When I introduced the new AACN theme, I spoke about the importance of being grounded in reality but turned toward a hopeful future. This idea isn’t new.
Admiral James Stockdale, a prisoner of war, and holocaust survivor Viktor Frankl, both wrote about the importance of confronting current reality but maintaining an enduring belief in the end of the story as key to survival. This dual perspective applies to all aspects of our lives, not just the worst possible conditions, and it is not only for individuals. We cannot put the weight of change solely on one person. Success also requires groups, organizations and systems to be grounded in reality and committed to a hopeful future
More recently, Roshi Joan Halifax, a Buddhist teacher, Zen priest and scholar, spoke about “wise hope” during the pandemic. She said, “A hopeful person sees the truth of uncertainty and the possibility that anything can happen, including the best.” Hope is an active process and is captured in the phrase:
I will __________________ because I hope _______________.
For a nurse, it may be stating: I will continue to study for my CCRN because I am hopeful about the future now that testing centers have reopened in many cities. “I will” can define what All In means to you.
Central to each of these ideas is realistic possibility. As I think about hope and possibility,
Central to each of these ideas is realistic possibility. As I think about hope and possibility, I am faced with some questions — What does a hopeful future look like and how can I, one person, make a difference? What is possible?What does a hopeful future look like and how can I, one person, make a difference? What is possible?
Because I always look to the evidence, I searched the literature and found a meta-analysis about hope that indicates the key characteristics of hope include goal-directed energy and planning to meet goals. For AACN, hope is reflected in an ongoing commitment to a vision where acute and critical care nurses make their optimal contribution.
A clinical example of a hopeful future is a decrease in mortality from septic shock. For years, I've talked at NTI about research studies nurses need to know about, most recently studies on fluid management in septic shock.
One study by Mitchell (2015) demonstrates how individual and system-level actions can make a difference. This study found that if a patient had volume overload at the time of ICU discharge, they were two times more likely to be unable to walk at hospital discharge. We know that if a patient can't walk at discharge, they are more likely to be transferred to a skilled nursing facility, which also aligns with the study findings.
Why is this relevant? If our goal — our hopeful future — is optimal outcomes for patients and families, what might happen if each of us looked differently at the patients I&O on our next shift? What if we started a new conversation in our units about evidence-based fluid management, including exploration of system-level factors that get in our way? This single act could create a ripple effect that would benefit not just one patient but potentially thousands of patients.
These examples are what All In at individual and system levels can look like. How might this perspective apply to a different challenge?
This Is Our Moment to embrace both reality and hope. I look forward to hearing about your journey toward a hopeful future. Write to me at OurMoment@aacn.org.