Hopelessness occurs when a patient sees no alternative to their situation and is unable to energize themselves to overcome obstacles. Hopelessness is often seen in healthcare as patients suffer from chronic diseases or traumatic accidents that prevent them from living life to their full ability. When patients cannot perform ADLs, maintain a career, or parent their children, they may feel discouraged and unmotivated. When these feelings persist and patients feel there is no solution, hopelessness develops. Research shows that hopelessness increases mortality so it is vital to recognize and intervene when observed.
Hopelessness can be overcome. Nurses can be the nonjudgmental, listening support system many patients need to begin to recognize their feelings and manage their challenges. Nurses can provide therapeutic interventions during hospitalization, refer to specialists to continue working through feelings of loss or depression, and teach them simple ways to cope after discharge when feeling hopeless.
Attention: This nursing diagnosis has been renamed.
Nursing diagnoses are revised, added, or retired by the NANDA International Diagnosis Development Committee (DDC) to coincide with shifts in language standardization. “Hopelessness” has been renamed to “Impaired Resilience”. Students and seasoned nurses alike may be unfamiliar with this change, and thus NurseTogether has chosen to continue to use the diagnostic label “Hopelessness” in this article until the recent relabeling receives wider adoption.
In this article:
- Causes (Related to)
- Signs and Symptoms (As evidenced by)
- Expected Outcomes
- Nursing Assessment
- Nursing Interventions
- Nursing Care Plans
- References
Causes (Related to)
The following are common causes of hopelessness:
- Prolonged activity restrictions causing social isolation
- Deteriorating health status
- Abandonment
- Loss of spiritual belief
- Long-term stress
- Chronic pain
- Poverty
- Complex conditions or treatments
Signs and Symptoms (As evidenced by)
The following are common signs and symptoms of hopelessness:
- Passivity, decreased verbalization
- Flat affect
- Loss of appetite
- Decreased response to stimuli
- Difficulty making decisions
- Lack of initiative or involvement
- Increased or decreased sleep
- Turning away from speaker/shrugging as a response
- Angry outbursts
Expected Outcomes
The following are common nursing care planning goals and expected outcomes for hopelessness:
- Patient will incorporate coping mechanisms to counteract feelings of hopelessness.
- Patient will recognize and verbalize thoughts and feelings with a trusted individual.
- Patient will participate in care that is within their control (ADLs, making small decisions).
- Patient will develop short-term goals to foster a positive outlook.
Nursing Assessment
The first step of nursing care is the nursing assessment, during which the nurse will gather physical, psychosocial, emotional, and diagnostic data. In the following section, we will cover subjective and objective data related to hopelessness.
1. Identify recent physical or emotional changes.
Assess for any changes that could spark feelings of hopelessness such as a chronic or terminal diagnosis, recent job loss, or loss of a family member.
2. Assess for a history of psychological issues.
Assess for a history of poor coping behavior, long-term family dysfunction, lack of family support or abandonment, or trauma.
3. Identify spiritual or cultural values.
Determine what beliefs the patient may hold that are meaningful to them. Assess for disengagement, anger, or loss of belief.
4. Assess for suicidal ideation.
Patient safety is the first priority and it is the nurse’s responsibility to assess if the patient is having any thoughts of harming themselves. Assess if the patient has had any previous suicide attempts.
5. Investigate the patient’s situation.
After building rapport, attempt to get the patient to discuss what they are feeling and their understanding of their illness/prognosis/concern. The patient may not have an accurate or realistic understanding of their situation and may require the outside perspective of a professional.
6. Assess support system or lack thereof.
Assess for family, friends, or other individuals that the patient relies on for support. A lack of outside support fuels isolation and hopelessness.
Nursing Interventions
Nursing interventions and care are essential for the patients recovery. In the following section, you will learn more about possible nursing interventions for a patient with hopelessness.
1. Take time to listen.
Patients who feel hopeless may assume no one cares what they are feeling. Reassure the patient you are available and want to help. It may take time to build a rapport before the patient will open up and express what is causing their hopelessness.
2. Help establish short-term goals.
Encourage setting, planning, and meeting short-term goals. Achieving manageable steps promotes success and a sense of control.
3. Encourage involvement and decision-making.
Patients who feel hopeless may have “checked out” from the decision-making process and let others take control. Encourage them to take initiative even in small instances such as choosing what time they want to eat a meal or encouraging participation in bathing and dressing.
