Rehabilitation NURSING
Inspiring Hope in Our
Rehabilitation Patients,
Their Families, and Ourselves
Donald Kautz, PhD RN CNRN CRRN-A
Note. Portions of this article were excerpted from Donald Kautz’s Founder’s Address delivered at the 2006 ARN conference.
KEY WORDS
chronic pain management
enhancing intimacy
inspiring hope
patient-staff relationships
rehabilitation nursing
interventions
When confronted with a devastating disability or chronic illness, rehabilitation nurses play a key role in inspiring hope for
patients and their families. This article examines strategies nurses can implement in everyday practice: creating an environment of hope in a rehabilitation unit; assisting patients to manage their negative feelings about their disability; relieving
chronic neuropathic pain; sustaining patient relationships with staff and family; helping patients to forgive themselves
and others; enhancing patient intimacy with others; using literature to promote hope; acknowledging a patient’s belief that
nothing is impossible; using humor therapeutically; and maintaining hope for the moment. It is the moment—the time we
spend with our patients—that is essential. In that moment, we are promoting hope.
Judith Fitzgerald Miller (2000) defines hope as “a state
of being characterized by an anticipation of a continued good state, an improved state, or a release from a
perceived entrapment.” She also characterizes hope as
“an anticipation of a future that is good and is based
upon: relationships with others, purpose and meaning
in life, as well as [a] sense of the possible” (pp. 253–
254). Miller makes a clear distinction between nursing
actions that can lead a patient to despair and those
that can lead a patient to hope. For example, if a nurse
helps a patient develop and revise goals, the patient
is led to hope. If the nurse fails to help the patient set
goals, the patient is led to despair. This article outlines
several actions nurses can take to lead patients toward
hope. When nurses implement these interventions
they also find renewal in what they do.
When a person has an upsetting or terrifying experience, their friends and family members typically
respond by saying “It will all be okay.” Rehabilitation
nurses, however, should not automatically assure
people that everything will be fine. It is not “okay” to
have chronic pain, a head injury, a stroke, or a spinal
cord injury. Nurses need to promote hope without using clichés.
Nurses also need to remind patients’ friends and
family members to avoid saying “It will be okay” or
“Get well soon.” Promises of recovery are not useful
when it is clear a patient will not recover. A patient with
a spinal cord injury explained how he was tired of receiving “get well” cards from well-intentioned friends:
“They know I am not going to get well,” he said. This
patient would have preferred a card with a message
like: “I am so sorry this happened to you. I just wanted
you to know I am thinking of you, and hoping you are
learning all you need so you can come home soon.”
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Inspiring Hope
Miller (2000) and other researchers suggest many
ways in which nurses can inspire hope. Some of
the strategies discussed in this article were recommended by Miller, others were gathered from the
literature and the author’s personal experience as
a rehabilitation nurse. Some of these interventions
are research based, others are not. Rehabilitation
nurses can conduct research to test some of these
interventions; however, studying others may be
impractical and even unethical because patients cannot be randomly assigned to groups nor can nurses
withhold interventions such as listening or providing
privacy from some patients and families (Kautz &
Van Horn, 2008). These strategies include creating an
environment of hope in a rehabilitation unit; assisting patients to manage negative feelings about their
disability; relieving chronic, neuropathic pain; sustaining patient relationships with staff and family;
helping patients to forgive themselves and others;
enhancing patient intimacy with others; using literature to promote hope; acknowledging a patient’s
belief that nothing is impossible; using humor therapeutically; and maintaining hope for the moment.
Creating an Environment of Hope
New rehabilitation nurses may be surprised when
patients lose hope. As time passes, however, these
same nurses may begin to wonder why all patients
do not lose hope. How can some patients get up every
day and accept that being disabled is part of their daily
lives? Patients—even early on—remain hopeful and
believe they are going to do well because of the way
rehabilitation is structured. A chapter on rehabilitation
nursing in an older trauma nursing text, Rehabilitation:
A Therapeutic Escape from Reality, presents the idea that
a therapeutic escape often is preferable to reality. In
a rehabilitation unit (unlike in the real world), staff
ensure everything is wheelchair-accessible and they
are knowledgeable about disabilities. Rehabilitation
nurses and staff also do not regard disability as anything unusual; they help ensure patients can perform
basic hygiene and are dressed in their own clothes
every day, which gives them hope. These essential
tasks remain the same for any person—regardless
of disability—who is trying to maintain hope. Amie
Smith, RN, (Smith & Kautz, 2007) tells the story of
a patient who was hospitalized with small bowel
obstruction; this person returned to Smith’s unit
9 months after being discharged. The patient said to
her, “You were the only one who washed my hair.” By
performing this simple but often-ignored task, Smith
made a lasting impression on her patient. Rehabilitation nurses must not underestimate the power of the
moments spent with patients.
