Hopelessness Concept Paper

Hopelessness:

A Concept Analysis by Linda Gouthro A Paper Submitted in partial fulfillment of the requirements for NU 607 Critical Analysis of the Scientific Underpinnings of Advanced Nursing Practice University of South Alabama College of Nursing Fall 2010

Hopelessness:

A Concept Analysis Introduction Paragraph: Hopelessness is a familiar term generally used to denote a negative emotional state.

Despite frequent use of the term in the English language, conveying what might be considered a simplistic idea, hopelessness as a concept is multi-dimensional and complex.

A review of the professional literature reflects an abundance of research accumulated by a variety of disciplines, including nursing, medicine, psychology, religion, sociology and the arts. The richness of the literature will be used to discuss hopelessness.

The purpose of this paper is to analyze the significance of hopelessness using the concept analysis framework discussed by Chinn and Kramer (2008). Significance of Hopelessness to Nursing and Practice: Hopelessness was selected as a concept based on observed response variances viewed between different individuals faced with travesty and admitted to an inpatient mental health unit.

The question as to why some individuals manage to cope with tragedy in a productive manner, while others opt to give up, emerged.

Studies examining epidemiological prevalence of suicide suggest 25% of the general population experience suicidal ideation with depression (Goldney, Wilson, Del Grande, Fisher & McFarlane, 2000), while 50% of depressed inpatients report thoughts of suicide (Mann, Waternaux, Haas & Malone, 1999). The inclusion of hopelessness by the North American Nursing Diagnostic Association (1996) in their nursing diagnostic manual reflects the nursing profession’s sensitivity to the impact of this concept in nursing practice.

Dyer, Sparks, and Taylor (1995) use defining characteristics to differentiate between hopelessness associated with chronic illness, physical disability and psychiatric disorders. However, several authors emphasize the relationship of hopelessness to depression, physical  illness or disability resulting in ambiguous crucial features associated with hopelessness (Dunn, 2005; Grewal & Porter, 2007; Hamzaoglu, Ozkan, Ulusoy& Gokdogan, 2010). Clarity about concepts specific to hopelessness can lead to greater understanding and can impact nursing practice.

Uses and Definitions of the Concept: Using the Online Etymology Dictionary, the earliest listed origin of hopelessness dates to the 1560’s as a combination of the words hope and less. The word hope originates from the Old English word hopian and refers to “wish, expect, look forward (to something)”. The origin of hopian is unknown, however may be related to the West Germanic languages of Frisian, Middle Low German, Middle Dutch, or to Middle High German; all were languages in use between 1100 and 1500.

Less comes for the Old English, leas meaning “free (from), devoid (of), false, feigned,” and likely from the earlier Proto-Germanic language, theoretically identified as the beginning of Germanic words, including English. Interestingly, the verb spout, from the Middle Dutch language of the early 14th century, was first recorded as a noun during the late 14th century and was used as a colloquial term to describe the pawnbroker’s shop lift in the early 19th century. Up the spout was used to refer to being “lost, hopeless, gone beyond recall”. The meaning of desperate and deplore were defined using hopeless as a descriptive term (Harper, 2010).

The Oxford English Dictionary Online (OED, 1989) defines hopelessness as a “hopeless condition; want of hope, despair, state of being despaired of, desperateness”. The contemporary definition of hopelessness varies little from the earliest recorded origins of the word. The literature of various disciplines was reviewed to further delineate the meaning of hopelessness. The review included literature in religion, ethics, law, business, politics, education, nursing, medicine and psychology, and often included reference to despair,  espondency, grief or depression. Results from the basic literature search ranged from no identifiable text associated with law or business, to diverse perspectives drawn from religion, ethics, and the health literature. One political article referencing hopelessness was reviewed, but included no specific discussion or definition for hopelessness (Fremsted, 1977). Hopelessness is often defined by religious or ethical resources with reference to suffering being a requirement for greater faith and leading to an expanded understanding about the purpose of life (Fryback & Reinert, 1999; Warren, 2002).

Beck, Halling, McNabb, Miller, Rowe, and Schulz (2003) suggest the Christian values of suffering and despair as they relate to sin, establish a social stigma for the suffering individual that may lead to hopelessness (p. 340). Beck, et al. (2003) examine the concept of hopelessness as it relates to guilt, suffering, shame, loss, helplessness, and lost control, concluding that “Hopelessness is a geography, it is a universe onto itself, cut off from a world of interconnectedness, frozen in time and space” (Beck, et al. , 2003, p. 349).

The experiences of youth workers offer an alternate definition of hopelessness, while echoing similar themes identified by other specialty literatures. Competent professionals faced with insurmountable circumstances and having no identifiable solution available experienced feelings of impotence, incompetence, loss of control, and abandonment. Hopelessness is an emotion that evolves from a sense of futility realized by acknowledging a state of helplessness (Anderson-Nathe, 2008). Definitions of hopelessness in the medical literature reflect varying perspectives and focus.

The Diagnostic and Statistical Manual of Mental Disorders (DSM IV-TR, 2000) published by the American Psychiatric Association organizes symptoms into diagnostic psychiatric categories. Hopelessness is a symptom of depression, but not viewed as a unique concept. Revising research published earlier, Abramson, Metalasky, and Alloy (1989) proposed a modified theory titled hopelessness depression. Hopelessness was defined based on two fundamental ideas: first, a negative outcome is anticipated and second, control to change the outcome is absent (1989).

