Dorothea Orem self care-

deficit Theory
by: Markos Makisha
Orem's self care theory by MARKOS
03/29/2023 1
MAKISHA
 Presentation Out line
 Introduction of the Theorist
 Description of the theory
 Major Assumptions
 Basic Concepts
 Principles of the theory
 Importance of the theory
 Nursing paradigm
 Application of the theory
• References

Orem's self care theory by MARKOS

03/29/2023 2
MAKISHA
 Dorothea Orem
one of America’s foremost nursing theorists who
developed the Self-Care Deficit Nursing Theory.
 born in1914 in Baltimore
she earned her diploma from the Providence Hospital
School of Nursing in Washington
BSc Nursing in 1939 & MSc in Nursing in 1945, both
from Catholic University of America in Washington,
D.C.
 served as Ass.Professor from 1959 to 1964, Associate
Professor from 1964 to 1970, and Dean of the School of
Nursing from 1965 to 1966.
Orem's self care theory by MARKOS
03/29/2023 3
MAKISHA
 Dorothea Orem…

• Orem published Nursing: Concepts of Practice, the

work in which she outlines her theory of nursing, the
Self-care Deficit
• She also served as chairperson of the Nursing
Development Conference Group
• She continued to work on the conceptual
development of Self-Care Deficit Nursing Theory.

Orem's self care theory by MARKOS

03/29/2023 4
MAKISHA
 Self-Care Deficit Theory of Nursing
By Dorothea Orem (1914-2007)
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.” 
 defined as “the practice of activities that individuals
initiate and perform on their own behalf in
maintaining life, health, and well-being.”

Orem's self care theory by MARKOS

03/29/2023 5
MAKISHA
 Dorothea Orem's theory…

Three components of Orem's theory

• Self care
• Self care deficit
• Nursing system
Self care deficit is a core of Orem's theory because it
determines when nursing is needed.

Orem's self care theory by MARKOS

03/29/2023 6
MAKISHA
 Major assumptions of orem’s theory
Orem (1991) described several sets of general
assumptions
• People should be self-reliant and responsible for their
own care and others in their family needing care.
• People are distinct individuals.
• Nursing is a form of action – interaction between two
or more persons

Orem's self care theory by MARKOS

03/29/2023 7
MAKISHA
 conti…

• Successfully meeting universal and development self-

care requisites is an important component of primary
care prevention and ill health.
• A person’s knowledge of potential health problems is
necessary for promoting self-care behaviors.

Orem's self care theory by MARKOS

03/29/2023 8
MAKISHA
 Theory concepts and definitions
 Self care deficit theory of Nursing is composed of six
basic concepts.
• Self care, self care agency, therapeutic self care
demand, self care deficit are related to the patient or
the person in need of nursing,
• whereas nursing agency and Nursing system are
related to the nurses and their action

Orem's self care theory by MARKOS

03/29/2023 9
MAKISHA
 1. Theory of Self-Care: Major Concept
 Focus on self care that a person performs
independently to him/her self or their dependant's to
maintain health .
A ) self – care
• Is the performance or practice of activities that
individuals initiate and perform on their own behalf to
maintain life, health, and wellbeing.
• Self-care is learned through interpersonal relations
and communications.

Orem's self care theory by MARKOS

03/29/2023 10
MAKISHA
 Conti--
B) Self-Care Agency-
 The human’s acquired powers and capabilities to
engage in self-care
 The ability to engage in self-care activities are
influenced by “Basic Conditioning Factors ( age,
educational status, health status, enviromental
factors.
• In usual circumstances adult care for themselves.

Orem's self care theory by MARKOS

03/29/2023 11
MAKISHA
 Conti-
C) Therapeutic Self-Care Demand
• is the totality of self care actions needed be
performed for some duration in order to meet self care
requisites by using valid methods and related sets of
operations and actions.
• Is modeled on deliberate action that is intentional
performed by some members .

Orem's self care theory by MARKOS

03/29/2023 12
MAKISHA
 Conti--
D) Self-Care Requisites-
• An additional concept that defines it as the reasons for
which self-care activities occur
• These are the self-care needs categorized into three
distinct requirements:
a. Universal Self-care Requisites
b. Developmental Self-care Requisites
c. Health Deviation Self-care Requisites

Orem's self care theory by MARKOS

03/29/2023 13
MAKISHA
 A. Universal self care requisites/ADLs
 Associated with life processes and the maintenance
of the integrity of human structure and functioning
 Common to all; activities of daily living
 Identifies these requisites as:
• Maintenance of sufficient intake of air ,water, food
• Provision of care associated with elimination process
• Balance between activity and rest, between solitude
and social interaction
• Prevention of hazards to human life well being .

Orem's self care theory by MARKOS

03/29/2023 14
MAKISHA
 B. Developmental self care requisites
 Associated with developmental processes/ derived
from a condition…or associated with an event.
E.g.
• adjusting to a new job
• adjusting to body changes
• It includes life cycle changes like intrauterine life,
birth, infancy, childhood , pregnancy

Orem's self care theory by MARKOS

03/29/2023 15
MAKISHA
 C. Health deviation self care requisites
• 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
 Learning to live with effects of pathologic conditions.

Orem's self care theory by MARKOS

03/29/2023 16
MAKISHA
 Theory of Self-Care Deficit: Major
Concepts
• Is the basic element of the general theory of self-care
• It delineates WHEN nursing is required.
• Nursing is required when adults or parents for their
child are incapable of providing continuous effective
self-care.
• If there are more demands than abilities (Self-Care
Agency), nursing is needed.

Orem's self care theory by MARKOS

03/29/2023 17
MAKISHA
 3. Theory of Nursing Systems
• Describes how the patient’s self care needs will be met
by the nurse , the patient, or both.
• Orem recognized that specialized technologies are
usually developed by members of the health profession
• Identifies 3 classifications of nursing system to meet the
self care requisites of the patient:-
 Wholly compensatory system
 Partly compensatory system
 Supportive – Educative system

Orem's self care theory by MARKOS

03/29/2023 18
MAKISHA
Types of Definitions Conti-- Example
Nursing
Systems

Wholly Is represented by the Patients under coma,

Compensat situation in which the anesthesia, with
ory individual is unable to carry fractures
out needed self-care actions, spinal dysfunctions,
Partly when the patient and nurse Patients with major
surgeries, and temporal
Compensa are both physically active in limitation of physical
meeting the patient’s self-
tory activity by casting
care needs
Supportive Represented by the person Clients wishing to
Educative has the capability to perform know
independently . about contraceptive
In either case, the person Methods, counseling
needs some manner of on breast feeding
assistance
Orem's self care theory by MARKOS
03/29/2023 19
MAKISHA
 Conti--

Orem's self care theory by MARKOS

03/29/2023 20
MAKISHA
 Three Steps by Orem versus Nursing
Nursing Orem’s self care theory
process Process
ASSESMENT Step 1- collect information on 06 areas of assessment ( The
persons health status, the persons perspective of his health ,
the persons health goals in the context of , the persons
requirements , the persons capacity/ agency/ , medical
problem and plan,
NURSING Step 2. design nursing system that is wholly or partly
DIAGNOSIS, compensatory or supportive education, plan for therapeutic
PLANNING self care demand
Step 3. A nurse assists a patient or family in self care
Implementation matters
 actions are identified based on etiologic component on
Evaluation nursing matters
 evaluation of the plan.

Orem's self care theory by MARKOS

03/29/2023 21
MAKISHA
 Meta-paradigm
Person (Man):
• Man is the total being who can function biologically,
symbolically and socially….
• Man is self-reliant and responsible for self-care and
wellbeing of his or her dependents.
• Man is a logical organism with rational powers.
• patient is an individual who is in need of assistance in
meeting specific health-care demands because of lack
of knowledge, skills, motivation, or orientation.

Orem's self care theory by MARKOS

03/29/2023 22
MAKISHA
 Conti-
Nursing
• is art, a helping service, and a technology
• Actions deliberately selected and performed by
nurses to help individuals or groups under their care
to maintain or change conditions in themselves or
their environments.
• Goal of nursing – to render the patient or members of
his family capable of meeting the patient’s self care
needs.

Orem's self care theory by MARKOS

03/29/2023 23
MAKISHA
 Conti-
Health
• State of wholeness or integrity of the individual human
beings, his parts, and his modes of functioning
• This concept is inherent in her nursing systems since
the goal in each system is optimal wellness relative to
that system.
• Responsibility of a total society and all its members.

Orem's self care theory by MARKOS

03/29/2023 24
MAKISHA
 Conti-
Environment
• Encompasses the elements external to man but she
considered man and environment as an integrated
system related to self-care.
• Environment components are enthronement factors,
elements, conditions, and developed environment

Orem's self care theory by MARKOS

03/29/2023 25
MAKISHA
 Strengths and Limitations Orem's Theory

Strengths
 It provides a comprehensive base to nursing practice
 Specifies when nursing is needed and expanded her
focus of individual self care to include multi person
units
 has utility on the nursing practice ,nursing
curricula ,nursing education administration ,and
nursing research

Orem's self care theory by MARKOS

03/29/2023 26
MAKISHA
 Limitation
• In general system theory a system is viewed as a single
whole thing while Orem defines a system as a single
whole, thing.
• Although the family, community and environment are
considered in self care action, the focus is primarily on
the individual.
• Health is often viewed as dynamic and ever changing
• Appears that the theory is illness oriented rather with
no indication of its use in wellness settings.

Orem's self care theory by MARKOS

03/29/2023 27
MAKISHA
 Importance of the theory
A) Nursing practice
• Many articles document the use of the self-care theory
as a basis for clinical practice.
• Orem’s self-care deficit theory has been used in the
context of the nursing process
B) education
• Orem’s self-care deficit theory has been the focus of
the curriculum in nursing education at many schools of
nursing.

