Dorothea Orem’s Self-Care Deficit Theory

Objectives

At the end of this lesson, you should be able to:

1. Discuss the early life of Dorothea Orem

2. Trace her educational and career background

3. Identify her contributions in nursing

4. Explain her nursing theory

5. Discuss the four paradigms in nursing

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 the 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.”

2.7.1. Credentials and Background

Early LIfe
Dorothea Orem was born on 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 completed 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 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. She 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 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 Causa from the University of Missouri in Columbia in 1998.

Appointments
Dorothea Orem occupied important nursing positions, like the directorship of both the nursing school and
the nursing department at Providence Hospital, Detroit, from 1940 to 1949, where she also taught
biological sciences and nursing from 1939 to 1941. At the Catholic University of America, Orem served as
Assistant Professor from 1959 to 1964, Associate Professor from 1964 to 1970, and Dean of the School of
Nursing from 1965 to 1966.

She also served as curriculum consultant to The Office of Education, United States Department of Health,
Education and Welfare, Practical Nurse Section in 1958, 1959, and 1960, to the Division of Hospital and
Institutional Services, The Indiana State Board of Health from 1949 to 1957, and to the Center for
Experimentation and Development in Nursing, The Johns Hopkins Hospital, 1969-1971, and to the Director
of Nursing, Wilmer Clinic, The Johns Hopkins Hospital, 1975-1976.

Works of Dorothea Orem

Dorothea Orem helped publish the “Guidelines for Developing Curricula for the Education of Practical
Nurses” in 1959.

The 6th edition of Nursing: Concepts of Practice, published by Mosby in January 2001.

In 1971 Orem published Nursing: Concepts of Practice, the work in which she outlines her nursing theory,
the Self-care Deficit Theory of Nursing. This work’s success and the theory it presents established Orem
as a leading theorist of nursing practice and education.

She also served as chairperson of the Nursing Development Conference Group, and in 1973 edited that
group’s work in the book Concept Formalization in Nursing.

She authored many other papers and, during the 1970s and 1980s, spoke at numerous conferences and
workshops around the world. The International Orem Society was founded to foster research and the
continued development of Orem’s nursing theories.
The second edition of Nursing: Concept of Practice was published in 1980. Orem retired in 1984, but she
continued to work on the third edition, published in 1985; the fourth edition of her book was completed
in 1991. She continued to work on the conceptual development of Self-Care Deficit Nursing Theory.

Orem continued to be active in theory development. She completed the 6th edition of Nursing: Concepts
of Practice, published by Mosby in January 2001.

Awards and Honors

Dorothea Orem was also given many awards during her career: the Catholic University of America Alumni
Achievement Award for Nursing Theory in 1980, the Linda Richards Award from the National League for
Nursing in 1991, and an Honorary Fellow of the American Academy of Nursing in 1992.

She also received accolades for her contributions to nursing, including honorary degrees from
Georgetown University, Incarnate Word College, Illinois Wesleyan University, and the University of
Missouri-Columbia.

She was inducted into the American Academy of Nursing and received awards from the National League
for Nursing and the Sigma Theta Tau Nursing Honor Society.

Death
Dorothea Orem died on June 22, 2007, in Savannah, Georgia, where she had spent the last 25 years of her
life as a consultant and author. She was 92.

2.7.1. Metaparadigm Of Nursing

Person

• Who can be viewed as functioning biologically, symbolically and socially and who initiates and
performs self-care activities on own behalf in maintaining life.

Nursing

• Helping or assisting client to identify ways to perform self-care activities.

• Nursing is HUMAN SERVICE

Health

• Is a state that is characterized by soundness or wholeness of developed human structures and of

bodily and mental functioning.
• It includes physical, physiologic, interpersonal and social aspects.

Environment

• External source of influence in the internal interaction of a person’s different aspects.

2.7.2. Orem’s Theory of Nursing

There are three parts to Orem’s general theory of nursing:

O M S S F CA TH O

• The theory of self-care, which focuses on the performance or practice of activities that individuals
perform on their own behalf. Those might be actions to maintain one’s life and life functioning,
develop oneself or correct a health deviation or condition.
• The theory of self-care deficit, which defines when nursing is needed because a person is limited
or incapable of providing self-care and needs help.
• The theory of nursing system, which focuses on the relationship between a nurse and a client
and the wholly or partial compensatory nursing system and supportive-educative system that
takes place between nurse and a person.

I. The 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. This theory Includes:

• Self-care – practice of activities that individual initiates and perform on their own behalf in
maintaining life, health and well being
• Self-care agency – is a human ability which is "the ability for engaging in self-care" -conditioned
by age developmental state, life experience sociocultural orientation health and available
resources.
• 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 – "totality of self-care actions to be performed for some duration
in order to meet self-care requisites by using valid methods and related sets of operations and
actions"
• Self-care requisites - action directed towards provision of self-care. 3 categories of self-care
requisites are-
• Universal self-care requisites
• Developmental self-care requisites
• Health deviation self-care requisites
1. Universal self-care requisites
• Associated with life processes and the maintenance of the integrity of human structure
and functioning
• Common to all, ADL
• Identifies these requisites as:
o The maintenance of a sufficient intake of air
o The maintenance of a sufficient intake of water
o The maintenance of a sufficient intake of food
o Provision of care associated with elimination process and excrements
o Balance between activity and rest
o Balance between solitude and social interaction
o Prevention of hazards to human life well-being and
o Promotion of human functioning

2. 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.”

