Hostname: page-component-7479d7b7d-qs9v7 Total loading time: 0 Render date: 2024-07-14T06:14:43.393Z Has data issue: false hasContentIssue false

Hope: a tool for working with families affected by dementia during the COVID-19 pandemic

Published online by Cambridge University Press:  27 July 2023

Amy Pepper*
Admiral nurse research assistant with the Research and Publications Team of Dementia UK, London, UK. Since qualifying as a mental health nurse in 2008 she has worked in various settings specialising in supporting families living with dementia. In 2014 she developed and led the Admiral Nursing Service in the London borough of Sutton, carrying out an evaluation of the role that led to an increase in funding and expansion of the team.
Zena Aldridge
Admiral nurse research fellow with Dementia UK, London, UK, a dementia nurse consultant with Norfolk and Waveney Clinical Commissioning Group, Norwich, UK, Regional Advisor (Dementia) for NHS Improvement and NHS England, London, UK, and a PhD student at de Montfort University, Leicester, UK. She has worked in health and social care for nearly 30 years, qualifying as a registered mental health nurse in 2003 and completing an MA in mental health in 2012. She became an Admiral nurse in 2013 and joined Dementia UK in 2016 as a service evaluator and senior consultant Admiral nurse before taking up her current post.
Karen Harrison Dening
Head of Research and Publications for Admiral Nursing and Dementia UK, London, UK and Professor of Dementia Nursing at de Montfort University, Leicester, UK. She has over 45 years’ experience in nursing, mostly in dementia care. For the past 15 years, she has worked with Dementia UK, initially as a consultant Admiral nurse, then the Director of Admiral Nursing before taking up her current post. She gained a PhD at University College London, London, UK focusing on advance care planning and end-of-life care in dementia. She has several honorary academic positions, one being an associate professor at the University of Nottingham, Nottingham, UK.
Correspondence Amy Pepper. Email:


The COVID-19 pandemic significantly increased the challenges faced by families affected by dementia, leading to an immediate increase in both the number of calls received by Dementia UK's Admiral Nurse Dementia Helpline and the levels of distress and complexity of the calls. Consequently, Admiral nurses experienced feelings of helplessness, echoed in the experiences of other health professionals. One of the approaches that enabled Admiral nurses to cope during this time was ‘hope’, and this article explores the use of hope-based approaches as tools for working therapeutically with families during the pandemic. Although written from the perspective of Admiral nurses, the approaches described are transferable to others working across health and social care. The article provides an overview of one of the main models of hope in the healthcare literature, Snyder's hope model, and explores the literature on hope more widely. Fictitious case vignettes, drawn from clinical practice during the pandemic, are used to illustrate how hope-based approaches can be applied to practice.

Copyright © The Author(s), 2023. Published by Cambridge University Press on behalf of Royal College of Psychiatrists

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)


