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As the Worm Turns

Hope as Meaning Construction in the Wake of Grief and Loss

de Sales Turner, , PhD, MN, RN

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Abstract

Erratum

In the online-only article by de Sales Turner that appeared in volume 30, number 3 of , three references were inadvertently left out of the article before it was published. They have been added to the corrected version of the article, which is available online at .

The new references are 11 (cited on page E52), 18 (cited on page E54), and 38 (cited on page E58). The remaining references have been renumbered accordingly, and all references are cited in full at the end of the article.

Advances in Nursing Science. 31(3):197, July-September 2008.

WHILE preparing for a lecture that I was scheduled to present to undergraduate bachelor of nursing students on the phenomena of grieving and loss, I became immersed in the work of Robert Neimeyer1 on meaning reconstruction and the experience of loss, as well as the work of authors Calhoun and Tedeschi2 on facilitating posttraumatic growth. I found the work of these authors to be arresting—even compelling, and decided I would use their theoretical constructs as the pivot around which my lecture would be crafted.

I was excited and felt that basing my lecture around the work of these authors would be a particularly useful way to inject fresh insights into the complexity of grieving and loss issues. I wanted to challenge students to go beyond the rhetoric of grieving and loss presented by theorists such as Rando3 and Kubler-Ross4 whose works, although valuable, emphasize “letting go,” “moving on,” and “relinquishing emotional ties” as essential tasks of grieving and loss. Furthermore, I wanted to convey that constructs that used authoritative “road maps” to chart the turbulent emotional terrain associated with grieving and loss may not place value on the benefits of having continued symbolic bonds with what was lost. I thought it important to be thought provoking, asking students to consider whether it is humanly possible to return to prebereavement emotional well-being states post loss, and wanted to encourage students at the early stage of their professional development to entertain possibilities that are embedded in socially constructed meanings of loss. Finally, I wanted to encourage them to consider that meaning reconstruction in response to loss was the central process of grieving, a position that is strongly reinforced through the writing of Neimeyer.1 I sensed that presenting the lecture in this way would be liberating, not only for the learning students but also for patients for whom they would care in the future.

Little did I realize that my immersion in research and preparation for this lecture would set in motion a chain of events that enabled me to experience a secondary benefit from giving this lecture, and that is a commitment to reexploring with “fresh eyes” data from a study that I carried out in 2002 on hope in young people in Australia, which is the actual focus of this article. As the title of this article suggests, over a rather lengthy period of time I found myself returning to what the participants of this study revealed about their hope. During these ruminations, I sensed that I had missed something important, and it was not until I explored in-depth the work of Neimeyer and Calhoun and Tedeschi that I stumbled on to what was nagging me on an unconscious level. Given that a number of the participants relayed their hopes through stories of suffering, pain, and loss, I wanted to reengage the data to learn how their hope would “speak” to me when explored through a social constructivist lens, which valued meaning construction in the wake of grieving and loss. I refer to reengagement in this sense as the “risking (of) one's stance and acknowledging the ongoing liminal experience of living between familiarity and strangeness.”5(p207) Through reengagement, I discovered aspects of hope that I had not previously considered or seen, which enabled me to develop a much deeper appreciation for the phenomenon of hope, as expressed by the participants of this study.

HOPE BRIEFLY VISITED: SELECTED REFLECTIONS ON THIS ELUSIVE PHENOMENON

Within literature, it is widely acknowledged that there is not a standard definition or understanding of hope.6 While on one hand lack of a unitary definition of hope is claimed by some to be problematic, contemporary authors such as Eliott and Olver urge us to consider abandoning the eternal quest for defining hope, instead focusing on what we know about hope, which is that it exists despite its “chameleon-like nature,”6(p191) and serves a very valuable function in peoples' lives. This single fact is important to consider—regardless of how elusive this concept may be and how often attempts to measure and define it are thwarted.

The words of Godfrey may be particularly helpful here: “I'd rather have hope than be able to define it.”7(p248) This sentiment seems to resonate, particularly within organizations such as the Hope Foundation, a not-for-profit philanthropic organization and center for hope research of the University of Alberta. The Hope Foundation has a mission to increase understanding of the role of hope in human life so that people can be intentional in using hope to enhance quality of life, particularly in relation to health, learning, and community. Commencing in 1992, hope scholars Edey et al8 created a hope-focused counseling process that has been refined and encompasses an ongoing program of counselor training that began in 1992.9 (Author's note: Further information about the Hope Foundation can be obtained through visiting its Web site at www.ualberta.ca/hope).

