The purpose of this qualitative study was to explore the definitions and sources of hope in patients with end stage renal disease (ESRD) receiving chronic hemodialysis. A convenience sample was recruited from a population of chronic hemodialysis patients from two dialysis centers in a rural area of the Pacific northwest. Study participants consisted of 9 men and 5 women between the ages of 43 and 81 (M = 62.5) who had been on chronic hemodialysis an average of 8.3 years. The data collection process consisted of an audiotaped interview guided by the pre-established research questions. The results of this study provide examples of the experience of hope in patients with ESRD on chronic hemodialysis. Hope is a multifaceted human response. The participants in this study were able to adapt to situational changes by attaching their hopes to reality consideration, therefore developing a cognitive process for maintaining hope.