Hope has been described as an inner power that can enrich lives and enable individuals to look beyond their pain, suffering and turmoil (Buckley 2004). The focus of this assignment will be to discuss the role of hope between physiotherapist and patient during palliative care and how a physiotherapist can help foster hope in a dying patient.
Palliative care is the overall care of patients with advanced, progressive illness (NICE, 2004). Hope can be used as a motivational tool to help people within palliative care live through their illness (Krieger, 1982). Patients can use hope in a positive way to redefine their future. Thus it is important that patients with terminal illness focus on short term goals, so they can reach their full potential each day (Hall, 1990). Physiotherapists can help to ensure that the patient finds new reasons to keep living.
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It is sometimes difficult for patients to see hope when they face death (Soundy et al 2010). This is understandable because, if ‘well’ people need hope to recover, it is important to recognise how much hope they will need in crisis (Hall, 1990). It is difficult for patients to move forwards when faced with terminal illness unless they have accepted their diagnosis and prognosis (Soundy et al, 2010). For many months after such a diagnosis, terminally ill patients, from the minute they wake up until the time that they go to sleep may think nothing except that they are dying (Hall, 1990). Therefore it is important that the physiotherapist ensures the patient understands that although a prognosis may suggest some people will die, this is only based on the therapists prediction made on experience and knowledge (Soundy et al, 2010). Hope is very complex and has been described as a four phase system within palliative care: Cure, Treatment, Prolongation of life and Peaceful Death, with hope being the core component (Krieger, 1982 cited in Penson, 2000, p95). If one takes away hope, then a coping strategy may be affected (Pattison, 2009). Hope is essential for the patients’ ability to go on living (Benzein, 2001). Therefore, it is important for physiotherapists to generate hope to motivate the patient.
Physiotherapists can help foster hope by helping the patient leave a legacy, setting short term goals, forming a caring relationship and bringing an element of humour within the care. By allowing the patient to leave a legacy behind; this gives them meaning to their life (Duggleby and Wright, 2004). By giving meaning to a patients the life, the patient may feel they have gained some control over there disease, by making decisions concerning their future and their families (Soundy, 2010). The physiotherapist can encourage a patient to leave a legacy by helping them achieve something which their families would be proud of for example going on holiday.
To achieve long term goals, short term goals need to be put in place. It is important that the physiotherapist and the patient can negotiate attainable goals, to give them the control they require (Duggleby, 2004). Working towards self-set goals and achieving them can be a source of pleasure (Buckley, 2004). If goals are unrealistic and the patient fails to meet them it is likely they will lose hope and look negatively on how their disease or condition is progressing and lose hope. For that reason, it is important that the physiotherapist recognises when targets are not going to be met so goals can be adapted. As a patient’s condition deteriorates their goals should be refocused and become less ambitious (Buckley and Herth, 2004). By altering goals the patient will not lose hope because they are still achieving. Patients coping with a terminal illness need support; therefore it is important that the physiotherapists elicit support from the patients’ family and friends to help them achieve their aims (Duggleby, 2001).
By negotiating patient goals, the physiotherapist will foster hope by developing a caring relationship. Patients will have more hope if they trust the person they are working with. Experience shows that physiotherapists working in palliative care work very closely with their patients and form very strong relationships with them. Caring relationships were described by hospice patients as ‘family, friends, and healthcare professionals who provided physical care, prayed with participants, and smiled’ (Duggleby, 2001). A physiotherapist can establish a caring relationship by ‘being there’ (Herth, 2004). Being physically present in times of crisis and listening attentively can foster hope whereas if a person feels abandoned or isolated this can be a hindrance (Herth, 2004). Thus, it is important not only for the physiotherapist to establish a relationship with the patient, but they must also ensure family and friends are included within the care.
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When a patient faces end of life it is difficult to look beyond the prognosis, however it has been shown that bringing an element of humour to the interaction between the therapist and patient can give a sense of normality to the patient which subsequently fosters hope for the patient. It is thought that hope can interrupt the downward spiral of despair (Corbett, et al 2007).Dying people are able maintain a sense of humour and by sharing this with them it can not only enrich their lives but the carers as well (Buckley, 2004). Humour fosters hope by drawing the patient away from the focus of the disease by distracting them from the experience (Soundy, 2010). Experience shows that allowing the patient to make people laugh, enables them to give pleasure to others, this may create positive thoughts which in turn can ‘refocus’ their hope on good future (Duggleby and Wright, 2004).
This essay has discussed a few of the methods for fostering hope within terminally ill patients. Hope essentially is the force driving a patient forward in fighting their disease. Hope is essential for the patients’ ability to go on living (Benzein, 2001). As a student physiotherapist I have been able to reflect on the literature and my experience of working, within the palliative care setting. I came to the conclusion that it is paramount that the physiotherapist is able to give hope to the patient so they are able to end there life with dignity and the satisfaction that they have achieved personal goals before they reach end of life.
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