Increasingly, within the Hope Foundation emphasis has been placed on fostering hope through the intentional use of language that conveys hope. Authors Edey and Jevne claim, “Language, honed and carefully directed, is a powerful hope-giver.”9(p49) These authors advocate for adoption of linguistic tools that use the language of “yet” (eg, you have not learned how to be hopeful “yet,” but in time you will); “when” (eg, a time will come a time “when” you learn to understand your emotions and feelings); and “I believe” (eg, “I believe” that you have the ability to change if you want to). In insightful discussion about the use of these linguistic tools, Edey and Jevne provide compelling evidence that utterance of these words raises hope in individuals as well as enables them to vision a future in which they are willing to participate. This willingness to vision the future with hope was the crux of my desire to reexplore the hope stories of the participants of my study. I sensed I had not fully understood that hope was embodied,10 and enabled the participants to go on in the face of their losses. In fact had reported that they persevered not through their immersion in hope but through sheer hard work and determination and in spite of their circumstances (d.S.T., XXX).

It is acknowledged that hope is vital to human health, and Cheavens et al11 argue that hope serves as a unifying framework across many therapeutic approaches. An unique therapeutic approach that explicitly uses hope as a catalyst of change is reported by Edey et al who claim that “to use hope effectively in counselling you need two things: the ability to think dynamically about hope, and the tools to introduce it into conversation.”12(p2) Through this work, Edey et al make it clear that the intentional, explicit use of hope in their counseling work is a decided asset that is instrumental to enabling individuals to develop a more robust self. They recommend among other things that counselors “make hope explicit in counselling, transforming it from silent partner to active assistant.”12(p6) Their many and varied suggestions include becoming hope focused through developing attributes of thinking dynamically about hope; developing a hoping self; immersing the self in a culture of hope; and learning how to recognize personal states of hopefulness.

Recognition of the importance of hope is not new to the healthcare field. Having, attaining, or maintaining hope is particularly vital in situations where individuals experience suffering and loss. In a remarkable address to the American Psychiatric Association, the then President Karl Menninger in 1959 implored his colleagues to intentionally focus on hope in their clinical practices.13 Since this landmark address, studies of hope in health and illness, which are illustrative of grief and loss situations, have proliferated. In an insightful description of hope in palliative care, Nekolaichuk and Bruera14 explored society's marginalization of those who are terminally ill. This work revealed 3 myths of terminal illness: (a) the myths of immortality, (b) the magic bullet, and (c) truth telling, each of which potentially threaten a person's ability to maintain hope when faced with a diagnosis of cancer. Nekolaichuk and Bruera implore those who work within palliative care to cast aside these myths and “extend our view of hope beyond unidimensional frameworks that primarily focus on futuristic goal setting and problem solving,”14(p40) instead embracing multidimensional models of hope that parallel the palliative care experience.

Relative to the experiences of hope and suffering, Jevne and Nekolaichuk remark, “Hope does not deny the experience of suffering. Rather it allows patients to cohabit with it.”15(p199) These sentiments certainly draw close to the stories and experiences of the participants of my hope study, and I used them as a filter through which their stories were reinterrogated. However, without being too preemptive, I suggest that they miss an important element of the participant's hope experiences, which is shortly discussed.

To conclude this brief discursion into contemporary thinking on hope, along with other contemporary hope scholars, I suggest that the era of searching for a unitary definition of hope has drawn to a conclusion. In its place is a thrust toward actualizing hope care practices, with greater emphasis being placed on purposively using implicit as well as explicit hope-facilitating strategies with recipients of our care. This trend, I propose, may lead to the development and utilization of more thoughtful hope practices that can be used within nursing and indeed across disciplinary boundaries.

THE CONTEXT OF THE STUDY IDENTIFIED

Methodology

As mentioned previously, a hermeneutic phenomenological study that employed the philosophical underpinnings of Hans Georg Gadamer16 was crafted to explore the phenomenon of hope seen through the eyes of 10 Australian youth. Concepts from Gadamer that were used throughout the study included Bildung or openness to meaning; fore-projection; prejudice, and fusion of horizons (Table 1). Within this study, there was no attempt to predict or control—rather an interpretive approach was used that placed priority on searching for, interpreting and illuminating the meanings of what was happening, being done to, being understood, or being interpreted by the study participants in relation to their hopes.

