TOTAL KNEE REPLACEMENT PATIENTS’ EXPERIENCES OF A BRIEF HOPE-BASED IN-HOSPITAL INTERVENTION ALFRED HAUPT DU PLESSIS 2016 © University of Pretoria TOTAL KNEE REPLACEMENT PATIENTS’ EXPERIENCES OF A BRIEF HOPE-BASED IN-HOSPITAL INTERVENTION by ALFRED HAUPT DU PLESSIS Submitted in partial fulfilment of the requirements for the degree PHILOSOPHIAE DOCTOR (Educational Psychology) Department of Educational Psychology Faculty of Education University of Pretoria South Africa SUPERVISOR: Dr. Suzanne Bester CO-SUPERVISOR: Dr. Kaye Herth PRETORIA 31 MARCH 2016 © University of Pretoria Acknowledgements (in no specific order)  To all the participants in this study for your unselfish involvement through sharing your experiences.  To the surgical practice for allowing me access to your patients and for teaching me so much about the need for holistic patient care.  To the hospital board that made it possible to work in the hospital.  To the therapist who made such a huge contribution to the study. May you continue to inspire hope in your patients!  To my study supervisor Dr. Suzanne Bester: you have been a great source of motivation, knowledge, and expertise. Thank you for your hard work, believing in me, and walking this journey with me.  To Dr. Kaye Herth for coming on board with your wide experience in this field. Your input was immensely valuable.  To Prof. Ronél Ferreira and my colleagues in the Department of Educational Psychology for your encouragement and advice along the way.  To Prof. Irma Eloff for always being aware of my research focus and putting me in touch with the people from Hope Research Central, Alberta, Canada.  To my parents, Jan and Kay, for your love throughout my life. Thank you for your inspiration and prayers – words cannot express my gratitude.  To Saskia, my wife, and my children, Yani-Marijke, Liam, and Cornel, for bearing with me throughout this study. You have been brave and loving. I am so proud of you!  To my mother-in-law, Frieda Smuts, who passed away during this journey, for believing in me and for her support.  To all my friends for standing by me.  Soli Deo Gloria! ---oOo--- Page | i © University of Pretoria Ethics Statement The author, whose name appears on the title page of this thesis, has obtained, for the research described in this work, the applicable research approval. The author declares that he has observed the ethical requirements in terms of the University of Pretoria‟s Code of ethics for researchers and the Policy guidelines for responsible research. ______________________ Alfred Haupt du Plessis March 2016 ---oOo--- Page | ii © University of Pretoria Ethics Clearance Certificate Page | iii © University of Pretoria Declaration of Authenticity “I, Alfred H. du Plessis (91376450/04315456) declares that this thesis titled: TOTAL KNEE REPLACEMENT PATIENTS‟ EXPERIENCES OF A BRIEF HOPE- BASED IN-HOSPITAL INTERVENTION, which I hereby submit for the degree Philosophiae Doctor in Educational Psychology at the University of Pretoria, is my own work and has not previously been submitted by me for a degree at this or any other tertiary institution.” _____________________ Alfred Haupt du Plessis Signed on the ______ day of _______________ 2016, Pretoria, South Africa. ---oOo--- Page | iv © University of Pretoria Declaration of Language Editor 14 April 2016 TO WHOM IT MAY CONCERN (DECLARATION OF EDITING) Mr. Alfred du Plessis‟ thesis, TOTAL KNEE REPLACEMENT PATIENTS’ EXPERIENCES OF A BRIEF HOPE-BASED IN-HOSPITAL INTERVENTION, was language-edited by me in the period September 2015 to April 2016. It is the responsibility of the author to accept or reject my suggested changes. Tim Steward Accredited translator and editor (South African Translators‟ Institute – Membership No: 1000723) Tel: +27 (0)12 346-8061 Cell: +27 (0) 82 586-7654 ---oOo--- Page | v © University of Pretoria Abstract The issue addressed by this study is the lack of individual in-hospital hope-based brief interventions for TKR patients, based on the integrative hope theory of Scioli et al. (2011). This descriptive-exploratory qualitative case study described the development of I-HOPE based on the theoretical framework of Scioli et al. (2011). It also explored and described I-HOPE in the unique context of TKR through the experiences of the 12 participants. The purposefully selected participants (n=12, male=6, female=6), aged between 50 and 80, were scheduled to undergo TKR surgery by an orthopaedic practice in a private hospital in Pretoria. The intervention took place between 1 August 2014 and 31 December 2014. Data were collected using participant diaries, semistructured interviews, and a mini- focus group interview. The study was able to confirm the application value of Scioli et al.‟s (2011) hope theory as well as its compatibility with existing psychological and nursing hope intervention techniques and activities for TKR patients. Based on the study‟s interpretive paradigm, the exploratory findings confirmed the acceptability of the intervention in meeting the TKR participants‟ needs. The study also indicated additional participant needs during TKR not met by I-HOPE in its current form. Lastly, it was able to confirm the value of I-HOPE in conveying fundamental hope to the 12 TKR participants and in providing detailed insight into the lived experiences of these participants. ---oOo--- KEY WORDS  Attachment  Positive psychology  Hope  Spirituality  Hopelessness  Survival  Hope-based intervention  Total knee replacement  Mastery  Very brief intervention ---oOo--- Page | vi © University of Pretoria Table of Contents Page Acknowledgements i Ethics Statement ii Ethics Clearance Certificate iii Declaration of Authenticity iv Declaration of Language Editor v Abstract vi Keywords vi Table of Content vii List of Tables xiii List of Figures xvi ---oOo--- Page Chapter 1 Overview of the Study 1.1 INTRODUCTION 2 1.2 PERSONAL AND ACADEMIC RATIONALE 7 1.3 PURPOSE OF THE STUDY 9 1.4 RESEARCH QUESTIONS 10 1.5 RESEARCH ASSUMPTIONS 10 1.6 CONCEPT CLARIFICATION 11 1.6.1 BRIEF HOPE-BASED INTERVENTION 11 1.6.2 HOPE 12 1.6.3 HOPELESSNESS 13 1.6.4 HOPE DEVELOPMENT 13 1.6.5 ARTHROPLASTY/TOTAL KNEE REPLACEMENT (TKR) 14 1.6.6 TKR PROCESS 15 1.7 MASTER THEORY OF THE STUDY 15 1.8 APPLYING THE MASTER THEORY 18 1.9 PARADIGMATIC PERSPECTIVES 25 1.10 RESEARCH METHODOLOGY 25 1.11 CHAPTER OUTLINE 28 ---OOO--- Page | vii © University of Pretoria Page Chapter 2 Broad Literature Review: Study Background 2.1 INTRODUCTION 31 2.2 POSITIONING HOPE IN THEORY 32 2.2.1 HISTORICAL OVERVIEW OF HOPE IN HOPE RESEARCH 32 2.2.2 INTERNATIONAL RESEARCH ON HOPE 36 2.2.2.1 Unidimensional understanding of hope 36 2.2.2.2 Multidimensional understanding of hope 38 2.2.3 NATIONAL RESEARCH ON HOPE 43 2.3 THE INTEGRATIVE HOPE THEORY OF SCIOLI ET AL. (2011) 44 2.3.1 HOPE AS ATTACHMENT MOTIVE 44 2.3.2 HOPE AS A SPIRITUAL MOTIVE 45 2.3.3 HOPE AS MASTERY MOTIVE 48 2.3.4 HOPE AS SURVIVAL MOTIVE 49 2.4 CONCLUSION 51 ---oOo--- Chapter 3 A Brief Hope-based In-hospital Intervention “I-HOPE” 3.1 INTRODUCTION 54 3.2 EXISTING HOPE-BASED INTERVENTIONS IN A MEDICAL CONTEXT 55 3.2.1 HOPE-BASED NURSING INTERVENTIONS 56 3.2.2 PSYCHOLOGICAL INTERVENTIONS 62 3.2.2.1 Unidimensional psychological interventions 63 3.2.2.2 Multidimensional psychological interventions 65 3.2.3 INTERVENTION SUMMARY 68 3.3 HOPE STRATEGIES RELATED TO THE MASTER THEORY 72 3.4 I-HOPE 79 3.4.1 POSITIONING THE INTERVENTION IN PSYCHOLOGY 79 3.4.2 DESCRIBING I-HOPE 81 3.5 CONCLUSION 91 ---oOo--- Page | viii © University of Pretoria