Hopelessness Nursing Diagnosis Care Plan: Comprehensive Guide for Nurses

Hopelessness is a distressing emotional state where a patient perceives no viable solutions to their challenges and lacks the motivation to overcome obstacles. Frequently encountered in healthcare settings, hopelessness affects individuals grappling with chronic illnesses, debilitating injuries, or life-altering diagnoses that significantly impair their ability to engage in everyday life. When patients find themselves unable to perform Activities of Daily Living (ADLs), sustain their careers, or fulfill their roles within their families, feelings of discouragement and lack of motivation can arise. If these negative emotions persist and individuals believe their situation is irreversible, hopelessness can take hold. Alarmingly, research has established a link between hopelessness and increased mortality rates, underscoring the critical importance of early recognition and timely intervention.

However, it is crucial to emphasize that hopelessness is not an insurmountable condition. Nurses, with their unique position and skills, can play a pivotal role in helping patients regain hope. By providing a nonjudgmental and empathetic listening environment, nurses can empower patients to acknowledge their emotions and begin to address their challenges. Nurses are instrumental in delivering therapeutic interventions during hospitalization, facilitating referrals to specialized mental health professionals for continued support in managing feelings of loss or depression, and equipping patients with practical coping strategies to utilize after discharge when faced with hopelessness.

Important Note on Terminology: It is important for healthcare professionals to be aware that the nursing diagnosis “Hopelessness” has been updated and renamed to “Impaired Resilience” by the NANDA International Diagnosis Development Committee (DDC). This change reflects ongoing efforts to standardize nursing language. While the updated term “Impaired Resilience” is gaining traction, “Hopelessness” remains a widely recognized and understood diagnostic label, particularly among practicing nurses and students. Therefore, this article will continue to use “Hopelessness” to ensure clarity and accessibility for a broader audience, while acknowledging the updated terminology.

Causes of Hopelessness (Related Factors)

Identifying the root causes of hopelessness is crucial for developing effective nursing interventions. Several factors can contribute to a patient’s feelings of despair:

• Prolonged Activity Restrictions Leading to Social Isolation: Extended periods of limited mobility or confinement, often due to illness or injury, can severely restrict social interaction, leading to feelings of loneliness and isolation, which are significant contributors to hopelessness.
• Deteriorating Health Status: A progressive decline in health, particularly with chronic or terminal illnesses, can understandably evoke feelings of hopelessness as patients face increasing physical limitations and uncertainties about the future.
• Abandonment: Experiences of emotional or physical abandonment, whether real or perceived, can profoundly impact a patient’s sense of security and self-worth, fostering feelings of hopelessness.
• Loss of Spiritual Belief: For individuals who derive strength and meaning from their spiritual or religious beliefs, a loss of faith or a perceived disconnect from their spiritual foundation can be a significant source of hopelessness.
• Long-Term Stress: Chronic and unmanaged stress, stemming from various life circumstances such as financial difficulties, relationship problems, or ongoing health issues, can erode a person’s coping mechanisms and contribute to feelings of hopelessness.
• Chronic Pain: Persistent and unrelieved pain can significantly diminish quality of life, leading to exhaustion, frustration, and ultimately, hopelessness as patients struggle to find relief and maintain a sense of normalcy.
• Poverty: Living in poverty often entails facing numerous stressors, including food insecurity, inadequate housing, and limited access to healthcare. These persistent hardships can create an environment conducive to feelings of hopelessness.
• Complex Conditions or Treatments: Dealing with complex medical conditions or undergoing lengthy and demanding treatments can be overwhelming and emotionally draining, potentially leading to feelings of hopelessness, especially if progress seems slow or uncertain.

Signs and Symptoms of Hopelessness (Evidenced By)

Recognizing the signs and symptoms of hopelessness is essential for nurses to initiate timely interventions. These indicators can manifest in various ways:

• Passivity, Decreased Verbalization: Patients experiencing hopelessness may exhibit reduced engagement, speaking less frequently or in shorter sentences, and generally appearing withdrawn.
• Flat Affect: A lack of emotional expression, appearing emotionally numb or unresponsive, is a common sign of hopelessness.
• Loss of Appetite: Changes in eating habits, including a significant decrease in appetite or refusal to eat, can be indicative of underlying hopelessness.
• Decreased Response to Stimuli: A reduced reaction to external stimuli, such as sounds, touch, or visual cues, may suggest a state of emotional withdrawal and hopelessness.
• Difficulty Making Decisions: Hopelessness can impair cognitive function, making it challenging for patients to make even simple decisions.
• Lack of Initiative or Involvement: A noticeable absence of motivation to participate in activities, self-care, or treatment plans can be a key indicator of hopelessness.
• Increased or Decreased Sleep: Disruptions in sleep patterns, including both excessive sleeping (hypersomnia) or insufficient sleep (insomnia), can be associated with hopelessness.
• Turning Away from Speaker/Shrugging as a Response: Nonverbal cues such as avoiding eye contact, turning away, or responding with shrugs can signal disengagement and feelings of hopelessness.
• Angry Outbursts: While seemingly counterintuitive, anger and irritability can sometimes be outward expressions of underlying hopelessness and despair.

