Staff  Utilization of Explicit Hope Facilitation Strategies in Long Term CareStaff  Utilization of Explicit Hope Facilitation Strategies in Long Term Care

Sharon Moore, PhD, M.Ed., RN, BASharon Moore, PhD, M.Ed., RN, BAsharon.moore@athabascau.casharon.moore@athabascau.ca

AcknowledgementsAcknowledgements

Athabasca UniversityAthabasca University Study ParticipantsStudy Participants Sheryl PlettSheryl Plett Dr. Ronna JevneDr. Ronna Jevne Wendy EdeyWendy Edey Hope Foundation of AlbertaHope Foundation of Alberta

PurposePurpose

Intentionalize health care staff use of explicit hope Intentionalize health care staff use of explicit hope facilitation strategies with residentsfacilitation strategies with residents

Consider strategies for how hope can be used to enhance Consider strategies for how hope can be used to enhance well being of residentswell being of residents

Develop beginning insights into theories about hope in Develop beginning insights into theories about hope in practicepractice

Offer recommendations for fostering hope in long term careOffer recommendations for fostering hope in long term care

ObjectivesObjectives

Develop heightened awareness of health care staff use of Develop heightened awareness of health care staff use of purposive hope facilitation strategies that can be used in purposive hope facilitation strategies that can be used in the course of providing day to day care.the course of providing day to day care.

Strengthen staff resolve to purposively engage in hope Strengthen staff resolve to purposively engage in hope promotion strategies with residents.promotion strategies with residents.

Normalize hope facilitation strategies as a vital component Normalize hope facilitation strategies as a vital component of care. of care.

ProcessProcess Ethics Review Ethics Review Approval through University Research Approval through University Research

Ethics Board Ethics Board

Approval from the Long Term Care CentreApproval from the Long Term Care Centre

Letter of invitation to participateLetter of invitation to participate

15 participants from a long term care facility in Western 15 participants from a long term care facility in Western CanadaCanada

RN’s, PCA’s, Pastoral Care, RTRN’s, PCA’s, Pastoral Care, RT

Data Collection StrategiesData Collection Strategies

Interpretive study Interpretive study interviews and education interviews and education

Initial interview with staff (15 Staff) audio recordedInitial interview with staff (15 Staff) audio recorded

Workshop “Workshop “Understanding Hope and Hope Facilitation Understanding Hope and Hope Facilitation StrategiesStrategies””

Follow up interview (11 Staff) audio recordedFollow up interview (11 Staff) audio recorded

““Celebration of Hope” Celebration of Hope” ReceptionReception

Initial InterviewInitial Interview

General orienting questions:General orienting questions:

– What do you think hope is?What do you think hope is?

– Why is it important for residents to have hope?Why is it important for residents to have hope?

– What kinds of things generally do you think staff can do What kinds of things generally do you think staff can do to facilitate a resident’s hope?to facilitate a resident’s hope?

– Request to bring an image of hope and a photograph or Request to bring an image of hope and a photograph or two for the workshoptwo for the workshop

WorkshopWorkshop

Introductions and Overview of DayIntroductions and Overview of Day What is Hope? (activity)What is Hope? (activity) Presentation (understanding and intentionalising hope)Presentation (understanding and intentionalising hope)

– Finding HopeFinding Hope– Reflections of Hope JournalReflections of Hope Journal– Making a Difference Making a Difference – Hope ImagesHope Images– Hopeful Things to Say to YourselfHopeful Things to Say to Yourself– Being HopefulBeing Hopeful– Hope KitsHope Kits– Video Video “This Thing Called Hope”“This Thing Called Hope”– ““Homework” ActivityHomework” Activity– The Importance of Nurturing Self HopeThe Importance of Nurturing Self Hope

Post Workshop InterviewPost Workshop Interview

Conversation with staff to talk about how they Conversation with staff to talk about how they might be using hope.might be using hope.

What did they take from the workshop that helped What did they take from the workshop that helped them in their practice?them in their practice?

Analysis Analysis

Tapes were transcribed verbatimTapes were transcribed verbatim Transcripts were read and re read by researcher and Transcripts were read and re read by researcher and

research assistantresearch assistant Coded and reviewed for themesCoded and reviewed for themes Conversations between researcher and research assistant Conversations between researcher and research assistant Reflection on themes and meaningsReflection on themes and meanings Reflection on learnings from interview 1 to interview 2Reflection on learnings from interview 1 to interview 2 Beginning reflection on theoretical perspectivesBeginning reflection on theoretical perspectives

General Observations General Observations

Common belief that when people enter long term care, they Common belief that when people enter long term care, they lose hope, see it as the “beginning of the end”. “lose hope, see it as the “beginning of the end”. “Come here Come here to die. Everything is taken away from them”. to die. Everything is taken away from them”.

