Oxford Radcliffe Hospitals
NHS Trust
NHS
The concept of hope in orthopaedic trauma and stroke care
1Trauma
Elizabeth Tutton1,3, Kate Seers3, Debbie Langstaff1, Martin Westwood2
Unit, John Radcliffe Hospital, 2Stroke Unit, John Radcliffe Hospital, 3RCN Research Institute, University of Warwick
Contact: liz.tutton@warwick.ac.uk
Background
Methodology
In general the concept of hope is appealing because it focuses on how
people survive and look forward to life despite the many traumas and
disruptive events that occur. The practical utility of hope in acute settings
is important as it may affect the nature of the care received. This study
provides an understanding of what hope means to both people living with
injury or a stroke and the staff who care for them on a Regional Trauma
Unit and Regional Stroke Unit.
The study drew on the principles of ethnography. In each unit 21 hours of
participant observation and in depth qualitative interviews with 10 patients
and 10 multidisciplinary members of staff were undertaken. In addition
two focus groups with staff were held to explore and expand preliminary
findings from the study. Data collection took place between March 2007
and October 2007. Data were analysed by sentence and coded using QSR
N6 as a means of managing the data.
Findings
The findings identified four themes that conveyed the meanings of hope in trauma and stroke care: suffering; struggling with no hope and despair; hope for
recovery (moving forward and finding a future) and realistic hopefulness. These themes are conveyed within a conceptual framework of hope.
Realistic hopefulness
„So I think anybody in any aspect, you know the relative, the
patient, the nurse, will never deal in “definites” and I think
you‟re naïve if you do in terms of what you say to people. But
then I think often people think you‟re hedging your bets and
fudging the scenario, well you are because you just don‟t want
to say to somebody oh yeah they‟re going to get up and walk
out of here because you don‟t know if they are‟.
(Trauma staff 1)
Hope for recovery
„I do think you could consider hope as both the
fuel and the catalyst to patient‟s recovery in a
way, you can‟t measure it but it appears to me
that that‟s what it is‟.
(Trauma Staff 10)
Struggling with no hope and despair
„If I let go its easy, my emotions drop everything drops. I get
into my depressive bit and that‟s it, I would be gone. I could
really make myself go‟.
(Stroke Patient 6)
Suffering
„Yes I have a physical job and I
walk a lot. I never sit down for
more than five minutes. For me to
sit down for hours and hours on end
is torture basically‟.
(Stroke Patient 2)
Hope for recovery
„Hope, hope for the future for my recovery yes. Yes it has given me
wonderful hope. Because I‟d have thought in the old days if you broke
your hip, you had to lie flat and they were not moving for months
….really they have been very optimistic all the time and they encourage
you….I would say its given me a lot of hope for the future‟.
(Trauma Patient 5)
Conclusion
Hope in this study represents the artistic blending of a range of theories into a practical activity that has relevance to daily ward life. A conceptual framework
is presented that provides a basis for reflection on the tensions inherent in facilitating hope in practice such as: information giving when there is uncertainty;
finding balance in the emotional labour/work on the unit; valuing idealistic hope but working with pragmatic hopes.
References
Lohne V. (2008) The battle between hoping and suffering. A conceptual model of hope within the context of spinal cord injury. Advances in Nursing Science. 31(3), 237-248. Morse J. M. & Penrod J. (1999) Clinical scholarship. Linking concepts of enduring, uncertainty, suffering, and hope.
Image: Journal of Nursing Scholarship 31, 145-150. Turner D. S. & Stokes L. (2006) Hope promoting strategies of registered nurses. Journal of Advanced Nursing 56, 363-372.