strengthens their capacity to endure suffering, favors transcendence(88 Sachse D. Hope: more than a refuge in a storm. A concept analysis using the Wilson method and the Norris method. Int J Psychiatr Nurs Res [Internet]. 2007 [2020 Apr 2];13(1):1546-53. Available from: https://europepmc.org/article/med/17927022
https://europepmc.org/article/med/179270...
,1010 Taraghi Z, Lolaty HA, Mohammadpour RA, Abbasabadi AO. Strategies to promote hope and spirituality in the elderly: a narrative review. Ann Trop Med Public Health. [Internet]. 2017 [2020 Mar 13];10:1619-26. Available from: http://www.atmph.org/text.asp?2017/10/6/1619/222684
http://www.atmph.org/text.asp?2017/10/6/...
), facilitates the recovery process, being both a powerful coping mechanism and an essential internal resource for quality of life(1010 Taraghi Z, Lolaty HA, Mohammadpour RA, Abbasabadi AO. Strategies to promote hope and spirituality in the elderly: a narrative review. Ann Trop Med Public Health. [Internet]. 2017 [2020 Mar 13];10:1619-26. Available from: http://www.atmph.org/text.asp?2017/10/6/1619/222684
http://www.atmph.org/text.asp?2017/10/6/...
). By exploring the clinical applications of hope, Farran, Herth and Popovich(1111 Farran C, Herth K, Popovich J. Hope and hopelessness: Critical Clinical Constructs. Cardif: Thousand Oaks, Sage Publications; 1995. 250 p.) proposed a hope framework for guiding nursing interventions to enable hope and prevent hopelessness. This theoretical framework encompasses four central attributes of the dialectical relation between hope and hopelessness that fits the chronic illness experience:

  1. An experiential process (the pain of hope) - involves the recognition and acceptance of suffering as part of the human experience. For the authors, in chronic conditions, hope encompasses ordeals and suffering and includes a potential for hopelessness inherent to impotence due to the inability to change external circumstances when personal resources are scarce. Working towards the acceptance of suffering (physical, psychological, social and spiritual), it simultaneously allows the occurrence of a creative and imaginative process, and resilience to modify the experience, overcome it and find hope again. In this process, the hope / hopelessness dialectic is highlighted as part of the learning process of hope, leading to different life experiences among people who learn to modify their life experiences and those whose hope has never been challenged;

  2. A spiritual or transcendent process (the soul of hope) - The spiritual process involves the incorporation of a transcendental dimension of life. Hope is a spiritual need expressed in association with the meaning of life, forgiveness or acceptance, reassurance from religious faith, relationship and transcendence. Reconciliation is an integral part of the spiritual process of hope. As a spiritual process, hope maintains and is maintained by faith (in oneself and others), and it may be a theological faith, or even in something that has not yet been proven or in a sense of uncertainty;

  3. A rational thought process (the mind of hope) - a process in which the person is actively involved in the expectation of reaching concrete goals, strengthened by the sense of control over their own destiny, assuming anticipation. In this process hope is associated with goals that are flexible and reality-based and motivates persons; pathways and resources, such as positive mental attitude;

  4. A relational process (the heart of hope) – an intersubjective process requiring recognition and acceptance of others. Open caring relationships have been identified as crucial to the mobilization, support or maintenance of hope and prevention of hopelessness. A caring environment together with a sense of connectedness with others has the power of fostering hope in clients and their families regardless of age or health condition(1111 Farran C, Herth K, Popovich J. Hope and hopelessness: Critical Clinical Constructs. Cardif: Thousand Oaks, Sage Publications; 1995. 250 p.).

