Titer Head:DOROTHEA ELIZEBETH OREM’S SELF CARE DEFICIT THEORY

Axum University
College of Health Science
School of Nursing
Department of Maternity and Reproductive Health
Assignment for the course Theoretical Foundation of Nursing

Tittle:DOROTHEA ELIZEBETH OREM’S Self Care Deficit Theory Analysis

Prepared by: Weldegebrial Asefa

Submitted to: Mr. Dawit ( BSC,MSc, Assistance professor)

January, 2023
Axum, Ethiopia

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Table of Contents
1. INTRODUCTION.......................................................................................................................1
1.1 Background................................................................................................................................1
2.General description of the theory.................................................................................................2
2.1. Theory of Self-Care (Dependent-Care)....................................................................................3
2.2. Theory of Self-Care Deficit (Dependent-Care Deficit)............................................................3
2.3. Theory of Nursing Systems......................................................................................................4
3. Major concepts of Dorothea Orem’s Self-Care Deficit Theory..................................................4
3.1. Self-care....................................................................................................................................4
3.2. Self-care agency........................................................................................................................4
3.3. Therapeutic Self-care Demand.................................................................................................4
3.4. Self-care deficits (Dependent care deficit)-.............................................................................5
3.5. Nursing Agency........................................................................................................................5
3.6. Nursing System.........................................................................................................................5
4. Conceptual framework.................................................................................................................6
5. Preposition, Assumption and Metaparadigm...............................................................................7
5.1 Proposition.................................................................................................................................7
5.2 Major Assumptions....................................................................................................................8
5.3 Meta-paradigms.........................................................................................................................9
6. Origins of the theory (1949-1959).............................................................................................10
6. Application of Orem’s Theory...................................................................................................11
7.Strengths and Limitations Orem’s Theory.................................................................................13
7.1 Strengths..................................................................................................................................13
7.2 Limitations...............................................................................................................................13
8. Evaluation of Theory:................................................................................................................14
9. Conclusion.................................................................................................................................14
10. Reference................................................................................................................................15

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1. INTRODUCTION

1.1 Background Information

Dorothea Elizabeth Orem was one of the foremost America’s Nursing Theorists born at Baltimore,
Maryland in 1914. Her father was a construction worker and her mother was a homemaker. She had youngest of
two daughters (Taylor, 2006).
She received her diploma in nursing in 1934 from Providence Hospital School of Nursing, Washington,
D.C. Orem received her bachelor of science in nursing education in 1939 and a master of science in nursing
education in 1945 from Catholic University of America, Washington D.C. She had a varied background in
clinical practice: OR, pediatrics, adult medical -surgical, private duty, and ER supervisor. She taught biological
sciences, served as director of nursing service and director of the school of nursing at Providence Hospital,
Detroit, Michigan ().
As part of her master’s degree work, Orem had to formulate a definition of nursing. During 1958-59, she
worked as a consultant to the Office of Education, Department of Health, Education and Welfare in Washington
and participated in a project to improve practical nurse training.
Orem held a number of positions as private duty nurse, hospital staff nurse, and educator. She was the
director of both the School of Nursing and Nursing Service at Detroit’s Providence Hospital until 1949, moving
from there to Indiana where she served on the Board of Health until 1957. She assumed a role as a faculty
member of Catholic University in 1959, later becoming acting dean (Taylor, 2006).
Orem’s interest in nursing theory was piqued when she and a group of colleagues were charged with
producing a curriculum for practical nursing for the Department of Health, Education, and Welfare in
Washington, DC. After publishing the first book on her theory in 1971, she continued working on her concept of
nursing and self-care.

She had numerous honorary doctorates and other awards as members of the nursing profession have
recognized the value of the self-care deficit theory (Taylor, 2006). Dr. Orem died in 2007 at the age of 93 after a
period of failing health. Nurses will remember her as one of the pioneers of nursing theory (Bekel, 2007).

2. General description of the theory

The Self-Care Deficit Nursing Theory

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The Theoretical Structure

Orem developed the Self-Care Deficit Theory of Nursing (SCDNT), which is composed of three
interrelated theories:
(1)The theory of self-care,
(2) the self-care deficit theory,
(3)the theory of nursing systems.
2.1. Theory of Self-Care
Self-care for one’s self or for dependent care (that is, care performed by another such as a family member)
must be learned and must be deliberately performed for life, human functioning, and well-being. Propose an
answer to the question “what is self-care and what dependent care is?” (Orem, 2006)
2.2. Theory of Self-Care Deficit

Self-care Deficit delineates when nursing is needed (Orem, 2001, pp. 146–147). Deficit is the imbalance
between self-care demand and nursing agency. Nursing is legitimate or needed when the individual’s self-care
capabilities and care demands are equal to, less than, or more than at a point in time. According to Orem there
are five methods of helping such as (1) Acting for and doing for others (2) Guiding others (3) Supporting
another (4) Providing an environment promoting personal development in relation to meet future demands (5)
Teaching another.

