Hope
Although there are a number of definitions of hope depicted in the literature, one of the most comprehensive, and perhaps applicable to the dynamic nature of health, is that of nurses Dufault and Martocchio (1985). They articulate hope as a multidimensional dynamic life force characterized by a confident yet certain expectation of achieving good which is realistically possible and personally significant.  Hope is dynamic, not static, focused on expectations of good outcomes. In healthcare, those outcomes may be tied to disease or illness treatments.

Qualitative 
Research investigations using qualitative methods use words rather than numbers for data analysis. Themes are generated from patterns in the data (Gray & Grove, 2021). The purpose articulated in qualitative studies usually focuses on perception and experiences. 

Review of the Literature
Because hope is such a holistic concept, the author of this article sought to explore qualitative studies with a focus on hope targeting Veterans. Research articles were sought from the CINAHL database for the last ten years, May 2013 to May 2023 using the words Veterans, hope, and qualitative research.  Ten articles were identified but four were deleted after a review yielded no mention of hope. Four qualitative studies included Veterans only, one study engaged both Veterans and providers in interviews, and a sixth study included only clinicians.
 
A secondary analysis of a phenomenological study was conducted by Levi et al. (2012) of ten Israeli reserve soldiers with PTSD and concluded a binary conceptualization of hope.  Hope develops but can be stopped; hope is conscious but also unconscious; and hope strengthens and weakens an individual.

Ten partners of Australian Veterans with posttraumatic stress disorder (PTSD) were interviewed, face-to-face, using phenomenology methodology to explore their experiences of being an intimate partner (Waddell et al., 2020).  Three themes were identified with one referring to hope.  Partners played a consistent and critical role in supporting well-being and recovery, expressing hope that proper treatment would restore their previous relationship. Investigators compared findings to previous research and speculate that differences in findings may be attributed to age of the subjects and/or recent onset of PTSD symptoms. A critical source of hope is the belief in an individual’s capacity to recover.

PTSD was also the focus in another study exploring Veterans’ perceptions about the benefits and drawbacks of peer support for the condition after attending at least eight clinic sessions. Hundt et al. (2015) interviewed twenty-three Veterans using and grounded theory analysis of transcripts yielded five themes reflective of benefits, one of which focused on hope. The positive example of a peer instilled hope and helped them to change their belief that they might never recover from PTSD.

A concept analysis and literature review were conducted on nature-based therapy for Veterans with PTSD (Poulsen, 2017). Six databases with applicable search terms resulted in identification of quantitative studies as well as two major reviews that included 25 qualitative studies. Hope increased after engagement in nature-based therapy in quantitative and qualitive methodologies. 

Veterans (N=38) with hepatitis C and providers (N=10) at three VA medical centers were interviewed about treatment and perceptions of care (Skolnik et al., 2019). Transcripts using a grounded theory approach for analysis resulted on five themes, one of which highlighted hope for improvement. Subjects were optimistic about treatment and improved health or longevity, which was a motivating factor to complete treatment.

Seventy-six clinicians caring for Veterans with advanced cancer at six Veteran Affairs (VA) were interviewed exploring factors that influence concurrent cancer care (Haverhals et al., 2019).  Concurrent care included both VA and community hospice services. One theme that emerged through qualitative content analysis was the recognition that concurrent care preserves hope and relationships. Preserving hope eased transition to comfort interventions and assessment of benefits and burden of cancer treatments.

Conclusion and Implications
The aim of the six investigations did not focus on hope, but rather, hope was identified in themes generated from analysis of interview transcripts. Hope is related to illness treatment and therapies. Engaging in treatment or therapies provides a sense of hope in Veterans, as identified by both Veterans and health care professionals. VA nurses are in a key position to explore, support, and enhance Veteran’s hope throughout the continuum of care and related interventions. There is a need to target hope in the purpose statement of future qualitative investigations with findings contributing to our understanding of this dynamic, multidimensional concept.

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References

Dufault , K., & Martocchio, B. C. (1985). Hope: Its spheres and dimensions. Nursing Clinics of 
North America, 20, 379-391. 
Gray, J. R., & Grove, S. K. (2021). Burns and Grove’s the practice of nursing research: Appraisal, synthesis, and generation of evidence (9th ed.). Saunders Elsevier.

Haverhals, L. M., Manheim, C. E., Mor, V., Ersek, M., Kinosian, B., Lorenz, K. A., Faricy-Anderson, K. E., Gidwani-Marszowski, R. A., & Levy, C. (2019). The experience of providing hospice care concurrent with cancer treatment in the VA. Supportive Care in Cancer: Official Journal of the Multinational Association of Supportive Care in Cancer, 27(4), 1263–1270. https://doi.org/10.1007/s00520-018-4552-z

Hundt, N. E., Robinson, A., Arney, J., Stanley, M. A., & Cully, J. A. (2015). Veterans' perspectives on benefits and drawbacks of peer support for posttraumatic stress disorder. Military Medicine, 180(8), 851–856. https://doi.org/10.7205/MILMED-D-14-00536

Levi, O., Liechtentritt, R., & Savaya, R. (2013). Binary phenomenon of hope: perceptions of traumatized veterans. Journal of Health pPychology, 18(9), 1153–1165. https://doi.org/10.1177/1359105312461661

Poulsen, D. V. (2017). Nature-based therapy as a treatment for veterans with PTSD: What do we know? Journal of Public Mental Health, 19(1), 16-20.

Skolnik, A. A., Noska, A., Yakovchenko, V., Tsai, J., Jones, N., Gifford, A. L., & McInnes, D. K. (2019). Experiences with interferon-free hepatitis C therapies: addressing barriers to adherence and optimizing treatment outcomes. BMC Health Services Research, 19(1), 91. https://doi.org/10.1186/s12913-019-3904-9

Waddell, E., Lawn, S., Roberts, L., Henderson, J., Venning, A., & Redpath, P. (2020). "Why do you stay?": The lived-experience of partners of Australian veterans and first responders with Posttraumatic Stress Disorder. Health & Social Care in the Community, 28(5), 1734–1742. https://doi.org/10.1111/hsc.12998

DISCLAIMER
The contents of this publication do not represent the views of the Department of Veterans Affairs or the United States Government