The standards of good clinical practice include the evaluation and promotion of hope as a criterion for quality of care(1212 National Consensus Project for Quality Palliative Care. Clinical Practice Guidelines for Quality Palliative Care. 4th edition. Pittsburgh: National Consensus Project for Quality Palliative Care [Internet]. 2018 &. [2020 Feb 10]. 165 p. Available from: https://www.nationalcoalitionhpc.org/wp-content/uploads/2018/10/NCHPC-NCPGuidelines_4thED_web_FINAL.pdf
https://www.nationalcoalitionhpc.org/wp-...
). Also, the most recent perspective of evaluating the quality of nursing care, includes comfort, hope and resilience as positive outcome indicators(1010 Taraghi Z, Lolaty HA, Mohammadpour RA, Abbasabadi AO. Strategies to promote hope and spirituality in the elderly: a narrative review. Ann Trop Med Public Health. [Internet]. 2017 [2020 Mar 13];10:1619-26. Available from: http://www.atmph.org/text.asp?2017/10/6/1619/222684
http://www.atmph.org/text.asp?2017/10/6/...
). In an integrative review on the role of hope for adolescents with a chronic illness, hope was found to promote health, facilitates coping and adjustment, enhances quality of life, is essential in purpose in life and illness, improves self-esteem, and is an important factor in resilience(1313 Griggs S, Walker RK. The Role of Hope for Adolescents with a Chronic Illness: an integrative review. J Pediatr Nurs [Internet]. 2016 [2020 Feb 10];31(4):404-21. Available from: https://www.ncbi.nlm.nih.gov/pubmed/27021596
https://www.ncbi.nlm.nih.gov/pubmed/2702...
). This far, the meta-synthesis of hope-based interventions in chronic illness from the perspective of older adults(66 Duggleby W, Holtslander L, Kylma J, Duncan V, Hammond C, Williams A. Metasynthesis of the hope experience of family caregivers of persons with chronic illness. Qual Health Res [Internet]. 2010 [2020 Mar 18];20(2):148-58. Available from: https://www.ncbi.nlm.nih.gov/pubmed/20065303
https://www.ncbi.nlm.nih.gov/pubmed/2006...
) and family caregivers(77 Duggleby W, Hicks D, Nekolaichuk C, Holtslander L, Williams A, Chambers T, et al. Hope, older adults, and chronic illness: a metasynthesis of qualitative research. J Adv Nurs [Internet]. 2012 [2020 Apr 2];68(6):1211-23. Available from: https://www.ncbi.nlm.nih.gov/pubmed/22221185
https://www.ncbi.nlm.nih.gov/pubmed/2222...
) comprehend the timeframe from 1980(66 Duggleby W, Holtslander L, Kylma J, Duncan V, Hammond C, Williams A. Metasynthesis of the hope experience of family caregivers of persons with chronic illness. Qual Health Res [Internet]. 2010 [2020 Mar 18];20(2):148-58. Available from: https://www.ncbi.nlm.nih.gov/pubmed/20065303
https://www.ncbi.nlm.nih.gov/pubmed/2006...
)/1987(77 Duggleby W, Hicks D, Nekolaichuk C, Holtslander L, Williams A, Chambers T, et al. Hope, older adults, and chronic illness: a metasynthesis of qualitative research. J Adv Nurs [Internet]. 2012 [2020 Apr 2];68(6):1211-23. Available from: https://www.ncbi.nlm.nih.gov/pubmed/22221185
https://www.ncbi.nlm.nih.gov/pubmed/2222...
)-2008(77 Duggleby W, Hicks D, Nekolaichuk C, Holtslander L, Williams A, Chambers T, et al. Hope, older adults, and chronic illness: a metasynthesis of qualitative research. J Adv Nurs [Internet]. 2012 [2020 Apr 2];68(6):1211-23. Available from: https://www.ncbi.nlm.nih.gov/pubmed/22221185
https://www.ncbi.nlm.nih.gov/pubmed/2222...
)/2010(66 Duggleby W, Holtslander L, Kylma J, Duncan V, Hammond C, Williams A. Metasynthesis of the hope experience of family caregivers of persons with chronic illness. Qual Health Res [Internet]. 2010 [2020 Mar 18];20(2):148-58. Available from: https://www.ncbi.nlm.nih.gov/pubmed/20065303
https://www.ncbi.nlm.nih.gov/pubmed/2006...
). A systematic review of interventions for hope/ hopelessness revealed that cognitive-behavioral interventions can improve hopelessness in depressed older adults. Life-review based interventions can positively impact hope in a range of older populations, but dignity therapy, physical exercise, and educational programs may not effectively improve hope/hopelessness in older adults(1414 Hernandez SC, Overholser JC. A systematic review of interventions for hope/hopelessness in older adults. Clin Gerontol [Internet]. 2020 [2020 Mar 2];8:1-33. Available from: https://www.ncbi.nlm.nih.gov/pubmed/31913808
https://www.ncbi.nlm.nih.gov/pubmed/3191...
). A recent study of meta-analysis was conducted to evaluate the efficacy of nursing interventions to increase the level of hope in cancer patients(1515 Li P, Guo YJ, Tang Q, Yang L. Effectiveness of nursing intervention for increasing hope in patients with cancer: a meta-analysis. Rev Latino-Am Enfermagem. 2018;26:e2937. doi: 10.1590/1518-8345.1920.2937
https://doi.org/10.1590/1518-8345.1920.2...
), concluding that nursing interventions has a positive effect on hope in cancer patients. Also nursing caring interventions that take into account the spiritual element was found to encourage positive ways of religious coping and, therefore, increase the levels of hope among cancer patients undergoing chemotherapy(1616 Costa DT, Silva DMR, Cavalcanti IDL, Gomes ET, Vasconcelos JLA, Carvalho MVG. Religious/spiritual coping and level of hope in patients with cancer in chemotherapy. Rev Bras Enferm [Internet]. 2019 [2020 Jan 18];72(3):640-45. doi: 10.1590/0034-7167-2018-0358
https://doi.org/10.1590/0034-7167-2018-0...
). Nevertheless, since 2009 little is known about what the interventions are used to promote hope in people with chronic illness besides cancer, as Nightingale intentionally did, which is a gap to be covered by an integrative review. Based on the multidimensionality of hope, to know what interventions can be used from the patient’s and families’ perspective, “might help nurses and other healthcare professionals to inspire hope as Florence Nightingale did when she walked with the lamp through the dark corridors and spread hope and light to the patients”(p.555)(1717 Hammer K, Mogensen O, Hall EOC. The meaning of hope in nursing research: a meta-synthesis. Scand J Caring Sci [Internet]. 2009 [2020 Feb 11];23(3):549-57. Available from: https://www.ncbi.nlm.nih.gov/pubmed/19453659
https://www.ncbi.nlm.nih.gov/pubmed/1945...
). The work and life of Florence Nightingale, as described in the literature, are used throughout this literature review, by analyzing her view of nursing from a holistic perspective.

OBJECTIVE

To identify the available evidence in the scientific literature about the strategies or interventions used to promote the hope of people with chronic disease.

METHODS

Ethical aspects

The study had no involvement with humans, so no research evaluation was required by the Ethics Committee on Research with Human Beings. Since it is methodology that analyzes data that has already been ethically published and analyzed, consideration by the Research Ethics Committee was not required.

Study design

An integrative literature review consists of a research method that gathers and synthesizes the results of previous studies in a systematic and rigorous manner. For preparation of this integrative review, the following steps were followed: definition of the guiding question; search in the literature; extraction of data from the selected studies; evaluation of the studies and summary of the results; discussion and presentation of the integrative review(1818 Hopia H, Latvala E, Liimatainen L. Reviewing the methodology of an integrative review. Scand J Caring Sci [Internet]. 2016 [2020 Feb 12];30(4):662-9. Available from: https://www.ncbi.nlm.nih.gov/pubmed/27074869
https://www.ncbi.nlm.nih.gov/pubmed/2707...
).