4. Offer distraction if needed.
Watching TV, drawing, coloring, reading, doing puzzles or word games can distract from negative thoughts and allow them a break from focusing on their internal dilemma.
5. Refer to a mental health professional.
Long-term hopelessness may lead to depression and require intervention from a specialist to uncover deeper issues and assist the patient in coping and learning strategies to manage their problem.
6. Encourage group activities.
Patients who feel isolated or abandoned may be reluctant to interact with others but simply being in the presence of others can lift spirits and connecting with the right people can bring a sense of hope and ease loneliness.
7. Incorporate self-care techniques.
Determine what the patient likes to do to improve their mood and help them create it. Journaling can help with reflection and expressing feelings. Assist the patient to get outside and spend time in nature and sunlight.
8. Don’t neglect physical health.
Ensure the patient continues to eat healthy, well-balanced meals and is getting a full night’s restful sleep. Patients who feel hopeless may not have a strong appetite and often suffer from malnourishment which can worsen co-morbidities. Exercise releases endorphins and promotes a feeling of well-being. Physical and mental well-being is connected and neglecting one negatively impacts the other.
9. Seek assistance from a chaplain or other clergy.
Patients experiencing spiritual hopeless or feeling forsaken by a higher power may need reassurance from a leader of their faith. This is a personal matter and should be handled by a professional so as not to offend or belittle the patient’s beliefs.
10. Focus on strengths and gratitude.
Long-term illnesses or debilitating physical limitations can cause hopelessness. Help the patient focus on their strengths such as a strong sense of humor, and to practice gratitude for the things and people that bring them happiness.
11. Incorporate the family or community.
If family or friends are available, encourage them to become more active and attentive to the patient’s concerns. If the patient is without a support system, refer them to support groups where they can interact with others in the same situation. Patients who may be limited physically can also research online support groups.
Nursing Care Plans
Nursing care plans help prioritize assessments and interventions for both short and long-term goals of care. In the following section, you will find nursing care plan examples for hopelessness.
Care Plan #1
Diagnostic statement:
Hopelessness related to impaired ability to cope secondary to chemotherapy as evidenced by increased sleep and stating a feeling of emptiness.
Expected outcomes:
- Patient will report improved sleep quality and pattern.
- Patient will demonstrate coping mechanisms to counteract feelings of emptiness.
Assessment:
1. Assess coping behaviors and defense mechanisms utilized in previous and current situations and the patient’s perception of their effectiveness.
Focusing and utilizing these strengths may encourage the patient to deal with the current situation.
2. Evaluate both useful and harmful defense mechanisms.
These include increased sleeping, substance abuse, illness behaviors, eating disorders, denial, forgetfulness, daydreaming, ineffectual organizational efforts, exploiting own goal setting, or regression. Helping the patient recognise maladaptive behaviors that may cause harm to their health would help redirect them to safe coping mechanisms.
3. Perform physical examination and review results of laboratory tests and diagnostic studies.
The current situation may be due to a decline in physical well-being or the progression of a chronic condition, or physical symptoms may be associated with the effects of depression (e.g., loss of appetite, lack of sleep).
Interventions:
1. Discuss current options and provide a list of helpful actions to gain a sense of control over the situation.
These options facilitate the use of own actions, validate reality, and promote a sense of control of the situation.
2. Encourage or assist with the use of relaxation exercises and guided imagery.
Relaxation may help the patient to look at possibilities of feeling more hopeful.
3. Make time to listen and offer support.
Patients with feelings of hopelessness may only need a person who could lend some ears and make them feel that they are not alone with their battle against cancer. Expressing support may boost their perceived self-worth.
4. Encourage to join a support group for cancer survivors.
Support groups help the patient to cope with feelings of hopelessness, improve self-esteem, and feel that they are not alone.
Care Plan #2
Diagnostic statement:
Hopelessness related to prolonged caretaking responsibilities as evidenced by decreased affect and suicidal thoughts.
Expected outcomes:
- Patient will acknowledge and verbalize feelings.
- Patient will demonstrate strategies to ease caretaking responsibilities.
Assessment:
1. Explore the events that lead to feelings of hopelessness.
Probing on these events helps identify sources of frustration and define problem areas so action can be taken to deal with them in more positive ways.
2. Determine suicidal thoughts and if the patient has a plan.
Suicidal thoughts should be explored to know whether there is a threat to the safety of the patient or others around them. The nurse may promptly initiate suicide prevention measures.
