Dame Cicely Saunders, the founder of St. Christopher's Hospice, near London,
once wrote in connection with the care of people who are terminally ill:
"You matter because you are you, you matter to the last moment of your life
and we will do all we can, not only to help you die peacefully, but to live
until you die."
It is the contention of this paper, that having hope is an important part of
being able to live until you die; in other words hope is a factor which
relates to the quality of life a person may have. Hope is worth fostering.
Hope is an important part of human life in all sorts of situations:
consider, for example, this situation different from the hospital context.
Imagine, if you will, a self-employed businessman who has been working
desperately for month after month to rescue his business from the awful
prospect of bankruptcy and receivership. Each month that passes seems longer
than the previous one, the financial figures get worse and worse, more and
more gloom and doom pervade the business; not just the owner but everyone
employed show the stress and strain on their faces, the worry and anxiety,
the fatigue and exhaustion; everyone has been trying so hard and yet the
company is still a long way from coming out of the wood. People are losing
hope and beginning to despair. But then one day the manager receives a phone
call: would he consider a substantial injection of cash from another
businessman who is now retiring and who would like to become a sleeping
partner in the firm. This is just what is needed, for ages the banks would
lend no more money; but now with some extra capital, new equipment can be
purchased, a new sales drive mounted and old debts paid off. As the news is
passed from person to person that the owner has accepted the offer of the
sleeping partner, it is as if an enormous surge of energy wells up and takes
hold of everyone in the company. There is new hope for the future, a new
sense of vitality is felt, excitement replaces dreariness and all the gloom
and doom. A new determination to weather the storm and come through is
expressed on many faces.
From our own differing experiences throughout our lives, we know the
difference it makes when we feel hopeful; without hope life feels flat and
dreary and lacking in vitality; with hope life is an adventure, a
challenge, it has a different feel and meaning to it.
I want now to move back to the hospital context, or at least to the world of
caring for people and not just people who are terminally ill. I share with
you seven factors which may help to foster hope in a person's life, and I
will say something about each of these factors in turn, and then will go on
to look with you, very briefly, at some factors which hinder or diminish
hope. I have been helped in what I have written by a book called "Mud and
Stars" about the impact of hospice experience on the Church's Ministry of
Healing and, in particular, by an article by Dr Kaye Herth in the Journal of Advanced Nursing called "Fostering Hope in terminally ill people"
in which she listed seven factors helping to foster hope. See Footnote
The seven factors helping to foster hope are as follows:
1. Having meaningful relationships with others (or at least one other)
2. Having attainable aims
3. Having a spiritual base
4. Personal attributes
6. Uplifting memories
7. Affirmation of worth.
1. Having Meaningful Relationships
People who were interviewed for Dr Herth’s article about what helped them when they were ill
to feel supported and hopeful, said things such as the following: “it is important for me to have a sense of being needed, of being part of something;
it helps me to have someone who shares my journey and walks with me; it means much to me to have a friend who shares a part of their self with me;
it is good to have others who radiate hope so I feel hope; it matters to me to have a feeling that another person is truly present with me;
the touch or the hug that communicates ‘I am with you’ is remembered.” Perhaps what all these different things are saying is that it helps
greatly through an illness, through a crisis, to have support, to feel the empathy of others, their solidarity with you, their deep concern and love for you,
their willingness to listen and to try and understand. All such support be it from family or friend, from hospital staff or visitors,
helps to foster hope for the future, even if it is only the hope that the person will not be abandoned or left alone.
2. Attainable Aims
It is one thing to have hope for the future, but are these hopes realistic,
are they attainable aims? It has been noticed that in the case of terminal
illnesses while a person is quite well, he or she will have various hopes
for the future which relate to themselves; for instance, I would like to get
home to tend to my roses, I would like to visit my relatives in their homes,
I would like to get to my nephew's wedding next Spring. However, as their
illness progresses their hopes focus less on themselves and more on those
whom they love, they are concerned with envisioning a positive outcome in
the lives of those they love; but when death comes close the person
re-focuses on themselves, hoping for a peaceful death, for serenity, for
inner peace - these are hopes less concerned with 'doing' than with 'being'
- being at peace, being released from sickness, having eternal rest.