Population, inclusion and exclusion criteria

The following inclusion criteria were used: - articles published between 2009 and 2019, available in full text in English, Spanish and Portuguese; - empirical studies of a quantitative, qualitative nature or using the triangulation of methods with adult/ elderly participants with chronic disease, with a description of the strategies intentionally used to promote hope.

The review excluded: - studies whose participants were exclusively families/caregivers; - children and adolescents; - studies associating hope with drug therapy; - studies in the context of acute, sudden illness or in the context of intensive care; - editorials, letters to the editor, review studies, theses, dissertations, repeated articles and studies that did not address the theme relevant to the purpose of this review.

Study protocol

For the elaboration of the guiding question of the integrative review, the PICO strategy was used(1919 Santos CMC, Pimenta CAM, Nobre MRC. The PICO strategy for the research question construction and evidence search. Rev Latino-am Enfermagem. 2007;15(3):508-11. doi: 10.1590/S0104-11692007000300023
https://doi.org/10.1590/S0104-1169200700...
), where P (participants) corresponds to adult patients with chronic disease and nurses who provide care, I (intervention) to Interventions for hope promotion, C (control) does not apply to this proposal and O (outcome) refers to the evaluation of interventions for hope promotion. The guiding question thus was: what is the available evidence about the strategies or interventions used to promote the hope of people with chronic disease?

The search for the studies was held in January of 2020, and encompassed the following databases: b-On; EBSCO (CINAHL - Cumulative Index to Nursing and Allied Health Literature, British Nursing Index, The Cochrane Collection, Medic Latina, Medline with full text; DARE - Database of Abstracts of Reviews of Effects, Academic Search Complete, ERIC - Educational Resource Information Center; PubMed; Medline; Current Contents-ISI); SciELO; PsycINFO; Google Scholar.

As research strategy, the Health Sciences Descriptors (DeCS) for the databases in Portuguese and the corresponding Medical Subject Headings (MeSH) for those in English were used, allied to the Boolean operators [and, or, not] enabling the following combinations: [hope* OR promoting hope OR enhancing hope OR instilling hope] AND [chronic disease OR end-of-life care OR palliative care OR long-term care] AND [nursing strategy OR nursing program OR nursing intervention] NOT [child* OR adolescent].

The search and selection of the studies followed the criteria recommended by the PRISMA group(2020 Moher D, Liberati A, Tetzlaff J, Altman DG, Group TP. Preferred Reporting Items for Systematic Reviews and Meta-Analyses: the PRISMA Statement. PLOS Med [Internet]. 2009 [2020 Jan 5] Jul 21;6(7):e1000097. Available from: https://www.ncbi.nlm.nih.gov/pubmed/19621072
https://www.ncbi.nlm.nih.gov/pubmed/1962...
) and was conducted simultaneously by two researchers. In situations of disagreement, a consensus was sought for with the participation of an auxiliary researcher (Figure 1).

Figure 1
Flowchart of the selection process to which the articles were submitted

The first selection of articles happened through the reading of the titles and abstracts; then, the articles were read in their entirety and the information obtained was distributed in tables and charts, with subsequent categorization of data.

Analysis of the results

For analysis of the information, a spreadsheet created in Microsoft Excel® was used, consisting of the items: database, journal, language, year of publication, methodological approach used, type and description of evaluation, country where the intervention was performed, and finally the hope-based interventions according to the categorization proposed by Ersek(2121 Ersek M. The Meaning of Hope in the Dying. In: Ferrel B, Coyle N, eds. Textbook of Palliative Nursing. 2nd ed. Oxford: Oxford University Press, 2006. p. 513-529.).

RESULTS

The search resulted in 8 articles that met the criteria for inclusion proposed. Most publications included were found in CINAHL (58.1%), followed by PubMed (12.5%). The description of the selected articles is presented in Chart 1.

Chart 1
Description of articles on the evaluation of interventions for promoting hope, according to author, year, country, type of approach, sample, type of intervention and the intervention's characteristics

The 8 selected studies were published between 2011 and 2019. In relation to language, all studies were published in English. Most used a quantitative approach as methodology used for data collection. Regarding the location in which the interventions were performed, there was a predominance of studies from the Asian continent, followed by American. Regardless of recruitment efforts, the samples are composed by different chronic conditions such as Diabetes, Congestive Heart Failure, Cancer and Multiple Sclerosis.

Most of the programs, scientifically tested and selected for this review, were applied individually or in groups over 4-12 sessions of 0.5h-2h each one, in which participants performed various activities. This is the case of Brief Hope Intervention from China(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...
), the Living with Hope Program from Canada(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...
), the HOPE-IN from Norway(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...
) and the Hope Therapy Program from Iran(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...
). Based on these programs hope in chronic illness: (i) promote coping and emotional adjustment, (ii) enhances quality of life, (iii) is essential in spirituality/purpose in life and illness (iv) improves self-esteem, (v) and is an important factor in resilience.

