 Biography of Dorothea E.

Orem
o Early Life
o Education
o Self-Care Theory
o Appointments of Dorothea Orem
o Works of Dorothea Orem
o Awards and Honors of Dorothea Orem
o Death
 Dorothea Orem's Self-Care Deficit Theory
o Description
o Assumptions of the Self-Care Deficit Theory
o Major Concepts of the Self-Care Deficit Theory
 Nursing
 Humans
 Environment
 Health
 Self-Care
 Self-Care Agency
 Basic Conditioning Factors
 Therapeutic Self-Care Demand
 Self-Care Deficit
 Nursing Agency
 Nursing System
o Theories
 Theory of Self-Care
 Self-Care Requisites
 Universal Self-Care Requisites
 Theory of Self-Care Deficit
 Theory of Nursing System
 Wholly Compensatory Nursing System
 Partial Compensatory Nursing System
 Supportive-Educative System
o Dorothea Orem's Theory and The Nursing Process
 Assessment
 Nursing Diagnosis & Care Plans
 Implementation & Evaluation
o Analysis of the Self-Care Deficit Theory
o Strengths
o Limitations
o Conclusion
 See Also
 References
 External Links
 Further Reading

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.

Appointments of Dorothea Orem

Dorothea Orem occupied important nursing
positions, like the directorship of both
the nursing school and the department of
nursing 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.

She was a member of the group of nurse theorists who presented Patterns
of Unitary Man (Humans), the initial framework for nursing diagnosis, to the
North American Nursing Diagnosis Association in 1982.
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 theory of
nursing, the Self-care Deficit Theory of Nursing. The
success of this work 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 theories of nursing.

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 which
was published in 1985; 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 of Dorothea Orem

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 was named an Honorary Fellow of the American Academy of
Nursing in 1992.

She also received accolades for her contributions to the field of 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.

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.

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.
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

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 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.

References
References and sources for this study guide about Dorothea Orem:

1. “Obituary: Dorothea Elizabeth Orem”, Savannah Morning News, June

24, 2007, retrieved June 17, 2014
2.  Taylor, Carol R.; Lillis, Carol; LeMone, Priscilla; Lynn, Pamela (2011).
Fundamentals of Nursing. Philadelphia: Wolters Kluwer Health. p.
74. ISBN 978-0-7817-9383-4.
 3. Orem, D. (1991). Nursing: Concepts of practice. (4th ed.). In George, J.
(Ed.). Nursing theories: the base for professional nursing practice.
Norwalk, Connecticut: Appleton & Lange.
4. Orem, D. (1995). Nursing: Concepts of practice. (5th ed.). In McEwen,
M. and Wills, E. (Ed.). Theoretical basis for nursing. USA: Lippincott
Williams & Wilkins.
5. Orem, D. (2001). Nursing: Concepts of practice. (6th ed.). In McEwen,
M. and Wills, E. (Ed.). Theoretical basis for nursing. USA: Lippincott
Williams & Wilkins.
6. Taylor, S.G. (2006). Dorothea  E. Orem: Self-care deficit theory of
nursing. 
7. Meleis Ibrahim Afaf (1997), Theoretical Nursing: Development &
Progress 3rd ed. Philadelphia, Lippincott.

External Links
 International Orem Society for Nursing Science and Scholarship
 Self-care requirements for activity and rest: an Orem nursing focus.
 Self-care: a foundational science.
 Self-care–the contribution of nursing sciences to health care (in
German).

Further Reading
 Nursing Concepts of Practice