Aldridge, Z, Harrison Dening, K (2019) Admiral Nursing in primary care: peri and post-diagnostic support for families affected by dementia within the UK primary care network model. OBM Geriatrics, 3(4): 081.10.21926/obm.geriatr.1904081CrossRefGoogle Scholar
Amalberti, R, Vincent, C, Nicklin, W, et al (2019) Coping with more people with more illness. Part 1: the nature of the challenge and the implications for safety and quality. International Journal of Quality Health Care, 31: 154–8.10.1093/intqhc/mzy235CrossRefGoogle ScholarPubMed
Anda, R, Williamson, D, Jones, D, et al (1993) Depressed affect, hopelessness, and the risk of ischemic heart disease in a cohort of U.S adults. Epidemiology, 4: 285–94.CrossRefGoogle Scholar
Beck, AT, Brown, G, Berchick, RJ, et al (1990) Relationship between hopelessness and ultimate suicide: a replication with psychiatric outpatients. American Journal of Psychiatry, 147: 190–5.Google ScholarPubMed
Blandford, A, Wesson, J, Amalberti, R, et al (2020) Opportunities and challenges for telehealth within and beyond, a pandemic. Lancet Global Health, 8(11): e1364–5.CrossRefGoogle ScholarPubMed
Brashear, N (2019) How is hope reimagined at the end of life? Clinical Journal of Oncology Nursing, 23(4): 448.CrossRefGoogle Scholar
Chen, ML (2003) Pain and hope in patients with cancer: a role for cognition. Cancer Nursing, 26: 61–7.CrossRefGoogle Scholar
Chu-Hui-Lin Chi, G (2007) The role of hope in patients with cancer. Oncology Nursing Forum, 34: 415–24.Google ScholarPubMed
Cousins, E, de Vries, K, Harrison Dening, K (2022) Four walls and a garden’: exploring the experiences of families affected by dementia during the COVID-19 pandemic. Dementia, 21: 810–29.CrossRefGoogle Scholar
Cutcliffe, JR, Herth, K (2002) The concept of hope in nursing 1: its origins, background and nature. British Journal of Nursing, 11: 832–40.10.12968/bjon.2002.11.12.10307CrossRefGoogle ScholarPubMed
Drayton, S, Harrison Dening, K (2020) Achieving positive outcomes in complex cases: the Admiral Nurse Dementia Helpline (innovative practice). Dementia, 19: 1308–15.CrossRefGoogle ScholarPubMed
Duggleby, W, Hicks, D, Nekolaichuk, C, et al (2012) Hope, older adults, and chronic illness: a metasynthesis of qualitative research. Journal of Advanced Nursing, 68: 1211–23.CrossRefGoogle ScholarPubMed
Flaskas, C (2007) Holding hope and hopelessness: therapeutic engagements with the balance of hope. Journal of Family Therapy, 29: 186202.CrossRefGoogle Scholar
Freshwater, D (2003) Counselling Skills for Nurses, Midwives and Health Visitors. Open University Press.Google Scholar
Furlanetto, LM, von Ammon Cavanaugh, S, Romildo Bueno, J, et al (2000) Association between depressive symptoms and mortality in medical inpatients. Psychosomatics, 41: 426–32.CrossRefGoogle ScholarPubMed
Gan, Y, Gong, Y, Tong, X, et al (2014) Depression and the risk of coronary heart disease: a meta-analysis of prospective cohort studies. BMC Psychiatry, 14: 371.CrossRefGoogle ScholarPubMed
Ghazavi, Z, Khaledi-Sardashti, F, Kajbaf, MB, et al (2015) Effect of hope therapy on the hope of diabetic patients. Iranian Journal of Nursing and Midwifery Research, 20: 7580.Google Scholar
Greenberg, NE, Wallick, A, Brown, LM (2020) Impact of COVID-19 pandemic restrictions on community-dwelling caregivers and persons with dementia. Psychological Trauma: Theory, Research, Practice, and Policy, 12(suppl 1): s220–1.CrossRefGoogle ScholarPubMed
Greene, GJ, Kondrat, DC, Lee, MY, et al (2006) A solution-focused approach to case management and recovery with consumers who have severe mental disability. Families in Society, 87: 339–50.CrossRefGoogle Scholar
Jevne, RF, Miller, J (1999) Finding Hope: Ways to See Life in a Brighter Light. Willowgreen Publishing.Google Scholar
John, A, Okolie, C, Eyles, E, et al (2020) The impact of the COVID-19 pandemic on self-harm and suicidal behaviour: a living systematic review. F1000Research, 9: 1097.CrossRefGoogle ScholarPubMed
Kondrat, DC, Teater, B (2010) Solution-focused therapy in and emergency room setting: increasing hope in persons presenting with suicidal ideation. Journal of Social Work, 12: 315.CrossRefGoogle Scholar
Lewis, F, Karlsberg Schaffer, S, Sussex, J, et al (2014) The Trajectory of Dementia in the UK – Making a Difference. Office of Health Economics.Google Scholar
Lopez, SJ, Snyder, CR, Magyar-Moe, JL, et al (2004) Strategies for accentuating hope. In Positive Psychology in Practice (eds Linley, PA, Joseph, S): 388404. John Wiley & Sons.CrossRefGoogle Scholar
Michael, ST, Taylor, JD, Cheavens, J (2000) Hope theory as applied to brief treatments: problem-solving and solution-focused therapies. In Handbook of Hope: Theory, Measures, and Applications (ed Snyder, CR): 151–66. Academic Press.Google Scholar
Mitchell, UA, Dellor, ED, Sharif, MZ, et al (2020) When is hope enough? Hopefulness, discrimination and racial/ethnic disparities in allostatic load. Behavioral Medicine, 46: 189201.CrossRefGoogle ScholarPubMed
Moore, S, Hall, SE, Jackson, J (2014) Exploring the experience of nursing home residents participation in a hope-focused group. Nursing Research and Practice, 2014: 623082.CrossRefGoogle Scholar
O'Connell, B (2005) Solution-Focused Therapy (2nd edn). Sage Publications.Google Scholar
O'Dwyer, ST, Moyle, W, Zimmer-Gembeck, M, et al (2016) Suicidal ideation in family carers of people with dementia. Aging & Mental Health, 20: 222–30.CrossRefGoogle ScholarPubMed
Sandilyan, MB, Dening, T (2019) What is dementia? In Evidence Based Practice in Dementia for Nurses and Nursing Students (ed Harrison Dening, K): 1226. Jessica Kingsley.Google Scholar
Schnoll, RA, Harlow, LL, Stolbach, LL, et al (1998) A structural model of the relationships among stage of disease, age, coping and psychological adjustment in women with breast cancer. Psychooncology, 7: 6977.3.0.CO;2-8>CrossRefGoogle ScholarPubMed
Schulz, R, Beach, SR (1999) Caregiving as a risk factor for mortality: the Caregiver Health Effects Study. JAMA, 282: 2215–9.10.1001/jama.282.23.2215CrossRefGoogle ScholarPubMed
Shaw, SCK (2020) Hopelessness, helplessness and resilience: the importance of safeguarding our trainees’ mental wellbeing during the COVID-19 pandemic. Nurse Education Practice, 44: 102780.CrossRefGoogle ScholarPubMed
Snyder, CR (2000) Handbook of Hope: Theory, Measures, and Applications. Academic Press.Google Scholar
Stern, SL, Dhanda, R, Hazuda, HP (2001) Hopelessness predicts mortality in older Mexican and European Americans. Psychosomatic Medicine, 63: 344–51.CrossRefGoogle ScholarPubMed
Suarez-Gonzalez, A, Rajagopalan, J, Livingston, G, et al (2021) The effect of COVID-19 isolation measures on the cognition and mental health of people living with dementia: a rapid systematic review of one year of evidence. eClinicalMedicine, 39: 101047.10.1016/j.eclinm.2021.101047CrossRefGoogle Scholar
Sullivan, MD (2003) Hope and hopelessness at the end of life. American Journal of Geriatric Psychiatry, 11: 393405.CrossRefGoogle ScholarPubMed
Wittenberg, R, Hu, B, Barraza-Araiza, L, et al (2019) Projections of Older People Living with Dementia and Costs of Dementia Care in the United Kingdom, 2019–2040 (CPEC Working Paper 5). London School of Economics and Political Science.Google Scholar
Woelk, CJ (2008) Management of hope. Canadian Family Physician, 54: 1243–5.Google ScholarPubMed
Submit a response


No eLetters have been published for this article.