During the implementation phase, the health team members constantly sought balance between Helen’s hopes and realistic steps forward toward attaining her cycle goals. Those team members who worked closely and at length with her remained conscious of the need to support her hopefulness and remain focused on those targets that were adaptable.
Her occupational therapist, for instance, focused on improving the mobility of several upper extremity joints through the use of passive mobilization and hand braces. Improvements in proprioception, among other targets, were addressed by the physical therapist through standing training and body positioning.
Box 3 | Additional Factors to Consider for Integrating Hope into Rehabilitation
Health professionals have an opportunity to choose supportive interventions that recognize and integrate the power of hope as an important patient resource in the recovery phase of GBS. Despite a patient’s limitations, hope can offer needed energy and motivation to allow him or her to move forward. A number of factors may play an important role for considering hope in rehabilitative interventions:1214
- setting realistic goals
- does the patient believe in him or herself (trust, sees possibilities)
- patients that participate in their own care have a greater sense of hope
- making resources available, including spiritual components as well as information
- about disease or condition
- emotional reactions (hope is a feeling)
- relationship with others (family, friends, care givers)
- active involvement (taking action)
- a patient and health professionals must adapt and adjust to changes and circumstances
- a patient needs an explanation of changes and reevaluations of treatment/rehabilitation
- acknowledging that there is future (future/goal-oriented)
Here, members of the health team describe their experiences of working with Helen and of promoting hope as part of Helen's rehabilitation .
Helen is shifting between phases of intense hope for improvement and then suffering from her impairments … a lot of both optimism and pessimism
To inspire hope in Helen, I tell her that I share her hope that her functioning will improve. Nevertheless, it’s important to clarify over and over that we are not working on her hand function right now but on the improvement of realistic activities like her moving the wheelchair on her own. That means focusing on the present rather than the more uncertain future...To highlight this, I make all little improvements clear to her. For example, she is now able to move an electrical wheelchair with a standard control. This is a really great improvement because she won’t need any expensive technology and it increases her independence. These small triumphs really motivate her and inspire her hope.
Helen’s Occupational Therapist
To maintain and strengthen Helen’s hope, I tried to explain to her that her hand function alone isn’t enough for her to manage her day. To improve hand function is still a global goal, but at the moment we have to define smaller, achievable goals...We celebrate her improvements together (for example, by having a coffee). These little celebrations keep and strengthen her hope, put the pleasure in the foreground and motivates both of us for the next little steps.
Helen's Physical Therapist
I try to find the middle course between fostering too much and too little hope. She has to be patient, and I try to strengthen her patience to maintain the hope for improvement at any time.