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HOPELESSNESS Nursing Care Plan

Hopelessness

NANDA-I Definition
Subjective state in which an individual sees limited or no alternatives
or personal choices available and is unable to mobilize
energy
on own behalf
Defining Characteristics
Major (Must Be Present, One or More)
Expresses profound, overwhelming, sustained apathy in response
to a situation perceived as impossible.
States “My future seems dark to me”

Physiologic
Increased sleep
Lack of energy
Decreased response to stimuli*
Emotional
Person Feels:
As though they do not receive any breaks and there is no reason
to believe they will in the future
Empty or drained
Demoralized
Helpless
Incompetent or trapped
Lack of meaning or purpose in life
Sense of loss and deprivation
Unable to seek good fortune, luck, God’s favor
Person Exhibits:
Passivity* and lack of
involvement in care
Decreased affect*
Giving up–given up complex
Lack of responsibility for
decisions and life
Isolating behaviors
Negative present and future
comments
Decreased verbalization*
Lack of ambition, initiative*,
and interest
Inability to accomplish
anything
Slowed thought processes
Demoralization
Fatigue
Participation in health related
risk-taking behaviors such
as failure to wear seat belt,
helmet, or driving while
intoxicated
Cognitive
Focus on past and future, not here and now
Decreased flexibility in thought processes
Rigidity (e.g., all-or-none thinking)
Lack of imagination and wishing capabilities
Inability to identify or accomplish desired objectives and goals
Inability to plan, organize, make decisions, or problem-solve
Inability to recognize sources of hope
Suicidal thoughts
Minor (May Be Present)
Physiologic
Anorexia Weight loss
Emotional
Person Feels:
A lump in the throat
Tense
Discouraged
Overwhelmed and exhausted
At the end of his or her rope
Loss of gratification from roles
and relationships
Vulnerable
Person Exhibits:
Poor eye contact
Decreased motivation
Sighing
Regression
Resignation
Fatigue (Hammell, Miller,
Forwell, Forman, &
Jacobson, 2009)
Cognitive
Decreased ability to integrate information received
Loss of time perception (past, present, and future)
Decreased ability to recall from the past
Inability to communicate effectively
Distorted thought perceptions and associations or confusion
Unreasonable judgment
Related Factors
Pathophysiologic
Any chronic or terminal illness (e.g., heart disease, diabetes,
kidney disease, cancer, acquired immunodeficiency syndrome
[AIDS]) can cause or contribute to hopelessness.
Related to impaired ability to cope secondary to the following:
Failing or deteriorating physiologic condition
New and unexpected signs or symptoms of previously diagnosed
disease process (i.e., recurrence of cancer) (Brothers and
Anderson, 2009).
Prolonged pain, discomfort, and weakness
Impaired functional abilities (walking, elimination, eating,
dressing,
bathing, speaking, writing)
Treatment Related
Related to:
Prolonged treatments (e.g., chemotherapy, radiation) that cause
pain, nausea, and discomfort
Treatments that alter body image (e.g., surgery, chemotherapy)
Prolonged diagnostic studies
Prolonged dependence on equipment for life support (e.g., dialysis,
respirator)
Prolonged dependence on equipment for monitoring bodily
functions (e.g., telemetry)
Situational (Personal, Environmental)
Related to:
Prolonged activity restriction (e.g., fractures, spinal cord injury,
imprisonment)
Prolonged isolation (e.g., infectious diseases, reverse isolation for
suppressed immune system)
Abandonment by, separation from, or isolation from significant
others (Brothers and Anderson, 2009)
Inability to achieve valued goals in life (marriage, education,
children)
Inability to participate in desired activities (walking, sports,
work)
Loss of something or someone valued (spouse, children, friend,
financial resources)
Prolonged caretaking responsibilities (spouse, child, parent)
Recurrence of breast cancer
Exposure to long-term physiologic or psychological stress
Recurrence of breast cancer (Brothers & Anderson, 2009)
Loss of belief in transcendent values/God
Ongoing, repetitive losses in community related to AIDS
Repetitive nature disasters (hurricanes, tornadoes, flooding, fires)
Prolonged exposure to violence and war
Maturational
Child
Loss of autonomy related to illness (e.g., fracture)
Loss of bodily functions
Loss of caregiver
Loss of trust in significant other
Inability to achieve developmental tasks (trust, autonomy,
initiative,
industry)
Rejection, abuse, or abandonment by caregivers
Adolescent
Change in body image
Inability to achieve developmental task (role identity)
Loss of bodily functions
Loss of significant other (peer, family)
Rejection by family
Adult
Abortion
Impaired bodily functions, loss of body part
Impaired relationships (separation, divorce)
Inability to achieve developmental tasks (intimacy, commitment,
productivity)
Loss of job, career
Loss of significant others (death of spouse, child)
Miscarriage
Older Adult
Cognitive deficits
Inability to achieve
developmental tasks
Loss of independence
Loss of significant others,
things (in general)
Motor deficits
Sensory deficits

