Running head: HOPELESSNESS: A CONCEPT ANALYSIS PAPER
Hopelessness: A Concept Analysis
Trina Skinner
Stenberg College
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HOPELESSNESS: A CONCEPT ANALYSIS PAPER
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Hopelessness: A Concept Analysis
The objective of this paper is to offer an analysis, “separation of a whole into its
component parts” (Merriam-Webster, 2012) of the concept of hopelessness and the residual
effects that a feeling of hopelessness may have on an individual’s psychological health. In
deconstructing the concept of hopelessness this paper will address three defining characteristics
of hopelessness. Hopelessness and depression, risk for suicidality, and insufficient or
maladaptive coping skills are all examples of circumstances that create or exacerbate an
environment that breeds hopelessness.
Hopelessness can be defined as “a manner of thinking and feeling which frames life with
negative perceptions of the present and bleak expectations about the future” (Barker, 2009, p.
184). A person experiencing feelings of hopelessness generally anticipates that there is no way
for life to improve, upholding the belief that he or she is powerless in effecting any positive
change. (Barker, 2009, p. 184). The nature of a hopeless person’s thought process and content is
often of a very narrow manner.
In attempt to provide a sufficient concept analysis of ‘hopelessness’ it is crucial that the
reader is aware of the hopelessness theory of depression (Abramson et al, 1989). The theory
suggests that “inferred negative consequences and negative characteristics about the self
contribute to the formation of hopelessness, and in turn the symptoms of hopelessness contribute
to depression” (Stuart, 2009, p. 289). This author explains that the hopelessness theory is thus
closely linked to the cognitive model of depression. The cognitive model of depression “proposes
that people experience depression because their thinking is disturbed” (Beck et al, 1979, as cited
in Stuart 2009). According to Stuart (2009), “Depression is seen as a cognitive problem
dominated by a person’s negative evaluation of self, the world, and the future” (p. 288).
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Although one must express caution in potentially regarding hopelessness and depression as
interchangeable terms, the relativity of this particular theory relies on the notion of feelings of
hopelessness as a precursor to depression. In identifying common behaviors associated with
depression, Stuart (2009), has separated these into four categories; affective, physiological,
cognitive, and behavioral. Hopelessness, helplessness, apathy, and sense of personal
worthlessness are some of the common examples of affective behaviors related to depression.
Some of the notable cognitive behaviors of depression which offer evidence of the presence of
hopelessness are ambivalence, loss of interest and motivation, pessimism, and self-destructive
thoughts due to the strong belief that there is no conceivable way that life will improve and
expectations for the future are dismal at best (p. 286). It is crucial that the psychiatric nurse be
properly educated and maintains a high level of awareness regarding signs and symptoms of
depression in assessing a person’s feelings of hopelessness. Social stigma must also be
considered in regards to nursing intervention concerning hopelessness and depression. Some
patients may deny feelings of hopelessness or depression and focus on identification of various
somatic complaints as physical symptoms are more socially acceptable than those of a
psychological nature (Stuart, 2009). In this case the nurse must be cognizant of what sort of
physical symptoms and behaviors are associated with depression in order to assess the individual
who is potentially struggling with feelings of hopelessness; offering encouragement to identify
and bring these feelings to the forefront to be assessed and managed in an effective manner that
enhances the person’s quality of life. Hopelessness in the depressed patient is extremely
dangerous as the hopeless person is not only expressing depressed mood and behaviors but
perseverates on the pessimistic view that life is unbearable and positive change is unfathomable.
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It is imperative that the prudent nurse always assess the potential for suicide in individuals living
with severe mood disturbances, such as hopelessness.
In considering the risk for suicidality as a defining characteristic of persons affected by
hopelessness, experience of a crisis is proven to generate feelings and thoughts of hopelessness
that may lead to attempted or completed suicide. (Barker, 2009, p. 184). In examining
personality traits and disorders related to suicidality, four aspects of personality “most closely
associated with increased risk of suicide are hostility, impulsivity, depression, and hopelessness”
(Dumais et al, 2005; Swann et al, 2005 as cited in Stuart, 2009, p. 318). A study conducted in
1994, Hope, hopelessness, and suicidality in college students, set out to “estimate the
associations among measures of hope, hopelessness, and suicidality” (Range and Penton, 1994).