Expected Outcomes for Hopelessness

Setting realistic and achievable goals is a crucial component of the nursing care plan for hopelessness. Expected outcomes typically include:

• Patient will incorporate coping mechanisms to counteract feelings of hopelessness: This outcome focuses on equipping the patient with strategies and skills to manage and reduce feelings of despair, promoting self-efficacy and resilience.
• Patient will recognize and verbalize thoughts and feelings with a trusted individual: Encouraging open communication and emotional expression is vital. This outcome aims to create a safe space for the patient to share their feelings and begin processing their emotions.
• Patient will participate in care that is within their control (ADLs, making small decisions): Re-establishing a sense of control is essential in combating hopelessness. This outcome focuses on empowering the patient to actively participate in their care and daily routines, fostering autonomy and self-determination.
• Patient will develop short-term goals to foster a positive outlook: Breaking down overwhelming challenges into manageable steps and setting short-term goals can instill a sense of progress and hope. This outcome encourages the patient to focus on achievable steps towards recovery and well-being.

Nursing Assessment for Hopelessness

A thorough nursing assessment is the foundation for developing an individualized care plan. It involves gathering both subjective and objective data to understand the patient’s experience of hopelessness.

1. Identify Recent Physical or Emotional Changes:

• Rationale: Changes in physical health, such as a new diagnosis of a chronic or terminal illness, or significant emotional events like job loss or bereavement, can be precipitating factors for hopelessness.
• Assessment Questions/Techniques: Inquire about any recent diagnoses, health changes, losses, or significant life events. Use open-ended questions to encourage the patient to describe their experiences and feelings.

2. Assess for a History of Psychological Issues:

• Rationale: Past experiences with mental health challenges, ineffective coping mechanisms, family dysfunction, lack of support, or trauma can increase vulnerability to hopelessness in the face of current stressors.
• Assessment Questions/Techniques: Ask about any history of mental health diagnoses, past coping strategies (both effective and ineffective), family dynamics, support systems, and any history of trauma or adverse childhood experiences.

3. Identify Spiritual or Cultural Values:

• Rationale: Spiritual and cultural beliefs can be significant sources of strength and meaning. Assessing these values helps understand the patient’s resources and potential areas of spiritual distress that might contribute to hopelessness.
• Assessment Questions/Techniques: Explore the patient’s spiritual or religious beliefs, their importance to them, and whether they are experiencing any spiritual distress or loss of faith. Be culturally sensitive and respectful of diverse belief systems.

4. Assess for Suicidal Ideation:

• Rationale: Hopelessness is a significant risk factor for suicidal ideation. Patient safety is paramount, and assessing for suicidal thoughts is a critical responsibility for nurses.
• Assessment Questions/Techniques: Directly and sensitively ask about suicidal thoughts or plans. Assess for previous suicide attempts. Use validated screening tools if appropriate. Remember direct questioning is crucial; asking about suicidal thoughts does not plant the idea in their head and is vital for safety.

5. Investigate the Patient’s Situation:

• Rationale: Understanding the patient’s perspective on their situation, illness, prognosis, or concerns is essential. Misunderstandings or inaccurate perceptions can fuel hopelessness.
• Assessment Questions/Techniques: After establishing rapport, encourage the patient to describe their understanding of their situation, illness, or concerns. Clarify any misconceptions and provide accurate information in a supportive manner.

6. Assess Support System or Lack Thereof:

• Rationale: Social support is a crucial buffer against hopelessness. Lack of support can exacerbate feelings of isolation and despair.
• Assessment Questions/Techniques: Inquire about the patient’s support network, including family, friends, and community connections. Assess the quality and availability of their support system.

Nursing Interventions for Hopelessness

Nursing interventions are crucial for addressing hopelessness and promoting patient well-being. These interventions are designed to provide support, empower patients, and foster hope.

1. Take Time to Listen:

• Rationale: Patients experiencing hopelessness may feel unheard and believe that no one cares. Active listening conveys empathy and demonstrates that their feelings are valid and important.
• Intervention: Dedicate time to listen attentively to the patient without interruption. Maintain eye contact, use nonverbal cues to show engagement, and reflect back what you hear to ensure understanding.