Similarly, O’Connor, and Cassidy (2007) described hopelessness as an existing condition colored by the prospect of negative outcomes, while others view hopelessness as it relates to negative cognitions (Williams, Van der Does, Barnhofer, Crane, & Segal, 2008). From a nursing outlook, hopelessness has been accepted as a concept in the nursing literature, driven by the North American Nursing Diagnosis Association’s (NANDA) inclusion of hopelessness as nursing diagnosis (North American Nursing Diagnosis Association, 1996).

Hopelessness is classified as a diagnosis by Dyer, Sparks, and Taylor (1995) and associated with chronic illness, decline in physical capabilities, and mood disturbances, with each variable eliciting a different diagnosis. The definition of hopelessness associated with chronic illness relates to the absence of choice; hopelessness characterized with a decline in physical capabilities incorporates the emotion of despair in response to lost ability, while hopelessness identified with mood disturbance is associated with lost hope (1995).

Wake, Fehring, and Fadden (1991) addressed the importance of clarifying the international implementation of nursing diagnosis, analyzing three separate nursing diagnoses, including hopelessness. Interestingly, of the three concepts examined, only hopelessness results had no critical elements identified, but tearfulness and thoughts of suicide were noted as additional criteria (1991). Scroggs, Shattell, and Cowling, (2010) discuss in the context of despair the link between hopelessness and a sense of helplessness and isolation.

Although the concept of hopelessness  remains a contemporary focus of nursing research, clearly the definition remains ambiguous (Dunn, 2005). Defining Attributes Including Antecedents and Consequences: Chinn and Kramer (2008) discuss the development of conceptual meaning drawn from process of concept analysis (p. 208-211). Through identification of repeated themes associated with the development of a concept, combined with a comparison of expected outcomes defining attributes can be determined.

Defining attributes drawn from the current literature review and analysis include (a) the perception of helplessness or impotence to change the circumstances; (b) the expectation of negative future outcomes; and (c) the inability to reverse the negative emotional or physical trajectory. Antecedents of hopelessness identified by Dunn (2005) include the interpretation of a life experience as traumatic, a value of importance associated with that event which changes life, a sense of helplessness to alter events, and personalization and ownership of the negative aspects associated with the event leading to low self-esteem.

Consequences to hopelessness are increased vulnerability to depression, suicide, being immobilized, cognitive dissonance, and the development of chronic physical disorders (Dunn, 2005; Scroggs, Shattell, & Cowling, 2010; Williams, Van der Does, Barnhofer, Crane, & Segal, 2008). Model Case: The following example is drawn from the clinical setting as a model case used to outline defining attributes associated with hopelessness. Mr. X is a 62-year-old Caucasian, a widowed man who was bought to the hospital emergency room by his son after being found in his home with a bottle of medications he had recently obtained from the pharmacy.

He was admitted to the inpatient mental health unit. During the admission assessment, Mr. X admitted to a long history of suicidal behaviors, with his last attempt made a year ago. He indicated he had experienced a series of losses, including the death of his mother six months ago and a recent diagnosis of advanced throat cancer. Mr. X began to cry sharing, “I’m going to die anyway, so why shouldn’t I just kill myself” and “Cancer can’t be cured and I can’t do anything about that. In this example, the man views his situation as hopeless, believes he can do nothing to change the situation, and views the future as holding only negative outcomes. Borderline, Related, and Contrary Cases: A borderline case is an example exhibiting a few of the defining attributes, but not all of them. A case is drawn again from the practice setting as a borderline case. Mrs. P. is an 84year-old woman diagnosed with terminal cancer, who presented to the emergency room four weeks after the unexpected death of her oldest son related to a motor vehicle accident.

She was admitted to the inpatient mental health unit, after reporting she has not been sleeping, had not eaten for several days, and was staying in her home alone, which was not typical. Mrs. P. also described a deep sadness. She indicated feeling helpless to change the circumstances, stating, “I just feel like giving up; children should not die before their parents. ” Mrs. P. described wanting to “…feel better, so I can live out the rest of the days God gives me. In this situation, the patient exhibits feelings of helplessness to change the situation, but anticipates a positive change in the future, including the ability to return to her previous lifestyle. An example of a related case would be one that shares commonalities with an identified concept, but does not contain the definitive attributes. The concept of hopeless idealist is used to represent a similar idea and is drawn from the literature. Mr. Hotchkiss was a respectable man employed in a prestigious office; he was single.

Having attended an annual business meeting, he was fortunate enough to be introduced to a young woman, with whom he felt most comfortable. Mr. Hotchkiss soon found himself hopelessly in love, despite knowing the young lady was promised to another. Believing he had no chance of winning his beloved’s hand in marriage, Mr. Hotchkiss waged a silent love affair that was filled with passion and impracticality. In the end, the young woman married the other man, despite announcing to Mr. Hotchkiss her steadfast love for him (Rossiter, 1895).

This case was used as it reflects components of helplessness, but not the belief in a future or destiny that is unchangeable. The last example used will be a contrary case; a case that obviously does not represent hopelessness. Several years ago, a young child sat on a chicken egg, hopeful the egg would produce a chick, as he had witnessed on a farm. Although the egg was ruined, the child’s curiosity was satisfied, with no further desire to hatch an egg. In this example, the child’s hopefulness guided his choices and behavior. None of the defining characteristics are present.

The goal of this paper was to provide greater clarity to the concept of hopelessness. Defining attributes identified were (a) the perception of helplessness or impotence to change the circumstances, (b) the expectation of negative future outcomes; and (c) the inability to reverse the negative emotional or physical trajectory. A model case combined with borderline, related, and contrary cases, were used to clarify the understanding of hopelessness.

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