““Hope is not something that someone coming into long Hope is not something that someone coming into long term care has a lot of, because they are coming in and term care has a lot of, because they are coming in and they pretty well know they are going to die”.they pretty well know they are going to die”.

Some understanding that there is a reciprocity about hope Some understanding that there is a reciprocity about hope ““give it but you get a lot back”. give it but you get a lot back”.

Also reflected in the fear that lack of hope in staff will be Also reflected in the fear that lack of hope in staff will be sensed by residents.sensed by residents.

Many had not thought intentionally about hope or about Many had not thought intentionally about hope or about instilling hope. instilling hope.

When asked to reflect about its role, they were able to When asked to reflect about its role, they were able to recognize its importance and realize that they often behave recognize its importance and realize that they often behave in ways that generate hope.in ways that generate hope.

Some did not see ways to generate hope because they Some did not see ways to generate hope because they viewed hope as “viewed hope as “hope for a cure – hope for discharge”. hope for a cure – hope for discharge”.

They did see it important to make life comfortable for They did see it important to make life comfortable for residents.residents.

Several people expressed interest in learning how Several people expressed interest in learning how to instill hope in others.to instill hope in others.

Conceptions of Hope (First Interview Set)Conceptions of Hope (First Interview Set)

How hope is defined.How hope is defined.– Hope gives a reason to get up, it facilitates Hope gives a reason to get up, it facilitates “living life to the full”. “living life to the full”.

Hope gives meaning to life and it engenders a sense of home. Hope gives meaning to life and it engenders a sense of home. ““When they have no hope, they want to die”.When they have no hope, they want to die”.

– Faith and spirituality “Faith and spirituality “hope is tied to faith. That’s where hope comes hope is tied to faith. That’s where hope comes from”. from”.

– Hope is how you live itHope is how you live it– Hope is also having peaceHope is also having peace– Individual and internalIndividual and internal

How Do You Foster Hope?How Do You Foster Hope?

In simple thingsIn simple things talking, encouraging, recognizing the person, creating a sense of talking, encouraging, recognizing the person, creating a sense of

home, giving a hug, involving in activities to create a sense of purpose home, giving a hug, involving in activities to create a sense of purpose and meaning, sharing kindness and tenderness, make life better, and meaning, sharing kindness and tenderness, make life better, creating opportunities to look forward, giving empathy, understanding, creating opportunities to look forward, giving empathy, understanding, simple hellos, comfort, reassurancesimple hellos, comfort, reassurance

In “being with” In “being with” going beyond the task going beyond the task ““whenever I have some who is dying, I go in and sit with them and hold whenever I have some who is dying, I go in and sit with them and hold

their hand, and read to them so they know that we are right here and their hand, and read to them so they know that we are right here and they won’t be alone”.they won’t be alone”.

Creating magic momentsCreating magic moments people create hope in their own unique ways (reading, saying a people create hope in their own unique ways (reading, saying a

prayer, getting a cup of coffee)prayer, getting a cup of coffee) responding to a need responding to a need developing a sense of trust developing a sense of trust

Hope in the Present Hope in the Present ““I always felt we had to give them hope on a daily basis to do I always felt we had to give them hope on a daily basis to do

the things that they can do… bring laughter, family, join in the things that they can do… bring laughter, family, join in activities… so the could actually know that they’re living the activities… so the could actually know that they’re living the best they can in the time they have”best they can in the time they have”

General Observations (Post Workshop)General Observations (Post Workshop)

More aware of hope, broadened understanding More aware of hope, broadened understanding

Discovered that hope means different things to Discovered that hope means different things to different peopledifferent people

More intentional about how they might foster hopeMore intentional about how they might foster hope

A deeper understanding that hope is possibleA deeper understanding that hope is possible

Conceptions of Hope (Second Interview Set)Conceptions of Hope (Second Interview Set)

Expanded understanding of hope and its importance.Expanded understanding of hope and its importance. ““It’s good to spread the word about hope, you know, because it gives a It’s good to spread the word about hope, you know, because it gives a

whole different perspective”. whole different perspective”.

Awareness that personal hope needs attentionAwareness that personal hope needs attention ““I have started some journalling”.I have started some journalling”. ““I’ve started intentionally taking time to nurture my own spirit and hope”. I’ve started intentionally taking time to nurture my own spirit and hope”.

View it in a different light, it is possible regardless of ability View it in a different light, it is possible regardless of ability or disability.or disability.