Table 1
Table 1:
Glossary of terms

METHODS

Accessing participants

Participants were recruited through 2 means. One was through utilization of a snowball sampling technique, which relied upon 1 participant contacting a friend and using a noncoercive approach to invite them to contact the researcher directly if they were interested in participating. The other was through extending an invitation to individuals who were registered in a creative arts program. The program coordinator, who did not have a vested interest in the research and was known by the researcher, made available within the organization a flyer that explained the particulars of the study and participation requirements. In this flyer, individuals were asked to contact the researcher directly as well if they were interested in being involved. Through these 2 recruitment strategies, 10 participants were secured.

Data collection

Multiple sources of data were used in the conduct of this study. As the researcher, I kept a professional journal in which reflections on hope were recorded. Using reflective techniques enabled me to identify my initial prejudices, preconceptions, and horizons of the phenomenon of hope, as well as to track how my horizons shifted over time and fused with the participants throughout immersion in the study.

I met the participants on 3 separate occasions prior to engagement in an in-depth conversational interview about hope. At the first meeting, the purpose of the study was reinforced, questions were answered, and written consent was obtained from those who definitely expressed interest in being involved. At the second meeting, participants were given a disposable color camera and asked to imagine that they were being paid to mount a photographic exhibition of hope. On this basis, they were asked to take photographs of anything that they felt depicted their hope. At the third meeting, I collected the camera to have the photographs developed at no expense to the participants. At this time, a date, time, and place for the interview was set.

During the interview, the participants' photographs were used to trigger reflections on hope. Questions were raised such as:

  • So, having taken your pictures what can you tell me about hope?
  • What is hope to you?
  • If you could add or remove anything to this picture that would make it even more hopeful what would it be?
  • Thinking back on your life, tell me about a situation or event in which you were really full of hope and what made this situation really hopeful.
  • Tell me about a situation or event in your life in which you did not have any hope and what made this situation hopeless for you?

Some of these questions had been used and found to be highly effective in a study of homeless youth by Herth.17 Others stemmed from readings on hope, my own experiences and understanding of hope, and from careful listening and reflection during the interviews. Although each interview was unique, from these questions it can be seen that interview focus was on the participants' lived experience and understanding of hope.

Data analysis

To create the text for analysis, the audiotapes were transcribed verbatim. The process of analysis, which was faithful to a Gadamerian phenomenological approach (and which was used for the first and second data analyses), is described elsewhere (d.S.T., XXX). However, in brief, this process was as follows:

  1. Identification of the researcher's preunderstanding of the phenomenon of hope through journaling of thoughts and feelings about the phenomenon at the start of the study.
  2. Adoption of an attitude of Bildung, or remaining open to meaning, while reading and listening to audiotapes. Maintaining an attitude of Bildung enabled the researcher to embrace more universal points of view.
  3. Identification of prejudices. Prejudice in this instance is not regarded negatively, rather as a condition of understanding, for according to Gadamer,16 prejudices are expectations or projections about the whole that are continually revised as more parts of the whole come into view.
  4. Utilization of prejudices to develop horizons, or shared standpoints, between and across participants.
  5. Fusion or blending of horizons for the purpose of understanding the phenomenon of hope.

In this sense, the analysis used an additive process that enabled deeper and richer understandings of the phenomenon of hope to be achieved.

HORIZONS OF HOPE: EMBODIED IN SUFFERING AND LOSS

As previously mentioned, the stories of hope that were shared by the participants were often expressed through experiences of suffering and grief. Although all participants of this research had significant issues relative to suffering and loss, in this article, I share the stories of 3 participants, which clearly illustrate the nexus between hope, grieving, and loss. Consider the story of Erica, who had been married for almost 1 year and had just turned 24 at the time of her interview. She relayed a story from when she was 20 and undertaking her nursing qualification. She had failed a prerequisite subject and tearfully said that she “just felt completely stupid, like I wasn't even, shouldn't even, be in the course.” She believed she did not have the knowledge to be a nurse, had let herself down, and she was angry. She expressed that she did not know how she was going to face the friends she had left behind and “was in the most horrible state, thinking what if I fail again?” In her words, “I didn't have any hope at all, so I sort of closed my self off and didn't want to associate with anyone who would find out what I'd done because I'd be mortified.” She intermitted from her studies and used this time to reflect on what she wanted and how to get it. In the end, she decided, “I had to be a nurse—nothing else really mattered.” She resumed her studies, and reenrolled in the subject that she had failed. Her expressions of hope during this time are poignant:

While I was studying, if I had a lot of difficulty grasping the concept I'd stop and go for a walk. And it would give me an opportunity to clear my mind. And I could feel the sun on me and I could just feel not necessarily God, but something inside of me was saying—I could just feel my heart contract and I just had this sense of knowing that I'd been injected with (hope)—that I could go back and try again and I would get it. As she continued she expressed hope to me is looking to the future. Hope is even though you are really having a rotten today there's always tomorrow—tomorrow is a day with no mistakes in it. There are opportunities and everything is not just black and white—this might be where I started off, but it is not where I will end. And so she emphasized, this time I knew that I had put the study in and that I had pulled my finger out. And I knew that there was only one person who was going to make me pass and that was me. I'd done the study time and I was prepared to take the exam. She ended this story by saying and now, I'm sort of looking forward to more things that I can do—if I can achieve this then I can do anything.

We now turn to another story of hope, that of Vanesha. Vanesha had a passion for painting and as she expressed, “Being an artist, that is my hope—they are the same.” At the time of our interview, she was preparing for her first exhibition, made remarkable by the fact that she had taken up painting only that year. She said, “I've had a burning passion to be an artist for as long as I can remember.” It is through her hope to become a world-renowned artist that her story is told.

Vanesha told me that she did not really understand where she got her passion to paint and said, “I have to paint—it just rises within me. I see images everywhere and I want to exhibit paintings overseas and in other countries.” She went on: “I need to paint and achieve things every day; it's like a drug.” However, in the midst of her euphoria about painting, she also revealed,

This past year I got a bit down about this painting thing because I was producing them way too quickly. And I felt it can't be art if I'm producing them so quickly. And so for months and months I just gave up on painting and withdrew into myself. I mean, for me things have to be out of my reach. Hope is getting things that are out of my reach, doing things that I never thought I'd be able to do, but also doing the things that I'd be too scared to do.

She went on to talk about her favorite artist who did not think he was worthy enough and it was a struggle. However, she claimed her knowledge of his life story inspired her and placed hope within her because

if he thought he could do it and had no money at all, well I just said I'm just gonna paint, I don't care. I'm just gonna do it. If I'm not going to do this I may as well be dead. You can't go on not doing what you have to do. I'm not sure if it's hope, but I just reached inside of myself and finally knew what I had to do—it's about taking chances.

When I asked Vanesha, why she pressed on, why she continued to paint if it was so hard, she reached for a photograph she had taken and said,

You can always try and do things on this side of the arches, the known side. But the unknown side is the thing where passions lead, where things really come together, where there is no gravity. Sometimes you just jump into nowhere, having faith and hope that the elements around and within you will provide for you. To me that's hope.

Finally, I briefly relay the hope story of Keisha, who through a variety of circumstances faced a situation in which she decided she needed to give up her daughter for adoption. She revealed embodied hope while telling a story about the lead up to her decision to adopt out her daughter. She said:

I was just in this space for a really long time; this really heavy space and I couldn't get out of it. Like, I couldn't get out of it and the only thing that I could do to help myself was—I was going to counselling, I was doing, I was having Chinese medicine, and all that sort of stuff, and massage and everything, but it just wouldn't shift—I just couldn't shift it.

And the only thing that helped was to actually leave and go travelling for a while. I went to Tasmania by myself and just travelled around. I spent time up at top end of Tassie and camped and just spent four days all by myself completely, and didn't really see anybody for that time … and it was like I'd been walking up a big hill, struggle, struggle, struggle. And then suddenly, there's no struggle any more, and it's like I'm out of the clouds, I can actually breathe again. I was just able to see a lot clearer what we needed to do. When I think about it now, even though I didn't feel really hopeful at the time, I was. It just really brought me inner peace. Adopting out my daughter was an extremely hard decision for me to make. It caused me to explore numerous avenues and options before I made it, because I wanted to do what was best for my child.

