Contributor: Lisa M. Sabo, BSN, RN, PMHN-BC and Anna Lybarger, BSN, RN, PMHN-BC at Princeton Center for Eating Disorders
Often, individuals with eating disorders come to treatment not ready for progress – and in some cases, even feeling like they don’t deserve to recover. The eating disorder may be perceived as the only tangible thing in their lives, making it extremely difficult to set goals or have hope for the future.
Over the past year, nurses at Penn Medicine Princeton Center for Eating Disorders have been inspired to examine the concept of hope as it relates to patients with eating disorders. Particularly how nurses might play a key role in engendering hope among these patients to improve their quality of life.
This initiative’s catalyst was a 2019 study on the differences between nurse and patient perceptions of hope and hope-engendering nurse interventions for patients with eating disorders. One specific article, co-authored by Robbi Alexander of Princeton Center, noted the following implications for mental health nursing practice :
- Patients with eating disorders have low levels of hope, and nurses in the eating disorders field should be prepared to work with patients who are feeling hopeless about their future.
- Nurses perceived that they offered patients hope-engendering actions more often and effectively than the patients believed.
- Patient feedback identified ways nurses may improve care to engender hope: providing an open, caring environment, nurse presence, comfort/pain relief, and involving patients in their care.
- Nursing educators should further develop strategies that enable nurses to deliver care that inspires hope and improves connectedness in patients with eating disorders.
A Review of the Literature
Recognizing an opportunity for enhancing clinical practice, nurses conducted a thorough literature review on hope and healing at Princeton Center for Eating Disorders. One book and 26 research articles were reviewed by dayshift nurses, who were tasked with uncovering the answers to two questions:
- What provides hope?
- What discourages hope?
One resource in particular resonated with the nursing team. In the chapter on Kindling Hope in Adults in The Psychology of Hope: You Can Get Here from There, C.R. Snyder addresses that learning hopeful thinking can eventually exceed negative thinking.
Making changes in the way a person thinks, such as setting goals, can help foster significant changes in a person’s ability to hold hope. Snyder explained that setting goals increases one’s ability to be thoughtful, appreciate successes, and embrace errors as feedback.
Additional notable findings included:
- Describing hope as a motivational or emotional state that is multidimensional. If one is anticipating the future, they can be motivated to retain that future .
- Reference specific to eating disorders, discussing recovery in terms of being committed, “…wholeheartedly, to valuing life outside ED.” 
- Patients with schizophrenia suffer from hopelessness. A key to recovery is looking toward the future with positive expectations and intentions. Furthermore, goals and purpose were identified as reasons to go on .
- Interpersonal engagement is the spirit of psychiatric mental health nursing, and “…patients find that being in an environment that encourages learning from experience is an important aspect in feeling hope in recovery.”  In a sample of adults 65 and older, they found that “nurses organized the environment to make use of opportunities for clients to experience hope.” 
- The primary nurse is in an ideal position to foster or hinder hope to patients by talking, providing encouragement, offering choices, listening, and maintaining a positive attitude .
Putting Evidence of Hope for Recovery into Practice
In addition to gathering information that might help mitigate hopelessness in individuals with eating disorders, nurses utilized the research to develop an evidence-based, nurse-led, psychoeducational group series to educate patients about hope theory and aid them in finding ways to establish goals. This initiative was conceptualized by Princeton Center for Eating Disorders Nurse Manager Lauren Firman, and spearheaded by Sabo and Lybarger.
Rather than teaching individuals about hope for recovery, this new four-week curriculum uses Snyder’s theories as a foundation to teach patients that through hope, by finding and renewing motivation and pathways to achieving their goals, they can create a sense of purpose.
The curriculum helps patients explore the concept of hope and goal-setting as it relates to hope, expand goal-setting in a way that patients can visualize their goals through a storyboard or other visual element, identify obstacles to goals and ways around these roadblocks, and examine motivating factors that facilitate and sustain progress.
Having nurses lead this educational initiative is important for several reasons:
- Research has established that there is an opportunity for nurses to engender hope among patients with eating disorders.
- Providing a therapeutic milieu is part of the psychiatric nursing scope of practice, particularly as it relates to holistic care.
- Nurses are engaged with patients 24/7, putting them in a position to foster or hinder hope at any time.
- Incorporating nursing perspectives into care plans enhances the multidisciplinary approach to treatment.
Nurses at Princeton Center for Eating Disorders have been trained in the curriculum to further integrate hope-related goal planning as part of individual care plans and the daily dialogue with patients.
Perceptions of hope and the pathways that lead to it are unique for everyone and may be particularly challenging for patients with eating disorders. Incorporating nurse-led psychoeducational efforts into the care plan can place nurses in a position to help patients find that path, gain deeper insight into their own accountability for recovery, and broaden their ability to lead happier, more productive, lives.