The adaptation of Ersek’s categorization(2121 Ersek M. The Meaning of Hope in the Dying. In: Ferrel B, Coyle N, eds. Textbook of Palliative Nursing. 2nd ed. Oxford: Oxford University Press, 2006. p. 513-529.), presented in Chart 2, contains interventions that, while not mutually exclusive, cover most of the themes found in the literature and provide a good organizational scheme, constituting a useful tool for nurses. Ersek(2121 Ersek M. The Meaning of Hope in the Dying. In: Ferrel B, Coyle N, eds. Textbook of Palliative Nursing. 2nd ed. Oxford: Oxford University Press, 2006. p. 513-529.), categorized interventions based on the four attributes of hope identified in the work of Farran et al.(1111 Farran C, Herth K, Popovich J. Hope and hopelessness: Critical Clinical Constructs. Cardif: Thousand Oaks, Sage Publications; 1995. 250 p.) and Herth(3030 Herth KA. Development and implementation of a Hope Intervention Program. Oncol Nurs Forum [Internet]. 2001 [2020 Jan 15];28(6):1009-17. Available from: https://www.ncbi.nlm.nih.gov/pubmed/11475874
https://www.ncbi.nlm.nih.gov/pubmed/1147...
-3131 Herth K. Enhancing hope in people with a first recurrence of cancer. J Adv Nurs [Internet]. 2000 [2020 Jan 15];32(6):1431-41. Available from: https://www.ncbi.nlm.nih.gov/pubmed/11136411
https://www.ncbi.nlm.nih.gov/pubmed/1113...
), which in chronic disease involve the following six assumptions:

  1. Hope is a tailored process that can occur at different levels of abstraction for the same person - includes identification of threats, resources and identification of objects of hope(3030 Herth KA. Development and implementation of a Hope Intervention Program. Oncol Nurs Forum [Internet]. 2001 [2020 Jan 15];28(6):1009-17. Available from: https://www.ncbi.nlm.nih.gov/pubmed/11475874
    https://www.ncbi.nlm.nih.gov/pubmed/1147...
    -3131 Herth K. Enhancing hope in people with a first recurrence of cancer. J Adv Nurs [Internet]. 2000 [2020 Jan 15];32(6):1431-41. Available from: https://www.ncbi.nlm.nih.gov/pubmed/11136411
    https://www.ncbi.nlm.nih.gov/pubmed/1113...
    );

  2. Hope is based on the past but lived in the present and oriented towards the future: the success of the past and its impact on the present, associated with the mobilization of energy makes us believe in future capacities(66 Duggleby W, Holtslander L, Kylma J, Duncan V, Hammond C, Williams A. Metasynthesis of the hope experience of family caregivers of persons with chronic illness. Qual Health Res [Internet]. 2010 [2020 Mar 18];20(2):148-58. Available from: https://www.ncbi.nlm.nih.gov/pubmed/20065303
    https://www.ncbi.nlm.nih.gov/pubmed/2006...
    -77 Duggleby W, Hicks D, Nekolaichuk C, Holtslander L, Williams A, Chambers T, et al. Hope, older adults, and chronic illness: a metasynthesis of qualitative research. J Adv Nurs [Internet]. 2012 [2020 Apr 2];68(6):1211-23. Available from: https://www.ncbi.nlm.nih.gov/pubmed/22221185
    https://www.ncbi.nlm.nih.gov/pubmed/2222...
    );

  3. Hope is essential to act in the face of adversity - personal attributes such as faith, trust, the ability to resist and motivation have a fundamental role(66 Duggleby W, Holtslander L, Kylma J, Duncan V, Hammond C, Williams A. Metasynthesis of the hope experience of family caregivers of persons with chronic illness. Qual Health Res [Internet]. 2010 [2020 Mar 18];20(2):148-58. Available from: https://www.ncbi.nlm.nih.gov/pubmed/20065303
    https://www.ncbi.nlm.nih.gov/pubmed/2006...
    ,2121 Ersek M. The Meaning of Hope in the Dying. In: Ferrel B, Coyle N, eds. Textbook of Palliative Nursing. 2nd ed. Oxford: Oxford University Press, 2006. p. 513-529.);

  4. Hope is a feeling of having possibilities, being able to deal positively with suffering and transcending the situation, maintaining a sense of dignity(2121 Ersek M. The Meaning of Hope in the Dying. In: Ferrel B, Coyle N, eds. Textbook of Palliative Nursing. 2nd ed. Oxford: Oxford University Press, 2006. p. 513-529.); it is fueled by the positive feelings associated with realistic goals and the ability to create successful plans to achieve them(3030 Herth KA. Development and implementation of a Hope Intervention Program. Oncol Nurs Forum [Internet]. 2001 [2020 Jan 15];28(6):1009-17. Available from: https://www.ncbi.nlm.nih.gov/pubmed/11475874
    https://www.ncbi.nlm.nih.gov/pubmed/1147...
    -3131 Herth K. Enhancing hope in people with a first recurrence of cancer. J Adv Nurs [Internet]. 2000 [2020 Jan 15];32(6):1431-41. Available from: https://www.ncbi.nlm.nih.gov/pubmed/11136411
    https://www.ncbi.nlm.nih.gov/pubmed/1113...
    );

  5. Hope is a coping strategy, used spontaneously by people with chronic illness, but highly influenced by interpersonal relationships, help and care(2121 Ersek M. The Meaning of Hope in the Dying. In: Ferrel B, Coyle N, eds. Textbook of Palliative Nursing. 2nd ed. Oxford: Oxford University Press, 2006. p. 513-529.);

  6. The strategies that promote hope start, most of the time, by themselves, when faced with adversity, uncertainty and suffering, in situations that they perceive as threats(2121 Ersek M. The Meaning of Hope in the Dying. In: Ferrel B, Coyle N, eds. Textbook of Palliative Nursing. 2nd ed. Oxford: Oxford University Press, 2006. p. 513-529.), but are enhanced by nurses, considered important catalysts of hope in people with chronic disease.