2.3. Theory of Nursing Systems

The third theory encompasses the others. The central focus is the product of nursing, establishing both
structure and content for nursing practice as well as the nursing role (Orem, 2001, pp. 111, 147–149).

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3. Major concepts of Dorothea Orem’s Self-Care Deficit Theory

General Self-care deficit theory is composed of six basic concepts. The first four are related to patient
whereas the rest are related to the nurse & their action
3.1. Self-care: -According to the theory, “self-care” is described as learned behavior, and the activities of self-
care are learned according to the beliefs and practices that characterize the cultural way of life of the group to
which the individual belongs (Orem, 1985).

3.2. 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 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.

3.3. 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 Requisites or requirements can be defined as actions directed toward the provision of self-care. 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. It has eight components, those are the
maintenance of a sufficient intake of air, water, food, provision of care associated with elimination process and
excrements, the maintenance of a balance between activity and rest, solitude and social interaction, prevention of
hazards to human life, human functioning, and human well-being and promotion of human functioning and
development within social groups in accord with human potential, known human limitations, and the human
desire to be normal 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. Composed of 3 needs, which are Promote development, engage in self-
development, and preventing or overcoming adverse human conditions and life situations
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. Examples of self-care requisites are:
Wound care, Activities of Daily Living, Bowel program, Glucose monitoring
3.4 Self-care deficits -is the relation between self-care agency and therapeutic self-care demands of individuals
in which capabilities for self-care because of existence limitations.
3.5. 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

3.6. Nursing System is the product of a series of relations between the persons: legitimate nurse and legitimate
client. Nursing system composed of three systems;

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(A) 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.
(B) 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
(C) 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.”

4. Conceptual framework

Where: R indicates a relationship between components and < indicates a current or potential deficit where
nursing would be require

5. Preposition, Assumption and Metaparadigm

5.1 Proposition

A. Proposition of self –care Theory

(1) Self-care is intellectualized as a human regulatory function deliberately executed with some degree of
completeness. (2) Its concreteness is directed and deliberate that is responsive to persons’ knowing how human
functioning and human development can and should be maintained within a range that is compatible with human
life and personal health and well-being under existent conditions and circumstances. (3)Its concreteness involves
the use of material resources and energy expenditures to establish and maintain essential and safe relationships
with environmental factors and forces. (4) Self-care in its concreteness when externally oriented emerges as
observable events directed by persons to themselves or their environments and internally oriented self-controlling
actions is not observable and can be known by others only by seeking subjective information. (5) Self-care that is

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performed over time can be understood (intellectualized) as a self-care system.(6) Constitute components of self-
care system are sets of care measures or tasks necessary to use valid and selected means.
B. Proposition of self –Care Deficit Theory (Dependent –Care Deficit)

Persons who take action to provide their own self-care for dependents have specialized capabilities for action.
(1)The individual‘s abilities to engage in self-care or dependent care are conditioned by age, developmental
status, life experience, health and available resources. (2) The relationship of individuals’ abilities for self-care to
the qualitative and quantitative self –care demand can be determined when the value of each is known. (3) The
relationship between care abilities and care demand can be defined in terms of equal to, less than, more than. (4)
Nursing is a legitimate service (5)Persons with existing or projected care deficits are in, or can expect to be in,
states of social dependency that legitimate a nursing relationship.
C. Proposition of nursing system theory

(a) Nurses relate to and interact with persons who occupy the status of nurse’s patient (b) Legitimate patients
have existent and projected continuous self-care requests (c) they have existent and projected deficit for meeting
their own self acre requests (d) Nurses determine valid and reliable process or technologies for meeting self-care
requests (e) formulate the courses of action (f) Nurses determine their self-care requests using specific the current
and changing values of patients’ abilities to meet their self-care requests using specific process or technologies.
(g) Nurses estimate the potential of patient to refrain from engaging in self-care for therapeutic purposes or
develop or refine abilities to engage in care now or in the future. (h)Nurses and patients act together to allocate in
the production and in the regulation of patients’ self-care capacities. (i) The action of nurses and patients
constitute nursing system.
5.2 Major Assumptions

(1) Nurses deliberately and purposefully perform nursing as a helping service to others.(2) People are willing and
capable of performing self-care for themselves and for dependent family members (children).(3) Health, well-
being, and human development is dependent on self-care as a necessity in life integrated with the environment.
(4) Individuals are influenced by culture and education.(5) Communication and human interaction fosters and
teaches self-care (6) Deliberate and systematic actions are performed to meet self-care
5.3 Meta-paradigms

Orem (1995, 2001) defined The Meta-paradigm concepts which is provide a general & consistent
perspective for a discipline to develop and to make comparisons among its several conceptual models
Nursing is as 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.

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Humans/persons are “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 & community.
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.

