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 Dorothea Elizabeth Orem (1914-2007) is one of

America’s foremost nursing theorists.

 She was born at Baltimore, Maryland.
 She started her nursing education by joining at the
Providence Hospital School of Nursing.
 She earned her Bachelor of Science in nursing
education in 1939 and Master’s of Science in
Nursing in 1945.
 She received honorary doctor of science degree in
 Dorothea E Orem in her nursing experience includes
private duty nursing, hospital staff nursing and
 Orem’s dedicated her life to creating and developing
a theoretical structure to improve nursing practice.
 She recognized the need to continue in developing
conceptualization of nursing. Published first formal
articulation of her ideas in nursing: Concept of
Practice in 1971.
A definitive movement towards nursing as a
field of knowledge as well as a field of practice
occurred in the 1950s where she worked as a
consultant with the division of hospital and
Institutional Service of The Indiana State Board of
Health. Her contact with nurses impressed upon
her, their interest for nursing, desires for progress
as well as absence of knowing leaders in nursing.
She was overwhelmed by the nurses’ inability to
communicate nursing in their patients, physicians
and others. She plans to upgrade the quality of
nursing in general hospitals throughout the state.
During this time she developed her definition of
nursing practice. In 1957 Orem moved to
Washington D.C where she was working as
curriculum consultant. In that period she wrote
“Hope of Nursing”, which was published in the
journal of nursing education..
This work stimulated her to consider the
question “what condition exist in a person
when that person or other determines that
the person need nursing care”-this idea also
evolved her into concept of self care.
Assumption basic to the general theory were
formulated in the early 1970s and were first presented
at Marquette University School of nursing 1973.Orem
identifies the five premises underlying the general
theory of nursing.

 Human beings required continuous deliberate inputs

to themselves and their environments to remain alive
and function in accordance with natural human
 Human agency, power to act deliberately is
exercised in the form of care for self and others in
identifying needs and making needed inputs.
 Mature human beings experience privations in the
form of limitations of actions in care for self and
others involving and making of life sustaining and
function regulation inputs.
 Human agency is exercised in discovering,
developing and transmitting ways and means to
identify needs for and make inputs to self and
 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 input to self and
In 1958, Orem experienced a spontaneous
insight about why individuals required and
could be helped through nursing. This
knowledge enables her to formulate and
express her concept of nursing.

 Is an art, a helping service and a technology; it is

the actions deliberately selected and performed
by nurses to help individuals or groups under
their care to maintain or change conditions in
themselves on their environment.
 Goals being-maintaining health, to regain normal
state of health, to minimize, stabilized and
control poor health or disability.
It is a state of physical, mental, social and
spiritual wellbeing and not merely the absence of

The environment components are
environmental factors, environmental elements,
conditions and developmental environment.
Human being:
It has the capacity to reflect, symbolize and
use of symbols; is the unity that can function
biologically symbolically and socially.

A human being who has little health related/
health derived limitation that renders him
incapable of continuous self care or limitation that
result in ineffective/ incomplete care.
Developmental self care requisites:
Occurs due to a health condition or life
events. Includes disease process, injury, effects
related to aging etc.

Universal self care requisites:

Are common to all human beings. Consist of
basic life requirements such as air, food,
elimination ,activity etc
Deviation requisites:
Action necessary to employ when a deficit
in self care exists. Procuring medical
treatment and nursing intervention.

Nursing therapeutics:
It is a deliberate, systematic and
purposeful action.
Nursing process:
It is a system to determine;
 Why a person is under care.
 A plan for care.
 The implementation of care.
Orem’s theory:
 Interrelate concepts in such a way as to
create a different way of looking at a
particular phenomenon.
 Is logical in nature.
 Is relatively simple yet generalizable
 Is basis for hypothesis that can be tested.
 Contribute to and assist in increasing the
general body of knowledge within the
discipline through the research implemented to
validate them.
 Can be used by the practitioners to guide and
improve their practice.
 Must be consistent with other validated
theories ,laws and principles.
It includes three related parts;





Self care–
The performance of activities that individual initiates
and perform on their behalf to maintain life, health and

Self care agency –

Is a human ability which is "the ability for engaging in
self care" and conditioned by age developmental state,
life experience socio-cultural orientation health and
available resources.
Consists of two agent
 Self care agent (person who provides the self care).
 Dependent Care Agent (person other than the
individual who provides care such as parents).

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.
 Three categories of self care requisites are:--
a. Universal
b. Developmental
c. Health deviation

 The maintenance of sufficient intake of air, water , food.

 The provision of care associated with elimination processes
and excretion.
 The maintenance of a balance between activity and rest.
 The maintenance of a balance between solitude and social
 The prevention of hazards to human life, functioning and
well being.
 The promotion of human functioning and development
within social groups in accordance with human potentials,
human limitations and desire to be normal.

 Associated with developmental processes/

derived from a condition or associated with
an event.

E.g.- Adjusting to a new job

- Adjusting to body image
Health deviation self care is required in
conditions of illness, injury or disease or and
may result from medical measures required to
diagnosed and correct the condition.
Health deviation of self care requisites are-
 Seeking and securing appropriate medical
 Being aware of and attending to the effects
and results of pathologic conditions
 Effectively carrying out medically prescribed
 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
 Specifies when nursing is needed.
 Nursing is required when an adult (or in the
case of a dependent, the parent) is capable 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 [physical or
 Providing an environment promoting personal
development in relation to meet future
 Teaching another.
It describes how the patient self care needs
will be met by the nurse, patients or both. The
theory of nursing system propose that nursing is
human action, nursing system are action system
formed by nurses through the exercise of their
nursing agency for person with health deviated
or health associated limitations in self care.
Orem’s identifies three classification of
nursing system to meet self care requisites of
the patients.
Orem presents a model to show the
relationship between her concepts. From this
model it can be seen that at a given time an
individual has specific self care abilities as
well as self care demand. If there are more
demand than abilities, nursing is needed.
 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
 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.
 Diagnosis and prescription; determine why
nursing is needed. Analyze and interpret,
make judgment regarding care.
 Design of a nursing system and plan for
delivery of care.
 Production and management of nursing
 Orem’s theory has been used as the basis for the
development of research instruments to assist
researchers in using the theory.
 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.
 The theory has been used as a conceptual framework
in associate degree programs (Fenner 1979) also in
many nursing schools.
 Provides a comprehensive base to nursing
 It has utility for professional nursing in the
areas of nursing practice, nursing education,
administration and nursing research.
 Specifies when nursing is needed.
 Also includes continuing education as a part
of the professional component of nursing
 Herself care approach is contemporary with
the concepts of health promotion and health
 Expanded her focus of individual self care to
include multi person units.
 In general theory a system is viewed as a single
whole thing while Orem defines a system as single
whole things.
 Health is often viewed as dynamic and ever-
changing Orem’s visual presentation of the boxed
nursing system implies three static conditions of
 Appears that the theory is illness oriented rather
with no indication of its use is wellness setting.