2. Help Establish Short-Term Goals:

• Rationale: Breaking down overwhelming challenges into smaller, achievable goals provides a sense of progress and control, counteracting feelings of helplessness.
• Intervention: Collaboratively work with the patient to identify and set realistic short-term goals. Focus on small, manageable steps that the patient can successfully achieve. Celebrate successes to reinforce positive momentum.

3. Encourage Involvement and Decision-Making:

• Rationale: Hopelessness can lead to passivity and a sense of lost control. Encouraging patient involvement in decision-making, even in small matters, restores autonomy and self-efficacy.
• Intervention: Offer choices whenever possible in care decisions, such as meal times, activity schedules, or clothing choices. Encourage participation in ADLs to the extent possible, promoting independence and control.

4. Offer Distraction if Needed:

• Rationale: Engaging in distracting activities can provide temporary relief from negative thoughts and rumination, offering a mental break and promoting relaxation.
• Intervention: Suggest and facilitate engaging in enjoyable and distracting activities such as watching TV, reading, puzzles, games, or creative pursuits like drawing or coloring.

5. Refer to a Mental Health Professional:

• Rationale: Persistent hopelessness may be indicative of underlying depression or other mental health conditions that require specialized intervention.
• Intervention: Refer patients experiencing prolonged or severe hopelessness to a mental health professional, such as a therapist or psychiatrist, for comprehensive evaluation and treatment, including therapy and potentially medication management.

6. Encourage Group Activities:

• Rationale: Social isolation exacerbates hopelessness. Group activities, even simple presence among others, can combat loneliness and foster a sense of connection.
• Intervention: Encourage participation in group activities, support groups, or social gatherings. Facilitate connections with others who share similar experiences or interests.

7. Incorporate Self-Care Techniques:

• Rationale: Self-care practices are essential for emotional and physical well-being. Engaging in enjoyable and mood-boosting activities can improve overall well-being and counter hopelessness.
• Intervention: Explore the patient’s preferred self-care activities. Encourage and assist them in incorporating these practices into their daily routine, such as journaling, spending time in nature, engaging in hobbies, or practicing relaxation techniques.

8. Don’t Neglect Physical Health:

• Rationale: Physical and mental health are interconnected. Neglecting physical needs can worsen mental well-being and exacerbate hopelessness.
• Intervention: Ensure the patient receives adequate nutrition, hydration, and restful sleep. Encourage gentle exercise as appropriate to improve mood and physical health. Address any physical health concerns promptly.

9. Seek Assistance from a Chaplain or Other Clergy:

• Rationale: Spiritual distress can be a significant contributor to hopelessness for some patients. Spiritual support from a chaplain or clergy member can provide comfort and reassurance.
• Intervention: Offer to connect the patient with a chaplain or clergy member of their faith or spiritual tradition if they express spiritual distress or a desire for spiritual guidance.

10. Focus on Strengths and Gratitude:

• Rationale: Hopelessness often involves focusing on deficits and losses. Shifting attention to strengths and practicing gratitude can promote a more positive outlook.
• Intervention: Help the patient identify their personal strengths, past successes, and positive qualities. Encourage them to practice gratitude by focusing on things they are thankful for, even small things.

11. Incorporate the Family or Community:

• Rationale: Strong social support networks are vital. Engaging family and community members can strengthen support systems and combat isolation.
• Intervention: With the patient’s consent, involve family members or friends in the care plan. Encourage them to provide emotional support and practical assistance. If the patient lacks a support system, connect them with community resources and support groups.

Nursing Care Plans for Hopelessness

Nursing care plans provide a structured framework for organizing assessments and interventions to address hopelessness, guiding both short-term and long-term care goals. Here are examples of nursing care plans for different scenarios:

Care Plan #1

Diagnostic statement:

Hopelessness related to impaired ability to cope secondary to chemotherapy as evidenced by increased sleep and stating a feeling of emptiness.

Expected outcomes:

• Patient will report improved sleep quality and pattern.
• Patient will demonstrate coping mechanisms to counteract feelings of emptiness.

Assessment:

1. Assess coping behaviors and defense mechanisms utilized in previous and current situations and the patient’s perception of their effectiveness.

• Rationale: Understanding past coping strategies provides insights into the patient’s resilience and potential resources.
  2. Evaluate both useful and harmful defense mechanisms.
• Rationale: Identifying maladaptive coping mechanisms allows for targeted interventions to promote healthier strategies.
  3. Perform physical examination and review results of laboratory tests and diagnostic studies.
• Rationale: Physical factors can contribute to hopelessness; assessing physical health helps identify and address contributing issues.

