The first point addressed by Clark's review determines that a fundamental change in medical perspective had begun to transpire with the assumption of varying clinical research investigations on the subject. This would contribute to what Clark identifies as a major shift in the way that physicians had begun to perceive and treat terminal illness. As opposed to a cut and dry preparation of the patient for the certainty of death, Clark points to a juncture in the mid to late 20th century at which medical professionals had begun to adopt "an active rather than a passive approach to the care of dying people was promoted in which the fatalistic resignation of the doctor ('there is nothing more we can do') was supplanted by a determination to find new and imaginative ways to continue caring up to the end of life." (Clark, 2002) In addition to serving as a fundamental motivation for the continuing investigation of ways to extend life expectancy with or without the presence of supposedly terminal illness, the optimism here reflected serves to improve the quality of life for those in the final phases. The simple expression of optimism -- not unrealistic or patronizing but conducive of an emotionally connected assurance that all possible measures will be taken to preserve life -- can have the impact of promoting a sense of value and support for one on the cusp of death. Even where life cannot be preserved, the expression of optimism suggests that these moments of life can be made more tolerable by the perspective taken by healthcare providers.

This idea speaks to another fundamental inflection point in the way that healthcare professional have begun to treat the emotional orientation of patients. Clark points to a "growing recognition of the interdependency of mental and physical distress created the potential for a more embodied notion of suffering, thus constituting a profound challenge to the body-mind dualism on which so much medical practice of the period was predicated." (Clark, 2002) This period, late in the 20th century, has led us to the current consensus that there is indeed a real and tangible value to the emotional fortitude of one enduring a physical breakdown. The presence of hope in the healthcare provider, we can clearly see, is likely to improve the prospect that even a terminally ill or age-advanced patient might adopt a hopefulness as well. This speaks to the opportunity for the healthcare provider to display personality through interest in the patient's emotional disposition. The patient is likely to respond positively where capable to indications of an interest beyond the physical body. This has even greater implications to a patient's life than a single visit or stay in the hospital though.

This is to indicate that the emotional disposition and preparation which the individual undergoes in the individual health circumstance will correlate to a lifetime of experience with the healthcare system. Positive and negative experiences involving hospital visits, concerning interactions with physicians and relating to past health concerns will precede one's entrance into a new healthcare experience. Therefore, one's emotional constitution can have a direct relationship to a history or pattern that speaks positively or negatively to expectations for a hospital or physician visit. According to the text by Zerbe et al. (2006), "it is suggested that in healthcare it is the patients' journey through their lives (the macro contest), as well as their individual encounters with the system at different times of need (the micro context), that iteratively constitute the construction of the emotional terrain." (Zerbe et al., 146)

This principle of emotional terrain transcends the concept of emotion relating to a single physician visit or stay in a hospital or long-care facility. The patient will bring with her the weight of all manner of experiences. For adult and senior healthcare patients, a visit to or stay at a healthcare facility will be given emotional prelude by a personal history in which poor treatment by healthcare professionals, long waits for treatment in hospital emergency rooms, negative outcomes as a result of treatment practices or even a long lapse in medical attention manifesting as an unfamiliar fear of the hospital and the implications of serious diagnoses can have a stultifying psychological impact. Indeed, as discussed here throughout, this can have distinctly negative treatment outcomes. To the text by Zerbe et al., this functions as an indicator that there is a need for medical practitioners and facilities throughout the healthcare sector to approach all patients through a continuum of positive emotional orientation. Standards dictating facility orientation should...

text indicates, this is a goal which has been given philosophical grounding in the field but has yet to be formalized as is needed. Zerbe et al. contend that "although the terrain of healthcare has always dealt with the consequences of emotion or affect, for example, in the doctor-patient relationship, it is not seen as part of the explicit activity of the organization. However, the use of metaphor of narrative, in the delivery of healthcare, is a notable exception, showing as it does that 'emotion words and emotion talk are key ingredients.'" (Zerbe et al., 146)
A study by Eliott & Olver (2006) likewise provides an important body of insight into the subject of emotional consequences in medical proceedings. Its emphasis on the relationship between hope in the medical context and the object of coping with the end of life reveals the depths and persistence of hope as part of the human condition. The merit of the overarching argument here is especially strengthened by the resolutions of this study, which demonstrate a fundamental value to hope in alleviating the pain, discomfort, fear and loneliness which can otherwise be the characteristic emotions of a recognition of the end of life.

The functionality of hope in the face of impending death is particularly interesting. In cases of advanced age or advanced terminal illness, the physician or nurse's responsibility shifts from curative focus or aggressive treatment methodology to a focus on the alleviation of suffering. In this context, healthcare professionals must be prepared to help ease such patients into death with as little anguish and as great a level of comfort as is possible. This is why such matters as acceptance, realism and a sense of support are all crucial emotional aspects of the treatment process. Here, the capacity in the patient to summon hope, and the ability of healthcare providers to offer humane support to the extent of instilling hope, will together be essential to assisting patients in the difficult final phase of the life cycle. Thus, "in the context of discussions about decision-making at the end of a terminal illness, when used as a noun, hope invariably referenced the medical domain -- focusing either on the objective probability of medical cure (typically taking the negative form "there is no hope"), or the subjective possession of the patient, needed to fight their disease." (Eliot & Olver, 2006) Without positive or negative connotation, this indicates that the concept of hope is a definite emotional presence as individuals face terminal conditions. Whether it is realistic for one to fight or to submit to illness, hope makes a transition from an abstract sentiment to a real and tangible emotion which may either be palpable in its absence or powerfully evident in its presence.

Managerial Applications:

In considering the managerial applications of appealing to the emotional management prospects as they relate to treatment processes and outcomes, the Health Belief Model serves to inform practical ways of implementation. This denotes that individuals will tend to approach healthcare and treatment according to their own ideas and prejudices herewith. The greatest limitation to this approach is, of course, the incapacity of some of the most afflicted patients to express themselves fully. Another limitation is the pointedly qualitative, observational and therefore non-empirical nature of the study conducted here. By and large, as Stokes & Turner (2006) note on this subject, related "literature is replete with claims that Registered Nurses engage in hope facilitation with their patients. However, these claims are largely conjecture, with few studies empirically identifying the extent to which Registered Nurses use hope interventions with their patients." (p. 363) Indeed, the research investigation here follows a similar pattern, generally seeking to draw observations without making distinctions regarding control and experimental groups. Moreover there is made no real attempt to disprove or critique the value of hope as counterpoint.

With this in mind, the greatest value of the emotion-based strategies which we examine here would be in their application. We may ably suggest at least from the research which has been conducted that hope is not detectably threatening in any way to the process of recovery or coping with mortality. Moreover, it has already had proven applied success in other clinical contexts. Name, it is already true, according to Moore (2005), that "hope is at the heart of psychiatric nursing practice." (p. 100) Therefore, for the general subject of…