Results were measured by a means of analyzing scores of 206 undergraduates attending the
University of Southern Mississippi on surveys that include the “Reasons for living inventory”,
the “Hopelessness scale, and the “Hope scale”. Not surprisingly the conclusion identified
“significant correlations [indicating] that as hope is increased, hopelessness decreased. This
conclusion emphasizes the importance of early detection of conceptual feelings of hopelessness
in the clinical setting as a potential means of decreasing the risk for suicidality. Those who
scored as relatively more suicidal had relatively fewer feelings of total hope...[and increased
feelings of hopelessness]” (Range & Penton, 1994). Various studies consistently report
hopelessness as a “key variable in linking depression to suicidal behavior” (Grewal & Porter,
2007; Hunter & O’Connor, 2003; Kuo, Gallo, & Eaton, 2004; MacLeod et al., 2005; Uncapher,
Gallagher-Thompson, Osgood, & Bongar, 1998) as cited in (Sun, 2011, p. 460).“Grewal and
Porter (2007) pointed out that hopelessness is found to correlate better with suicidal ideation than
depression, and is more precise than depression in predicting eventual suicide” (Sun, 2011, p.
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460). Findings indicate that individuals who had previously expressed hopelessness (1981)”
were 11.2 times more likely to have completed suicide over the 13-year follow-up period than
those who did not” (Kuo et al. (2004) as cited in Sun, 2011, p. 460). “When presented with a
situational problem to solve, a person whose thoughts are hopeless and rigid may conclude that
suicide is the only choice”. The hopeless person may view death as a means to an end, an
opportunity to escape the pain experienced in life (Barker, 2010, p. 184). In terms of nursing
intervention and selected rationales in the case of a person who is at risk for suicide as a result of
hopelessness, it is crucial that the nurse establishes open and honest communication with the
client, asking them outright “Have you thought about harming yourself in any way? If so what
do you plan to do? Do you have the means to carry out this plan?” (Townsend, 2011, p. 129).
Directly questioning the hopeless client about suicidal ideation will not result in the person
taking suicidal action. On the contrary, “most patients will be relieved to be asked about these
feelings” (Stuart, 2009, p. 318). Further effective intervention in the case of caring for a patient
suffering from a state of hopelessness, Stuart (2009), emphasizes the importance “that nurses
have a systematic way of evaluating a patient for the risk of suicide, preferably through the use
of a standardized suicide assessment tool and safety plan” (p. 318). Finally, Townsend, 2011,
reminds us that spending time with a client and expressing genuine concern for his or her
wellbeing is the most important aspect in working with the client at risk for suicide as a result of
hopelessness. “This provides a feeling of safety and security, while also conveying the message,
‘I want to spend time with you because I think you are a worthwhile person’” (p. 131).
A final characteristic of hopelessness is the impact a lack of adequate coping skills and
has on increased feelings of hopelessness within an individual. A person who is experiencing the
conceptual feelings of hopelessness tends to think in extremely narrow terms (as presented
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earlier), “This constriction in cognitive processes limits the range of understanding of situations
and potential choices that may be available for problem resolution” (Barker, 2010, p. 184).
In 2010, the Southern African Journal of HIV Medicine published an article based on the
study, Feelings of Hopelessness in Stable HIV-Positive Patients on Antiretrovirals. According to
conclusions drawn from this study, “the coping skills and styles individuals utilize to deal with
the stress of HIV infection greatly influence the psychological impact of this illness and potential
consequent feelings of hopelessness” (Moosa & Joonah, 2010). Although this study focuses
strictly on people living with HIV it is reasonable to deduce that an inventory of one’s coping
skills, based on effectiveness, therapeutic value, ability to access such skills, and willingness to
put healthy adaptive coping skills to use is applicable to all individuals living with any illness or
disorder that has the potential to compromise the quality of that persons mental health.