1. Stavarski, D.H., Alexander, R.K., Ortiz, S.N., & Wasser, T. (2019). Exploring nurses’ and patients’ perceptions of hope and hope-engendering nurse interventions in an eating disorder facility: A descriptive cross-sectional study. Journal of Psychiatric and Mental Health Nursing, 26(1-2), 29-38. doi:10.1111/jpm.12507
2. Snyder, C.R. (1994). The psychology of hope: You can get here from there. Riverside: Free Press.
3. Schrank, B., Stanghellini, G., & Slade, M. (2008). Hope in psychiatry: A review of the literature. Acta Psychiatrica Scandinavica, 118(6), 421-433. doi:10.1111/j.1600-0447.2008.01271.x
4. Eaton C.M. (2020). Eating Disorder Recovery: A Metaethnography. Journal of the American Psychiatric Nurses Association, 26(4):373-388. doi:10.1177/1078390319849106
5. Barut, J. K., Dietrich, M. S., Zanoni, P. A., & Ridner, S. H. (2016). Sense of belonging and hope in the lives of persons with schizophrenia. Archives of Psychiatric Nursing, 30(2), 178-184. doi:10.1016/j.apnu.2015.08.009
6. Koehn, C. V., & Cutcliffe, J. R. (2007). Hope and interpersonal psychiatric/mental health nursing: A systematic review of the literature, part one. Journal of Psychiatric and Mental Health Nursing, 14(2), 134-140. doi:10.1111/j.1365-2850.2007.01054.x
7. Cutcliffe, J. R., & Koehn, C. V. (2007). Hope and interpersonal psychiatric/mental health nursing: A systematic review of the literature, part two. Journal of Psychiatric and Mental Health Nursing, 14(2), 141-147. doi:10.1111/j.1365-2850.2007.01055.x
8. Turner, D. S., & Stokes, L. (2006). Hope promoting strategies of Registered Nurses. Journal of Advanced Nursing, 56(4), 363-372. doi:10.1111/j.1365-2648.2006.04017.x
About Our Sponsor:
At the Princeton Center for Eating Disorders at Princeton Medical Center, we believe that seeking professional treatment for an eating disorder is a critical moment on the path to recovery. We understand the courage necessary to take this step, and we support our patients with the structure and care needed to facilitate the journey back to health in our inpatient program.
About the Authors:
Lisa M. Sabo, BSN, RN, PMHN-BC
With nursing experience ranging from medical/surgical, critical care, and pediatrics to mental health, Lisa M. Sabo, BSN, RN, PMHN-BC joined Penn Medicine Princeton Medical Center (then Princeton Hospital) in 2007 as a unit secretary. She cross-trained as a nursing assistant and earned her associate degree in nursing from Burlington County Community College in 2012 and her BSN from Walden University in 2015. After serving as a float nurse for several years, Sabo joined Princeton Center for Eating Disorders in 2018 and achieved her PMHN certification. She is former chair and currently co-chair of the center’s Unit-Based Council. A member of the American Psychiatric Nurses Association, Sabo is certified in BLS, PALS, and ACLS. Together with Anna Lybarger, BSN, RN, PMHN-BC, she helped initiate nurse-led psychoeducational groups at Princeton Center for Eating Disorders.
Anna Lybarger, BSN, RN, PMHN-BC
A board-certified psychiatric nurse at Princeton Center for Eating Disorders, Anna Lybarger, BSN, RN, PMHN-BC began her nursing career as a telemetry nurse in Arizona before moving to New Jersey to serve as a medical/surgical/telemetry travel nurse. She joined Penn Medicine Princeton Medical Center in 2015 as a float nurse, including for Princeton Center for Eating Disorders, which sparked her interest in the eating disorders field. She joined the Princeton Center for Eating Disorders team in 2016, and in 2019 attained her PMHN certification. Lybarger earned her BSN degree from Gannon University in Erie, Pa. She is certified in ACLS/PALS and as a Handle with Care instructor for Penn Medicine. Lybarger leads the Hope nursing initiative at Princeton Center for Eating Disorders together with Lisa Sabo, BSN, RN, PMHN-BC.
The opinions and views of our guest contributors are shared to provide a broad perspective on eating disorders. These are not necessarily the views of Eating Disorder Hope, but an effort to offer a discussion of various issues by different concerned individuals.
We at Eating Disorder Hope understand that eating disorders result from a combination of environmental and genetic factors. If you or a loved one are suffering from an eating disorder, please know that there is hope for you, and seek immediate professional help.
Published November 3, 2020, on EatingDisorderHope.com
Reviewed & Approved on November 3, 2020, by Jacquelyn Ekern MS, LPC