Researchers who study language have noted a
change in the way clinicians and support staff speak.
Instead of saying “I hope,” rehabilitation nurses often
say “hopefully”; in a conversation with a patient, for
example, a rehabilitation nurse might say “Hopefully,
at the end of your rehabilitation stay you will be able
to live independently at home” rather than “I hope
that at the end of your rehabilitation stay you will be
able to live independently at home.” Notice the difference in these statements. When “hopefully” is used,
the rehabilitation nurse is not making any promises
to the patient, but he or she is acknowledging the uncertainty of the situation. Patients may go home; they
may not. Using the phrase “I hope” implies the nurse
is saying, “It is my goal, and I will do everything I can
to ensure you go home.”
Rehabilitation teams are successful when they set
goals, believe in accomplishing them, and focus the
expertise and efforts of a diverse team on each patient’s goals. Every week, rehabilitation nurses document a patient’s progress toward specific objectives;
achieving these goals is the focus of the patient’s life.
Setting and achieving weekly goals, treating a disability as if it is normal, and having patients get up
and get dressed every day are key principles for any
inpatient rehabilitation unit (Booth & Jester, 2007;
Pryor, 2002). This is why rehabilitation patients are
less likely to lose hope. They have an entire team
working with them every day.
Managing Patients’ Negative
Feelings About Their Disability
The article “Common Psychological Challenges for
Patients with Newly Acquired Disability” (Larner,
2005) is an excellent resource of information about
the psychological challenges faced by patients with
new disabilities. Nurses may overhear upsetting
conversations similar to the following one I heard
between a man with quadriplegia who was in his
late sixties and a new 17-year-old quadriplegic. The
older quadriplegic said: “We should have died, we’d
be better off dead—especially you. I am old. You are
young. What do you have to look forward to? You
should die.” Patients may be anxious and worried
all the time; they may have posttraumatic stress
disorder, constantly reexperiencing life-threatening
situations. They also may experience memory loss,
pessimism about the future, and feelings of worthlessness and powerlessness. Patients may be frightened by how angry they have become. All of these
overwhelming feelings are likely to cause fatigue.
Patients need to be referred for counseling, and
counselors should be a part of every rehabilitation
team. Nurses also can play a major role in helping
patients manage negative feelings through “activity
scheduling” (i.e., trying several activities until finding one that works best for a patient). Being with
someone they love or care about, having a cup of
coffee with friends, listening to the radio, thinking
about a positive upcoming event, sitting in the sun,
attending a religious service, watching animals, and
reading all are activities patients can incorporate into
their daily routines (Larner). Encourage patients to
try at least one of these activities every day to escape
the mindset of being disabled.
Relieving Chronic Neuropathic Pain
Most, if not all, patients in rehabilitation experience
some type of chronic, unrelenting pain—not the
type of pain from a serious cut that will heal and
go away. These patients will have chronic pain that
likely will never diminish or stop. It is likely that
in the acute stage of rehabilitation, patients will
experience either one type of pain or a combination
of somatic, visceral, neuropathic, muscle, inflammatory, mechanical, or compressive pain (Institute
for Clinical Systems Improvement [ICSI], 2006,
2007). All neurological insults—whether a stroke,
head injury, spinal cord injury, peripheral nerve
injury, amputation, or a severe multiple fracture
(without neurological injury)—result in some type
of chronic nerve dysfunction. In rehabilitation texts,
the terminology describing chronic nerve dysfunction includes burning, numbness, or paresthesias.
