MPWER Paper 1
Harboring Hope Stephen Wagner Miami University Department of Nursing
MPWER Paper 2 Harboring Hope Introduction Our clinical work group had the opportunity to work with members of the Harbor House Social Club for our MPWER (Miami Partnerships Working to Empower and Renew) project. The clinical work group chose, “Harboring Hope,” as the project title. The purpose of the “Harboring Hope” project is to address an issue of concern relating to limited meaningful life enrichment opportunities. This project will address other issues that are related to the main concern such as stereotypes and stigma, hopelessness, motivation, and limited meaningful contributions. The MPWER paper will discuss perspectives on the issue, project planning, implementation, and evaluation. Perspectives on the Issue When interviewing the Harbor House members about what activities they participate in that provides meaning or hope in their lives, the majority of the members (those who are not board members) ask, “What do you mean?” or “I don’t understand.” After clarification, the members respond saying, “I don’t know” and “We usually hang out, play cards or video games, and make crafts.” Most of the clients appear content to socialize, relax, and to participate in occasional recreational activities such as movies or a picnic at a local park. Only one board member thought it would be a good idea to come up with activities that involves meaningful life enrichment and hope. The other two board members, not unlike the other nonboard members, also appeared to lack motivation and insight on what is the meaning of hope and life enrichment opportunities. The majority of the members also pointed out that if they are offered free food, they will more likely participate in an activity. The staff at the Harbor house was concerned that the members often lack motivation,
MPWER Paper 3 usually content on playing games and socializing, and do not like activities involving physical work. They added that they usually don’t respond well to “new people” coming into their environment and are unsure how the clients would respond to an activity that involves meaningful life enrichment. The staff also stressed that organizing a group activity will be challenging because of individual schedules and limited means of transportation. Another concern was physical limitations may hold some members back from participating. The staff confirmed that food seems to be the biggest motivating factor for participation. Response on the issue concerning the local community varies. While researching local retail outlets for pricing and resources from Miami University faculty, the response from most individuals was positive. There was a negative response from a library faculty member when it was time to pick up cameras for the project. Upon learning that the cameras being loaned out were going to be used by clients with mental illnesses, the faculty member with an uncomfortable look on his face said, “Well I am going to get older cameras and let them use those instead.” When informing the staff member that the older cameras won’t be necessary and that we will use our own cameras instead since he did not want to help to make a difference, he reluctantly provided the newer camera models. Providing meaningful life enrichment opportunities can potentially increase hope and improve quality of life for clients. Review of literature emphasizes hope in varying concepts that will empower clients to express themselves, have a higher quality of life, more meaning in their lives, increase resiliency for survival, and purpose (Cutliffe, 2009; Fleming, Mahoney, Carlson, & Engebretson, 2009; Lamb, 2009; Moore, 2005. Turner, 2005). I did not think the clients displayed hopelessness but a lack of insight and motivation on activities that could bring meaning and hope into their lives. The staff confirmed my thoughts
MPWER Paper 4 when they expressed their concern about motivation in regards to the members. Originally our clinical work group thought limited physical activity and motivation was the main priority. As I thought about it, limited motivation and physical activity is a result of underlying factors and is not the main barrier to the Harbor House members’ needs. I determined meaningful life enrichment opportunities as the main priority issue for several reasons. First, activities that involve meaningful life enrichment opportunities can increase or provide hope into the members’ lives. When one gains hope, it is a powerful enabling tool that can create a momentum of positive change that will more likely enhance motivation, coping, selfesteem, meaningful contributions, and quality of life (Cutliffe, 2009). Second, after observing stereotypical behavior from a library staff member, I learned that if I tailor an activity relating meaningful life enrichment in a community/public setting, it could reduce stigma and stereotypes towards the mentally ill (Fleming, Mahoney, Carlson, & Engebretson, 2009; Lamb, 2009). Negative and false attitudes and behaviors towards individuals with mental illnesses are barriers that often lead to hopelessness and inability to express themselves (Fleming, Mahoney, Carlson, & Engebretson, 2009; Lamb, 2009). Finally, I realized that despite the Harbor House staff having lower expectations, it is important to selfassess my thoughts and feelings of hope, to have the need to have my own hope, and carry a positive mindset because my own body language and tone will transfer to the members of the Harbor House (Cutliffe, 2009; Moore, 2005. Turner, 2005). This can affect the outcome of the project either in a positive or negative manner (Cutliffe, 2009; Moore, 2005). Having hope is what sustains a person through psychological adjustment to any serious illness or threatening event. On the contrary, loss of hope leads to suffering and poor physical outcome. My suggestion to change the issue did not sit well with my fellow clinical work group