DISCUSSION

My previous understanding of hope, gleaned through immersion in literature, reflection on my own understanding of hope, and careful contemplation of the horizons shared by the participants expanded my understanding of this complex phenomenon. For example, while I had previously thought of hope as something that is ever present, in other words, on tap and readily available, through immersion in this study, I came to understand having hope often requires hard work. This is apparent in the story of Erica, who worked hard to achieve her hope of becoming a nurse, the expressions of Vanesha who relayed that she could not possibly be an artist except through hard work, and the reflections of Keisha, who struggled and found hope in making a decision to give her daughter for adoption. The portrayal of hope as hard work is seldom revealed in literature, with the exception of the work of Hinds,18 who identified hope as hard work in young people with cancer. Instead, hope is revealed as an innate human response,19,20 a confident, yet uncertain, expectation of achieving good,21 a process of anticipation involving interaction of thinking, acting, feeling, and relating,22 an anticipation of possibilities through envisioning the not yet,23 and a belief that a positive future exists for the self.24 In each of these definitions, hope is portrayed as something that simply exists, rather than something that exists because we work hard to hold on to it, as revealed by the participants of this study. In this sense, literature reveals hope as passive rather than active.

Casting hope within a passive framework, in which a healthcare worker might arguably be justified in adopting a “wait and see” approach, while keeping a watchful eye as they go about providing care has limitations and is fraught with difficulties, particularly in situations whereby a person may be suicidal and in obvious need of active hope engagement.25,26 Encouraging hope through engagement in hard work/hope work offers new possibilities and cautions us not to presume that hope will always be present or able to be maintained, except through tenacity and perseverance, as evidenced through the hope stories shared by these participants.

There are divided views within literature on whether encouraging hope in others ought to be pursued. Begley and Blackwood27 argue that in certain circumstances, it may be morally acceptable and indeed even more humane for healthcare workers to lie to their patients if they feel that telling the truth will take away hope. On the other hand, Simpson28 argues that healthcare workers ought to engage in “imagining with” patients, as a means of enabling them to see beyond the many and varied negative consequences that they experience through illness and injury. In this discussion, Simpson makes it clear that when faced with the consequences of infirmity many would imagine poorly what life will be like after the event, and hence lose their hope. Thus, she encourages healthcare workers to engage in “positive collaborative imaginings [that] may need to be repeated and/or address different aspects of patients' lives as they learn how to adapt and cope….”28(p438)

To accomplish collaborative imaginings, some authors advocate that we listen for implicit as well as explicit utterances of hope, that is, the individual's use of the language of hope, which opens doors and paves the way for engagement in hope facilitating strategies and practices.6,9,10,12 As foreshadowed, it might be useful at this stage to return to the work of Jevne and Nekolaichuck,15 who stated that hope does not deny the experience of suffering—rather it allows patients to cohabit with it. Although there is strong support for this statement within the 3 hope stories presented, I suggest that this statement does not penetrate to the heart of their hope. That is, these participants did not merely cohabit with hope, which implies a relative passivity—they struggled with it, anguished over it, and allowed it to drive them into taking action. My reimmersion in the data of this study enabled me to focus explicitly on how the participants, who had temporarily lost connection with their hope, were able to move from the in-between or liminal sate of hope/no hope to reclamation of hope. For these individuals, their losses were poignant and imbued with a sense of hopelessness, yet this provided the very fuel through which they explored their options and made decisions to turn their circumstances around. In these cases, it seemed that hopelessness enabled them to make meaning of their circumstances and to vision a future that was full of hope and purpose.

I pondered how it happened that these individuals experienced hopelessness and ultimately become hopeful whereas others do not, and in so doing I teased out unifying horizons that were threaded across the hope stories of these participants. Although clear differences existed between the circumstances of the participants' hope/no hope states, for each it was the confluence of each horizon of hope that enabled them to go forward. I return to my previous description of hope, which provides the context for this statement. In my original analysis, hope was portrayed as a driving force characterized by a necessity for human connectedness and the need to have options and choices in life, which, when experienced, produced feelings of at-one-with. As I carefully deconstructed and reconstructed the hope stories of these participants, which were told and lived through experiences of personal grief and loss, I became aware of the confluence of having a driving force, being connected, having options and choices, and being at-one-with as vital horizons in each circumstance of hope/no hope states. For instance, when one or more of these horizons of hope was absent, hope diminished. Conversely, when the horizon of hope that was diminished was resolved, hope resumed. To crystallize these thoughts, I briefly return to the story of Erica.