Paresthesias hurt, and most of them hurt all the
time. In addition, many rehabilitation patients have
had recent surgery, which leads to low-level muscular and inflammatory pain that lasts for weeks to
months. Functional limitations, which all rehabilitation patients face, also result in pain. These functional limitations can cause stiffness or achiness;
joints that do not move regularly or do not have
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Inspiring Hope in Our Rehabilitation Patients, Their Families, and
Ourselves
normal muscle support because of disuse, atrophy, or
paralysis cause chronic low-level pain. Most patients
older than 40 years of age also have arthritis and
previous joint injuries that lead to pain. The only sensations new quadriplegics experience in a halo brace
or cervical traction are painful ones, unless they are
sitting up in a wheelchair; then patients experience
dizziness and nausea in addition to pain.
Evidence shows that even though healthcare professionals know how to treat pain, pain remains largely undertreated in hospitals (O’Malley, 2005) and it is likely
pain is undertreated in rehabilitation facilities, as well.
Unrelenting, exhausting pain certainly may destroy
hope. In fact, pain is one of the major reasons patients lose
their hope, self-esteem, and the will to live. Often, when
rehabilitation nurses start working with new quadriplegic patients, they resist therapy. Rehabilitation nurses
commonly blame patients for this reluctance—“they are
unmotivated and difficult” is a common complaint. Most
rehabilitation nurses quickly learn, however, that patients
often resist participating in therapy because they are in
pain. Bruno (1995) found that chronic pain is a common
reason for rehabilitation therapy noncompliance.
Although some patients require narcotic pain
medication for their entire lives, most can live tolerably without narcotic medication. However, patients
should have access to medications that will treat
their pain (ICSI, 2006, 2007). The Core Curriculum
for Rehabilitation Nursing (Mauk, 2007) outlines several effective approaches for managing pain. These
methods recognize patients may need several classes
of medications, including either acetaminophen or
a nonsteroidal anti-inflammatory drug around the
clock, and that other drug options should be used as
needed for breakthrough pain. Continuous medication intake is just the beginning. Ice packs, massage,
hot tubs, distraction, and other alternative methods
also are valuable for relieving pain. Every patient
in rehabilitation should be treated with a combination of these methods every day. ICSI has published
evidence-based practice guidelines for treating acute
pain (2006) and chronic pain (2007), as well as patient
education materials (available at www.icsi.org). The
guidelines include recommendations for combination
therapies to treat neuropathic, muscular, inflammatory, mechanical, and compressive pain. In addition,
the American Pain Society (www.ampainsoc.org)
regularly publishes guidelines and helpful resources
for nurses who want to learn more about managing
pain.
Sustaining Patient Relationships
Another way to inspire hope among patients is
to help them sustain relationships with their family, friends, and rehabilitation staff. A professional
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boundary must remain intact between rehabilitation nurses and their patients, however.
The first step toward building relationships with
patients is getting to know them. Learn about their
likes and dislikes. What were they doing before they
came to the rehabilitation unit? Who is important to
them? Write this information down and pass it on
from shift to shift. Document bits of conversation or
personal information about patients in their charts
so that during subsequent visits nurses can resume
these conversations. Taking this extra step tells patients their caregivers care about them—not just as
people with a diagnosis, but as people who have a
life and interests outside of the rehabilitation unit.
Also keep track of the people who have called or
visited each patient and pass this information to the
next shift. When nurses work with the same patients
for consecutive days, they can start their conversations with “Yesterday when I saw you … and now
today….” These details go a long way toward building meaningful relationships with patients.
When patients can maintain their identities, this
sustains their relationships. Christopher Reeve credits his wife, Dana, for saving his life, explaining that
she wanted him to live “because you’re still you. And
I love you” (Reeve, 1998, p. 28). Rehabilitation nurses
must encourage patients to express who they are. When
caregivers know their patients as people, outcomes are
much better. Knowing patients on a personal level
makes it easier to individualize care; this allows patients
to improve more quickly. When caregivers can recognize subtle changes in their patients, they can intervene
before these changes become major complications.
Individualized care results in a variety of positive
effects for patients. In one example, a woman who
was in a coma following a head injury was placed
in an intensive care unit (ICU). A nurse who was assigned to the ICU temporarily for 1 week cared for
the patient every day. Even though the woman was
either completely unresponsive or only minimally
responsive to external stimuli (i.e., Rancho Level I or
II), the nurse talked to the patient throughout the day,
explaining her actions or talking about more general
topics. On the nurse’s last day of working in the ICU,
she told the patient it was her final day and that she
had enjoyed caring for her. Years later, the nurse was
riding the subway talking to another nurse. A woman
with a noticeable limp approached them. She mentioned her name and said “You were my window to
the world. When you left, I thought I had lost touch
with reality forever.”