Interventions:

1. Discuss current options and provide a list of helpful actions to gain a sense of control over the situation.

• Rationale: Empowering patients with options and actions promotes self-efficacy and reduces feelings of helplessness.
  2. Encourage or assist with the use of relaxation exercises and guided imagery.
• Rationale: Relaxation techniques can reduce anxiety and promote a sense of calm, fostering a more hopeful outlook.
  3. Make time to listen and offer support.
• Rationale: Empathy and support are essential for validating patient feelings and building trust.
  4. Encourage to join a support group for cancer survivors.
• Rationale: Support groups provide peer support, reduce isolation, and offer shared experiences and coping strategies.

Care Plan #2

Diagnostic statement:

Hopelessness related to prolonged caretaking responsibilities as evidenced by decreased affect and suicidal thoughts.

Expected outcomes:

• Patient will acknowledge and verbalize feelings.
• Patient will demonstrate strategies to ease caretaking responsibilities.

Assessment:

1. Explore the events that lead to feelings of hopelessness.

• Rationale: Identifying triggers and stressors helps tailor interventions to specific needs.
  2. Determine suicidal thoughts and if the patient has a plan.
• Rationale: Suicidal ideation requires immediate attention and safety measures.
  3. Evaluate the degree of hopelessness using psychological testing such as Beck’s Depression Scale.
• Rationale: Standardized assessments provide objective measures of hopelessness severity.
  4. Assess access to resources, home care services, or other family members that can assist.
• Rationale: Identifying and accessing support resources can alleviate caregiver burden and reduce hopelessness.

Interventions:

1. Establish a therapeutic and facilitative relationship showing positive regard.

• Rationale: Trust and rapport are essential for open communication and emotional processing.
  2. Encourage them to verbalize and explore feelings and perceptions (e.g., anger, helplessness, powerlessness, confusion, despair, isolation, grief).
• Rationale: Emotional expression and validation are crucial for processing difficult emotions and reducing emotional burden.
  3. Explore options with the caregiver. If caregiving duties are indefinite, discuss options such as in home care, respite services, or long-term care.
• Rationale: Providing practical solutions and options for caregiving responsibilities can alleviate stress and prevent caregiver burnout.
  4. Assist the patient in identifying activities that would help to ease caregiving roles and make time for themselves.
• Rationale: Promoting self-care and respite activities is vital for caregiver well-being and preventing hopelessness.
  5. Collaborate with a psychiatrist.
• Rationale: Psychiatric consultation may be necessary for medication management and comprehensive mental health care.

Care Plan #3

Diagnostic statement:

Hopelessness related to prolonged activity restrictions secondary to spinal cord injury as evidenced by isolating behaviors and inability to plan.

Expected outcomes:

• Patient will make positive statements (e.g., “I can” or “I will try”).
• Patient will participate in care.

Assessment:

1. Assess for hopelessness with the modified Beck Hopelessness Scale.

• Rationale: Standardized tools provide reliable measures of hopelessness.
  2. Assess and monitor the potential for depression.
• Rationale: Hopelessness and depression are often co-occurring conditions.
  3. Ascertain the influence of norms, values, and cultural beliefs on feelings of hopelessness.
• Rationale: Cultural sensitivity is essential for understanding and addressing hopelessness in diverse populations.

Interventions:

1. Engage the patient in a therapeutic relationship to enhance social connectedness and support networks.

• Rationale: Social connection and support combat isolation and promote hope.
  2. Encourage decision-making and problem-solving.
• Rationale: Restoring a sense of control and problem-solving skills enhances self-efficacy and reduces helplessness.
  3. Refer to a physical therapist.
• Rationale: Physical therapy promotes physical activity and improves overall well-being, reducing hopelessness associated with physical limitations.

References

1. Ackley, B.J., Ladwig, G.B.,& Makic, M.B.F. (2017). Nursing diagnosis handbook: An evidence-based guide to planning care (11th ed.). Elsevier.
2. Carpenito, L.J. (2013). Nursing diagnosis: Application to clinical practice (14th ed.). Lippincott Williams & Wilkins.
3. 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.
4. 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
5. Gulanick, M. & Myers, J.L. (2014). Nursing care plans: Diagnoses, interventions, and outcomes (8th ed.). Elsevier.
6. Herdman, T. H., Kamitsuru, S., & Lopes, C. (Eds.). (2024). NANDA-I International Nursing Diagnoses: Definitions and Classification, 2024-2026. Thieme. 10.1055/b000000928
7. Patterson, E. (2020, July 20). Overcoming Feelings of Hopelessness. Choosing Therapy. Retrieved December 17, 2021, from https://www.choosingtherapy.com/overcoming-hopelessness/