Dorothea Orem is a nurse theorist who pioneered the Self-Care Deficit Nursing

Theory. Get to know the biography and works of Orem, including a discussion
about the major concepts, subconcepts, nursing metaparadigm, and
application of Self- Care Deficit Theory.

Biography of Dorothea E. Orem

Dorothea Elizabeth Orem (July 15, 1914 – June 22, 2007) was one of America’s
foremost nursing theorists who developed the Self-Care Deficit Nursing
Theory, also known as the Orem Model of Nursing.

Her theory defined Nursing as “The act of assisting others in the provision and
management of self-care to maintain or improve human functioning at home
level of effectiveness.” It focuses on each individual’s ability to perform self-
care, defined as “the practice of activities that individuals initiate and perform
on their own behalf in maintaining life, health, and well-being.”

Early Life

Dorothea Orem was born in July 15, 1914 in Baltimore, Maryland. Her father
was a construction worker and her mother is a homemaker. She was the
youngest among two daughters.

In the early 1930s, she earned her nursing diploma from the Providence
Hospital School of Nursing in Washington, D.C. She went on to complete her
Bachelor of Science in Nursing in 1939 and her Master’s of Science in Nursing
in 1945, both from the Catholic University of America in Washington, D.C.

Education

Dorothea Elizabeth Orem

Dorothea Orem attended Seton High School in Baltimore, and graduated in

1931. She received a diploma from the Providence Hospital School of Nursing
in Washington, D.C. in 1934 and went on to the Catholic University of America
to earn a B.S. in Nursing Education in 1939, and an M.S. in Nursing Education in
1945.

She had a distinguished career in nursing. She earned several Honorary

Doctorate degrees. She was given Honorary Doctorates of Science from both
Georgetown University in 1976 and Incarnate Word College in 1980. She was
given an Honorary Doctorate of Humane Letters from Illinois Wesleyan
University in 1988, and a Doctorate Honoris Causae from the University of
Missouri in Columbia in 1998.

Self-Care Theory

Dorothea Orem’s Self-Care Deficit Theory focuses on each “individual’s ability

to perform self-care, defined as ‘the practice of activities that individuals
initiate and perform on their own behalf in maintaining life, health, and well-
being.'” The Self-Care or Self-Care Deficit Theory of Nursing is composed of
three interrelated theories: (1) the theory of self-care, (2) the self-care deficit
theory, and (3) the theory of nursing systems, which is further classified into
wholly compensatory, partial compensatory and supportive-educative. It is
discussed further below.

Dorothea Orem’s Self-Care Deficit Theory

There are instances wherein patients are encouraged to bring out the best in
them despite being ill for a period of time. This is very particular in
rehabilitation settings, in which patients are entitled to be more independent
after being cared for by physicians and nurses. Through these, the Self-Care
Nursing Theory or the Orem Model of Nursing was developed by Dorothea
Orem between 1959 and 2001. It is considered a grand nursing theory, which
means the theory covers a broad scope with general concepts that can be
applied to all instances of nursing.

Description

Dorothea Orem’s Self-Care Deficit Theory defined Nursing as “The act of

assisting others in the provision and management of self-care to maintain or
improve human functioning at home level of effectiveness.” It focuses on each
individual’s ability to perform self-care, defined as “the practice of activities
that individuals initiate and perform on their own behalf in maintaining life,
health, and well-being.”

“The condition that validates the existence of a requirement for nursing in an

adult is the absence of the ability to maintain continuously that amount and
quality of self-care which is therapeutic in sustaining life and health, in
recovering from disease or injury, or in coping with their effects. With children,
the condition is the inability of the parent (or guardian) to maintain
continuously for the child the amount and quality of care that is therapeutic.”
(Orem, 1991)

Assumptions of the Self-Care Deficit Theory

The assumptions of Dorothea Orem’s Self-Care Theory are: (1) In order to stay
alive and remain functional, humans engage in constant communication and
connect among themselves and their environment. (2) The power to act
deliberately is exercised to identify needs and to make needed judgments. (3)
Mature human beings experience privations in the form of action in care of self
and others involving making life-sustaining and function-regulating actions. (4)
Human agency is exercised in discovering, developing, and transmitting to
others ways and means to identify needs for, and make inputs into, self and
others. (5) Groups of human beings with structured relationships cluster tasks
and allocate responsibilities for providing care to group members.

Major Concepts of the Self-Care Deficit Theory

In this section are the definitions of the major concepts of Dorothea Orem’s
Self-Care Deficit Theory:

Nursing
Nursing is an art through which the practitioner of nursing gives specialized
assistance to persons with disabilities which makes more than ordinary
assistance necessary to meet needs for self-care. The nurse also intelligently
participates in the medical care the individual receives from the physician.

Humans

Humans are defined as “men, women, and children cared for either singly or as
social units,” and are the “material object” of nurses and others who provide
direct care.