In another case, a young mother had sustained a
serious head injury and was placed on an ICU ventilator and was not expected to survive. The doctors
were going to wean her off the ventilator, and decided
it was time to have her young daughter come in to
say goodbye. In the ICU, the daughter squirmed out
of her father’s arms and climbed onto the bed. She
crawled up to her mother’s face, grabbed her gown,
and screamed, “Mommy, you get better, I need you.”
Incredibly, the mother did get better. This scenario
further illustrates the importance of maintaining relationships with patients even if they cannot respond.
Working with families can be one of the most challenging aspects of rehabilitation nursing; families can
be too demanding, too uninvolved, or dysfunctional.
Many nurses leave rehabilitation because they tire of
dealing with families. Rehabilitation nurses must remind themselves each day that dysfunctional family
members may be the only relatives patients have, and
sustaining these relationships may help encourage
and rehabilitate them.
Helping Patients to Forgive
Themselves and Others
Another integral facet of rehabilitation nursing (that
sometimes is overlooked) is the need for rehabilitation nurses to help their patients forgive those responsible for their disability (this can mean the patient is
struggling to forgive himself or herself). Many people
sustain disabilities shortly after having major arguments with someone whom they love. Forgiveness
is a crucial component of making progress in rehabilitation and for the duration of a patient’s life (Wohl,
Kuiken, & Noels, 2006). Patients can learn forgiveness
techniques with the help of a qualified mental health
professional. I learned this lesson through personal
experience. Some people were mistreating me and I
was very angry. I even found myself thinking about
hurting these people. After several weeks of feeling
this way, I decided I needed to do something to remedy the situation. I decided to see a therapist. After a
couple of sessions he said, “Let me teach you how to
forgive these people. Say to your self, ‘These people
treated me wrong. They (spell out what they did).
It was bad, they hurt me. And, I forgive them.’” He
suggested I do this every time I thought about these
people. I took his advice and it worked. Forgiveness
is seen as an essential component of many people’s
faith, and Watts, Dutton, & Gilliford (2006) advocate
measuring hope, forgiveness, and gratitude as indicators of subjective well-being resulting from spiritual
practices.
Promoting Patient Intimacy with
Others
Nurses can promote patient intimacy. A psychologist
in her late 20s who grew up with juvenile diabetes
had severe joint deformities and chronic pain. She
found that having sexual intercourse in the middle of
the day was best for her because this was when her
pain was the least intense. Once a week, her partner
would schedule himself as her 11 am “appointment.”
She would drive home to find he had made her lunch;
they enjoyed a relaxing bath and sexual intercourse.
Sex and love are known to raise endorphin levels,
which help to relieve pain (Paice, 2003). Consequently,
the psychologist’s weekly “appointments” with her
significant other helped her cut her pain medications
by half that day and the next.
Nurses often do not talk to patients about intimacy
because they are unsure of their role regarding the
topic and they do not have printed resources. Internet
resources are available, however; nurses can print Web
pages and distribute them to patients (reprint permission must be received in some instances). To research
the topic, nurses can type “sex and head injury,” “sex
and stroke,” or “sex” and a term related to the patient’s
specific condition into the “Google” search engine and
find informative links to patient education handouts.
The following Web sites provide reputable information
on intimacy and disability: www.goodvibes.com, www.
siecus.org, www.sexed.com, www.sexualhealth.com,
and www.womenshealth.org. At the time of publication,
these sites were checked for accuracy; however, please
note that Web site text changes frequently. The key is to
give patients and their partners information they need
regardless of whether conversations have taken place.
Kautz (2006, 2007) offers additional information about
intimacy and sexuality with aging and chronic illness,
and about love, sex, and intimacy after stroke.
