Nursing is caring, protecting, educating, and preventing harm. The intention of every health care provider is to intervene and provide the best practice to patients. While hospitalized, patients are under the care of nurses, advanced practicing nurses, physicians, and a multidisciplinary team, but 30-day hospital readmissions are still an issue.
Identifying gaps in healthcare and addressing those issues are the purpose of theory. Discussing how theory can be utilized to address self-care thus preventing hospital readmissions will be detailed throughout this written wo.
The role of the nurse practitioner in the hospital setting varies, but one is to identify barriers to discharge and prevent 30-day readmissions. According to an article I read, the acute care nurse practitioners perform, “daily visits, progress notes, calling consults, discharges, discharge summaries, procedures, and billing” (Scheurer & Cardin, 2017, p. 1). The nurse practitioner also gathers information about the patient’s past medical conditions, physical assessment, and social situation.
During the initial assessment the practitioner can gather valuable information about the patient, then begin to implement a plan of care including discharge planning. Since discharge planning is an important process, understanding that health disparities within every population of people differs. Patient’s needs can range from no housing, no income, no transportation, and no insurance, which is why each patient must be managed accordingly.
The quality of discharge planning can prevent hospital readmissions. Many patients are usually readmitted due to chronic conditions such as chronic obstructive pulmonary disease, pneumonia, heart failure, hip arthroplasty, sickle cell crisis, and diabetes. Hospitals are penalized for frequent 30-day admissions according to Medicare. The Centers for Medicare and Medicaid Services (CMS) states: “In October 2012, CMS began reducing Medicare payments for Inpatient Prospective Payment System hospitals with excess readmissions.
Excess readmissions are measured by a ratio, by dividing a hospital’s number of “predicted” 30-day readmissions for heart attack, heart failure, and pneumonia by the number that would be “expected,” based on an average hospital with similar patients.” (Medicare, 2018, p.1). Indiana 30-day readmission statistics reports, “Sixty-six Indiana hospitals will have Medicare payments docked in 2019 by a total of about $12 million from 30-day readmissions — up from $9 million in penalties three years ago.” (Knowles, 2018, p.1).
Incorporation of Theoretical Thinking
Theory utilization is essential to managing hospital readmissions, but the following question should be answered: What is the cause of 30-day readmissions? Once this question is answered then a theory can be applied for intervention. To theoretically approach this phenomenon, reading the Smith and Parker literature, chapter 3, gives insight on how to use insight when choosing theory, for example, it asks: “What nursing theory seems consistent with the values and beliefs that guide my practice?” (Smith & Parker, 2015, p. 30).
In this scenario, using Dorothea E. Orem, Self-Care Deficit Theory, as a guide will address many of the various reasons for 30-day readmissions. Many patients lack education on their disease process, and medication regimen, leading to readmissions. Patients also lack resources that links them to primary care providers and/or community outpatient programs.
Dorothea’s Self-Care Deficit Theory acknowledges that people must be responsible and self-reliant for their own care. Self-care is performing activities of daily; taking medications as prescribed; attending follow-up appointments; meeting emotional, psychological, and social needs; caring for chronic conditions; and preventing further illness. Dorothea notes that self-care “is the practice of activities that an individual initiate and performs on his or her own behalf to maintain life, health, and well-being” (Petiprin, 2016, p. 1).
This quote reflects why educating the patient on admission and prior to discharge is important because without the proper tools self-care is impossible. A patient must understand their health symptoms, when to intervene, and risks associated with the lack of self-care. To impact the issue of self-care deficits leading to 30-day readmissions, providers must utilize resources for patients, such as a case manager.
The case manager can arrange for home health care providers (e.g. nurse, therapist, social worker); durable medical equipment; primary care providers; insurance screenings; outpatient programs (e.g., cardiac/pulmonary rehab, therapy); and post-acute rehab facilities. The case manager also utilizes a readmission tool to help identify patients who are at high risk for readmission.
This information is accessible to providers in the hospital setting. As mentioned earlier, the quality of discharges matter. Once a patient is discharged home, the only tools they have is education and discharge instructions. The Self-Care deficit theory see’s people in a holistic manner and makes people responsible for their own health and well-being.
The purpose of this written work was to draw attention to how self-care deficit in patients can lead to 30-day readmissions. With a combination of Dorothea Orem’s, Self-Care Deficit Theory, a thorough assessment, resources, and extensive education can lower or prevent the rate of readmissions. The implication of 30-day readmissions for hospitals are penalties enforced by the CMS which can eventually affect nursing wages. Achieving a successful self-care regimen tailor-made for each individual will decrease the number of 30-day readmission’s.