Author's Notes
Hopelessness describes a person who sees no possibility that his or
her life will improve and maintains that no one can do anything to help.
Hopelessness differs from Powerlessness in that a hopeless person sees
no solution or no way to achieve what is desired, even if he or she
feels in control. In contrast, a powerless person may see an alternative
or answer, yet be unable to do anything about it because of lack
of control or resources. Sustained feelings of powerlessness may lead
to hopelessness. Hopelessness is commonly related to grief, depression,
and suicide. For a person at risk for suicide, the nurse should also use
the diagnosis Risk for Suicide. A study by Brothers and Anderson (2009)
supported
the view that hopelessness is a distinct concept and not
merely a symptom of depression.

Goals
• Demonstrate increased energy, as evidenced by an increase in
activities (e.g., self-care, exercise, hobbies).
• Express desirable expectations for the near future. Describe
one’s own meaning and purpose in life.
• Demonstrate initiative, self-direction, and autonomy in
decision-making. Demonstrate effective problem-solving
strategies.
• Redefine the future, setting realistic goals with expectation to
meet these goals.
• Exhibit peace and comfort with situation.

The client will strive for the goals listed above as evidenced by the
following indicators:
• Shares suffering openly and constructively with others.
• Reminisces and reviews life positively.
• Considers values and the meaning of life.
• Expresses optimism about the present.
• Practices energy conservation.
• Develops, improves, and maintains positive relationships with
others.
• Participates in a significant role.
• Expresses spiritual beliefs.
Interventions
Assist Client to Identify and Express Feelings
• Listen actively, treat the client as an individual, and accept his
or her feelings. Convey empathy to promote verbalization of
doubts, fears, and concerns.
• Validate and reflect impressions with the person. It is important
to realize that clients with cancer often have their own
reality, which may differ from the nurse’s.
• Encourage expressions of how hope is uncertain and areas in
which hope has failed the client.
• Assist the client in recognizing that hopelessness is part of
everyone’s life and demands recognition. The client can use
it as a source of energy, imagination, and freedom to consider
alternatives. Hopelessness can lead to self-discovery.
• Assist the client to understand that he or she can deal with the
hopeless aspects of life by separating them from the hopeful
aspects. Help the client to identify and to acknowledge areas of
hopelessness. Help the client to distinguish between the possible
and impossible.
• The nurse mobilizes a client’s internal and external resources
to promote and instill hope. Assist clients to identify their
personal reasons for living that provide meaning and purpose
to their lives.
Assess and Mobilize the Client’s Internal Resources (Autonomy,
Independence, Rationality, Cognitive Thinking, Flexibility,
Spirituality)
• Emphasize strengths, not weaknesses.
• Compliment the client on appearance or efforts as appropriate.
• Promote motivation.
• Identify reasons for living.
• Identify client’s perception of hope.
• Identify areas of success and usefulness; emphasize past
accomplishments.
Use this information to develop goals with
the client.
• Assist the client in identifying things he or she has fun doing
and perceives as humorous. Such activities can serve as distractions
to discomfort and allow the client to progress to cognitive
comfort (Hinds, Martin & Vogel, 1987).
• Assist the client in identifying sources of hope (e.g., relationships,
faith, things to accomplish).
• Assist the client in adjusting and developing realistic short- and
long-term goals (progress from simple to more complex; may
use a “goals poster” to indicate type and time for achieving
specific goals). Attainable expectations promote hope.
• Inspire hope by reflecting on the following metaphors of hope:
• Living in hope is a living dimension
• Hoping for something is a doing dimension
• Hope as a light on the horizon is a becoming dimension
• Hope as a human-to-human relationship is a relational
dimension
• Hope versus hopelessness: two sides of the same coin is a
dialectic dimension
• Hope as a weathering storm is a situational and dynamic
dimension
• Teach the client to monitor specific signs of progress to use as
self-reinforcement.
• Encourage “means–end” thinking in positive terms (i.e., “If I
do this, then I’ll be able to . . .”).
• Foster lightheartedness and the sharing of uplifting memories.
Assist the Client With Problem Solving and Decision-Making
• Respect the client as a competent decision-maker; treat his or
her decisions and desires with respect.
• Encourage verbalization to determine the client’s perception of
choices.