For the sake of clarity, I have collapsed Erica's story and used superscript text to identify Erica's horizons of hope. I just felt completely stupid,LOSS OF CONNECTING WITH SELF like I wasn't even, shouldn't even, be in the course.LOSS OF THE DRIVING FORCE TO BE A NURSE I was in the most horrible state, thinking what if I fail again?LOSS OF THE BELIEF THAT THERE ARE CHOICES AND OPTIONS I didn't have any hope at all,LOSS OF HOPE AS A DRIVING FORCE so I sort of closed my self off and didn't want to associate with anyone who would find out what I'd done because I'd be mortified.LOSS OF CONNECTING AND BEING CONNECTED I had to be a nurse.OPTIONS AND CHOICES Nothing else really mattered.HOPE AS A DRIVING FORCE While I was studying, if I had a lot of difficulty grasping the concept I'd stop and go for a walk.HAVING CHOICES AND OPTIONS And it would give me an opportunity to clear my mind.CONNECTING AND BEING CONNECTED And I could feel the sun on meAT-ONE-WITH and I could just feel not necessarily God, but something inside of me was saying—I could just feel my heart contract and I just had this sense of knowing that I'd been injected with (hope)—that I could go back and try again and I would get it.AT-ONE-WITH Hope to me is looking to the future.HAVING CHOICES AND OPTIONS Hope is even though you are really having a rotten today there's always tomorrow—tomorrow is a day with no mistakes in it.HAVING CHOICES AND OPTIONS There are opportunities and everything is not just black and whiteHAVING CHOICES AND OPTIONS—this might be where I started off, but it is not where I will end.AT-ONE-WITH And so she emphasized, this time I knew that I had put the study inHAVING CHOICES AND OPTIONS and that I had pulled my finger out. And I knew that there was only one person who was going to make me pass and that was me.CONNECTING AND BEING CONNECTED I'd done the study time and I was prepared to take the exam.A DRIVING FORCE And now, I'm sort of looking forward to more things that I can do—if I can achieve this then I can do anything.CONNECTING AND BEING CONNECTED

As demonstrated through this analysis of Erica's hope story, the elements of hope were present in varying degrees and amounts in her story. When her hope was diminished, she drew into herself—perhaps to find her hope reserves, or perhaps to savor the experience of no hope as a means of exploring whether she had the drive and determination to go on. Frankl29 described hope, or at-one-with, as man's [sic] search for meaning. In the foreword to Frankl's work, Allport maintained that man's [sic] eternal search for meaning was achieved when individuals rose above their outward fate or transcended their predicament. Frankl himself said that his personal search for meaning was achieved because he “succeeded somehow is rising above the situation, above the sufferings of the moment … as if they were already in the past.”29(p95) These sentiments, in essence, describe hope and the horizon of at-one-with, a belief or knowledge that we can transcend our circumstances, to be or to have whatever is important to us. Like Frankl, these participants lost their hope focus, but regardless, they rose above the immediacy of their own situations to find ways to go forward in their lives. What is important is for registered nurses to not focus with our patients on the circumstances or conditions of their lives, rather on their responses at the inner core of their being, which they identified as hope or hopefulness and I have identified as the horizon of at-one-with.

The findings of this study support a position that it is important for registered nurses and other healthcare practitioners to maintain a future orientation when working with individuals in any life circumstance. Having said this, further clarity is needed regarding what is meant by having a future orientation. For some, it may mean focusing on the next hour, for others it might be the next day, and for others the next year or years to come, as exemplified in the work by Cox et al,30 who explored individuals' responses to rehabilitation after sustaining a serious orthopedic injury following road accidents.

