According to Orem “Nursing has as its special concern , the individual need for self-care action and

the provision and management of it on a continuous basis in order to sustain life and health ,
recovery from diseases or injury , and cope with their effects”.

Orem ‘s developed her general theory of nursing in 3 related parts :-

A. Self care
B. Self care defecit
C. Nursing system

A . THE THEORY OF SELF CARE

The theory of self care includes / central concepts are :

1. Self care : Self care is the “ Practice of activities that the individual initiate and perform on
their own behalf in maintaining life, health and well being .
Action Directed by the individual to themselves or their environment to regulate their own
functioning and development in the interest of sustaining life, maintaining or restoring
integrated functioning under stable or changing environmental condition , and maintaining
or bringing about a condition of well being .
The theory of self care is based on the promise that a relationship exists between deliberated
self-care actions and the development and functioning of individual and group .
2. Self care agency : It is the human ability which is “ The ability for engaging in self -care”

“The individual abilities to engage in self-care are conditioned by the age , Developmental
state , life experiences , socio-cultural orientation , health and available resources”

“A complex capability of maturing and mature individual to

 Determine the presence and characteristic of specific requirements for regulating

their own functioning and development .
 Make judgement and decision about what to do
 Perform care measures to meet specific self-care requisite”

At different times in each person’s life , the person (self agent ) has different abilities or skills
in performing self care (sefl care agency ) , self care agency refers to the power o findividua to
engage in self-care .
 3. Therapeutic self-care demand or requisite :- “It is the totality of self-care action to be
performed for some duration in order to meet self-care requisite by using valid method , and
related sets of operation and action”
Self care requisite can be defined as action is directed towards the provision of self-care
.here Orem presents three categories .
a. Universal self-care requisite : It is associated with life process and maintenance of the
integrity of human structure and function .

Universal self care requisite are associa ted with life processes and maintenance of the
integrity of human structure and functioning . they are common to all human beings during
all stages of the life cycle and should be viewed as interrelated factors , Its affecting the
others . Common terms for these requisite are Activities of Daily Living (ADL).

Orems identifies self care requisite as

 Maintenance of sufficient intake of air and water

 Maintenance of sufficient intake of air and water
 The provision of care associated with elimination processes and excrements
 The maintenance of balanced between activity and rest , solitude and social
interaction
 The prevention of hazards to human life , functioning and well being
 The promotion of human functioning and development within social groups in
accordance with human limitation and the human desire to be normal .

Orem’s theory and nursing process

According to orem (1991) , “ Nursing process is a term used by nurses to refer to the professional
–technologic operation of nursing practice and to associated planning and evaluative operation”.
Process is a continuous and regular actions taking place or carried out in a definite manner .
Orem(1991) discusses a three-step nursing process which she labels the technologic process of
nursing practice . These steps are :
 Step 1 . Nursing diagnosis and prescription –that is , determining why nursing is needed ,
analysis and interpretation – making judgement regarding care , also labelled case
management operations.
 Step 2 . Designing the nursing system and planning for delivery of care .
  Step 3 . The production and management of nursing system , also labeled planning and
controlling .

Nursing diagnosis and prescription (Step1)

“Nursing diagnosis necessitates investigation and the accumulation of facts about patient’ self care
agency and their therapeutic self-care demand and the existence or projected relationship between
them” . The goal defines the direction and the nature of actions . prescriptive operation specify the
means to be used to meet particular self-care requisite , or to meet all components of the therapeutic
self –care demands . Orem emphasize that , in nursing diagnostic and prescriptive operation ,
patients and families abilities and interest in collaboration affects what nurses can do .

Design for regulatory Operation (step 2)

Designing an effective and efficient system of nursing involves selecting valid ways of assisting the
patient . This design includes nurse and patient roles in relation to which self-care tasks will be
performed when adjusting the therapeutic self-care demands , regulating the exercise of self-care
agency , protecting the already developed powers of self-care agency , protecting the already
developed powers of self-care agency , and assisting with the new development in self-care
agency .planning is the movement from the design of nursing system to ways and means of their
production . A plan sets forth the organization of essential tasks to be performed in accordance with
the role responsibilities . The planning for implementation of the design and related procurement
activities determines when the nurse should be with patients and when essential materials and
equipments will be available and ready to use .

Production and management of nursing system (step 3 )

Nursing system are produced by means of the actions of nurses and patients during nurse-patient
encounters . The nurse produces and manages the designated nursing system and methods of
helping for as long as the patients self-care deficit or dependent –care deficit exists . in this , the
third step of nursing process, nurse act to produce and manage nursing system . During the
interaction of nurses and patients , nurses do the following :
  Perform and regulates self care or dependent care tasks for patients or assist patients with
their performance of self-care or dependent-care tasks .
 Co-ordinate self-care or dependent care task performance so that a unified system of care is
produced and co-ordinated with other component of health care .
 Help patients, their families , and others bring about system of daily living for patients that
support the accomplishment of self care or dependent care and are , at the same time ,
satisfying in relation to patient’s interest , talents , and goals .
 Guides , directs , and supports patients in their exercise of , or in the withholding of teh
exercise of , their self-care agency or dependent care agency .
 Stimulates patient’s interest in self-care or dependent care by raising questions and
promoting discussion of care problems and issues when conditioning permits .
 Supports and guide patients in learning activities and provide cues for learning as well as
instructional sessions .
 Supports and guides patients as they experience illness or disability and the effect of medical
care measures were performed and as they experience the need to engage in new measures
of self-care or change their ways of meeting ongoing self-care requisites.
 Monitor patients and assist patent to monitor themselves to determine if self care measures
were performed and to determine the effect of self-care , the result of efforts o regulate the
exercise or development of self care agency , and the sufficiency and efficiency of nursing
action direction to these ends .
 Make characterizing judgement about the sufficiency and efficiency of self-care , the
regulation of the exercise or development of self-care agency , and nursing assistance
 Make judgement about the meaning of the results derived from nurse’s performance of the
preceding two operations for the well being of patient’s and make recommended adjustment
in the nursing care system through the change in nurse patient roles .

The first seven operations constitute direct nursing care . The last three are for the purpose of
deciding if the care provided should be continued in the present form or changed . This comprises
the evaluation component of the nursing process .