Chart 2
Description of the articles on the evaluation of hope-based interventions according to the four attributes of hope

DISCUSSION

“With increasing pressure on emotional changes and the need to improve care worldwide, nursing interventions to increase levels of hope are of significant importance. Hope is the most common psychological factor after diagnosis and is a major contributing factor to quality of life” (p.7)(1212 National Consensus Project for Quality Palliative Care. Clinical Practice Guidelines for Quality Palliative Care. 4th edition. Pittsburgh: National Consensus Project for Quality Palliative Care [Internet]. 2018 &. [2020 Feb 10]. 165 p. Available from: https://www.nationalcoalitionhpc.org/wp-content/uploads/2018/10/NCHPC-NCPGuidelines_4thED_web_FINAL.pdf
https://www.nationalcoalitionhpc.org/wp-...
). Also, nursing interventions on hope can significantly improve the level of hope among cancer patients, specially caring behaviors developed individually(1515 Li P, Guo YJ, Tang Q, Yang L. Effectiveness of nursing intervention for increasing hope in patients with cancer: a meta-analysis. Rev Latino-Am Enfermagem. 2018;26:e2937. doi: 10.1590/1518-8345.1920.2937
https://doi.org/10.1590/1518-8345.1920.2...
-1616 Costa DT, Silva DMR, Cavalcanti IDL, Gomes ET, Vasconcelos JLA, Carvalho MVG. Religious/spiritual coping and level of hope in patients with cancer in chemotherapy. Rev Bras Enferm [Internet]. 2019 [2020 Jan 18];72(3):640-45. doi: 10.1590/0034-7167-2018-0358
https://doi.org/10.1590/0034-7167-2018-0...
), compared to Nightingales’ rounds(1717 Hammer K, Mogensen O, Hall EOC. The meaning of hope in nursing research: a meta-synthesis. Scand J Caring Sci [Internet]. 2009 [2020 Feb 11];23(3):549-57. Available from: https://www.ncbi.nlm.nih.gov/pubmed/19453659
https://www.ncbi.nlm.nih.gov/pubmed/1945...
).

In the scope of the intervention, the International Council of Nurses, at ICNP, defines intervention lines to promoting hope such as Counselling about Hopes and Promoting Hope(3232 International Classification for Nursing- ICN. International Classification for Nursing Practice: nursing interventions statements. Geneva: ICN; 2017. 26 p. Available from: http://www.icn.ch/images/stories/documents/pillars/Practice/icnp/icnp2017-ic.pdf
http://www.icn.ch/images/stories/documen...
). Likewise, NIC defines as hope-promoting interventions those that result in an improved belief in one’s ability to initiate and maintain actions(3333 Butcher HK, Bulechek GM, Dochterman JM, Wagner CM (ed). Nursing Interventions Classification (NIC). 7th ed. St. Louis: Elsevier Mosby; 2019. 512 p.).

The strategies used to increase hope were based on four central attributes of hope i.e., experiential process, spiritual or transcendent process, rational thought process, and relational process, to highlight the importance of Nightingale vision of holistic nursing. Regarding the experience of hope, nurses’ concern is led by attention to pain relief, symptom control in order to provide comfort (3232 International Classification for Nursing- ICN. International Classification for Nursing Practice: nursing interventions statements. Geneva: ICN; 2017. 26 p. Available from: http://www.icn.ch/images/stories/documents/pillars/Practice/icnp/icnp2017-ic.pdf
http://www.icn.ch/images/stories/documen...

33 Butcher HK, Bulechek GM, Dochterman JM, Wagner CM (ed). Nursing Interventions Classification (NIC). 7th ed. St. Louis: Elsevier Mosby; 2019. 512 p.
-3434 Sapeta P. Cuidar em fim-de-vida: o processo de interação Enfermeiro-Doente. Loures: Lusociência; 2011. 306 p.). From the nursing perspective, helping patients experiencing difficult situations to maintain hope is an essential goal in providing care to patients facing a chronic illness diagnosis(1515 Li P, Guo YJ, Tang Q, Yang L. Effectiveness of nursing intervention for increasing hope in patients with cancer: a meta-analysis. Rev Latino-Am Enfermagem. 2018;26:e2937. doi: 10.1590/1518-8345.1920.2937
https://doi.org/10.1590/1518-8345.1920.2...

16 Costa DT, Silva DMR, Cavalcanti IDL, Gomes ET, Vasconcelos JLA, Carvalho MVG. Religious/spiritual coping and level of hope in patients with cancer in chemotherapy. Rev Bras Enferm [Internet]. 2019 [2020 Jan 18];72(3):640-45. doi: 10.1590/0034-7167-2018-0358
https://doi.org/10.1590/0034-7167-2018-0...
-1717 Hammer K, Mogensen O, Hall EOC. The meaning of hope in nursing research: a meta-synthesis. Scand J Caring Sci [Internet]. 2009 [2020 Feb 11];23(3):549-57. Available from: https://www.ncbi.nlm.nih.gov/pubmed/19453659
https://www.ncbi.nlm.nih.gov/pubmed/1945...
) It is not possible to promote hope when the basic need for relief of physical symptoms is not guaranteed to a minimum level that makes it possible to transcend the situation. For this reason, nurses consider this to be the most effective and most common intervention in approaching chronic patients or in palliative situations, both in hospital and at home(3030 Herth KA. Development and implementation of a Hope Intervention Program. Oncol Nurs Forum [Internet]. 2001 [2020 Jan 15];28(6):1009-17. Available from: https://www.ncbi.nlm.nih.gov/pubmed/11475874
https://www.ncbi.nlm.nih.gov/pubmed/1147...
). Cognitive strategies are reported to be extremely important in maintaining hope when there are fluctuations in disease progression(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...
-3030 Herth KA. Development and implementation of a Hope Intervention Program. Oncol Nurs Forum [Internet]. 2001 [2020 Jan 15];28(6):1009-17. Available from: https://www.ncbi.nlm.nih.gov/pubmed/11475874
https://www.ncbi.nlm.nih.gov/pubmed/1147...
) and humor is considered a therapeutic strategy that promotes 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...
).