Using Literature to Promote Hope
Creative use of readings, journals, and storytelling
can help people cope with disability, sustain hope
and comfort, and manage their life demands (Hobus,
2000). Nurses may need to tell their patients “I don’t
know the answers. I don’t know what the outcome
will be. I know that right now, everything seems
hopeless. But I also know you need to get up and go
to breakfast. You need to go on. Breakfast is cooked in
the cafeteria; it smells good. I’m going to get you up
now.” A Zen parable that Hobus quotes is both disturbing and comforting. In the story, a man falls over
a cliff while trying to escape a tiger and clings tightly
to a vine. “But, there is another tiger below him, snapping and snarling. All he can do then is with his free
hand pluck a strawberry on that same vine and eat
it, and enjoy its sweetness” (Hobus, p. 456). Hobus
points out that as adults (and as rehabilitation nurses),
we realize some problems just cannot be worked out;
we might as well make the most of today.
Acknowledging a Patient’s Belief
That Nothing Is Impossible
When I first became a rehabilitation nurse, I was
taught that denial is a step a patient goes through
to adjust and accept their new disability. Nurses
also are taught that if a patient is in denial, their job
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is to gently prompt him or her onto the next stage
of grieving. However, the following four patients
changed my mind. They said:
“I am a truck driver. I have lived by my
fists, and when I came to rehabilitation,
I believed you all would beat me and I
wouldn’t be able to do anything about it.”
“Every morning when I wake up, it takes
me a few moments to realize that I am a
quadriplegic and can’t walk. I have been
a quadriplegic for 15 years, and every
morning it is the same.”
“You are so mean. When you wake me
up in the morning, I am almost always
dreaming. And in my dreams, I am
always walking. And then you wake me
up, and I become a quadriplegic again.”
“Do you believe that I will be a
quadriplegic forever? Do you believe that
I will never walk? Do you believe I will
be a quadriplegic in heaven? What does
it matter to you what I believe?”
Patients’ denial and hope can serve as useful
lessons for nurses. First, the word denial is used too
loosely. Nothing Is Impossible by Christopher Reeve
(2002) focuses in part on the value of denial. Believing in the seemingly impossible, as Christopher
Reeve did until his death, does not necessarily mean
a person is in denial about his or her present state. It
is rare to hear a patient with paralysis say “I can walk
right here, right now.” But many patients will say “I
will walk.” Believing that nothing is impossible is a
key element of survival.
In an integrative review of the literature on acceptance and denial, Telford, Kralik, and Koch (2006)
concluded that when healthcare providers use labels
and patients internalize them, the labels may obstruct
the transition to living well with a chronic illness. It is
far more important to listen to each patient’s unique
story than to label a patient as being in acceptance
or denial.
When a patient says “I am going to walk (or recover function in my…),” or asks “Will I walk (or
recover)?” nurses can use one of the following responses: “Do you think today is the day?” “Wouldn’t
that be wonderful?” “I’ve seen a miracle or two.” “No
one knows,” or “Only God knows.” Or, to paraphrase
Gulley in the movie “Harriett the Spy,” a potential response could sound like “Someday that may happen,
but that day does not appear to be today. And today,
we have to….” Another option is to simply give the
patient a nod and a caring look and remain silent, or
say “Okay” as in “Okay, I heard you.” Then proceed
by saying “Now it’s time to get up for therapy.”
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Therapeutic Humor
A closing speaker at an Association of Rehabilitation
Nurses conference many years ago asked these
questions of the audience:
• Is it fun where you work?
• Do other staff members like working with
you?
• When you leave patients’ rooms (or when
they leave you), are they smiling? If not,
what have you allowed to happen?
Each of us is responsible for making sure our
work is fun for us and for our coworkers, patients,
and their families.
Jan Karon, a North Carolina author, offers examples of therapeutic humor in the Mitford Series.
Karon created a fictional town, Mitford, which is
the setting for her book series. In the first book of
the series, At Home in Mitford (1998), the reader
meets Uncle Billy, who always has a joke to tell.
Uncle Billy has many lessons for rehabilitation
nurses. By practicing his jokes, Uncle Billy inspired
others to find joy in their lives. Uncle Billy was in
love with (and married to) Miss Rose Watson, a
woman with schizophrenia, believed by many of
the townsfolk to be one of the most wicked people
on earth. His legacy involved his love for Rose Watson and his jokes. In the last book of the Mitford
Series, Light from Heaven (2005), Uncle Billy dies. At
his funeral, the minister speaks about him:
Uncle Billy spent his life modeling a
better way to live, a healthier way,
really, by inviting us to share in a
continued feast of laughter. When
the tide seemed to turn against
loving, he loved anyway. And when
circumstances sought to prevail
against laughter, he laughed anyway.
