Self-Care Deficit Theory
HEALTH: Orem supports the WHO’s definition of health
Dorothea E. Orem
Credentials and Background:
- Born on 1914 in Baltimore, Maryland
- Began her nursing education at Providence Hospital
School of Nursing in Washington,DC
- 1939 – she earned her BSN education at the Catholic
University of America
- 1946 – earned her M.S.N. from Catholic
University of America.
- Her nursing experiences included
a. operating room nursing.
b. private duty nursing
(home & hospital).
c. hospital staff nursing
on pediatric and adult
medical and surgical units.
d. evening supervisor in the E.R.
e. biological science teacher.
- 1958-1960 curriculum consultant.
- 1959 – “Guides for developing the curricula for the
Education of PracticaL Nurses” was published
- 1971 – “Nursing Concepts of Practice” which is Orem’s
first book was published.
- Orem’s theory addresses client’s self-care needs.
- It is defined as Goal-oriented activities that are set
towards generating interest in the part of the client
to maintain life & health development.
- The theory is aimed towards making the clients
perform self-care activities in order to live
independently.
METAPARADIGM
PERSON: Defined as the patient- a being who functions
biologically, symbolically & socially & who has the
potential for learning & development.
Is an individual subject to the forces of nature, with a
capacity for self-knowledge, who can engage in
deliberate action, interpret experiences & perform
beneficial actions.
Is an individual who can learn to meet self-care
requisites; if for some reason, the person cannot learn
self-care measures, others must provide the care.
as “the state of physical, mental, and social well-being
and not merely the absence of disease or infirmity”.
Consists of physical, psychological, interpersonal &
social aspects; according to Orem, these aspects are
inseparable.
Includes promotion & maintenance of health, treatment
of illness & prevention of complication.
ENVIRONMENT: Consists of environmental factors,
environmental elements, environmental conditions
(external physical & psychosocial surroundings) &
developmental environment (promotion of personal
development through motivation to establish
appropriate goals & to adjust behavior to meet these
goals; includes formation of or change in attitudes &
values, creativity, self-concept & physical development
NURSING: Helping clients to establish or identify ways
to perform self-care activities.
- Nursing actions are geared towards the independence
of the client.
- Nursing is a human service-its focus is on persons with
inabilities to maintain continuous provision of
healthcare.
- Nursing is based on values.
Major Concepts & Definitions
* Self – Care
* Self – Care Requisites
* Universal Self-Care Requisites
* Developmental Self – Care Requisites
* Health Deviation Self – Care Requisites
* Therapeutic Self – Care Demand
* Self-Care Agency
* Agent
* Dependent-Care Agent
* Self-Care Deficit
* Nursing Agency
* Nursing Design
* Nursing System
* Helping Methods
Self-care deficit theory as a general theory is
composed of 3 related theories:
1. THE THEORY OF SELF-CARE - Describes why & how
people care for themselves
Self- Care : refers to those activities an individual
performs independently throughout life to promote &
maintain personal well-being.
Self- Care agency : the complex acquired ability of
mature & maturing persons to know & meet their
continuing requirements for deliberate, purposive
action to regulate their own functioning & development
- consists of two agents:
An agent (individual who is engage in meeting the need
of a person; like bridges that facilitate what has been
done and what needs to be done)
Self-care agent – person who provides the self-care.
Dependent care agent – person other than the
individual who provides cares
Self-care requisites or Self-care needs : are insights of
actions or requirements that a person must be able to
meet and perform in order to achieve well-being.
Categories of Self-care requisites:
A. Universal Self-care requisites - These are universally
set goals that must be undertaken in order for an
individual to function in scope of healthy living.
1. Maintenance of sufficient intake of air.
2. Maintenance of sufficient intake of food.
3. Maintenance of sufficient intake of water.
4. Provision of care associated with elimination.
5. Maintenance of balance between activity and rest.
6. Maintenance of balance between solitude and social
interaction.
7. Prevention of hazards to human life, human
functioning and human well-being;
8. Promotion of human functioning and development.
B. Developmental Self-care requisites - result from
maturation or associated with conditions or events such
as adjusting to a change in body image or loss of a
spouse.
- They promote processes for life & maturation &
prevent conditions deleterious to maturation or those
that lessens those effects.
C. Health deviation self-care requisites - requisites
that result from illness, injury or disease or its
treatment; they include such actions as seeking medical
assistance, carrying out a prescribed treatment or
learning to live with the effects of illness or treatment
- These health care deviations set standards to which
the degree of self-care demand is needed.
Therapeutic Self-Care Demand
- Refers to all self-care activities required to meet
existing self-care requisites.
- Involves the use of actions to maintain health & well-
being, each patient’s therapeutic self-care demands
varies throughout life.
2. THE THEORY OF SELF-CARE DEFICIT - which
describes & explains why people can be helped through
nursing
Self-care deficit : arises when the self-care agency
cannot meet self-care requisites.
Helping Methods:
1. Acting or doing for another
2. Guiding and directing
3. Providing physical or psychological support
4. Teaching
5. Providing and maintaining an environment that
supports personal development.
3. THEORY OF NURSING
SYSTEMS - describes and explains relationships that
must be brought about & maintained for nursing to be
produced
- refers to the series of actions a nurse takes to meet a
patient’s self-care requisites.
Nursing Agency: set of established capabilities of a
nurse who can legitimately perform activities of care for
a client.
- helps a person achieve their health care demand.
Nursing Design: these are professional functions that
must be performed by the nurse in order to meet client
needs.
- it serves as a guideline of needed & foreseen results in
the production of nursing toward the achievement of
nursing goals.