• Clarify the client’s values to determine what is important.
• Correct misinformation.
• Assist the client in identifying those problems he or she cannot
resolve to advance to problems he or she can. In other words,
assist the client to move away from dwelling on the impossible
and hopeless and to begin to deal with realistic and hopeful
matters.
• Assess the client’s perceptions of self and others in relation to
size. (People with hopelessness often perceive others as large
and difficult to deal with and themselves as small.) If perceptions
are unrealistic, assist the client to reassess them to restore
proper scale.
• Promote flexibility. Encourage the client to try alternatives and
take risks.
Assist Client to Learn Effective Coping Skills
• Assist the client with setting realistic, attainable short- and
long-term goals.
• Teach the importance of mutuality in sharing concerns.
• Teach the value of confronting issues.
• Allow the client time to reminisce to gain insight into past
experiences.
• Explain the benefits of distraction from negative events.
• Teach and assist with relaxation techniques before anticipated
stressful events.
• Encourage mental imagery to promote positive thought
processes.
• Teach the client to “hope to be” the best person possible today
and to appreciate the fullness of each moment.
• Teach the client to maximize aesthetic experiences (e.g., smell
of coffee, back rub, feeling warmth of the sun, or a breeze) that
can inspire hope.
• Teach the client to anticipate experiences he or she delights in
daily (e.g., walking, reading favorite book, writing a letter).
• Assist the client to express spiritual beliefs (Jennings, 1997).
• Teach the client ways to conserve and generate energy through
moderate physical exercise.
• Encourage music therapy, aromatherapy, and message with
essential oils to improve the client’s physical and mental status.
Assess and Mobilize the Client’s External Resources
Family or Significant Others
• Involve the family and significant others in plan of care.
• Encourage the client to spend increased time or thoughts with
loved ones in healthy relationships.
• Teach the family members their role in sustaining hope
through supportive, positive relationships.
• Discuss the client’s attainable goals with family.
• Empower clients who have chronic disease by instilling hope
through the bolstering of support systems.
• Convey hope, information, and confidence to the family
because
they will convey their feelings to the client.
• Use touch and closeness with the client to demonstrate to the
family its acceptability (provide privacy).
• Herth (1993) found the following strategies to foster hope in
caregivers of terminally ill people:
• Cognitive reframing—positive self-talk, praying/meditating,
and envisioning hopeful images (this may involve letting go
of expectations for things to be different)
• Time refocusing—focusing less on the future and more on
living
one day at a time
• Belief in a power greater than self—empowering the caregiver’s
hope
• Balancing available energy—listening to music or other
favorite activities to empower the caregiver’s hope through
uplifting energy
Health Care Team
• Develop a positive, trusting nurse–client relationship by:
• Answering questions
• Respecting client’s feelings
• Providing consistent care
• Following through on requests
• Touching
• Providing comfort
• Being honest
• Conveying positive attitude
• Convey attitude of “We care too much about you to let you
just give up,” or “I can help you.”
• Hold conferences and share the client’s goals with staff.
• Share advances in technology and research for treatment of
diseases.
• Have available a list of laughter resources (e.g., books, films).
• Provide nurses and caregivers support in times of disaster.
Support Groups
• Encourage the client to share concerns with others who have
had a similar problem or disease and positive experiences from
coping effectively with it.
• Provide information on self-help groups (e.g., “Make today
count”—40 chapters in the United States and Canada; “I can
cope”—series for clients with cancer; “We Can Weekend”—
for families of clients with cancer).
God or Higher Powers
• Assess the client’s belief support system (value, past experiences,
religious activities, relationship with God, meaning and
purpose of prayer; refer to Spiritual Distress).
• Create an environment in which the client feels free to express
spirituality.
• Allow the client time and opportunities to reflect on the meaning
of suffering, death, and dying.
• Accept, respect, and support the client’s hope in God.
Pediatric Interventions (Adolescent)
• Provide truthful explanations.
• Engage in activities.
• If appropriate, discuss knowledge of survivors.
• Focus on future.
• Discuss topics interesting to the child.
• Use humor if appropriate.

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