MPWER Paper 5 members and that signaled the beginning of conflicts within the group. Despite their discontent with me, I think their reason why they went along with the change is that our clinical Professor also viewed that limited meaningful life enrichment opportunities relating to hope as the main priority. I say that because the Professor was handing us out journal articles focusing on hope periodically during the semester. I was struck by how different aspects of a person’s life can be influenced with or without meaningful life enrichment opportunities and how it relates to the IllnessWellness Continuum. Without the benefits of hope, clients with mental illness will head towards the left on the continuum resulting in worsening disability and premature death. Project Planning Once we established limited meaningful life enrichment opportunities as a priority concern, we took on an idea from our Professor when she suggested doing a project based on photography. The main idea is to carry out a photography/nature excursion at a local park and a lunch followed by a second event to display the client’s pictures. The local park theme fits with the client and staff perspectives since they have indicated that they had picnics at a local park and the lunch would help motivate clients to participate. We presented and collaborated our plan to the board, general members, and the staff. The majority of the members suggested Millikin Woods and shared what kind of food they like to eat. Conducting an activity in a nature setting can help the clients have an avenue of exercise and instill hope into the clients (Noe, Choe, & Yang, 2008). The park also allows the members to have a safe and therapeutic setting to express themselves through the use of cameras and sharing their meaningful statement (Lamont, Brunero, & Sutton, 2009; Noe, Choe, & Yang, 2008). We came up with several locations for the second open house event before settling down with University Hall. I wanted a “public” location for the pictures to be displayed because it
MPWER Paper 6 could meet an outcome regarding stigma and stereotypes. Another reason is that having a public venue will increase meaning and hope as a result of the local community getting a vantage point from the client’s pictures and statements (Hacking, Secker, Spandler, Kent, & Shenton, 2008; Lamb, 2009. Lamont, Brunero, & Sutton, 2009). We planned to have the clients provide a statement about how their picture means to them and pair them with their pictures as a narrative caption. The idea of narrative captions came from a concept called “photovoice,” a combination of a picture and narrative used as a therapeutic portal for the clients to express themselves providing an opportunity for the nurse and the viewer to gain deeper insight and understanding about the client (Fleming, Mahoney, Carlson, & Engebretson, 2009; Thompson, Hunter, Murray, Ninci, Rolfs, & Pallikkathayil, 2008). Furthermore, there is strong evidence from other literature supporting the use of the arts and photography to be used as a research tool, a portal for the mentally ill to express themselves, and instilling hope (DouglasFujimoto, & Fujimoto, 2008; Fleming, Mahoney, Carlson, & Engebretson, 2009; Hacking et. al 2008; Lamb, 2009; Lamont, Brunero, & Sutton, 2009; Miller & Happell, 2006; Thompson et. al, 2008). Last but not least, we planned to frame the individual pictures as a rewarding gift so they can have something to take home with them and share their stories with friends and relatives. There were several outcomes that were hoping to achieve. The first step is to increase meaning and hope for the clients. Secondly, increase client interest to take on more meaningful life enrichment activities in the future. We would like to reduce stigma and stereotypes of mental illness from the viewers at the open house event. We also wanted them to feel they are part of the group process giving their input on the project to foster empowerment and participation. Finally, we wanted the possibility that the client’s pictures and captions will inspire the viewers.
MPWER Paper 7 The clinical work group created several surveys using questionnaires and scales to measure the outcomes as a formal evaluation. The surveys are customized for each event and made in a way that we can measure effectiveness of the events whether or not hope is achieved. There is also a survey for the Harbor House staff upon the conclusion of the open house event to evaluate their perspective of before/after completion of the project and their insight on the impact of our interventions. For the informal evaluation, our clinical group clarified comments from individual members when the survey answers may not be understandable and establish therapeutic communication. We also took in suggestions if they do not like something that they would have done differently or changed. We also talked with various instructors and individuals associated with the mental health profession for feedback at the open house event. Project Implementation While planning the project, our clinical work group had to find a way to corral the Harbor House members to work together as a group. The biggest thing we learned is that the club members are grouped in clusters. One side of the house would be the members playing card games and watching T.V., one cluster would be playing video games or surfing the Internet, and some would hang out on the front porch. We relied heavily on one of the board members, the social club director, and those who are really motivated by the photography project to be our voice while we are not at the site. This is because group structures (clusters) change often where each week we do not have the same members showing up every week. Regarding the Harbor House social club members, we hope to achieve outcomes that are instilling hope, imparting information, altruism, development of socializing techniques, interpersonal learning, attaining group cohesiveness much as possible, existential factors, and
