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Staff  Utilization of Explicit Hope Facilitation Strategies in Long Term Care

Staff  Utilization of Explicit Hope Facilitation Strategies in Long Term Care. Sharon Moore, PhD, M.Ed., RN, BA sharon.moore@athabascau.ca. Acknowledgements. Athabasca University Study Participants Sheryl Plett Dr. Ronna Jevne Wendy Edey Hope Foundation of Alberta. Purpose.

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Staff  Utilization of Explicit Hope Facilitation Strategies in Long Term Care

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  1. Staff  Utilization of Explicit Hope Facilitation Strategies in Long Term Care Sharon Moore, PhD, M.Ed., RN, BA sharon.moore@athabascau.ca

  2. Acknowledgements • Athabasca University • Study Participants • Sheryl Plett • Dr. Ronna Jevne • Wendy Edey • Hope Foundation of Alberta

  3. Purpose • Intentionalize health care staff use of explicit hope facilitation strategies with residents • Consider strategies for how hope can be used to enhance well being of residents • Develop beginning insights into theories about hope in practice • Offer recommendations for fostering hope in long term care

  4. Objectives • Develop heightened awareness of health care staff use of purposive hope facilitation strategies that can be used in the course of providing day to day care. • Strengthen staff resolve to purposively engage in hope promotion strategies with residents. • Normalize hope facilitation strategies as a vital component of care.

  5. Process • Ethics Review  Approval through University Research Ethics Board • Approval from the Long Term Care Centre • Letter of invitation to participate • 15 participants from a long term care facility in Western Canada • RN’s, PCA’s, Pastoral Care, RT

  6. Data Collection Strategies • Interpretive study  interviews and education • Initial interview with staff (15 Staff) audio recorded • Workshop “Understanding Hope and Hope Facilitation Strategies” • Follow up interview (11 Staff) audio recorded • “Celebration of Hope” Reception

  7. Initial Interview • General orienting questions: • What do you think hope is? • Why is it important for residents to have hope? • What kinds of things generally do you think staff can do to facilitate a resident’s hope? • Request to bring an image of hope and a photograph or two for the workshop

  8. Workshop • Introductions and Overview of Day • What is Hope? (activity) • Presentation (understanding and intentionalising hope) • Finding Hope • Reflections of Hope Journal • Making a Difference • Hope Images • Hopeful Things to Say to Yourself • Being Hopeful • Hope Kits • Video “This Thing Called Hope” • “Homework” Activity • The Importance of Nurturing Self Hope

  9. Post Workshop Interview • Conversation with staff to talk about how they might be using hope. • What did they take from the workshop that helped them in their practice?

  10. Analysis • Tapes were transcribed verbatim • Transcripts were read and re read by researcher and research assistant • Coded and reviewed for themes • Conversations between researcher and research assistant • Reflection on themes and meanings • Reflection on learnings from interview 1 to interview 2 • Beginning reflection on theoretical perspectives

  11. General Observations • Common belief that when people enter long term care, they lose hope, see it as the “beginning of the end”. “Come here to die. Everything is taken away from them”. • “Hope is not something that someone coming into long term care has a lot of, because they are coming in and they pretty well know they are going to die”. • Some understanding that there is a reciprocity about hope “give it but you get a lot back”. • Also reflected in the fear that lack of hope in staff will be sensed by residents.

  12. Many had not thought intentionally about hope or about instilling hope. • When asked to reflect about its role, they were able to recognize its importance and realize that they often behave in ways that generate hope. • Some did not see ways to generate hope because they viewed hope as “hope for a cure – hope for discharge”. • They did see it important to make life comfortable for residents.

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

  14. Conceptions of Hope (First Interview Set) • How hope is defined. • Hope gives a reason to get up, it facilitates “living life to the full”. Hope gives meaning to life and it engenders a sense of home. “When they have no hope, they want to die”. • Faith and spirituality “hope is tied to faith. That’s where hope comes from”. • Hope is how you live it • Hope is also having peace • Individual and internal

  15. How Do You Foster Hope? • In simple things • talking, encouraging, recognizing the person, creating a sense of home, giving a hug, involving in activities to create a sense of purpose and meaning, sharing kindness and tenderness, make life better, creating opportunities to look forward, giving empathy, understanding, simple hellos, comfort, reassurance • In “being with”  going beyond the task • “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 they won’t be alone”.

  16. Creating magic moments • people create hope in their own unique ways (reading, saying a prayer, getting a cup of coffee) • responding to a need  developing a sense of trust • Hope in the Present • “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 activities… so the could actually know that they’re living the best they can in the time they have”

  17. General Observations (Post Workshop) • More aware of hope, broadened understanding • Discovered that hope means different things to different people • More intentional about how they might foster hope • A deeper understanding that hope is possible

  18. Conceptions of Hope (Second Interview Set) • Expanded understanding of hope and its importance. • “It’s good to spread the word about hope, you know, because it gives a whole different perspective”. • Awareness that personal hope needs attention • “I have started some journalling”. • “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 or disability. • “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 your life”.

  19. Hope carries over to personal experience. • “You can’t give something that you don’t have. You have to fill your own cup first, and others will be touched by the overflow”. • Hope is a life well lived, a life that has had meaning. • Recognizing that hope is be experienced in the little things. • Recognition for some that they have already been (unconsciously) giving hope

  20. How Do You Foster Hope? • Lend hope: an understanding that this is possible • “The more you give, the more you get”. • Things that make a difference • “Well, you know, life is so wonderful, and to touch someone’s life and make a difference, can only enrich your own life”. • Find out the circumstances people are in and convey understanding (to residents and families) • “Hearing them, being with them. You don’t need a solution. Help them to be hopeful and know they will be heard”. • “I try to walk in their shoes”. • Caring and show that caring • “Hope is knowing that someone cares. You know, shares what you are going through”. • “It’s not what you do or say, it’s how you make them feel that they’ll remember”.

  21. The telling and hearing of stories • “Being with” the resident (just giving them hope people will be around them) • Hope in simple things  an ice cream cone

  22. Conclusions • Hope is in the small things • “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 difference to them”. • The day to day • “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”. • Moments of hope • “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, then you have to have your moments, and that’s when you have to lend hope”.

  23. Hope in the now • “It’s understanding how the little things that you just normally do or don’t think about, just understanding that it does make a difference”. • Need for a hope advocate • Being with is often enough (can rekindle hope) • Convey caring • Simple things holding a hand • Hope is not just about the residents its about me

  24. Implications for Practice in Long Term Care • Commitment from leadership regarding the importance of hope in practice • Reinforce the importance of hope in the small things  Moments of Hope • Convey the possibility of hope regardless of ability or disability • Reinforce the need to add to the personal hope bank and the resident hope bank • Intentional efforts to make hope visible (images, stories, music) • Integrate fostering hope as part of practice (regularly schedule events and activities, part of orientation of new staff) • Communicate hope and hope stories • Look for hope and share what is found • Celebrate hope

  25. 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.

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