Skip to main content Accessibility help

Harmonizing hope: A grounded theory study of the experience of hope of registered nurses who provide palliative care in community settings

  • Kelly Penz (a1) and Wendy Duggleby (a2)



The purpose of this study was to explore the hope experience of registered nurses (RNs) who provide palliative care services in community settings. The specific aims of the study were to (1) describe their hope experience, (2) develop a reflexive understanding of the processes of their hope, and (3) construct a substantive theory of hope of palliative care RNs.


Using constructivist grounded theory methodology, purposeful theoretical sampling was used to enroll 14 practicing community palliative care RNs in the study. Twenty-seven open-ended telephone interviews were conducted and nine daily journal entries on hope were copied. Interviews and journals were transcribed verbatim and analyzed using Charmaz's grounded theory approach.


Participants described their hope as a positive state of being involving a perseverant and realistic understanding of future possibilities. Their hope sustained and motivated them, and helped them to strive to provide high-quality care. The main concern for participants was keeping their hope when faced with work life challenges and contrasting viewpoints (i.e., when their hopes differed from the hopes of others around them). They dealt with this through harmonizing their hope by the processes of “looking both ways,” “connecting with others,” “seeing the bigger picture,” and “trying to make a difference.” Their experience of hope was defined within the social context of their work and lives.

Significance of results:

The results of this study suggest that hope is very important to palliative care RNs, in that it helps them to persevere and sustains them when faced with work life challenges in their practice. This study also highlights the need for continued research in this area as there appears to be a lack of evidence on the meaning of hope for healthcare professionals, and, in particular, understanding hope in the context of palliative and end-of-life care delivery.


Corresponding author

Address correspondence and reprint requests to: Kelly Penz, College of Nursing, University of Saskatchewan, Southern Saskatchewan Campus, 4500 Wascana Parkway Regina, SK S4P 3A3, Saskatchewan, Canada. E-mail:


Hide All
Appelin, G., Broback, G. & Bertero, C. (2005). A comprehensive picture of palliative care at home from the people involved. European Journal of Oncology Nursing, 9, 315324.
Arnaert, A., Seller, R. & Wainwright, M. (2009). Homecare nurses' attitudes toward palliative care in a rural community in western Quebec. Journal of Hospice and Palliative Nursing, 11, 202208.
Benzein, E., Norberg, A. & Saveman, B. (2001). The meaning of the lived experience of hope in patients with cancer in palliative home care. Palliative Medicine, 15, 117126.
Borneman, T., Stahl, C., Ferrell, B.R., et al. (2002). The concept of hope in family caregivers of cancer patients at home. Journal of Hospice and Palliative Nursing, 4, 2133.
Carstairs, S. (2005). Still not there quality end-of-life care: A progress report.
Carter, H., McKenna, C., MacLeod, R., et al. (1998). Health professionals' responses to multiple sclerosis and motor neurone disease. Palliative Medicine, 12, 383394.
Charmaz, K. (2000). Grounded theory: Objectivist and constructivist methods. In Handbook of Qualitative Research, 2nd ed.Denzin, N.K. & Lincoln, Y.S. (eds), pp. 509535. Thousand Oaks, CA: Sage Publishers, Inc.
Charmaz, K. (2004). Grounded theory. In Approaches to Qualitative Research: A Reader on Theory and Practice. Hesse-Biber, S.N. & Leavy, P. (eds), pp. 496521. New York: Oxford University Press.
Charmaz, K. (2006). Constructing Grounded Theory: A Practical Guide Through Qualitative Analysis. Thousand Oaks, CA: Sage Publishers, Inc.
Dufault, K. & Martocchio, B.C. (1985). Hope: Its spheres and dimensions. Nursing Clinics of North America, 20, 379391.
Duggleby, W. & Wright, K. (2005). Transforming hope: How elderly palliative patients live with hope. Canadian Journal of Nursing Research, 37, 7184.
Duggleby, W. & Wright, K. (2007). The hope of professional caregivers caring for persons at the end of life. Journal of Hospice & Palliative Nursing, 9, 4249.
Duggleby, W.D., Degner, L., Williams, A., et al. (2007). Living with hope: Initial evaluation of a psychosocial hope intervention for older palliative home care patients. Journal of Pain & Symptom Management, 33, 247257.
Dunne, K., Sullivan, K. & Kernohan, G. (2005). Palliative care for patients with cancer: District nurses' experiences. Journal of Advanced Nursing, 50, 372380.
Feudtner, C., Santucci, G., Feinstein, J.A., et al. (2007). Hopeful thinking and level of comfort regarding providing pediatric palliative care: A survey of hospital nurses. Pediatrics, 119, e186e192.
Gelling, L., Fitzgerald, M. & Blight, I. (2002). Hope in the ICU: A qualitative study exploring nurses' experiences of the concept of hope. Nursing in Critical Care, 7, 271277.
Herth, K. (1993). Hope in the family caregiver of terminally ill people. Journal of Advanced Nursing, 18, 538548.
Holtslander, L. & Duggleby, W. (2009). The hope experience of older bereaved women who cared for a spouse with terminal cancer. Qualitative Health Research, 19, 388400.
Holtslander, L.F., Duggleby, W., Williams, A.M., et al. (2005). The experience of hope for informal caregivers of palliative patients. Journal of Palliative Care, 21, 285.
Koopmeiners, L., Post–White, J., Gutknecht, S., et al. (1997). How healthcare professionals contribute to hope in patients with cancer. Oncology Nursing Forum, 24, 15071513.
Kulig, J.C. (2001). Hope at the community level according to rural-based public health nurses. Online Journal of Rural Nursing and Health Care, 2, 119.
Luker, K.A., Austin, L., Caress, A., et al. (2000). The importance of ‘knowing the patient': Community nurses' constructions of quality in providing palliative care. Journal of Advanced Nursing, 31, 775782.
Mok, E. & Chiu, P.C. (2004). Nurse–patient relationships in palliative care. Journal of Advanced Nursing, 48, 475483.
Musselwhite, K., Cuff, L., McGregor, L., et al. (2007). The telephone interview is an effective method of data collection in clinical nursing research: A discussion paper. International Journal of Nursing Studies, 44, 1064.
Newton, J. & Waters, V. (2001). Community palliative care clinical nurse specialists' descriptions of stress in their work. International Journal of Palliative Nursing, 7, 531540.
Pask, E.J. (2003). Moral agency in nursing: Seeing value in the work and believing that I make a difference. Nursing Ethics, 10, 165174.
Pask, E.J. (2005). Self–sacrifice, self-transcendence and nurses' professional self. Nursing Philosophy, 6, 247254.
Patton, M.Q. (2002). Qualitative Research and Evaluation Methods, 3rd ed.Thousand Oaks, CA: Sage Publications, Inc.
Payne, N. (2001). Occupational stressors and coping as determinants of burnout in female hospice nurses. Journal of Advanced Nursing, 33, 396405.
Post-White, J., Ceronsky, C., Kreitzer, M.J., et al. (1996). Hope, spirituality, sense of coherence, and quality of life in patients with cancer. Oncology Nursing Forum, 23, 15711579.
Romanow, R.J. (2002). Building on Values: The Future of Health Care in Canada–Final Report. Saskatoon: Commission on the Future of Health Care in Canada.
Sherwin, E.D., Elliott, T.R., Rybarczyk, B.D., et al. (1992). Negotiation the reality of caregiving: Hope, burnout and nursing. Journal of Social and Clinical Psychology, 11, 129139.
Simmons, B.L. & Nelson, D.L. (2001). Eustress at work: The relationship between hope and health in hospital nurses. Health Care Management Review, 26, 718.
Spiers, J.A. (2002). The interpersonal contexts of negotiating care in home care nurse—Patient interactions. Qualitative Health Research, 12, 10331058.
Stephen-Haynes, J. (2002). The concept of hope—A phenomenological study. Journal of Community Nursing, 16, 2830.
Thulesius, H., Hakansson, A. & Petersson, K. (2003). Balancing: A basic process in end-of-life cancer care. Qualitative Health Research, 13, 13531377.
Wilkes, L.M. & Beale, B. (2001). Palliative care at home: Stress for nurses in urban and rural New South Wales, Australia. International Journal of Nursing Practice, 7, 306313.
Wilson, K., Roe, B. & Wright, L. (1998). Telephone of face-to-face interviews? A decision made on the basis of a pilot study. International Journal of Nursing Studies, 35, 314321.
Wilson, V. & Edwards, L. (2005). Telephone interviewing in educational settings.



Altmetric attention score

Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed