Eco-Systems Theory and Its Relevance to Hospice Care

Any relationship needs revelation. We want to learn all about that person. We may ask a lot of questions. Where did the person live? What about their childhood experiences? Why they think as they do? Who has been helpful or harmful in their life? It is a necessary process if we truly want to get to know them. As with normal relational behavior, so is the field of human services. Practices are guided by theories. How human services evaluate a situation, or person, is led by our prevailing theory of operation. Human services have developed several working theories used in the assessment of its clients. A way of “getting to know them”, if you will. One theory we will discuss is the Eco-Systems Theory. What is its relevance in the human services field? More specifically, how is it relevant to the area of Hospice care?Bronfenbrenner’s Ecological Systems Theory Urie Bronfenbrenner’s theory, developed in 1979, explained four areas of a person’s environment and how these interactions have influence on the development of that person. The first level is the Microsystem. It is the “smallest and most direct system that a person directly experiences” (Nash, Munford, & O’Donoghue, 2005, p. 37). It would include the individual, their home, and family. Next, is the Mesosystem. This involves interactions the person has with the office, neighborhood, or school. Third, is the Exosystem. It includes organizations or groups that the person may not be directly involved with, but they still have an impact on them (state or federal government). The outside area is the Macrosystem which involves the social or cultural setting in general.How Eco-Systems Influence Hospice Care? When encountering the area of hospice care for the terminally ill and dying, the needs are varied as in all fields of human services. “No one individual can meet all the needs of the terminally ill patients and families all the time” (Kulys & David, 1986, p. 448). Using the Ecological Systems Theory encourages the analysis and consideration of the different environments in and around a patient. The evaluation may present an “opportunity for an open and comprehensive approach to the issues facing clients” (Blok, 2012, p. 59) and their families. In the case of Bronfenbrenner’s approach, the terminally ill patient and his family are the center of concern. The individual’s needs and wishes are central to the assessment. Family is considered as well. From that inner circle, as other areas intersect, the care the patient needs is clearer. At times, a client may not know what they need, and the hospice worker becomes a valuable tool, providing resources and knowledge in a time of crisis. In fact, Eco-Systems “encourage breaking down barriers between sciences and profession, and building bridges between different disciplines,” (Blok, 2012, p. 59) all at a crucial time in the life of the individual. Why is Bronfenbrenner’s Ecological Systems Theory Valuable to Hospice Care? The primary concern in hospice care is the individual. Dying is a natural process of life. As such, the person should be able to die with dignity and respect. “A core value of the hospice philosophy is that each person has the right to die without pain and that the dying process should be a meaningful experience” (Martin, 2014, p. 230). Managing the care of the individual using the Eco-Systems Theory ensures a holistic attitude to their treatment. For example, Joe is in the last stages of terminal cancer. The hospital has referred him to the availability of hospice care. A worker would meet with Joe and begin to assess his needs. Perhaps, he has a wife who needs to be told. An explanation of the services offered by hospice would be given. If Joe decides to remain at home as long as possible, then another level of the approach or theory enters. Physicians, nurses, clergy or spiritual counselors may be introduced widening the environment. “Although they each perform a certain task there is an overlap in the services because of a holistic approach” (McDonald, 2018). The main concern is the patient and family, but many factors intersect in the care. As workers in the field of human services, there is a need to know why something is done the way it is done. The theory you work from matters. It matters for the client who is in need. As in the case of hospice care, it can be their last need. According to Nash, Munford, & O’Donoghue (2005) is must have “street-level applicability.” Applying the Eco-Systems theory to the evaluation process is a valuable tool for patient and family in hospice care.

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