Both the person who is ill as well as those with whom they talk are
concerned then with this task of focusing on attainable aims. It may no
longer be realistic to hope for some things or to do some things, but others
may be more readily fulfilled. Perhaps an elderly person is having to give
up their home and move into sheltered housing or a nursing home; new hope
may be fostered in the person, and the future looked forward to. I am not
suggesting that re-focusing one's hopes onto different and more attainable
aims will necessarily be an easy task - it may be very difficult, for some
there may be much inner turmoil and distress, anger or rage as adjustments
are attempted to be made. We should note that one aim or hope people, who are
terminally ill, sometimes have is the hope to become reconciled with someone
from whom they have been estranged. Sometimes too a person hopes to come to
be at peace with God. The work of thinking what are attainable aims and of
fostering hope in relation to them is worthwhile.
3. Spiritual Base
For many people this will mean having a faith in God; for others it will
relate to their value system and their belief in the significance of life
and their search for a meaning to death. "God is my refuge and strength" the
Psalmist wrote, "all my hope on God is founded" we sing. For the believer,
God is a source of hope for both this life and the next "changed from glory
into glory, till in heaven we take our place, till we cast our crowns before
Him, lost in wonder, love and praise". Believing, hoping, trusting in God
help a person to move trustingly into the future. There are many hopes
connected with faith in God: for example, I may hope that through my illness
God will find ways to use me, I may hope that there will be ways for me to
witness to love and courage, I may hope to grow closer to God, to mature and
deepen spiritually. I may hope that tomorrow will bring new blessings, as
God remains unceasingly active around me and in me.
4. Personal Attributes
Once again when people were asked what they felt were the most important
personal attributes to have through an illness, attributes which helped them
to live with hope, there was a consensus on three main ones: determination,
courage and serenity. Whether you are living with multiple sclerosis or
recovering from a stroke or living with some other illness, to have
determination, courage and serenity will greatly strengthen you in your
inner being, in your relationship with others and with God - they will help
you maintain an outlook that includes hope for the future, even if some
hopes have to be altered from time to time. It is something of a mystery how
other people's prayers and presence impart to another person new strength so
that resources of determination, courage and serenity do not fail, but in
practice it can and does happen.
Humour allows a sense of the ridiculous to lighten the load. Laughter can
strengthen bonds, ease tensions, make the unbearable seem bearable.
Light-heartedness , by dispelling some of the gloom and despair, can lift
people's spirits fostering and fanning the flames of hope.
6. Uplifting Memories
To think back over the good times, to share memories with others, to look
back over the years and recall how other difficulties were weathered, to
remind oneself of many blessings - all of this activity may help to sustain
a person; and if they believe in God, to renew their sense of the care and
goodness of God, enabling them to move forward with hope and faith.
7. Affirmation of Worth
To know I matter, am loved unconditionally, accepted for myself, as I am,
strengthens me in my inner being, helps me feel better. I am not just a
burden, not just useless, people are genuinely concerned for me, are
sincerely working for my well being and my good. If a person believes in God,
they may remind themselves that God remains ever loving and faithful - all
these ways of affirming one's worth help to foster an attitude of
positiveness and hope.
So much for factors, which help to foster hope, but what, briefly, may
hinder or diminish hope within a person? I list the following for your
consideration: being mentally isolated by a 'conspiracy of silence' or by
inadequate explanations of what is happening, or why you are feeling as you
do or when fears and questions are not properly addressed or answered. Hope
is diminished when it is implied that there is nothing more which can be
done, when pain and other symptoms remain unrelieved, when symptoms such as
depression are ignored, when the person feels alone or unsupported, when
spiritual distress is not recognised, when the future seems to be no more
than an insufferable mountain of problems and/or an unrelieved catastrophe.
I believe all us can foster hope in the people we meet: for some of us it
may be through our gift for light-heartedness, for others through the
strength we seem to impart, for others through our listening, but for all of
us through our loving, accepting and affirming other people as we seek to
reach out with the love which God has given us to share with others.
Journal of Advanced Nursing, 1990, 15, 1250-1259 Fostering hope in terminally-ill people Kaye Herth PhD RN Assistant Professor, Graduate Programme, School of Nursing,
Northern Illinois University, 1240 Normal Road, DeKalh, Illinois 60115-2894, USA Accepted for publication 13 March 1990 HERTH K (1990) Journal of Advanced Nursing 15,1250
I wrote this article some years ago for a study day for lay visitors who assisted the Chaplaincy team in a large hospital where I was working in pre Covid 19 days.
For more articles