Orem's self care theory by MARKOS

03/29/2023 28
MAKISHA
 conti
C) Research
• The self-care theory provided conceptual framework
for many researches.
Ex
 Self-care requirements for activity and rest: an Orem
nursing focus
 Orem's theory in practice. Hospice nursing care

Orem's self care theory by MARKOS

03/29/2023 29
MAKISHA
 Application of Orem’s self-care deficit
theory of nursing

Base line data

Name- Abebe Kebede
Age- 30 years old
Sex- Male
Occupation- Farmer
Marital status- married
Religion- orthodox Christian
Dx. – Tibular Fracture
Theory applied- Orem’s theory

Orem's self care theory by MARKOS

03/29/2023 30
MAKISHA
 Case history
• He came to Arba minch general hospital with
complaints of pain, loss of function ,deformity of
extremity, oedema on right lower leg after sustaining
crashing force accident .
• He was apparently healthy before this injury.
• He was unable to do ADL by him-self after injury

Orem's self care theory by MARKOS

03/29/2023 31
MAKISHA
 Assessment using Orem's model
1) Heath care status the patient
• Health status –acutely ill due to fracture
• Socio-cultural orientation- no formal education
• Health care system- institutional health care
• Family system- married, farmer and lead the home
• Patterns of living- at home with partner
• Environment- rural area, items for activity of daily
living not easy
• Perception of his health status – Severely ill

Orem's self care theory by MARKOS

03/29/2023 32
MAKISHA
 2) Universal self care requisites
• Air- breath without difficulty
• Water- fluid intake sufficient
• Food- loss appetite , non nutritious food intake
• Elimination- Can void, but assisted
• Activity/rest- Impaired activity, rest is required due to
pain, deformity over there
• Social interaction- communicates well, good
• Prevention of hazards- needs counsel on bed rest, on
diet, on immobilization

Orem's self care theory by MARKOS

03/29/2023 33
MAKISHA
 3) Developmental self-care requisites
 Maintenance of developmental environment
 sociable, able to communicate
 Impaired performance of daily activity
 Disturbed self image
 Free of any risk personal behaviors.

Orem's self care theory by MARKOS

03/29/2023 34
MAKISHA
 4) Health deviation self care requisites'
• Adherence to medical regimen- he needs continuity of
care and cooperates with the medicines
• Not much aware about the treatment options for his
problem
• Not aware about the side effect of the management
• Needs counseling about body self image modification
until healing

Orem's self care theory by MARKOS

03/29/2023 35
MAKISHA
 5) Medical problem and plan

• medical diagnosis- right leg tibular fracture

• medical Treatment- immobilization using cast
application, anti-pain( Tramadol 50 mg Iv TD)
• Supportive therapy- Physiotherapy and Nutritional

Orem's self care theory by MARKOS

03/29/2023 36
MAKISHA
6. Areas of inadequacy ( self care demand
and agency
• Food Intake –Imbalanced
• Elimination- assisted elimination
• Activity- frequent rest is required, activity level has
come down , pain is not completely removed
• Activity of daily living- impaired
• stress and coping- He feels stressed.
Self care agency/ ability - inadequate

Orem's self care theory by MARKOS

03/29/2023 37
MAKISHA
 Nursing diagnosis
• Altered self care activity related to injury of the arm
and leg
• Acute pain related to fracture
• Disturbed body self image related to injury .
• Lack of knowledge about disease condition re/to
patient verbalization

Orem's self care theory by MARKOS

03/29/2023 38
MAKISHA
 Outcome and plan
The patient needs whole compensatory care such as
 Relieve pain,
 Improve dieting
 Improved nutrition
 Improve self image
• Method of helping
 Teaching , counseling
 Treating
 Immobilizing him for short period of time .

Orem's self care theory by MARKOS

03/29/2023 39
MAKISHA
 Implementation
• Teaching
• Treating pain
• Assisting in dress, bath, toileting,
• Immobilizing the patient with cast…

Orem's self care theory by MARKOS

03/29/2023 40
MAKISHA
 Evaluation
• The pt. understood importance the best treatment
options
• The patients self image improves
• The patients self care activities improved.
• He verbalized that “I will take proteinous diet”
• He stated that relative pain free period

Orem's self care theory by MARKOS

03/29/2023 41
MAKISHA
 Acknowledgment

My deepest and heart felt gratitude and appreciation

goes to instructor Wubshet E(Bsc, Msc Ass. Prof)
for giving this chance to present nursing theory

Orem's self care theory by MARKOS

03/29/2023 42
MAKISHA
 References
• Alligood, M.R. & Tomey, A.M. (2010).Nursing
Theory Utilization and Application(4th ed.).St. Louis,
Missouri: Mosby.
• George, J. B. (2011).Nursing theories: The base for
professional nursing practice(6thed.) Boston: Pearson
• Parker, M. (2001).Nursing Theories and Nursing
Practice. Philadelphia: F. A. Davis.
• Taylor, S.G. (2006). Dorthea E. Orem: Self-care
deficit theory of nursing
• Tomey. M.A. & Alligood, M.R. (2010).Nursing
Theorists and Their Work (7th ed.). St. Louis,
Missouri: Mosby. Orem's self care theory by MARKOS
03/29/2023 43
MAKISHA