“THEORIES ARE NOT DISCOVERED IN NATURE BUT ARE

HUMAN INVENTIONS.”

NURSING THEORY:
It is the term given to the body of knowledge that is used to support
nursing practice. It is any theory developed within or adapted to nursing which
seeks to describe, explain or predict relationships between concepts relevant to
the practice of nursing, and which may also be used to prescribe or guide
nursing actions. It is important to both nursing as a discipline and as a
profession.

SELF CARE DEFICIT THEORY OF NURSING BY

DOROTHEA OREM:

BIOGRAPHICAL SKETCH OF THE THEORIST:

 One of America’s foremost nursing theorist who was born in
Baltimore, Maryland.
 Dorothea Orem began her nursing career at Providence
Hospital School of Nursing in Washington, DC and earned her
Bachelor of science in nursing education in 1939 and Master
of science in nursing in 1945
 Received honorary Doctor of Science degree in 1976
 Doctor of Humane Letters (1988) Illinois Wesleyan University,
Bloomington, Illinois
 Doctor of Nursing Honoris Causae, (1998) University of
Missouri-Columbia
 Dorothea Orem as a member of a curriculum subcommittee
at Catholic University recognized the need to continue in
developing a conceptualization of nursing.
 Published first formal articulation of her ideas in Nursing:
Concepts of Practice in 1971.second in 1980,and finally in
1995

AWARDS AND HONOUR:

 Catholic University of America Alumni Achievement Award for
Nursing Theory (1980)
 Linda Richards Award, National League for Nursing (1991)
 Honorary Fellow of the American Academy of Nursing (1992).
NURSING EXPERIENCE:
 Hospital staff nurse (pediatric & adult MS units)
 Private duty nurse
 Night supervisor in the ER
 Biological science teacher
 Professor of nursing education
 Directorship: both nursing school and department at
Providence hospital
 Curriculum consultant

DEVELOPMENT OF THEORY:
 The Orem model of nursing was developed between 1959 and 2001
by Dorothea Orem and is also known as the 'Self Care' Model of
Nursing. It is particularly used in rehabilitation and primary care
settings where the patient is encouraged to be as independent as
possible.
 During 1949-1957 Orem worked for the Division of Hospital and
Institutional Services of the Indiana State Board of Health. There
she was asked a question and did not have an answer because she
had no conceptualization of nursing. There she noted (Indiana
University) that nurses had difficulty articulating needs to hospital
administrators in the face of demands made upon them regarding
such issues as length of stay, scheduling admissions and
discharges, etc.Her goal was to upgrade the quality of nursing in
general hospitals throughout the state. During this time she
developed her definition of nursing practice. Orem’s Nursing
Concept of Practice was first published in 1971 and subsequently in
1980, 1985, 1991, 1995, and 2001.she Continued to develop her
theory after her retirement in 1984.

DOMAIN CONCEPTS:
Definitions of domain concepts: the major
concepts in theory are:

1. PERSON – has the capacity to reflect, symbolize and use symbols.

Conceptualized as a total being with universal, developmental needs
and capable of continuous self care. A unity that can function
biologically, symbolically and socially.
  Person is “…an integrated whole composed of an internal
physical, psychologic, and social nature with varying degrees of
self-care ability.”
(Chinn & Kramer, 2004)

According to Orem’s theory person is:

 The recipient of nursing care
 A being who functions biologically, symbolically, and
socially
 Has the potential for learning & development
 Is subject to the forces of nature
 Has a capacity for self-knowledge
 Can learn to meet self-care needs (requisites)

2. ENVIRONMENT – environment components are environmental

factor, environmental éléments, conditions, and developmental
environment.

3. HEALTH – Health and healthy are terms used to describe living

thing. Health is “a state of physical, mental, and social well-being,
and not merely the absence of disease or infirmity”
 It is a state of well-being, which refers to a person’s perceived
condition of existence, characterized by experiences of
contentment, pleasure, happiness, and movement toward self
ideals and continuing personalization.

4. NURSING – “an art through which the practitioner of nursing gives

specialized assistance to persons with disabilities of such a character
that greater than ordinary assistance is necessary to meet daily
needs for self care and to intelligently participate in the medical care
they are receiving from the physician”

 Goal of nursing – goal of nursing is:

1. To render the patient or members of his family capable of
meeting the patient’s self care needs
2. To maintain a state of health
 3. To regain normal or near normal state of health in the event of
disease or injury
4. To stabilize, control, or minimize the effects of chronic poor
health or disability.

COMPONENTS OF NURSING:
 Nursing art: The intellectual quality of nurses which allows
them to make creative investigations, analyses, and syntheses
of variables and conditioning factors in nursing situations.
 Nursing prudence: The quality that enables the nurse to seek
advice in new or difficult situations, to make correct judgments,
to decide to act in a particular manner, and/or to act.
 Nursing service:A human service that focuses on a person’s
inabilities to maintain health care.
 Nursing client- a human being who has "health related /health
derived limitations that render him incapable of continuous self
care or dependent care or limitations that result in ineffective /
incomplete care. A human being is the focus of nursing only
when a self –care requisites exceeds self care capabilities.
 Nursing problem – these are the deficits in universal,
developmental, and health derived or health related conditions
 Nursing process- it a system to determine (1)why a person is
under care (2)a plan for care ,(3)the implementation of care.
 Nursing therapeutics– deliberate, systematic and
purposeful action.
 Nursing agency: a complex property of people educated and
trained as nurses that enables them to act , to know, to help
others to meet their therapeutic self care demands.

MAJOR ASSUMTONS:
Assumptions basic to the general theory were formalized in the early
1970s and were first presented at Marquette University School of Nursing
in 1973.

Orem identifies the five premises underlying the general theory of

nursing:

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 form of
care for self and others in identifying needs and making input
needs.
3. Mature human beings experience privations in the form of
limitations of action in care for self and others involving and making
of life sustaining and function regulation inputs.
4. Human agency is exercised in discovering, developing and
transmitting ways and means to identify needs and inputs of self
and others.
5. 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 inputs to
self and others.

OREM’S GENERAL THEORY OF NURSING:

Orem’s general theory of nursing can be easily understood by in three
related parts:-

 Theory of self care

 Theory of self care deficit
 Theory of nursing system

1.THEORY OF SELF CARE:

This theory describes why and how people care for themselves.

 Self care-the performance of activities that individuals initiate and

perform on their behalf to maintain life, health, and well-being.

 Self care agency – it is a complex human ability which is "the

ability for engaging in self care" and Conditioned by age
developmental state, life experience, sociocultural orientation health
and available resources· Consists of two agents:

1. Self-care Agent - person who provides the self-care

2. Dependent Care Agent - person other than the individual who

provides the care (such as a parent)
  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
“therapeutic self care demand at any time

a) Describes factors in the patient or the environment that must be

held steady.

b) Has known degree of effectiveness in controlling patient or

environmental factors.

 Self care requisites-reasons for which self-care is done; these

express the intended or desired results. 3 categories of self care
requisites are:--

 Universal
 Developmental
 Health deviation

1. UNIVERSAL SELF CARE REQUISITIES:

Universally required goals are to be met through self care or dependent

care have their origin in what is validated or what is in the process of
being validated about human structure l and functional integrity at
various stages of the life cycle. These Associated with life processes and
the maintenance of the integrity of human structure and functioning and
Common to all (ADL). 6 self care requisites common to men, women, and
children are:

 Maintenance of sufficient intake of air ,water, food

 Provision of care associated with elimination process and excretion.
 Balance between activity and rest,
 Balance between solitude and social interaction
 Prevention of hazards to human life well being and
 Promotion of human functioning and development within social
groups in accordance with human potential, human limitations and
desire to be normal.

II)DEVELPOMENTAL SELF CARE REQUISITES:

Development self care requisites promote processes for life and
maturation and prevent conditions delirious to maturation or those that
mitigate those effects. These are associated with developmental
processes/ derived from a condition or associated with an event E.g.
adjusting to a new job, adjusting to body changes.

III)HEALTH DEVIATION SELF-CARE REQUISITES:

These self care requisites are required in conditions of illness, injury, or
disease. These include:--

 Seeking and securing appropriate medical assistance

 Being aware of and attending to the effects and results of
pathologic conditions
 Effectively carrying out medically prescribed measures
 Modifying self concepts in accepting oneself as being in a particular
state of health and in specific forms of health care.

 Learning to live with effects of pathologic conditions.

2.THEORY OF SELF CARE DEFICIT:

The central idea of the theory of self care deficit is that requirements of
persons for nursing are associated with the subjectivity of mature and
maturing persons to health related action limitation. These limitations
render them partially or completely unable to know existing and emerging
requisites for regulatory care. it specifies when nursing is needed i.e.
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 .

Self care deficit is the term that expresses the relation between the action
capabilities of individuals and their demands for self care. it is an abstract
concept and provides guides for the selection of methods for helping and
understanding patients role in self care. according to OREM 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.

Orem identifies 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

The OREM theory’s concepts ( THEORY OF SELF CARE DEFICIT)

can be well understood by the following framework:

OREM’S GENERAL THEORY OF NURSING

(CONCEPTUALFRAMEWORK)
Self
care

factors
Conditioning
R R
Conditioning

Self
Care / Therapeutic
factors

Dep. R Self care

Care demands
Agency
Deficit
Conditionin

R
g factors

R
Nursing
Agency

3.THEORY OF NURSING SYSTEMS:

It describes how the patient’s self care needs will be met by the nurse,
the patient, Or both. The theory of nursing systems purposes that nursing
is human action ,nursing systems are action systems formed by nurses
through the exercise of their nursing agency for persons with health
deviated or health associated limitations in self care.

Orem identifies 3 classifications of nursing system to meet the self care

requisites of the patient:-

 Wholly compensatory system

 Partly compensatory system
 Supportive – educative system
a) Wholly compensatory system:
Under this nurse’s action is to accomplish patient’s therapeutic self
care, compensates for patient’s inability to perform self care,
support and protect the patient. A patient’s self-care agency is so
limited that s/he depends on others for well-being. Unable to
engage in any form of action (e.g. coma)

b) Partly compensatory system:

A patient can meet some self-care requisites but needs a nurse to
help meet others; either the nurse or the patient have the major
role in the performance of self-care under this NURSE’s ACTIONS
are to:

 Performs self care measures for patient

 Compensates for self care limitations of patients
 Assists patients as required

Also the PATIENT’s ACTIONS are to:

 Performs some self care measures

 Regulates self care agency
 Accepts care and assistance from nurse.

c) Supportive – educative system:

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)

Under this nurse’s action are to –

 Regulate the exercise.
 Development of self care agency.

And the Patient action is to

 Accomplishes self care.
BASIC NURSING SYSTEM (OREM 1995):

OREM’S THEORY AND NURSING PROCESS:

Orem’s approach to the nursing process presents a method to determine
the self care deficits and then to define the roles of person or nurse to
meet the self care demands. The steps within the approach are
considered to be the technical component of the nursing process. Orem
emphasizes that the technological component "must be coordinated with
interpersonal and social processes within nursing situations.

Comparison of Orem’s Nursing Process and the Nursing Process

Nursing Process:
a. Assessment
b. Nursing diagnosis
c. Plans with scientific rationale
d. Implementation
e. evaluation
 1. Orem’s nursing. Process:
a. Diagnosis and prescription; determine why nursing is needed.
analyze and interpret –make judgment regarding care
b. Design of a nursing system and plan for delivery of care
c. Production and management of nursing systems.

Step 1-collect data in six areas:-

a. The person’s health status

b. The physician’s perspective of the person’s health status
c. The person’s perspective of his or her health
d. The health goals within the context of life history ,life style,
and health status
e. The person’s requirements for self care
f. The person’s capacity to perform self care

Step 2:-

Nurse designs a system that is wholly or partly compensatory or

supportive-educative. The 2 actions are:-

 Bringing out a good organization of the components of patients’

therapeutic self care demands

 Selection of combination of ways of helping that will be effective

and efficient in compensating for/ overcoming patient’s self care
deficits

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

Step 4:-

Actions are directed by etiology component of nursing diagnosis

Step 5:-

Evaluation
APPLICATIONS OF THE THEORY:
1. PRACTICE:
 First use of Orem’s theory as a basis for structuring practice is
found in descriptions of nurse managed clinics at John Hopkins
hospital in 1973.

 This theory is used in a variety of clinical population and age groups

such as elderly, children , neonates and various conditions also such
as in study of Paediatric patient controlled analgesia: enhancing self
care construct( vesely.c.(1995), paediatric nursing,21(2), 124-8)

 This theory is also useful in Defining and describing various roles of

nurses such as Clinical nurse-specialist role, Case-management
role, Advanced practice role,Primary-care role

2. EDUCATION:
 Some of the elements of Orem’s theory have been mentioned in
Guides for developing curriculum for the educational of practical
nurse.

 Orem book of Foundations of nursing and its practice which was

published and used at Morris Harvey College.

 Orem’s self care deficit theory is) used in Evaluation of education

material (Faleta.E.Alison and et al, nursing science quarterly, 2003

3. RESEARCH:
Orem’s self care deficit theory has been used in various research
studies which can be classified under:

1. The development of research instruments for measuring the

conceptual elements of the theory:
 The first instrument to measure the exercise of self
care agency (ESCA) was published in 1975.
 A self care questionnaire was developed and tested by
Moore (1995) for the special purpose of measuring the
self care practice of children and adolescents.
 Orem’s theory of self care deficit was used in design of
the Self –As-Carer Inventory(SCI)

2. Studies that test elements of the theory in specific population.

  Self-care operations and nursing interventions for
children with cancer and their parents( Jean burley
moore,nursing science quarterly,2008)
 Self care requirements for activity and rest (Sarah. E.
Alison, nursing science quarterly,2007)
 Orem’s theory was used to build conceptual framework
for the study to explore relationships among health
promoting self care behaviours, self care efficacy and self
care agency.(Donna M, Callaghan)
 Orem’s theory was employed to determine self care and
dependent-care operations children and parents perform
to address self care requisites and to explore nursing
interventions to promote operations.(Jean Burley Moore,
Asher E. Beckwitt)
 Orem’s theory has been used in exploring self-care for
the person coping with cancer treatment: a
review( Alison Richardson, international journal of
nursing studies, 1992)
 An operational study on maintenance of hair hygiene
among women at a resettlement colony, U.T.,
Chandigarh, 2005( manpreet kaur)
 A study on effectiveness of oral hygiene nursing care
among ’self care deficit’ patients admitted in the medical
wards of Nehru hospital, PGIMER, Chandigarh,2002( Ram
sharan Mehta)
 A study on the effect of physical abuse on women’s
health and their management practices in a low socio-
economic community of Chandigarh, 1999(sushila Devi)

 CRITIQUE:
a) POSITIVE ASPECTS OF THE THEORY:
 Provides a comprehensive base to nursing practice
 Specifies when nursing is needed
 Also includes continuing education as part of the professional
component of nursing education
 Herself care approach is contemporary with the concepts of
health promotion and health maintenance
 Expanded her focus of individual self care to include
multiperson units.
 Presented in a straightforward manner
  Relationship among entities can be presented in a simple
diagram.

b) LIMITATIONS OF THE THEORY:

 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.

SUMMARY:
 Orem’s general theory of nursing is one of the major theories.
It composed of three constructs. It is based upon the
philosophy that all "patients wish to care for themselves".
They can recover more quickly and holistically if they are
allowed to perform their own self cares to the best of their
ability.
 Throughout her work, she interprets the concepts of human
beings, health, nursing and society and has defined 3 steps of
nursing process.
 It has a broad scope in clinical practice and to lesser extent in
research, education and administration.

REFERENCES:
1. Tomey. Ann mariner(2001):conceptual models and grand theories,
nursing theorists and their work: pg no. 189-200

2. Hartweg l. Donna(1991), Dorothea Orem(self care deficit theory):

notes on nursing theories: sage publications, 1-39

3. http//www.google.com( Orem model of nursing From Wikipedia,

the free encyclopedia)

4. Taylor.G.susan(2007).tribute to the theorist:Dorothea Orem over

the years, nursing science quarterly, vol. 20 no. 2, April, 106.

5. Basford .Lynn, Jlevin Oliver. An integrated approach to caring

practices. Theories and practices of nursing, 2nd edition, 266-267.
6. Sarah E. Allison(2007) Self care requirements for activity and rest:
An Orem Nursing focus, Nursing Science Quaterly,vol 20,pg 68-76

7. Jean Burley Moore, Asher E. Beckwitt(2006) Self care operations

and nursing interventions for children with cancer and their parents,
nursing Science Quaterly,vol 19,147-156

8. Feleta Wilson, Darlene W.Wood(2003) Evaluation of education

materials using Orem’s self care deficit theory, Nursing science
Quaterly,vol 16,68-76

9. Richardson Alison (1992). Studies exploring self care for the person
coping with cancer treatment; a review, international journal of
nursing studies., vol 29, no. 2, 191-204