Uncle Billy loved us with his jokes.
And, oh, how he relished making us
laugh, prayed to make us laugh. And
we did (Karon, 2005, pp. 225–226).
One of Uncle Billy’s favorite jokes was:
An ol’ man and a ol’ woman was settin’
on th’ porch, don’t you know.
Th’ ol’ woman said, “You know what I’d
like t’ have?”
Ol’ man said, “What’s at?”
She says “A big ol’ bowl of vaniller ice
cream with choc’late sauce an’ nuts on
top!”
He says, “By jing, I’ll jis’ go down t’ th’
store an’ git us some.”
She says, “You better write that down or
you’ll fergit it.”
He says, “I ain’t goin’ to’ fergit it.” Went
to th’ store, come back a bit later with a
paper sack. Hands it over, she looks in
there, sees two ham san’wiches.
She lifted th’ top off one of them
san’wiches, says, “Dadgummit, I told you
you’d fergit! I wanted mustard on mine!”
(Karon, 2005, pp. 227–228)
More and more nurses (Chinery, 2007; Christie &
Moore, 2005) have written about the healthy effects
of laughter, and recent qualitative nursing studies
have found what many nurses and patients have
known all along: People with chronic illnesses and
disabilities use humor to help them cope and maintain hope. Nurses can use humor to diffuse anger,
lighten mood, and reassure patients they are going
to give them the care they need in the moment. This
is especially true regarding pain relief. A sense of humor and compassion go hand in hand with patient
care and rehabilitation.
Some nurses are reluctant to use humor. They cannot be certain their patients will appreciate it. Christopher Reeve noted how important humor was to
him, especially when dealing with anger. Reeve said,
“It doesn’t matter if you are not that funny” (Reeve,
2002, p. 34). Kevin Lee Smith, a nurse practitioner who
writes a monthly column on humor in Nurse Practitioner World News, also points out that we do not need to
worry about being funny, but instead be open to sharing spontaneous humor and joy. He believes laughing relaxes both patients and nurses, increases open
communication, and is the shortest distance between
two people (Smith, 2003). He recommends adopting
a routine, cheerful greeting to use with new patients.
If a patient responds in kind, then continue to use humor. If a patient does not respond in kind, move on.
Simmons-Mackie and Schultz (2003) have outlined
techniques they recommend for using humor with
aphasic patients.
Humor may be inappropriate when anxiety levels
are high or if a patient has a memory or hearing impairment. Jokes that focus solely on a patient’s condition are inappropriate. But when situations are at their
worst, humor may be the only solution. Writing about
life at the Auschwitz concentration camp during World
War II, Freeman (2002) notes that when survivors were
experiencing the unimaginable (traveling for days in
cattle cars and being forced to line up and be stripped,
showered, and shaved), the jokes began. Those who
survived the concentration camps used humor, art, and
music to bring hope to their lives.
Certainly, rehabilitation units are not concentration
camps but patients often endure the unimaginable as a
result of their disability and during rehabilitation. Laughter demonstrates we can see beyond our circumstances,
pain, and limitations. When two people laugh together,
both share the belief there is hope for the moment.
Maintaining Hope for the Moment
The most important aspect of inspiring hope and preventing powerlessness in patients is the ability of the
nurse to promote hope for the moment. Even without
using any equipment or specialized knowledge—just
by being with a patient or family—nurses can promote hope. When a patient has been incontinent with
diarrhea in bed and is covered from waist to knees
in diarrhea, the approaching nurse does not say, “Oh
my God, look at you, that’s disgusting.” Instead, he
or she says, “Oh, I see you’ve had an accident. Let
me get you cleaned up. Then let’s talk about what we
need to do to adjust your bowel program.” With this
type of response, a nurse increases the patient’s control, makes the unimaginable manageable, focuses on
sustaining the relationship with the patient, and uses
a life-promoting framework. Synder, Brandt, and
Tseng (2000) say that when nurses are present with
their whole being and are attuned to their patients’
needs and concerns, they can transform a technical,
potentially impersonal setting into a humane, healing
place. The time nurses spend with their patients (the
“right here, right now”) is what is essential. Every
time a nurse tells a patient, “I will be your nurse
today,” he or she is also saying “You are worth my
time, right here, right now.” In that moment, the
nurse is promoting hope.