Environment

The environment has physical, chemical and biological features. It includes the
family, culture, and community.

Health

Health is “being structurally and functionally whole or sound.” Also, health is a

state that encompasses both the health of individuals and of groups, and
human health is the ability to reflect on one’s self, to symbolize experience,
and to communicate with others.

Self-Care

Self-care is the performance or practice of activities that individuals initiate

and perform on their own behalf to maintain life, health, and well-being.

Self-Care Agency

Orem's Self-Care Theory: Interrelationship among concepts. Click to enlarge.

Orem’s Self-Care Theory: Interrelationship among concepts. Click to enlarge.

Self-care agency is the human’s ability or power to engage in self-care and is
affected by basic conditioning factors.

Basic Conditioning Factors

Basic conditioning factors are age, gender, developmental state, health state,
socio-cultural orientation, health care system factors, family system factors,
patterns of living, environmental factors, and resource adequacy and
availability.

Therapeutic Self-Care Demand

Orem's Self-Care Theory - Conceptual Framework. Click to enlarge.

Orem’s Self-Care Theory – Conceptual Framework. Click to enlarge.

Therapeutic Self-care Demand is the totality of “self-care actions to be

performed for some duration in order to meet known self-care requisites by
using valid methods and related sets of actions and operations.”

Self-Care Deficit

Self-care Deficit delineates when nursing is needed. Nursing is required when

an adult (or in the case of a dependent, the parent or guardian) is incapable of
or limited in the provision of continuous effective self-care.

Nursing Agency

Nursing Agency is a complex property or attribute of people educated and

trained as nurses that enables them to act, to know, and to help others meet
their therapeutic self-care demands by exercising or developing their own self-
care agency.

Nursing System
Nursing System is the product of a series of relations between the persons:
legitimate nurse and legitimate client. This system is activated when the
client’s therapeutic self-care demand exceeds available self-care agency,
leading to the need for nursing.

Theories

The Self-Care or Self-Care Deficit Theory of Nursing is composed of three

interrelated theories: (1) the theory of self-care, (2) the self-care deficit theory,
and (3) the theory of nursing systems, which is further classified into wholly
compensatory, partial compensatory and supportive-educative.

Theory of Self-Care

This theory focuses on the performance or practice of activities that individuals

initiate and perform on their own behalf to maintain life, health and well-
being.

Self-Care Requisites

Self-care Requisites or requirements can be defined as actions directed toward

the provision of self-care. It is presented in three categories:

Universal Self-Care Requisites

Universal self-care requisites are associated with life processes and the
maintenance of the integrity of human structure and functioning.

The maintenance of a sufficient intake of air

The maintenance of a sufficient intake of water

The maintenance of a sufficient intake of food

The provision of care associated with elimination process and excrements

The maintenance of a balance between activity and rest

The maintenance of a balance between solitude and social interaction

The prevention of hazards to human life, human functioning, and human well-
being

The promotion of human functioning and development within social groups in

accord with human potential, known human limitations, and the human desire
to be normal

Normalcy is used in the sense of that which is essentially human and that
which is in accord with the genetic and constitutional characteristics and the
talents of individuals.

Developmental self-care requisites

Developmental self-care requisites are “either specialized expressions of

universal self-care requisites that have been particularized for developmental
processes or they are new requisites derived from a condition or associated
with an event.”

Health deviation self-care requisites

Health deviation self-care requisites are required in conditions of illness, injury,

or disease or may result from medical measures required to diagnose and
correct the condition.

Seeking and securing appropriate medical assistance

Being aware of and attending to the effects and results of pathologic
conditions and states

Effectively carrying out medically prescribed diagnostic, therapeutic, and

rehabilitative measures

Being aware of and attending to or regulating the discomforting or deleterious

effects of prescribed medical measures

Modifying the self-concept (and self-image) in accepting oneself as being in a

particular state of health and in need of specific forms of health care

Learning to live with the effects of pathologic conditions and states and the
effects of medical diagnostic and treatment measures in a lifestyle that
promotes continued personal development

Theory of Self-Care Deficit

This theory delineates when nursing is needed. Nursing is required when an

adult (or in the case of a dependent, the parent or guardian) is incapable of or
limited in the provision of continuous effective self-care. Orem identified 5
methods of helping:

Acting for and doing for others

Guiding others

Supporting another

Providing an environment promoting personal development in relation to

meet future demands

Teaching another

Theory of Nursing System

This theory is the product of a series of relations between the persons:

legitimate nurse and legitimate client. This system is activated when the
client’s therapeutic self-care demand exceeds available self-care agency,
leading to the need for nursing.
Wholly Compensatory Nursing System

This is represented by a situation in which the individual is unable “to engage

in those self-care actions requiring self-directed and controlled ambulation and
manipulative movement or the medical prescription to refrain from such
activity… Persons with these limitations are socially dependent on others for
their continued existence and well-being.”

