Critique of a Hospice Health Promotion Plan

Health Promotion Plan

Health Promotion in Hospice

The use of Dorothea Orem's Self-Care Theory as the framework for the health promotion plan, for improving depressive symptoms among hospice patients (Nursing Theories, 2012), is appropriate and consistent with a patient-centered care model. This model provides enough room for a gradient of patient self-care efficacy, from fully autonomous to unconscious, which is appropriate for the hospice setting. The author of Health Promotion in Hospice emphasized the need to increase the care efficacy of both hospice patients and their caregivers and mentioned how the role of a hospice nurse must remain fluid to constantly changing care needs of hospice patients. Under Orem's model there is thus a gradient of self-care need and autonomy that is negatively correlated and where deficits emerge the nurse must step in to meet these care needs.

I would also emphasize the concept of 'nursing client' discussed in Orem's theory (Nursing Theories, 2012) because the gradient of self-care efficacy is close to its minimum for many patients in hospice care. The two principles outlined under the concept of 'nursing client' are: (1) nursing care is needed only when the care needs exceeds the ability of the patient to meet these needs and (2) existing limitations creates a chronic need for nursing interventions. This paradigm between acute and chronic need arises frequently within a hospice setting. Another concept discussed on Orem's theory is 'developmental self-care requisites.' This principle seems particularly appropriate to end-of-life care, because aging and the dying process is considered a developmental process by some (Murray, Zentner, & Yakimo, 2008, Chapter 17).

The health promotion plan proposed by the author of Health Promotion in Hospice provides a detailed plan for evaluating hospice patients for depression and lists the goals of a nursing intervention. Within Orem's Self-Care Theory there would also seem to be room for screening informal caregivers for depression as well, since poor health can afflict the patient's loved ones during the dying process (Hirdes, Freeman, Smith, & Stolee, 2012). Current estimates suggest that one in five caregivers is experiencing distress related to providing informal end-of-life care, which may include depressive symptoms. In addition to the stress experienced while providing informal palliative care, caregivers are also faced with the grieving process. Providing care for informal caregivers would not only increase the quality of care they can provide to their dying loved one, but also their ability to protect their own psychological and physical health.