In the process of rational thinking, living better in the present was one of the ways identified by patients to maintain and strengthen hope in oncological disease(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...
), especially in the terminal phase(3030 Herth KA. Development and implementation of a Hope Intervention Program. Oncol Nurs Forum [Internet]. 2001 [2020 Jan 15];28(6):1009-17. Available from: https://www.ncbi.nlm.nih.gov/pubmed/11475874
https://www.ncbi.nlm.nih.gov/pubmed/1147...
). Turning off the mind, resorting to the support of family and friends, having symbols of hope, positive thoughts and reaching short-term goals are strategies used by terminally ill elderly patients to promote their hope(66 Duggleby W, Holtslander L, Kylma J, Duncan V, Hammond C, Williams A. Metasynthesis of the hope experience of family caregivers of persons with chronic illness. Qual Health Res [Internet]. 2010 [2020 Mar 18];20(2):148-58. Available from: https://www.ncbi.nlm.nih.gov/pubmed/20065303
https://www.ncbi.nlm.nih.gov/pubmed/2006...
-77 Duggleby W, Hicks D, Nekolaichuk C, Holtslander L, Williams A, Chambers T, et al. Hope, older adults, and chronic illness: a metasynthesis of qualitative research. J Adv Nurs [Internet]. 2012 [2020 Apr 2];68(6):1211-23. Available from: https://www.ncbi.nlm.nih.gov/pubmed/22221185
https://www.ncbi.nlm.nih.gov/pubmed/2222...
,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...
). The situation of chronic illness and the uncertainty related to the future, leads to sick people to keep hope living one day at a time(3535 Querido A. A esperança em Cuidados Paliativos. [Dissertação] [Internet]. Universidade de Lisboa; 2005[2020 Jan 15]. 201 p. Available from: http://iconline.ipleiria.pt/handle/10400.8/120
http://iconline.ipleiria.pt/handle/10400...
), focusing on the present, giving value to the little things of life. This means seeing the reality of the moment with a positive outlook, giving it meaning; valuing personal relationships, personal attributes and defining short-term goals(3030 Herth KA. Development and implementation of a Hope Intervention Program. Oncol Nurs Forum [Internet]. 2001 [2020 Jan 15];28(6):1009-17. Available from: https://www.ncbi.nlm.nih.gov/pubmed/11475874
https://www.ncbi.nlm.nih.gov/pubmed/1147...
,3535 Querido A. A esperança em Cuidados Paliativos. [Dissertação] [Internet]. Universidade de Lisboa; 2005[2020 Jan 15]. 201 p. Available from: http://iconline.ipleiria.pt/handle/10400.8/120
http://iconline.ipleiria.pt/handle/10400...
). “Being positive” is fundamental to deal with cancer disease and treatments, which implies maintaining some normality of life in addition to the disease, having a fighting spirit and the ability to look at the good side of life, the ability to accept the situation and 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...
,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...
). In this line, supporting the patient to express verbally or through writing, and fostering positive self-reflection of emotions and personal attributes(3030 Herth KA. Development and implementation of a Hope Intervention Program. Oncol Nurs Forum [Internet]. 2001 [2020 Jan 15];28(6):1009-17. Available from: https://www.ncbi.nlm.nih.gov/pubmed/11475874
https://www.ncbi.nlm.nih.gov/pubmed/1147...
), is an intervention that promotes hope as an experiential process(2121 Ersek M. The Meaning of Hope in the Dying. In: Ferrel B, Coyle N, eds. Textbook of Palliative Nursing. 2nd ed. Oxford: Oxford University Press, 2006. p. 513-529.), but also spiritual, in that it facilitates the attribution of meaning to experience and life (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...
,3030 Herth KA. Development and implementation of a Hope Intervention Program. Oncol Nurs Forum [Internet]. 2001 [2020 Jan 15];28(6):1009-17. Available from: https://www.ncbi.nlm.nih.gov/pubmed/11475874
https://www.ncbi.nlm.nih.gov/pubmed/1147...
). This will allow the patient to recognize the importance to live the moment, recognizing the value of life in spite of the chronic condition. These interventions reinforce Florence Nightingale’s transcended vision of nursing(3636 Dossey BM. Florence Nightingale’s Vision for Health and Healing. J Holist Nurs [Internet]. 2010 [2020 Feb 18];28(4):221-4. Available from: https://journals.sagepub.com/doi/pdf/10.1177/0898010110383111
https://journals.sagepub.com/doi/pdf/10....
). As she quoted, life is a splendid gift that is to be lived when we have it, and there in nothing small about it(3737 Nightingale F. Notes on Nursing: what it is, and what it is not. (First Published June 1st 1958). New York: Dover Publications; 1969. 140 p.).

The use of therapeutic letters as a form of expression of forgiveness and gratitude as well as the clarification of values allows to transform the experience of suffering, challenging people to change their attitude, and to promote hope as a relational process(44 Doe MJ. Conceptual Foreknowings: an integrative review of hope. Nurs Sci Q. 2020;33(1):55-64. doi: 10.1177/0894318419881805
https://doi.org/10.1177/0894318419881805...
-55 Cutcliffe JR, Herth K. The concept of hope in nursing 1: its origins, background and nature. Br J Nurs. 2002;11(12):832-40. doi: 10.12968/bjon.2002.11.12.10307
https://doi.org/10.12968/bjon.2002.11.12...
,1818 Hopia H, Latvala E, Liimatainen L. Reviewing the methodology of an integrative review. Scand J Caring Sci [Internet]. 2016 [2020 Feb 12];30(4):662-9. Available from: https://www.ncbi.nlm.nih.gov/pubmed/27074869
https://www.ncbi.nlm.nih.gov/pubmed/2707...
).