Example: care of a newborn, care of client recovering from surgery in a post-

anesthesia care unit

Partial Compensatory Nursing System

This is represented by a situation in which “both nurse and perform care

measures or other actions involving manipulative tasks or ambulation… [Either]
the patient or the nurse may have a major role in the performance of care
measures.”

Example: Nurse can assist postoperative client to ambulate, Nurse can bring a
meal tray for client who can feed himself

Supportive-Educative System

This is also known as supportive-developmental system, the person “is able to

perform or can and should learn to perform required measures of externally or
internally oriented therapeutic self-care but cannot do so without assistance.”

Example: Nurse guides a mother how to breastfeed her baby, Counseling a

psychiatric client on more adaptive coping strategies.
Dorothea Orem’s Theory and The Nursing Process

The Nursing Process presents a method in determining self-care deficits and to

define the roles of persons or nurse to meet the self-care demands.

Assessment

Diagnosis and prescription; determine why nursing is needed. Analyze and

interpret by making a judgment regarding care.

Design of a nursing system and plan for delivery of care.

Production and management of nursing systems.

Step 1 – Collect Data in Six Areas

The person’s health status

The physician’s perspective of the person’s health status

The person’s perspective of his or health health

The health goals within the context of life history, lifestyle, and health status.

The person’s requirements for self-care

The person’s capacity to perform self-care

Nursing Diagnosis & Care Plans

Step 2

The nurse designs a system that is wholly or partly compensatory or

supportive-educative.

The two actions are: (1) Bringing out a good organization of the components of
patients’ therapeutic self-care demands. (2) Selection of combination of ways
of helping that will be effective and efficient in compensating for/overcoming
patient’s self-care deficits.

Implementation & Evaluation

Step 3

Nurse assists the patient or family in self-care matters to achieve identified and
described health and health-related results. Collecting evidence in evaluating
results achieved against results specified in the nursing system design.

Actions are directed by etiology component of nursing diagnosis.

Analysis of the Self-Care Deficit Theory

There is a superb focus of Orem’s work which is self-care. Even though there is
a wide range of scope seen in the encompassing theory of nursing systems,
Orem’s goal of letting the readers view nursing care as a way to provide
assistance to people was apparent in every concept presented.

From the definition of health which is sought to be rigid, it can now be refined
by making it suitable to the general view of health as a dynamic and ever-
changing state.

The role of the environment to the nurse-patient relationship, although

defined by Orem was not discussed.

The role of nurses in maintaining health for the patient was set by Orem with
great coherence in accordance with the life-sustaining needs of every
individual.

Although Orem viewed the importance of the parents or guardian in providing

for their dependents, the definition of self-care cannot be directly applied to
those who need complete care or assistance with self-care activities such as
the infants and the aged.
Strengths

A major strength of Dorothea Orem’s theory is that it is applicable for nursing

by the beginning practitioner as well as the advanced clinicians.

Orem’s theory provides a comprehensive basis for nursing practice. It has

utility for professional nursing in the areas of nursing practice, nursing
education and administration.

The terms self-care, nursing systems, and self-care deficit are easily
understood by the beginning student nurse and can be explored in greater
depth as the nurse gains more knowledge and experience.

She specifically defines when nursing is needed: Nursing is needed when the
individual cannot maintain continuously that amount and quality of self-care
necessary to sustain life and health, recover from disease or injury, or cope
with their effects.

Her self-care approach is contemporary with the concepts of health promotion

and health maintenance.

Three identifiable nursing systems were clearly delineated and are easily
understood.

Limitations

Orem’s theory, in general, is viewed as a single whole thing while Orem defines
a system as a single whole thing.

Orem’s theory is simple yet complex. The use of self-care in multitudes of

terms, such as self-care agency, self-care demand, self-care deficit, self-care
requisites, and universal self-care, can be very confusing to the reader.

Orem’s definition of health was confined in three static conditions which she
refers to a “concrete nursing system,” which connotes rigidity.

Throughout her work, there is limited acknowledgement of the individual’s

emotional needs.

Health is often viewed as dynamic and ever-changing.

Conclusion

Orem’s theory is relatively simple, but generalizable to apply to a wide variety

of patients. It explains the terms self-care, nursing systems, and self-care
deficit which are very essential to students who plan to start their career in
nursing.

Moreover, this theory signifies that all patients want to care for themselves,
and they are able to recover more quickly and holistically by performing their
own self-care as much as they’re able. This theory is particularly used in
rehabilitation and primary care or other settings in which patients are
encouraged to be independent.
Though this theory greatly influences every patient’s independence, the
definition of self-care cannot be directly applied to those who need complete
care or assistance with self-care activities such as the infants and the aged.