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Strategies to treat hopelessness were described by 188 critical care nurses from Belgium, Canada, Colombia, England, France, and the United States. Data were collected by an open-ended questionnaire distributed by site coordinators to 50 randomly selected critical care nurses in one or more hospitals in each of the six countries. Data were analyzed using content analysis and data reduction techniques. Prior to collapsing data into hope-inspiring categories, discrete words or phrases to treat hopelessness were enumerated for each country. Interrater consensus was reached on each category label. Hope-inspiring strategies included use of interpersonal self (listening, presence, empathy, directing the interaction away from hopelessness themes); involvement and caring for the family; sharing success stories; use of progress reports; empowerment; and referral to experts (psychologists, clinical nurse specialists). Differences were evident among the countries. Providing physical comfort was emphasized by Belgium, Colombia, and Canada but not mentioned by other countries. Nurses from France used strategies labeled "positive provocation" to keep patients self-sufficient, autonomous, and able to move beyond dwelling on hopelessness.

The effective use of nursing diagnosis internationally depends in part on incorporating language and cultural difference into the common language of nursing. International validation studies can provide a basis for this effort. This study tested three diagnoses--anxiety, hopelessness, and ineffective airway clearance--through multinational validation. The Diagnostic Content Validity (DCV) model was used to collect data from critical care nurses in six countries. Defining characteristics rated as critical (greater than .80) by the total sample were dyspnea for ineffective airway clearance and panic and nervousness for anxiety. No critical defining characteristics for hopelessness were identified. DCV ratios for all defining characteristics are compared by country.