Acknowledgments
The author gratefully acknowledges the encouragement and editorial assistance of Elizabeth Tornquist and the technical assistance of Dawn Wyrick
and Brandy Conrad, MSN RN.
About the Author
Donald Kautz, PhD RN CNRN CRRN-A, is an assistant
professor of nursing at the University of North Carolina–
Greensboro School of Nursing, Adult Health Department.
Address correspondence to him at 308 Moore Building, PO
Box 26170, Greensboro, NC 27402, or [email protected].
References
Booth, S., & Jester, R. (2007). The rehabilitation process. In R.
Jester (Ed.), Advanced rehabilitation nursing. Malden, MA:
Blackwell.
Bruno, R. L. (1995). Predicting hyperactive behavior as a cause
of non-compliance with rehabilitation: The reinforcement
motivation survey. Journal of Rehabilitation, 61(2), 50–57.
Chinery, W. (2007). Alleviating stress with humour. A literature review. Journal of Perioperative Practice, 17, 172–182.
Christie, W., & Moore, C. (2005). The impact of humor on patients
with cancer. Clinical Journal of Oncology Nursing, 9, 211–218.
Freeman, L. H. (2002). Transcending circumstance: Seeking
holism at Auschwitz. Holistic Nursing Practice, 17, 32–39.
Hobus, R. (2000). Literature: A dimension of nursing therapeutics. In J. F. Miller (Ed.), Coping with chronic illness: Overcoming
powerlessness (3rd ed., pp. 437–465). Philadelphia: F. A.
Davis.
Institute for Clinical Systems Improvement. (2006). Assessment
and management of acute pain. Retrieved April 4, 2008, from
www.icsi.org.
continued on page 177
Rehabilitation Nursing • Vol. 33, No. 4 • July/August 2008
153
Nitz, N. M. (1997). Comorbidity. In R. L. Kane (Ed.),
Understanding health care outcomes research (pp. 153–174).
Gaithersburg, MA: Aspen.
Sager, M. A., Rudberg, M. A., Jalaluddin, M., Franke, T.,
Inouye, S. K., Landefeld, C. S. et al. (1996). Hospital
admission risk profile (HARP): Identifying older patients
at risk for functional decline following acute medical illness and hospitalization. Journal of the American Geriatrics
Society, 44, 251–257.
Saletti, A., Johansson, L., & Cederholm, T. (1999). Mini
Nutritional Assessment in elderly subjects receiving home
nursing care. Journal of Human Nutrition and Dietetics, 12,
381–387.
Schnelle, J. F., Wood, S., Schnelle, E. R., & Simmons, S. F.
(2001). Measurement sensitivity and the Minimum Data Set
depression quality indicator. Gerontologist, 41, 401–405.
Scudds, R. J., & Robertson, J. M. (2000). Pain factors associated with physical disability in a sample of community-
dwelling senior citizens. Journals of Gerontology Series A:
Biological Sciences and Medical Sciences, 55A, M393–M399.
Vap, P. W., & Dunaye, T. (2000). Pressure ulcer risk assessment in long-term care nursing. Journal of Gerontological
Nursing, 26, 37–45.
Zuliani, G., Romagnoni, F., Volpato, S., Soattin, L., Leoci,
V., Bollini, M. C., et al. (2001). Nutritional parameters,
body composition, and progression of disability in older
disabled residents living in nursing homes. Journals of
Gerontology Series A: Biological Sciences and Medical Sciences,
56, M212–M216.
Environmental Issues in Patient Care Management:
Proxemics, Personal Space, and Territoriality
continued from 147
Hall, E. T. (1966). The hidden dimension. New York: Random
House.
Hayter, J. (1981). Territoriality as a universal need. Journal of
Advanced Nursing, 6(2), 79–85.
Kilbury, R., Brodieri, J., & Wong, H. (1996). Impact of physical disability and gender on personal space. Journal of
Rehabilitation, 62(2), 59–64.
