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.
Causes of Hopelessness (Related to)
- Prolonged activity restrictions causing isolation
- Deteriorating health status
- Loss of spiritual belief
- Long-term stress
- Chronic pain
- Complex conditions or treatments
Signs and Symptoms (As evidenced by)
- 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
- 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 for 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 if there is a higher power that the patient values and if there is a sense of 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 for 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.
References and Sources
- 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
- Patterson, E. (2020, July 20). Overcoming Feelings of Hopelessness. Choosing Therapy. Retrieved December 17, 2021, from https://www.choosingtherapy.com/overcoming-hopelessness/