Focusing on what can be done to control pain and other symptoms is an important aspect to reduce the fear of the future reported by patients. “I am not afraid to die but rather to suffer” is a concern voiced by people with chronic illness(3535 Querido A. A esperança em Cuidados Paliativos. [Dissertação] [Internet]. Universidade de Lisboa; 2005[2020 Jan 15]. 201 p. Available from: http://iconline.ipleiria.pt/handle/10400.8/120
http://iconline.ipleiria.pt/handle/10400...
). Nightingale believed that every person who is drawn to ease the pain and suffering of another is an instrument of genuine healing(3030 Herth KA. Development and implementation of a Hope Intervention Program. Oncol Nurs Forum [Internet]. 2001 [2020 Jan 15];28(6):1009-17. Available from: https://www.ncbi.nlm.nih.gov/pubmed/11475874
https://www.ncbi.nlm.nih.gov/pubmed/1147...
). Reinforcing information referring to various options for symptom control, bringing the topic to the conversation, helps patients and families to deal with the situation, reducing the fear of the unknown(1818 Hopia H, Latvala E, Liimatainen L. Reviewing the methodology of an integrative review. Scand J Caring Sci [Internet]. 2016 [2020 Feb 12];30(4):662-9. Available from: https://www.ncbi.nlm.nih.gov/pubmed/27074869
https://www.ncbi.nlm.nih.gov/pubmed/2707...
,2020 Moher D, Liberati A, Tetzlaff J, Altman DG, Group TP. Preferred Reporting Items for Systematic Reviews and Meta-Analyses: the PRISMA Statement. PLOS Med [Internet]. 2009 [2020 Jan 5] Jul 21;6(7):e1000097. Available from: https://www.ncbi.nlm.nih.gov/pubmed/19621072
https://www.ncbi.nlm.nih.gov/pubmed/1962...
). At home, it is essential to teach and train clients to use non-pharmacological strategies to control symptoms and promote comfort, thus increasing their skills to manage the situation(1414 Hernandez SC, Overholser JC. A systematic review of interventions for hope/hopelessness in older adults. Clin Gerontol [Internet]. 2020 [2020 Mar 2];8:1-33. Available from: https://www.ncbi.nlm.nih.gov/pubmed/31913808
https://www.ncbi.nlm.nih.gov/pubmed/3191...
,2020 Moher D, Liberati A, Tetzlaff J, Altman DG, Group TP. Preferred Reporting Items for Systematic Reviews and Meta-Analyses: the PRISMA Statement. PLOS Med [Internet]. 2009 [2020 Jan 5] Jul 21;6(7):e1000097. Available from: https://www.ncbi.nlm.nih.gov/pubmed/19621072
https://www.ncbi.nlm.nih.gov/pubmed/1962...
).

In the spiritual component of hope, it is important for nurses to explore the meaning of suffering with the patient, assist in the search for meaning in the present situation using films or literature, assist in the preparation of diaries or newspapers and facilitate the expression of gratitude or forgiveness, encouraging reminiscence(66 Duggleby W, Holtslander L, Kylma J, Duncan V, Hammond C, Williams A. Metasynthesis of the hope experience of family caregivers of persons with chronic illness. Qual Health Res [Internet]. 2010 [2020 Mar 18];20(2):148-58. Available from: https://www.ncbi.nlm.nih.gov/pubmed/20065303
https://www.ncbi.nlm.nih.gov/pubmed/2006...
-77 Duggleby W, Hicks D, Nekolaichuk C, Holtslander L, Williams A, Chambers T, et al. Hope, older adults, and chronic illness: a metasynthesis of qualitative research. J Adv Nurs [Internet]. 2012 [2020 Apr 2];68(6):1211-23. Available from: https://www.ncbi.nlm.nih.gov/pubmed/22221185
https://www.ncbi.nlm.nih.gov/pubmed/2222...
,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...
,3030 Herth KA. Development and implementation of a Hope Intervention Program. Oncol Nurs Forum [Internet]. 2001 [2020 Jan 15];28(6):1009-17. Available from: https://www.ncbi.nlm.nih.gov/pubmed/11475874
https://www.ncbi.nlm.nih.gov/pubmed/1147...
). Facilitating participation in religious rituals and referring to the spiritual assistant is another intervention valued by patients and nurses as a promoter of hope(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...
,3333 Butcher HK, Bulechek GM, Dochterman JM, Wagner CM (ed). Nursing Interventions Classification (NIC). 7th ed. St. Louis: Elsevier Mosby; 2019. 512 p.). In today’s specialized world we often compartmentalize our lives as person and nursing professionals, separating our own professional interests from our spiritual concerns, in contrast to Nightingale vision of holistic nursing, where spiritual vision and professional identity were combined in one(3636 Dossey BM. Florence Nightingale’s Vision for Health and Healing. J Holist Nurs [Internet]. 2010 [2020 Feb 18];28(4):221-4. Available from: https://journals.sagepub.com/doi/pdf/10.1177/0898010110383111
https://journals.sagepub.com/doi/pdf/10....
,3939 Dossey BM, Beck D- M, Oerther S, Manjrekar P. Florence Nightingale’s Legacy: the rationale for an integral worldview in achieving the sustainable development goals. In: Rosa W, editor. A new era in global health nursing and the United Nations 2030 Agenda for Sustainable Development [Internet]. New York: Springer Publishing Company; 2017 [2020 Mar 10]. 624 p. Available from: https://connect.springerpub.com/content/book/978-0-8261-9012-3/part/part01/chapter/ch07
https://connect.springerpub.com/content/...
).