3 Types of Nursing Systems:

- Each system describes nursing responsibilities, roles of
the nurse & patient, rationales for the nurse-patient
relationship & types of actions needed to meet the
patient’s self-care agency & therapeutic self-care
demand.

1. A wholly compensatory nursing system - is

used when a patient’s self-care agency is so
limited that the patient depends on others for
well-being.
2. A partly compensatory nursing system - is
used when a patient can meet some self-care
requisites but needs a nurse to help meet
others - the nurse & the patient play major
roles in performing self-care.

3. Supportive – Educative Nursing System

- is used when a patient can meet self-care
requisites but needs assistance with decision
making , behavior control or knowledge
acquisition skills.

Major Assumptions
1. Human beings require continuous, deliberate
inputs to themselves and their environments to
remain alive and function in accordance with
natural human endowments.
2. Human agency, the power to act deliberately,
is exercised in the form of care for self and
others in identifying needs and making needed
inputs.
3. Mature human beings experience privations
in the form of limitations for action in care for
self and others involving and making of life
sustaining and functionregulating inputs.
4. Human agency is exercised in discovering,
developing, and transmitting ways and means
to identify needs and make inputs to self and
others.
5. Groups of human beings with structured
relationship cluster tasks and allocate
responsibilities for providing care to group
members who experience privations for making
required, deliberate input to self and others.
 in 1970.

Acceptance by the Nursing Community

1. Practice- The first documented use of Orem’s theory - She published From Novice to Expert in 1984 and
as the basis for structuring practice is found in became a Fellow in the American Academy of Nursing in
descriptions of nursemanaged clinics at John Hopkins 1985.
Hospital in 1973.
METAPARADIGM
Research articles on the use of SCDNT or components in A. PERSON - “ a self-interpreting being, that is, the
clinical practice include person does not come into the world predefined but
A. Teaching self-care to individuals with DM, ESRD, gets defined in the course of living a life.
hemodialysis, peritoneal dialysis, renal transplant
The three major aspects of understanding that the
B. Pain assessment
person must deal with:
C. Cardiac research
D. Oncology – focus cancer prevention, self-care after 1. The role of the situation
being diagnosed with malignancies. 2. The role of the body
3. The role of personal concerns
Psychiatry etc.. 4. The role of temporality.
Education “Guides for Developing Curriculum for the
Education of Practical Nurses” B. HEALTH
a. Orem worked on a book “Foundations of Nursing Health – what can be assessed
Practice” (Morris Harvey College) Well-being – human experience of health or wholeness.
Illness – the human experience of loss or dysfunction.
Research Disease – is what can be assessed at the physical level
a. First instrument to measure the exercise of Selfcare
agency (ESCA) was published in 1979 C. ENVIRONMENT
* She used the word situation because it suggests a
Further Development social environment with social definition and meaning.
- Orem is presently working with a group of scholars,
known as Orem study Group * Situation – defined by the person’s engaged
- International Orem Society for Nursing scholarships interaction, interpretation and understanding of the
(IOS est. 1993) situation.

* Persons enter into situations with their own sets of

The Sixth International SelfCare deficit theory meaning, habits & persperctives.
Conference which was held in Bangkok, Thailand in
February 2000.
D. NURSING
- She described nursing as a caring relationship, an
From Novice to Expert: Excellence and Power in “enabling condition of connection and concern.
Clinical Nursing Practice
Credentials and background of the theorist: - Viewed nursing practice as the care and study of the
Patricia Benner, R.N., Ph.D., F.A.A.N. lived experience of health, illness, and disease and the
- Professor, University of California-San Francisco relationships among these three elements.
- obtained a Bachelor of Arts degree from Pasadena
College in 1964.
- Earned a master’s degree in nursing from the
University of California, San Francisco Schoolof Nursing
EXPERT
Key aspects of the expert nurse practice:
- Demonstrating a clinical grasp and resource-based
practice
- Possessing embodied knowledge
- Seeing the big picture
- Seeing the unexpected

