There are two cases in this "Hope" module. Each case is written in a context relevant to this module. The first case, Mrs. Gregory is a common case that also can be found in modules for other topics. Suggested ways to respond to each situation are included.

Case 1: Mrs. Gregory

Case 2: Six-year-old

Case 1: Mrs. Gregory PowerPoint

Mrs. Gregory is a 62-year-old woman who has been a patient for many years at the office where you work as an office nurse. For the past few months, she has complained of increasingly severe upper abdominal pain and weight loss. An ultrasound ordered by Dr. Minor revealed a mass suspicious of primary liver cancer.

Mrs. Gregory and Gloria, the youngest of her three daughters, come to Dr. Minor�s office to discuss the test results. Dr. Minor discussed the test results, but you were with another patient. You know the family well and expect Mrs. Gregory to understand what Dr. Minor told her, and you plan to instruct her on use of the pain prescription Dr. Minor wrote for her. However, while clarifying her understanding about her illness, Mrs. Gregory becomes resistant. She tells you that there�s nothing wrong with her. She says, "All I need is some herbal remedies to help ease my indigestion." She leaves after agreeing to try the pain pills suggested by Dr. Minor.

Case History Audio Clip

Gregory1.wmv Mrs. Gregory's and Gloria's responses to diagnosis bad news

• In this case, Mrs. Gregory doesn't want to hear any more bad news. During a family meeting with Mrs. Gregory and her three daughters, they ask, "Is there any hope?" How would you respond to them?

Suggestions to Frame Your Response:

• The best approach is usually to turn the question around and ask what they think. This approach will open the discussion to uncover the patient's hopes and fears.
• In some cases the patient may in essence say, " I asked you." In these circumstances, ascertain what is meant by hope. "Hope for what?" Hope for recovery becomes supplanted with hope to live until some specified event.

A six-year-old who had loved to sit on his father's lap lay dying in his hospital bed. The parents had hoped for his recovery, but now had other hopes. They wrote to the tertiary care center about their hopes. What they hoped to do for their son was to care for him throughout his dying and after death. Their hope was that only their hands would touch their son and care for him.

The hospital administration was respectful of their wishes and the parents bathed their son, removing various tubes after his death. And before he died, this child who had rebuffed his father's invitation to sit on his lap said to his father as he lay dying, "I'd like to sit on your lap."

• Were the parent�s hopes reflective of cultural beliefs?
• Would the parent�s hopes interfere with nursing care?
• The phrase "hope for the best" is often used in health care. What was the "best" in these circumstances?