MPWER Paper 8 catharsis (Kneisl & Trigoboff, 2009). Each week we were able to meet different and gain more factors. For example during the first couple weeks, we worked more on existential factors and developmental of socializing techniques during the planning phase. For example, those activities include playing card games, bingo, and onetoone interactions. Next, during the photography event we were starting to instill hope and interpersonal learning. The club members were more motivated when we asked them what was the meaning behind the pictures. When that occurred, a portal opened between the club members and our group that increased our understanding and connectedness. Then, we were able to gauge on altruism, imparting information, and catharsis on the conclusion of the open house event when they see the result of their work. It is also because the event opened doors to acceptance of viewers from the public and the members receiving their framed pictures as a result of their participatory efforts, the members will be empowered to take on more meaningful activities. Most often I found myself working on improving therapeutic communication and self assessment with the Harbor House members rather than the Lindner Center of Hope. It is because I am in a social environment. I also learned another important concept in clarification in regards to client statements that do not make any sense and be assertive in understanding them. I was able to integrate literature regarding selfassessing hope in my life, how my body language and attitude affects hope in others (Cutliffe, 2009. Moore, 2005). For example, when I became more passionate about the project, it rubbed off onto the members. I also adapted on several occasions by learning to be flexible during the photography event when one client insisted to take a picture of my car instead of a “nature” oriented scene. At the time I realized its not about what I think is more therapeutic or important but what it means to the client. Project Evaluation
MPWER Paper 9 The result of the surveys for both events including informal evaluations from the clients, staff, and viewers were really positive. Nine out of 13 of the members filled out the surveys, almost all of them scored yes as if they enjoyed the photography event, that it inspired them, would do it again, and encourage others to do the activity. Eight out of the 10 respondents did not like the park, which I found interesting; the reaction was not negative but informational. Despite their dislike of the park, the members made the most out of their photographs and felt valued when we asked for their input. The survey from the clients in regards to the open house event showed a positive result. Five out of 6 checked yes when asked if the event will motivate them to do more activities in the future and increased meaning in their life. The clients also left statements how the project gave them hope. The survey results from the Harbor House staff was greatly positive, where they wrote that they were surprised and pleased with the overall responses from the clients. They added that they viewed that the clients did develop hope and meaning in their lives and are somewhat hopeful that the clients will keep up their motivation for future activities. The response from the viewers at the University Hall open house was positive as well. Many of them are impressed with the photos and the meaningful statements and found the event to be inspirational. I found this project to be very rewarding and see significant growth in my role as a future nurse. What I found to be surprising is that the literature is correct about how powerful transference of hope is, not coming from me but the clients. When I see the impact that our group had on the clients, it made me feel hopeful that I chose the right career path. However there were learning experiences, I learned that I need to communicate more efficiently and be more patient with my group members when there are conflicts. I wished that we saw things more eye to eye in
MPWER Paper 10 terms of sharing responsibilities in the project. I was not surprised that there were some bias or and viewed that the event will be successful. I also learned how to be a patient advocate when I had a talk with the library staff member in regards to his stereotyping and as well as protecting client information when it comes to HIPPA regulations. I learned to be careful in future situations that I need to be careful with pictures, not just because of legal implications but more importantly the wellbeing of the patients involved. I also will apply selfassessment as an integral part of my nursing career so I can be genuine, present, personify hope, and adapt when necessary. In conclusion, this project has been rewarding and I am proud and fortunate to work with the clients from the Harbor House Social Club.
References Cutliffe, J.R. (2009). Hope: the eternal paradigm for psychiatric/mental health nursing. Journal of Psychiatric and Mental Health Nursing, 16, 843847. DouglasFujimoto, M., Fujimoto, A. (2008) Art as a portal into the minds of those with mental illness. American Journal of Psychiatry, 165(7),
MPWER Paper 11 Fleming, J., Mahoney, J., Carlson, & Engebretson, J. (2009). An ethnographic approach to interpreting a mental illness photovoice exhibit. Archives of Psychiatric Nursing, 23(1), 1624. Hacking, S., Secker, J., Spandler, H., Kent, L., & Shenton, J. (2008). Evaluating the impact of participatory art projects for people with mental health needs. Health & Social Care in the Community, 16(6), 638648. Kneisl, C.R. & Trigoboff, E. (2009). Contemporary PsychiatricMental health Nursing (2nd ed.) New Jersey: Pearson Prentice Hall. Chapter 30, Table 302, p.808. Lamb, J. (2009). Creating change: using the arts to help stop the stigma of mental illness and foster social integration. Journal of Holistic Nursing, 27(1), 5765. Lamont, S. Brunero, S., & Sutton, D. (2009). Art psychotherapy in a consumer diagnosed with borderline personality disorder: a case study. International Journal of Mental Health Nursing, 18(3), 164172. Miller. G., & Happell, B. (2006). Talking about hope: the use of participant photography. Issues in Mental Health Nursing, 27(10), 10511065. Moore, S.L. (2005). Hope makes a difference. Journal of Psychiatric and Mental Health Nursing, 12, 100105. Noh, C., Choe, K., Yang, B. (2008). Hope from the perspective of people with schizophrenia (Korea). Archives of Psychiatric Nursing, 22(2), 6977. Thompson, N.C., Hunter, E.E., Murray, L. Ninci, L., Rolfs, E.M., & Pallikkathayil, L. (2008). The experience of living with chronic mental illness: a photovoice study. Perspectives in Psychiatric Care, 44(1), 1424.
MPWER Paper 12