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Dorothea E. Orem
The Self-Care Deficit Nursing Theory

Orem developed the Self-Care Deficit Theory of Nursing, which is composed of three interrelated
(1) the theory of self-care
(2) the self-care deficit theory
(3) the theory of nursing systems.

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.

Major Concepts

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

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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 ones 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:
Self-care agency is the humans 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, sociocultural orientation,
health care system factors, family system factors, patterns of living, environmental factors, and
resource adequacy and availability.

Therapeutic Self Care Demand:
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

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

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 clients therapeutic self-care demand exceeds available self-care
agency, leading to the need for nursing.


Self-care Requisites or requirements can be defined as actions directed toward the provision of self-
It is presented in three categories:
A. Universal self-care requisites are associated with life processes and the maintenance of the
integrity of human structure and functioning.

1. The maintenance of a sufficient intake of air

2. The maintenance of a sufficient intake of water

3. The maintenance of a sufficient intake of food

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4. The provision of care associated with elimination process and excrements

5. The maintenance of a balance between activity and rest

6. The maintenance of a balance between solitude and social interaction

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

8. 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.

B. 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.

C. 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.

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

4. Being aware of and attending to or regulating the discomforting or deleterious effects of
prescribed medical measures

5. 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

6. Learning to live with the effects of pathologic conditions and states and the effects of medical
diagnostic and treatment measures in a life-style that promotes continued personal development

The Three Basic Nursing Systems:

(1) The wholly compensatory nursing system
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.

(2) The partly compensatory nursing system
is represented by a situation in which both nurse and perform care measures or other actions
involving manipulative tasks or ambulation
the patient or the nurse may have the major role in the performance of care measures.

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(3) the supportive-educative system 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.

Relationship of the major components of Orems self-care deficit theory

R indicates a relationship between components; < indicates a current or potential deficit where nursing would
be required

Humans engage in continuous communication and interchange among themselves and their
environments to remain alive and to function.
In humans, the power to act deliberately is exercised to identify needs and to make needed
Mature human beings experience privations in the form of action in care of self and others
involving making life-sustaining and function-regulating actions.

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.

Finally, groups of human beings with structured relationships cluster tasks and allocate
responsibilities for providing care to group members who experience privations for making
required deliberate decisions about self and others (Orem, 1995).



A major strength of Orems theory is that it is applicable for nursing by the beginning practitioner as
well as the advanced clinicians.

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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

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.

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


Orems theory is simple yet complex. The use of self-care in multitude 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.

Orems 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 individuals emotional needs.

There is a superb focus of Orems work which is self-care.
Even though there is a wide range of scope seen in the encompassing theory of nursing systems,
Orems 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

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 needs complete care or assistance
with self-care activities such as the infants and the aged.