SEVEN DOMAINS OF NURSING PRACTICE

1. Helping role
2. Diagnostic client-monitoring function
3. Effective management of rapidly changing situations
4. Administering & monitoring therapeutic interventions
& regimens.
5. Monitoring & ensuring quality health care practices
6. Organizational & work-role performance
7. Teaching or coaching function
MARTHA ROGER’S SCIENCE OF UNITARY HUMAN
BEING
Introduction:
Martha Roger's theory Science of Unitary Human
- is Beings is mainly focusing on the four concepts and
three principles of homeodynamic that are energy
fields, openness, pattern, pandimensioal, integrality,
resonancy, and helicy respectively.
Assumptions:
-Human being is considered as whole which cannot be
viewed as subparts.
- The life process of human is irreparable and one way
i.e. from birth to death.
- Health and illness are the continuous expression of the
life process.
-The energy flows freely between the individual and
environment.
-Human being possesses the ability to think, imagine,
sense, feel, and can use language for expression.
- Human beings have the ability to adapt according to
the new changes in the environment.
CONCEPTS:
• All the human beings are viewed as an integral part of
universe.
• Human beings and the environment have energy field,
nursing action is directed towards patterning and
maintaining these energy fields.
Energy fields:
• it is the inevitable part of life. Human and
environment both have energy field which is open i.e.
energy can freely flow between human and
environment.
Openness:
• there is no boundary or barrier that can inhibit the
flow of energy between human and environment which
leads to the continuous movement or matter of energy.
Pattern:
• is the distinguishing character of the energy field.
Pandimensioal:
• Undeviating field which is not constricted by space or
time, it is an infinite domain without boundary.
Principle of Homeodynamics:
• Homeodynamics refers to the balance between the
dynamic life process and environment.
• These principles help to view human as unitary human
being. The three separate principles are integrality,
resonancy, and heliecy.
Principles of integrality:
• Energy fields are dynamic and constantly interact with
the human and environment, which affects our
environment and vice versa.
• This is the principle on which meditation and humor
works to produce a positive environment.
Principles of resonancy:
• is an ordered arrangement of rhythm characterizing
both human field and environmental field.
• Constant change in the way or pattern of the energy
field from a lower to higher frequency.
• This movement of energy can be made by human
touch. guided imagery activities, drawing, storytelling
and other active use of imagination.
Principles of heliecy:
• Any minute change in the environment which leads to
ripple effect i.e. results in a larger changes in other field
• This change is constant, unpredictable and there are
many factors which mutually interact and cause the
change.
METAPARADIGM
Person:
• a unitary human being is open systems which a
continuously interact with environment. A person
cannot be viewed as parts, it should be considered as a
whole.
Environment:
• it includes the entire energy field other than a person.
• These energy fields are irreducible, not limited by
space and time, identified by its pattern and
organization.
Health:
• Not clearly defined by Roger. It is determined by the
Nursing Education:
interaction between energy fields i.e. human and
• Emphasis should be given on the understanding of the
environment.
patient and self, energy field and environment.
• Bad interaction or misplacing of the energy leads to
• Training should lay more focus on teaching non-
illness.
invasive modalities such as therapeutic touch,
Nursing: meditation, humor, regular in-service education
• Is both science and art. programme etc.
• It constantly maintains the energy field which is
Nursing Research:
conducive for patient.
• Rogerian theory has been used in many research
• Nursing action directs the interaction of person and
works and has always been found testable and
environment to maximize health potential.
applicable in research.

APPLICATION OF SUBH
NURSING PROCESS ACCORDING TO SUBH:
1. PRACTICE
2. EDUCATION Pattern appraisal:
3. RESEARCH • It is an inclusive assessment of human and
environment energy fields, its organization of energy
Clinical Practice: field, and identification of areas of dissonance.
• Nursing action iS always focused on unitary human • Nurses validate the entire appraisal along with the
being and change the energy field between human and client.
environment.
• Nursing interventions include all the noninvasive Mutual patterning:
actions such as guided imaginary, humor, therapeutic • It is the proper patterning of the energy fields
touch, music etc. which are used to increase the between the human and environment.
potential of human being. • It is the mutual interaction between the client and
• The more importance should be on the management nurse
of pain, supportive psychotherapy and rehabilitation of • Patterning can be done by suggesting the various
the human being. alternatives, educating, empowering, encouraging etc.
depending on the client's condition and needs.
• Pattern appraisal include appraisal of nutrition, rest
and sleep, exercises, discomfort, and relation with
others.
• The pattering activities can be therapeutic touch,
meditation, humor, imaginery etc.

Evaluation:
• Evaluation is done by repeating the pattern appraisal
after the mutual patterning to determine the extents of
dissonance and harmony.