6. Origins of the theory (1949-1959)

Aristotle, Thomas Aquinas, Talcott Parsons, Pitirim Sorokin, and others influenced her thinking related to
human action, human agency for deliberate action, units of action, and social interaction (Orem, 2003). The
theory evolved from her individual work and collaboration with students, practitioners, researchers, educators,
administrators, and scholars, since 1949. In a 1996 newsletter to the International Orem Society she puts, “what
do nurses encounter in their worlds as they design and produce nursing for others and its meaning related to
persons, things, events, conditions, and circumstances they encounter?” After reflecting upon her own nursing
experiences, Orem says the answer came to her as a “flash of insight, an understanding that the reason why
individuals could benefit from nursing was the existence of self-care limitations”. (Orem, 1978, cited in Fawcett,
2005, p. 230).
Orem proposed directions by identifying five stages for model development.

(1) Development of theory, (2) Investigation of variations, (3) Development of models and rules for
nursing, (4) Development of nursing cases by practitioner within the model, (5) Development of models and rules
for providing nursing to population

6. Application of Orem’s Theory

Orem’s theory is applied in various models to practice, and nursing education as well as the use of the
model in nursing research.
i. Nursing practice

Orem’s theory has been applied to patients with specific diseases, to specific age groups, and used in a
variety of settings. Some authors use the model as a philosophical guide to nursing practice, often citing self-care
beliefs or building on Orem’s definition of self-care (Fitzgerald, 1980). Other uses the concept with precision and
develops guides to nursing practice (Backscheider, 1974). Is also used to develop a plan of care for individual
client, families and community. Orem’s self-care model is increasingly used as a frame work for practice in
specific institutions.
ii. Education

The theory is used by several school and college of nursing as a theoretical foundation for students’ basic
preparation for practice. Many schools use Orem’s nursing process in clinical practice, developing extensive
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tools, teaching packets and evaluation models. Orem’s frame work has been used as a conceptual guide to
nursing curricula in associate degree, diploma, and baccalaureate nursing programs. The model identifies
curricular content that differentiated the role and function of the technical nurse from that of the professional
nurse.
iii. Research

Orem’s conceptual framework has been used increasingly as a guide for using research. There has been
much variation in the application by researchers. Some researches use the beliefs and definitions in the model as
a basis for research and others cite concepts but build on the ideas of others. Much of the research with in Orem’s
self-care deficit theory of nursing has been directed to developing instruments to measure concepts in the model.
Hartweg (1990) conceptualized health promotion self-care within Orem’s Self-Care Deficit Nursing Theory and
went on to explore through a descriptive study the self-care actions performed by healthy middle-aged women to
promote well-being. Hanucharurnkul (1989) used Orem’s theory as a basis for her work with Thai patients who
were receiving chemotherapy for the treatment of cancer. Orem’s theory is also being applied by Jaarsma and
colleagues as a basis for an ongoing program of research with cardiac patients in the Netherlands.
iv. Theory Testing

Opportunities to test elements of the Self-Care Deficit Nursing Theory have been greatly enhanced by the
measurement work with self-care concepts that has transpired over the past 20 years. It is important to note that
the theory-testing studies cited above were made possible by the development and psychometric testing of
instruments to measure the theoretical concepts Orem’s theory of self-care has been used to generate testable
hypothesis in a variety of settings. 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.

7. Strengths and Limitations Orem’s Theory

7.1 Strengths

It provides a comprehensive base to nursing practice and has utility for professional nursing in the areas of
nursing practice nursing curricula, nursing education administration, and nursing research. Specifies when
nursing is needed and expanded her focus of individual self-care to include multi person units. Herself care
approach is contemporary with the concepts of health promotion and health maintenance. Another major strength
of Orem’s theory is its advocacy for the use of nursing process

7.2 Limitations

The ambiguity of applying theory to nursing practice may lie in the fact that one theory does not always
specifically support all aspect of nursing care. That is because of unclear definition of family, the nurse society
relationship and public education areas are weak. In general, system theory 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 this
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is contradict varying needs and level care requirement. Limited recognition of an individual’s emotional needs. It
focuses more on physical care rather than psychological care. Appears that the theory is illness oriented rather
with no indication of its use in wellness settings

8. Evaluation of 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 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 needs complete care or assistance
with self-care activities such as the infants and the aged. The self-care deficit theory of nursing as expressed is
universal. It used as a guide to practice initially and at present most commonly applied in the care of ill adults.
From the beginning, it has been applied in the care of both well and sick children. The universality of the theory
should differentiate from its application in terms of time, place and individuals. Orem’s self-care deficit theory of
nursing provides a general framework to direct nursing action. Orem views nursing within the framework of the
theory related to patient’s therapeutic self-care demands, their self-care agency and the relationships between
them.

9. Conclusion of the theory

Orem dreams of a time when a general theory of nursing is no longer needed but replaced by practice
models and rules. Orem’s general self-care deficit theory of nursing has three interrelated theories. Each of the
interrelated theories has a central idea, propositions and presuppositions. They are interrelated through the
presuppositions. The general Self-care deficit theory is composed of six basic concepts. Orem’s theory is applied
in various models of practice and education. In general, her goal was to upgrade the quality of nursing care in
general hospitals.

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