The relational process encompasses interventions that have been shown to strengthen ties and between patients and families by fostering the support of significant people(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...
). Promoting and establishing relationships and making time available for them to be truly meaningful and allow the reciprocity of hope between the patient and the health system is reinforced by several authors(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...
,3535 Querido A. A esperança em Cuidados Paliativos. [Dissertação] [Internet]. Universidade de Lisboa; 2005[2020 Jan 15]. 201 p. Available from: http://iconline.ipleiria.pt/handle/10400.8/120
http://iconline.ipleiria.pt/handle/10400...
).

As a rational thought process, interventions that promote hope are centered on the definition of objectives, paths and resources to achieve them as well as on the motivation to achieve those 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...
,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...
,3030 Herth KA. Development and implementation of a Hope Intervention Program. Oncol Nurs Forum [Internet]. 2001 [2020 Jan 15];28(6):1009-17. Available from: https://www.ncbi.nlm.nih.gov/pubmed/11475874
https://www.ncbi.nlm.nih.gov/pubmed/1147...
). Providing adequate information according to the patient’s conditions, and taking into account good communication practices in the final phase of life is an important intervention in supporting and increasing the patients’ hope. Using communication techniques, nurses can strengthen patients’ hopes by helping to identify past successes, enhancing the capabilities of sick people(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...
,3030 Herth KA. Development and implementation of a Hope Intervention Program. Oncol Nurs Forum [Internet]. 2001 [2020 Jan 15];28(6):1009-17. Available from: https://www.ncbi.nlm.nih.gov/pubmed/11475874
https://www.ncbi.nlm.nih.gov/pubmed/1147...
).

Study limitations

Limitations include the selection of databases, as studies addressing the topic may be found in other bases than those selected in this review. For future researches, the expansion in the number of databases is recommended, to supplement the results of this study. It should be noted that some of the interventions presented are limited in their application in other contexts of practice, because they are based on that individuals’ culture and require specific training for their application.

Contributions to the field of nursing, health, or public policy

This study synthesized the existing evidence on the evaluation of hope-based interventions shedding light on the knowledge about this subject to provide information that could divert the attention and practices of health professionals and managers in relation to promoting this psychological resource, and for the evaluation of these interventions. These findings suggest that some populations could be prioritized in public mental health interventions to prevent the occurrence of hopelessness, and interventions need to be provided to enhance hope. The evidence reported in this article should help inform healthcare professionals, patients, and educators that nursing interventions have a beneficial effect on hope.

CONCLUSION

Critical analysis of the selected articles in this integrative review made it possible to highlight different strategies or interventions used to promote the hope of people with chronic disease. Nightingale’s message moves us toward the integration of the scientific, moral, political, aesthetic, spiritual, and metaphysical aspects of nursing(3030 Herth KA. Development and implementation of a Hope Intervention Program. Oncol Nurs Forum [Internet]. 2001 [2020 Jan 15];28(6):1009-17. Available from: https://www.ncbi.nlm.nih.gov/pubmed/11475874
https://www.ncbi.nlm.nih.gov/pubmed/1147...
). In analyzing the listed interventions, it is important to emphasize some aspects. Firstly, most of the nursing strategies and interventions suggested to promote hope, in its essence are good clinical care practices in the physical, psychological, social and spiritual domains. There seem to be gaps regarding interventions specifically designed for hope and, however, if analyzed as a whole, much can be done by nurses to intentionally intervene in the hope of patients and families.

Another conclusion is that both strategies and interventions of hope are primarily the initiative of patients and/ or their families. Since hope is a personal experience, it is essential to involve oneself, even though others (especially health professionals) may influence this experience(3535 Querido A. A esperança em Cuidados Paliativos. [Dissertação] [Internet]. Universidade de Lisboa; 2005[2020 Jan 15]. 201 p. Available from: http://iconline.ipleiria.pt/handle/10400.8/120
http://iconline.ipleiria.pt/handle/10400...
). This involvement determines the effect of words or actions in promoting hope. At this point, Nightingale believed that sick persons should hear good news that would assist them becoming healthier(3737 Nightingale F. Notes on Nursing: what it is, and what it is not. (First Published June 1st 1958). New York: Dover Publications; 1969. 140 p.

38 McElligott D. Healing: the journey from concept to nursing practice. J Holist Nurs [Internet]. 2010 [2020 Mar 1];28(4):251-9. Available from: https://www.ncbi.nlm.nih.gov/pubmed/20660908
https://www.ncbi.nlm.nih.gov/pubmed/2066...
-3939 Dossey BM, Beck D- M, Oerther S, Manjrekar P. Florence Nightingale’s Legacy: the rationale for an integral worldview in achieving the sustainable development goals. In: Rosa W, editor. A new era in global health nursing and the United Nations 2030 Agenda for Sustainable Development [Internet]. New York: Springer Publishing Company; 2017 [2020 Mar 10]. 624 p. Available from: https://connect.springerpub.com/content/book/978-0-8261-9012-3/part/part01/chapter/ch07
https://connect.springerpub.com/content/...
). Many of the strategies used by people at the end of their lives are initiated with little influence from others(2121 Ersek M. The Meaning of Hope in the Dying. In: Ferrel B, Coyle N, eds. Textbook of Palliative Nursing. 2nd ed. Oxford: Oxford University Press, 2006. p. 513-529.), but their effectiveness can be improved if directed and monitored by others, namely nurses.

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Edited by

EDITOR IN CHIEF: Antonio José de Almeida Filho
ASSOCIATE EDITOR: Fátima Helena Espírito Santo

Publication Dates

  • Publication in this collection
    21 Dec 2020
  • Date of issue
    2020

History

  • Received
    14 Apr 2020
  • Accepted
    29 Aug 2020
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