3. Evaluate the degree of hopelessness using psychological testing such as Beck’s Depression Scale.
Note thoughts that life isn’t worth living and any other indications of hopelessness or worthlessness. Establishing the proper action to protect the patient requires accurately assessing hopelessness and potential suicidal ideation.
4. Assess access to resources, home care services, or other family members that can assist.
Identifying resources, services, and other family members who could be tapped to share the caregiving responsibilities will provide ease to the burnout felt by the patient.
Interventions:
1. Establish a therapeutic and facilitative relationship showing positive regard.
The patient may feel safe disclosing feelings and feeling understood and listened to.
2. Encourage them to verbalize and explore feelings and perceptions (e.g., anger, helplessness, powerlessness, confusion, despair, isolation, grief).
Verbalizing feelings will improve connection to self and others, promote communication, and enhance decision-making skills. It would also help to release negative emotions safely.
3. Explore options with the caregiver. If caregiving duties are indefinite, discuss options such as in home care, respite services, or long-term care.
This applies to settings that require long-term caregiving. Adjusting the care setting to be provided without compromising the necessary treatment to the family member may be another option to be considered in order to prevent the exhaustion of caregiving resources.
4. Assist the patient in identifying activities that would help to ease caregiving roles and make time for themselves.
Exercising, trying new hobbies, performing usual enjoyable recreational activities, yoga/meditation, taking breaks, or eating out are some of the strategies to help the patient rest from caregiving responsibilities and regain an optimistic outlook.
5. Collaborate with a psychiatrist.
The psychiatrist may perform a psychiatric medical history to have a comprehensive psychiatric history of the patient. They may prescribe antidepressants or antipsychotic drugs as needed.
Care Plan #3
Diagnostic statement:
Hopelessness related to prolonged activity restrictions secondary to spinal cord injury as evidenced by isolating behaviors and inability to plan.
Expected outcomes:
- Patient will make positive statements (e.g., “I can” or “I will try”).
- Patient will participate in care.
Assessment:
1. Assess for hopelessness with the modified Beck Hopelessness Scale.
The modified Beck Hopelessness Scale is a reliable tool to measure the significant aspects of hopelessness, such as feelings about the future, expectations, and motivation.
2. Assess and monitor the potential for depression.
Hopelessness may be suggestive of depressive and suicidal symptoms.
3. Ascertain the influence of norms, values, and cultural beliefs on feelings of hopelessness.
Interpretation of hopelessness varies per cultural background (e.g., talking about depression in the Latino culture is taboo.)
Interventions:
1. Engage the patient in a therapeutic relationship to enhance social connectedness and support networks.
Relationship-based interventions reduce feelings of hopelessness and improve the sense of social connectedness.
2. Encourage decision-making and problem-solving.
Hopelessness may be due to the perceived loss of control and self-efficacy. Problem-solving promotes resilience and lower levels of hopelessness.
3. Refer to a physical therapist.
Physical therapists may prescribe appropriate physical activity appropriate for patients with spinal cord injury. Promoting physical activity as an alternative coping strategy will help decrease hopelessness.
References
- Ackley, B.J., Ladwig, G.B.,& Makic, M.B.F. (2017). Nursing diagnosis handbook: An evidence-based guide to planning care (11th ed.). Elsevier.
- Carpenito, L.J. (2013). Nursing diagnosis: Application to clinical practice (14th ed.). Lippincott Williams & Wilkins.
- Doenges, M. E., Moorhouse, M. F., & Murr, A. C. (2008). Nurse’s Pocket Guide Diagnoses, Prioritized Interventions, and Rationales (11th ed.). F. A. Davis Company.
- Gruber, R., & Schwanda, M. (2021, April). Hopelessness during acute hospitalisation is a strong predictor of mortality. BMJ Journals. Retrieved December 17, 2021, from https://ebn.bmj.com/content/24/2/53
- Gulanick, M. & Myers, J.L. (2014). Nursing care plans: Diagnoses, interventions, and outcomes (8th ed.). Elsevier.
- Herdman, T. H., Kamitsuru, S., & Lopes, C. (Eds.). (2024). NANDA-I International Nursing Diagnoses: Definitions and Classification, 2024-2026. Thieme. 10.1055/b000000928
- Patterson, E. (2020, July 20). Overcoming Feelings of Hopelessness. Choosing Therapy. Retrieved December 17, 2021, from https://www.choosingtherapy.com/overcoming-hopelessness/
