Dorothea Orem's Self Care Deficit Theory Analysis

Nursing theories represent abstract ideas relating to the concepts of person, environment, health/illness and nursing. Many nursing leaders provide unique perspectives on the nursing process in relation to the whole of the metaparadigm. Nurses apply the concepts and frameworks described in various nursing theories as a baseline for critical thinking and decision making. (Creasia & Friberg, 2011). The nursing theory that best supports this writer’s proposed solution of using case management and remote monitoring to decrease readmission rates within 30 days is, Dorothea Orem’s self-care deficit theory (SCDT).

Orem’s SCDT is designed from the basic thought that people want to take care of their needs or those of dependent others (Fawcett,

2002). All human beings require basic self-care needs. These self-care requisites include “sufficient intake of air, water and food, provision of care associated with elimination, processes, a balance between activity and rest, solitude and social interaction, prevention of hazards to human life and promotion of human functioning’ (Current Nursing, 2012). Nursing care is needed when the patient has a physical, intellectual or psychological reliance upon another person to meet his or her self-care requisites (Orem & Repenning, 1995). Parsons (2008) describes how nursing uses Orem’s model to meet deficits in the basic self-care requisites by reducing the demands for self-care to allow the person or caregiver to meet the needs, empowering the person to increase their ability to meet self-care demands, empowering the person or caregiver to provide care when self-care is not possible and lastly when none of these can be achieved, the nurse shall provide the care needed. Orem refers to the role of the nurse as a nursing agency who responsibilities are to meet the needs of the patient.
Heart Failure results in the greater than 1 million hospital admissions per year. Desai & Stevenson (2012) share that despite improvements in medical regimes and patient outcomes, readmission rates remain high with approximate 24% of patients returning to the hospital within 30 days of discharge. Frequent exacerbations resulting in readmissions are prompted by remedial factors such as non-adherence to medication or diet, lack of recognition of signs and symptoms, delays in seeking medical attention, and lack of proper support systems (Desai, 2012). Tailored interventions specific to patient needs, knowledge, socio economic status and care giver support systems are variables that can be adjusted by the nursing agency to lead to improved outcomes. (Lee, Vellone, Lyons, Cocchieri, Bidwellm, Agostiono, Hiatt, Alvaro, Buck & Riegel , 2014).
Orem’s SCDT fits well with the author’s proposed plans to use remote monitoring and case management to reduce heart failure readmissions within 30 days. By providing the tools needed for real time monitoring in tandem with educational knowledge, prevention and early intervention of patient decompensation can improve self-care.