Maladaptive coping skills most certainly correlate with increased feelings of hopelessness and
depression in individuals already experiencing such debilitating states of altered perception.
“This small study suggests that hopelessness may be a common psychological distress
reaction…” The creators of this study recommend that the healthcare community “become aware
of this possibility and use the BHS [20-item Beck’s Hopelessness Scale] as a screening tool to
identify such individuals and refer them for basic psychotherapy to improve coping skills and
reduce feelings of hopelessness. The hopelessness theory proposes that it is not a trauma itself
that produces depression, but the belief that one has no control over the important outcomes in
life and therefore refrains from adaptive responses” (Seligman, 1975 as cited in Stuart, 2009, p.
289). In situations where a patient is suffering from the effects of hopelessness it is imperative
that the psychiatric nurse providing care is well educated and experienced in providing
therapeutic treatment that focuses on the development and implementation of effective coping
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skills. It is of critical importance that the nurse “Encourage verbalizations of honest feelings”.
Through exploration and discussion, the nurse is able to assist the client in identifying “symbols
of hope in his or her life” (Townsend, 2011, p. 128). During discussion with a client
experiencing feelings of hopelessness, it is important that the nurse become aware of situations
in which a sense of powerlessness or lack of control is communicated by the client. The nurse
may intervene by focusing on these perceived feelings, which in itself may assist the client in
regaining a feeling of control or power over his/her circumstance. “A sense of self-worth
develops and is maintained when an individual feels power over his or her own life situations”
(Townsend, 2011, p. 268).
In conclusion, hopelessness is a concept with far reaching implications within the context
of mental health. Hopelessness and depression, risk for suicidality, and a lack of effective coping
skill are three defining characteristics of the concept of hopelessness. It is imperative that a
competent and effective nurse in the psychiatric setting consider the effects and implications of
hopelessness in the psychologically disturbed client as a serious health deterrent, and should
therefore devise and put into practice an individual care plan taking the concept of hopelessness
into consideration when doing so, as a means of orchestrating the most relevant, effective and
caring approach to enhance the quality of a client’s holistic health and wellbeing. Modes of
intervention when considering the concept of hopelessness within the nursing process should be
multi-faceted, innovative, and detailed in order to address all causal factors associated with a
client’s diagnoses. A thorough comprehension of all aspects of hopelessness is necessary in
determining the most effective treatment modalities based on the clients individual needs. The
planning and implementation of nursing interventions surrounding the concept of hopelessness
first begins with the formation of a therapeutic relationship between nurse and client in which
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trust, respect, honesty, acceptance, and effective communication are paramount. Once a healthy
therapeutic relationship has been established, the nurse and client can seek out possible treatment
modalities in helping the person reduce feelings of hopelessness and hopefully regain a will to
live. Cognitive behavioral therapy, or other forms of group therapy that focus on restructuring
the disturbed thought process would likely be beneficial to a person suffering from hopelessness.
In some cases certain psychotropic medications used to treat depression may be necessary. If
anti-depressant medication is determined to be a reasonable intervention for a client, it should be
implemented in conjunction with psychotherapy. It is important to treat the underlying cause of
the person’s sense of hopelessness, simply prescribing medication with no opportunity to explore
and reframe one’s destructive thought patterns will only produce a ‘band-aid effect’ addressing
the symptoms without offering an opportunity for the person to reflect on and gain knowledge of
where this sense of hopelessness stems from in order to be able to better manage instances of
such feelings in the future. “Therapeutic relationships are the cornerstone of nursing practice
with people who are experiencing threats to their health” (Barker, 2009, p. 313), this principle
undoubtedly applies to the concept of hopelessness.
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References
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Moosa, M. Y., & Jeenah, F. Y. (2010). Feelings of hopelessness in stable HIV-positive patients
on antiretrovirals. The South African journal of HIV medicine. Department of Psychiatry,
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