Demoralization and remoralization: a review of these constructs in the healthcare literature

Abstract

Demoralization and remoralization: a review of these constructs in the healthcare literature Development of the constructs of demoralization and remoralization began in the psychiatric literature in the 1970s when a psychiatrist in the USA observed a pattern of characteristics in people referred to him for depression, which he believed, was not depression. These characteristics included hopelessness, helplessness, isolation, low self-esteem and despair. Such characteristics are often termed existential distress. Distinguishing between depression and the existential distress of demoralization is still central in the literature. This is important as successful responses to each condition differ. Research into these constructs has broadened and contributions now come from many different countries and multiple health disciplines, including nursing. This study presents a review and exploration of these constructs in the healthcare literature in an attempt to bring them to the attention of greater numbers of nurses. Facilitating remoralization requires time and sensitivity to people's personal narratives. Difficulty in achieving such a response in the present efficiency climate of many health institutions can lead to moral distress.

Receiving Palliative Treatment Moderates the Effect of Age and Gender on Demoralization in Patients with Cancer

“…Clarke and Kissane [7] define demoralization as an affective state of loss of meaning and hopelessness, with cognitions of helplessness and personal failure, subjective incompetence, and social alienation. Research has repeatedly applied this concept to severe medical illness, emphasizing that demoralization is essentially characterized by an entrapped feeling that “nothing can be done” and a subsequent loss of hope and meaning, while the two core symptoms of major depression, anhedonia and loss of interest, are typically not present [8]–[11]. Factor analytic studies support the conceptual and clinical separation of demoralization and major depression in cancer patients [12], [13].…”

Incorporating Demoralization into Social Work Practice

“…The loss of hope provides a focal point for social work interventions that seek to regenerate hope to reestablish coping. Cognitive-behavioral therapy has been shown to be less effective for severe demoralization, but certain cognitive strategies have the potential to restore hope and a renewed sense of purpose (Connor & Walton, 2011;Snyder, 1999). Snyder (2000) suggested that people who are hopeful and cope well in adversity have the capacity to find alternative hopeful futures.…”

Factors associated with demoralisation syndrome in patients before and after cardiac surgery

“…Effective demoralisation management includes the early reduction of stressors, the detection of negative emotions, and the provision of mental and spiritual care necessary to reinstate patients’ hope, self‐respect, and meaning of life (Connor & Walton, ; Thangathurai et al., ). Because a “sense of failure” is the worst domain of demoralisation before and after surgery, strategies should be designed to empower patients such as engaging with the patient throughout the medical decision‐making process to promote a sense of control, encouraging them to perform their own daily activities to decrease the perception of dependence, and addressing the importance of family for their support in helping patients solve life problems and not feel alone.…”

“…Demoralisation syndrome differs from depression with regard to its signs, causes and treatments (Tecuta et al., ). Demoralisation syndrome management includes psychotherapy and spiritual treatments that emphasise re‐moralisation to increase the patient's feelings of dignity and self‐worth (Connor & Walton, ); conversely, depression treatments include antidepressants, cognitive behavioural therapy and physical activity (Lichtman et al., ). Therefore, this study investigated the incidence and contributors to demoralisation syndrome among patients before and after cardiac surgery.…”