• E.g. adjusting to a new job

• adjusting to body changes

3. Health deviation self-care requisites

These requisites exist for persons who are ill or injured, including those with defects and
disabilities. These include:
1. Seeking and securing appropriate medical assistance
2. Being aware of and attending to the effects and results of pathologic conditions and states.
3. Effectively carrying out medically prescribed diagnostic, therapeutic, and rehabilitative
measures.
4. Being aware of and attending to or regulating the discomforting or deleterious effects of
prescribed medical measures.
5. Modifying self-concepts (self - image) in accepting oneself as being in a particular state of
health and in specific forms of health care
5. 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.
II. Theory of Self Care Deficit

This theory of self-care deficit describes and explains WHY people can be helped through nursing. Nursing
is required when an adult (or in the case of a dependent, the parent) is incapable or limited in the provision
of continuous effective self-care. The theory asserts that people benefit from nursing because they have
health-related limitations in providing self-care. Several concepts include:

• Agent - a person who engages in meeting the needs of a person. They are like bridges that
facilitate what has been done and what needs to be done.
• Two types:
1. Self-Care Agent

- who perform self-care independently

2. Dependent Care Agent

- Person who takes full responsibility of taking care of a person who are incapable of
providing care for themselves

• Nursing Agency – set of established capabilities of a nurse who can legitimately perform activities
of care for a client. Includes concepts of deliberate action, including operations of diagnosis,
prescription, and regulation.

Orem explains not only when nursing is needed but also how people can be assisted through the
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

III. Theory of Nursing Systems

This theory describes how the patient’s self-care needs will be met by the nurse, the patient, or both.
Nursing systems Are action system formed (designed and produced) by nurses through the exercise of
their nursing agency for persons with health derived or health associated limitations in self-care or
dependent care. The theory describes and explains relationships that must be brought about and
maintained for nursing to be produced.

Identifies 3 classifications of nursing system to meet the self-care requisites of the patient: -

• Wholly compensatory system

• Partly compensatory system
• Supportive – educative system
Wholly Compensatory Nursing System

• Required for individuals who are unable to control and monitor their environment and process
information.

“Doing for the patient...”

• Unable to engage in any form of action (e.g., coma)

• Aware and who may be able to make observations or judgments, and decisions about self-
care but cannot/should not perform actions requiring ambulation and manipulative
movements (e.g., patients with C3-C4 vertebral fractures)
• Unable to attend to themselves and make reasonable judgments about self-care but who
can be ambulatory and able to perform some self-care with guidance (e.g., severely mentally
retarded)

Partial Compensatory Nursing System

• Designed for individuals who are unable to perform SOME, but not all self-care activity.

“Helping the patient do for himself/herself.”

• a patient can meet some self-care requisites but needs a nurse to help meet others; either the
nurse or the patient has the major role in the performance of self-care

E.g., a patient with recent abdominal surgery

Supportive-Educative System

• Designed for persons who need to learn to perform self-care measures and need assistance to
do so.
• Helping patient to learn self-care and emphasizing on the importance of nurse’s role.
• A patient can meet self-care requisites but needs help in decision-making, behavior control, or
knowledge acquisition; the nurse’s role is to promote the patient as a self-care agent
(teacher/consultant)

E.g., a 16-year-old who is requesting birth control information

2.7.3. Dorothea Orem’s Theory and The Nursing Process

The Nursing Process presents a method in determining self-care deficits and defining the roles of
persons or nurses 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
1. The person’s health status
2. The physician’s perspective of the person’s health status
3. The person’s perspective of his or health health
4. The health goals within the context of life history, lifestyle, and health status.
5. The person’s requirements for self-care
6. 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 a combination of helping methods will be
effective and efficient in compensating for/overcoming the patient’s self-care deficits.
Implementation & Evaluation
Step 3
• A nurse assists the patient or family in self-care matters to identify and describe health and
health-related results. Collecting evidence in evaluating results achieved against results specified
in the nursing system design.
• The etiology component of nursing diagnosis directs actions.

2.7.4. Strengths/Limitations of Orem’s Self Care Deficit Theory

Strengths
✔ Provides a comprehensive base to nursing practice.
✔ It has utility for professional nursing in the areas of nursing practice nursing curricula,
nursing education administration, and nursing research.
✔ Specifies when nursing is needed.
✔ Also includes continuing education as part of the professional component of nursing
education.
✔ Her self-care approach is contemporary with the concepts of health promotion and health
maintenance.
✔ Expanded her focus of individual self-care to include multiperson units.

Limitations
✔ In general system theory a system is viewed as a single whole thing while Orem defines a system
as a single whole thing.
✔ Health is often viewed as dynamic and ever changing. Orem’s visual presentation of the boxed
nursing systems implies three static conditions of health.
✔ Appears that the theory is illness oriented rather with no indication of its use in wellness
settings.