““Many families see entry to long term care as the beginning of the Many families see entry to long term care as the beginning of the end…. With hope, it can be an active kind of living even at the end of end…. With hope, it can be an active kind of living even at the end of your life”. your life”.

Hope carries over to personal experience.Hope carries over to personal experience. ““You can’t give something that you don’t have. You You can’t give something that you don’t have. You

have to fill your own cup first, and others will be have to fill your own cup first, and others will be touched by the overflow”.touched by the overflow”.

Hope is a life well lived, a life that has had meaning.Hope is a life well lived, a life that has had meaning.

Recognizing that hope is be experienced in the little things.Recognizing that hope is be experienced in the little things.

Recognition for some that they have already been Recognition for some that they have already been (unconsciously) giving hope (unconsciously) giving hope

How Do You Foster Hope?How Do You Foster Hope?

Lend hope: an understanding that this is possibleLend hope: an understanding that this is possible ““The more you give, the more you get”.The more you give, the more you get”.

Things that make a differenceThings that make a difference ““Well, you know, life is so wonderful, and to touch someone’s life and make a Well, you know, life is so wonderful, and to touch someone’s life and make a

difference, can only enrich your own life”.difference, can only enrich your own life”.

Find out the circumstances people are in and convey understanding (to Find out the circumstances people are in and convey understanding (to residents and families)residents and families)

““Hearing them, being with them. You don’t need a solution. Help them to be Hearing them, being with them. You don’t need a solution. Help them to be hopeful and know they will be heard”. hopeful and know they will be heard”.

““I try to walk in their shoes”.I try to walk in their shoes”.

Caring and show that caringCaring and show that caring ““Hope is knowing that someone cares. You know, shares what you are going Hope is knowing that someone cares. You know, shares what you are going

through”.through”. ““It’s not what you do or say, it’s how you make them feel that they’ll remember”.It’s not what you do or say, it’s how you make them feel that they’ll remember”.

The telling and hearing of stories The telling and hearing of stories

““Being with” the resident (just giving them hope Being with” the resident (just giving them hope people will be around them)people will be around them)

Hope in simple things Hope in simple things an ice cream cone an ice cream cone

ConclusionsConclusions

Hope is in the small thingsHope is in the small things ““Hope is making a difference. If it’s just to hold their hand, you might Hope is making a difference. If it’s just to hold their hand, you might

not know what you do for them, but you know, hope has made a not know what you do for them, but you know, hope has made a difference to them”.difference to them”.

The day to dayThe day to day ““Hope is an everyday thing in long term care. It’s that sort of present Hope is an everyday thing in long term care. It’s that sort of present

experience because there may not be that much of a future”. experience because there may not be that much of a future”.

Moments of hopeMoments of hope ““In the moment, there is hope. Hope and memory function in so In the moment, there is hope. Hope and memory function in so

much of this stuff and when people don’t have a working memory, much of this stuff and when people don’t have a working memory, then you have to have your moments, and that’s when you have to then you have to have your moments, and that’s when you have to lend hope”.lend hope”.

Hope in the nowHope in the now ““It’s understanding how the little things that you just normally do It’s understanding how the little things that you just normally do

or don’t think about, just understanding that it does make a or don’t think about, just understanding that it does make a difference”.difference”.

Need for a hope advocateNeed for a hope advocate

Being with is often enough (can rekindle hope)Being with is often enough (can rekindle hope)

Convey caringConvey caring

Simple things holding a handSimple things holding a hand

Hope is not just about the residents its about meHope is not just about the residents its about me

Implications for Practice in Long Term CareImplications for Practice in Long Term Care Commitment from leadership regarding the importance of hope in Commitment from leadership regarding the importance of hope in

practicepractice Reinforce the importance of hope in the small things Reinforce the importance of hope in the small things Moments of Moments of

HopeHope Convey the possibility of hope regardless of ability or disabilityConvey the possibility of hope regardless of ability or disability Reinforce the need to add to the personal hope bank and the resident Reinforce the need to add to the personal hope bank and the resident

hope bankhope bank Intentional efforts to make hope visible (images, stories, music)Intentional efforts to make hope visible (images, stories, music) Integrate fostering hope as part of practice (regularly schedule events Integrate fostering hope as part of practice (regularly schedule events

and activities, part of orientation of new staff)and activities, part of orientation of new staff) Communicate hope and hope storiesCommunicate hope and hope stories Look for hope and share what is foundLook for hope and share what is found Celebrate hopeCelebrate hope

Hope is the dawning of a new day

Hope is seen in the eyes, Hope is heard in the voice,Hope is held in the heart.