A number of authors speak of hope arising out of disaster, threats, trials of life, and tragedy. Aronson31 offers a compelling argument of hope as a driving force in a detailed critique of forces shaping the responses to the holocaust or “final solution.” In his words, “the human race will sustain each struggle against oppression until it is finally won.”31(p215) Indeed, some seminal literature on hope suggests that hope emerges from or arises out of suffering and hopelessness.32–35 What is implicit, but not absolutely stated, within most literature is a preference for people to rise above the here and now, to hope for and choose life, or to anticipate a good outlook on life.36

The revelations of these participants portrayed hopelessness as a driving force of hope, not an emotional state displaying a sense of impossibility and feeling that life is too much to handle.37 That is, when they found themselves in situations where they felt hopeless or out of control, although they experienced a number of human emotions, these feelings spurred them to action. Aronson31 refers to the call to action in his discussion of the hope of hopelessness, where he states that the very act of survival is often drawn upon later for courage and strength. This is in sharp contrast to descriptions of hopelessness provided by Lynch, who wrote, “We all have areas of hopelessness, areas where we know that we are helpless or incompetent. We all know that there are situations we cannot handle, things we cannot do, tasks which for us would be hopeless.”33(p62) This description of hopelessness conveys a sense of the impossibility, as well as a subtle yet pervasive message to give up. However, the participants of this study, when faced with situations that prompted feelings of hopelessness, did not give up. They verbalized that although the thwarting of their desires prompted feelings of hopelessness, it also provided the very drive or motivation needed to change the situation, no matter the severity of their life circumstances. Hopelessness became the very fuel by which hope could be found, and rather than dwelling on the negative, they seemed eager to move the story along, focusing on ways their lives were enriched and full of meaning. Clearly, further work is required to test the applicability of these horizons of hope to determine whether they are applicable only in situations of loss and grief or they are applicable across all hope/no hope states.

A number of authors believe fostering hope is intrinsic to the role of healthcare professionals, while others acknowledge that hope facilitation is not a readily assumed skill of nurses (d.S.T., XXX). In this article, I have argued that it is time to put aside the eternal search for a unitary definition of hope. Instead, I advocate for those who engage in hope research and caring for others to focus on finding meaningful ways to embrace the language of hope and hopelessness and to develop the capacity to care holistically. As healthcare providers, it is imperative when we are working with those whose hope is fading, to identify the horizons of hope from which a person has become disconnected and those that have not. Once it is known which horizons remain, we must do everything we can to feed and nourish these horizons while the individual struggles to take control of the issue(s) robbing them of their hope. For example, if the person is still connecting, all stops must be pulled out to foster their connections by any means. This might translate into simple acts, such as varying visiting hours to enable loved ones to more easily visit those in hospital, or it might mean we facilitate a temporary leave of absence from a healthcare facility for those to need to reconnect with the self or others. The findings of this research and the literature suggest that hopelessness is found in times when a person has lost all his or her horizons of hope. Although not specifically explored in this study, previous research has identified that this is a dangerous period for any person,38 and all efforts must be made to connect the person to the core of his or her hope, which I suggest is a mandate of professional nursing care.

CONCLUSION

Presented in this article are constructions of how I came to understand hope differently through reimmersion in the data of a study in which I sought to understand hope as seen through the eyes of 10 Australian young people. In this reconstruction of the participant's hope/no hope states, it was identified that hope was embodied and enabled participants to reclaim their hope in the grieving and loss situations of their lives. Further exploration of embodied hope is warranted, particularly in situations where individuals are faced with grief and loss situations.

The initial research on this project ended some years ago, yet I have presented co-constructed accounts of the meaning of hope in the lives of these young people, and as a consequence have deepened and matured my understanding of hope. Developing new dimensions of understanding the phenomenon of hope fulfilled the goal of philosophic hermeneutics, which is to understand what is involved in the process of understanding itself.5 Although I feel buoyed by the discovery of hope as a confluence of having a driving force, being connected, having choices and options and being at-one-with, and admit that this realization added new dimensions to my own understanding of what hope is, how it functions in peoples' lives, and why it is important—I am also aware that further work will be beneficial to further elucidate these findings. Clearly, I need to engage (or perhaps someone else will if this work strikes a chord in them) in further research that explores how having hope provides the fuel through which loss and grief situations can be apprehended.

REFERENCES

1. Neimeyer R, ed. Meaning Reconstruction and the Experience of Loss. Washington, DC: American Psychological Association; 2002.
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Keywords:

constructivism; data analysis; Gadamer; grief; hermeneutics; hope; loss; phenomenology; youth

© 2007 Lippincott Williams & Wilkins, Inc.