Dorothea Orem’s Theory – Nursing Change Theory Essay

The paper explores the use of Dorothea Orem’s Theory Self-care Deficit Nursing Theory (SCDNT) and its implementation as the theoretical framework for the project.

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Section D Change Theory – Dorothea Orem’s Theory Self-care Deficit Nursing Theory (SCDNT)

Dorothea Orem’s Theory – Nursing Change Theory Essay


The increase of knowledge and self-care activities of patients with heart failure can reduce admission rates to an acute hospital setting. Thus, the evidence-based project, which focuses on lowering preventable heart failure readmissions, was proposed. The EBP incorporates the best education-related practices. To reduce readmissions and, at the same time, improve outcomes, it is necessary to educate the patient and their families on heart failure management. Dorothea Orem’s Theory Self-care Deficit Nursing Theory (SCDNT) provides the theoretical framework for the project.

Selected Theoretical Framework and Conceptual Model – Dorothea Orem’s Theory

SCDNT or Orem’s theory is suitable for heart failure patients since it actively encourages them to participate in their care. The patients are encouraged to be in a position to care for their daily weights, adhere to medications as well as identify worsening symptoms (Attaallah, Klymko, & Hopp, 2016). This self-care is an essential concept for the nurses while caring for heart failure patients since it captures the center of nursing philosophy and a crucial nursing practice aspect. In this model, nursing assessment, diagnosis, organization, execution, and evaluation processes Previous studies show that applying this theory to patients with heart failure brings about affirmative therapy and clinical outcomes when self-care measures are applied and reinforced inpatient heart failure education (Parke, 2017). Reduced readmissions would reduce the financial burden resulting from heart failure patient readmission within 30 days.


The Stages in The Change Model/Framework

Dorothea Orem’s self-care theory and possibilities of its application. Orem’s theory has systematically identified steps that will not only guide adjustment but also integrate into practice. First, there will be an assessment of the need for variance in practice. Measures needed to be taken by hospitals in order to reduce readmission within 30 days follow the review. The hospital’s target will be to reduce hospitalization by 20% because of the current heart failure readmission rates. Possible causes for change will be discussed. Secondly, problems, interventions, as well as results are linked. In this stage, some group members will present confirmation of suitable practices for a readmission rate reduction from seminars.

Different groups within the hospital share practices that produce positive results. Ways to help heart failure patients identify the variance of their condition and seek intervention before requiring hospitalization are devised. The next stage synthesizes the best evidence. ProQuest and PubMed are some of the databases that will apply to a literature review within a limited period (Amoah, & Mwanri, 2016). Terms such as heart failure, readmission education, decrease reimbursement, and self-care are used.

Dorothea orem’s theory consisted of designing of practice change. The change to be proposed in the discharge process is discussed by one of the groups. The possibility of practice change implementation, together with strategies are suggested. Necessary resources are also identified. Before engaging in the last stage, change in practice is to be implemented and also evaluated. Ways of evaluating the process are formulated by the students and concerned stakeholders like the quality manager. 30-day readmission rates on heart failure patients are evaluated as they are also further educated. Lastly, the change in practice is to be integrated and maintained. They can either accept or reject it to either integrate the practice into the standards or not is made as they observe the trend of readmission rates and heart failure self-care management.

Application of Each Stage of the Proposed Project Implementation

The steps of Dorothea Orem’s Self-care Deficit Nursing Theory (SCDNT), as the applied theoretical framework for this evidence-based project, are to be appropriately applied in the proposed implementation. Stage one, assessing the need for change practice, will help the administration recognize and report the recorded readmission rates in the hospital compared to the national average. Using guidelines of the best practice will help formulate a PICOT question to assess heart failure education’s impact on readmission rates within 30 days. Both internal and external factors that may affect the EBP project will be assessed. After applying the assessment for change practice, locating the best evidence will be useful in obtaining literature and seminar evidence concerning the best practices in lowering readmission rates. PubMed and ProQuest databases will be useful in the search process. In the third step, synthesizing the best evidence, the evidence will be analyzed using Melnyk and Covey’s (2016) rating system for critical consideration and hierarchy forms of evidence from books. The selected studies will summarize the evidence in a table form. Analysis of how the support of post-discharge for old heart failure patients reduces 30-day readmission will also be done.

Stage 4 of designing practice change will define what would change practice and decrease the readmissi0on rate. Patients will be given further education in heart failure clinics APNs. Implementing and evaluating change in practice will also be applicable. The educational tool will be administered to a patient. Intervention data will also be collected for 30 days while at the same time noting the rate of readmission. Finally, on integration and maintaining change in practice, a decision will be made to integrate the teaching tool into the practice standards for the hospital.


In conclusion, there will be an assessment of the impact of discharge education on readmission rates. The project will focus on reducing 30-day readmission rates. The education tool will be used In the future following its success.


Amoah, D., & Mwanri, L. (2016). Determinants of hospital readmission of medical conditions in developing countries. Austin J Public Health Epidemiol, 3(5), 1049.

Attaallah, S., Klymko, K., & Hopp, F. P. (2016). Self-care among older adults with heart failure. Gerontology and Geriatric Medicine, 2, 2333721416684013.

Melnyk, B. M., & Covey, S. R. (2016). Improving healthcare quality, patient outcomes, and costs with evidence-based practice. Reflections of Nursing Leadership, 42(3), 1-8.

Parke, H. (2017). Educational Intervention to Improve Self-Efficacy and Self-Care in Patients with Heart Failure.

Dorothea Orem’s Theory – Nursing Change Theory Essay Instructions

Roger’s diffusion of innovation theory is a particularly good theoretical framework to apply to an EBP project. However, students may also choose to use change models, such as Duck\’s change curve model or the transtheoretical model of behavioral change. Other conceptual models, such as a utilization model (Stetler\’s model) and EBP models (the Iowa model and ARCC model) can also be used as a framework for applying your evidence-based proposal in clinical practice. Apply one of the above models and carry your implementation through each of the stages, phases, or steps identified in the chosen model.

In 500-750 words (not including the title page and references page), discuss applying one of the change models to the implementation plan:

  1. Identify the selected model or theoretical framework and discuss its relevance to your project.
  2. Discuss each of the stages in the change model/framework.
  3. Describe how you would apply each stage in your proposed implementation.

In addition, create a conceptual model of the project. Although you will not be submitting the conceptual model you design in Topic 4 with the narrative, you will include the conceptual model in the appendices for the final paper.

You are required to cite three to five sources to complete this assignment. Sources must be published within the last 5 years and appropriate for the assignment criteria and nursing content.

Prepare this assignment according to the guidelines found in the APA Style Guide, located in the Student Success Center. An abstract is not required.

This assignment uses a rubric. Please review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion.

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