Lomranz, J. (1976). Cultural variations in personal space. The
Journal of Social Psychology, 99(1), 21–27.
Roosa, W. M. (1982). Territory & privacy. Residents’ views:
Findings of a survey. Geriatric Nursing, 3(4), 241–243.
Sommer, R. (1969). Personal space: The behavioral basis of design.
Englewood Cliffs, NJ: Prentice Hall.
Summers, A. (1979). Give your patient more personal space.
Nursing 79, 9(9), 56.
Ulrich, R., Quan, X., Zimring, C., Joseph, A., & Choudhary, R.
(2004). The role of the physical environment in the hospital of
the 21st century: A once-in-a-lifetime opportunity. Retrieved
April 10, 2008, from www.healthdesign.org/research/
reports/physical_environ.php.
Webb, J. D., & Weber, M. J. (2003). Influence of sensory
abilities on the interpersonal distance of the elderly.
Environment and Behavior, 35(5), 695–711.
Inspiring Hope in Our Rehabilitation Patients, Their
Families, and Ourselves
continued from 153
Institute for Clinical Systems Improvement. (2007). Assessment
and management of chronic pain. Retrieved April 4, 2008,
from www.icsi.org.
Karon, J. (1998). At home in Mitford. New York: Viking.
Karon, J. (2005). Light from heaven. New York: Viking.
Kautz, D. D. (2006). Appreciating diversity and enhancing intimacy. In K. L. Mauk (Ed.), Gerontological nursing: Competencies for care (pp. 619–643). Boston: Jones &
Bartlett.
Kautz, D. D. (2007). Hope for love: Personal advice for intimacy and sex after stroke. Rehabilitation Nursing, 32(3),
95–103, 132.
Kautz, D. D., & Van Horn, E. R. (2008). An exemplar of the
use of NNN language in developing evidence-based
guidelines. International Journal of Nursing Terminologies
and Languages, 19, 14–19.
Larner, S. (2005). Common psychological challenges for
patients with newly acquired disability. Nursing Standard,
19(28), 33–39.
Mauk, K. L. (Ed.). (2007). The specialty practice of rehabilitation nursing: A core curriculum (5th ed.). Glenview, IL:
Association of Rehabilitation Nurses.
Miller, J. F. (2000). Coping with chronic illness: Overcoming powerlessness (3rd ed.). Philadelphia: F. A. Davis.
O’Malley, P. (2005). The undertreatment of pain: Ethical and
legal implications for the clinical nurse specialist. Clinical
Nurse Specialist, 19, 236–237.
Paice, J. (2003). Sexuality and chronic pain. American Journal of
Nursing, 103(1), 87–88.
Pryor, J. (2002). Client and family coping. In S. P. Hoeman
(Ed.), Rehabilitation nursing: Process, application, and outcomes (3rd ed., pp. 162–190). St. Louis, MO: Mosby.
Reeve, C. (1998). Still me. New York: Ballantine Books.
Reeve, C. (2002). Nothing is impossible. New York: Ballantine
Books.
Simmons-Mackie, N., & Schultz, M. (2003). The role of
humour in therapy for aphasia. Aphasiology, 17, 751–766.
Smith, A. D., & Kautz, D. D. (2007). A day with Blake: Hope on
a medical-surgical unit. MEDSURG Nursing, 16, 378–382.
Smith, K. L. (2003). Clinical wit and wisdom. Advance for
Nurse Practitioners, 11(12), 83.
Synder, M., Brandt, C. L., & Tseng, Y. (2000). Use of presence
in the critical care unit. AACN Clinical Issues: Advanced
Practice in Acute and Critical Care, 11, 27–33.
Telford, K., Kralik, D., & Koch, T. (2006). Acceptance and
denial: Implications for people adapting to chronic illness: Literature review. Journal of Advanced Nursing, 55,
457–464.
Watts, Dutton, & Gilliford (2006). Human spiritual qualities: Integrating psychology and religion. Mental Health,
Religion, and Culture, 9, 277–289.
Wohl, M. J. A., Kuiken, D., & Noels, K. A. (2006). Three ways
to forgive: A numerically aided phenomenological study.
British Journal of Social Psychology, 45, 547–561.
Rehabilitation Nursing • Vol. 33, No. 4 • July/August 2008
177