Overview of Orem's Self-Care Deficit Theory of Nursing

What is the key "problem" or focus of the model/framework?

Purpose:
According to Polit & Henderson, each individual has the ability to perform self-care, and are responsible for their health and the
health of their dependents. Self-care is "the practice of activities that individuals initiate and perform on their own behalf in
maintaining life, health, and well-being" (as cited in Cardinal Stritch University Library, 2011).
Orem's initial definition of nursing's concern included "man's need for self-care action and the provision and management of it on
a continuous basis in order to sustain life and health, recover from disease or injury, and cope with their effects" (Orem, 1959, p.
3).
More simply stated, her definition of nursing's goal was "overcoming human limitations" (Orem, 1959, p. 4)
Orem's general theory of self-care deficit nursing states that a self-care demand exists when the patient of family members are not
able to provide care for him/herself and those self-care demands can be met by the nurse (Masters, 2011).
According to Sitzman & Eichelberger (2011), "Orem's Self-Care Model describes a structure wherein the nurse assists the client,
where needed, to maintain an adequate level of self-care. The degree of nursing care and intervention depends on the degree to
which the client is able (or unable) to meet self-care needs (p. 96)."
Orem's theory is made up of 3 related theories:
1. Theory of Self-Care
2. Theory of Self-Care Deficit
3. Theory of Nursing Systems
According to Orem, "the three-part theory focuses not on individuals, but on persons in relations. Each of the three theories has
as its focus a specific dimension of the person: the theory of self-care focuses on the self, the I; the theory of self-care deficit
focuses on you and me; and the theory of nursing system focuses on we, persons in community" (1990, p. 49).

Theory of Self Care

Why and how people care for themselves; how nursing is required to assist in performing self-care due to patient limitations.
Key Terms :Self care ,Self care agency ,Therapeutic self care demand ,Self care requisites
Self care ;Activities that an individual practices, performs, or initiates on his or her own behalf in order to maintain life, health
and well- being
Self care agency ;Persons ability to engage in self-care, which is conditioned by factors: Age ,Gender,Developmental stage ,Life
experience ,Sociocultural factors ,Health ,Pattern of living,Healthcare/family system ,Available resources
Therapeutic self care demand : All self-care actions needed at various times in a persons life to meet all of an individuals selfcare requisites
Self care requisites :Group of actions or needs for self care
Three categories of self-care requisites
1.Universal
2.Developmental
3.Health deviation
1. Universal Self-care requisites Associated with life processes and in maintaining the integrity of human structure and
functioning

Common to everyone, includes ADLs

These requisites are: air ,water ,food ,elimination ,activity and rest ,solitude and social interaction,prevention of hazards
,promotion of human functioning
2. Developmental self care requisites
Related to different stages in human life cycle ; i.e. college, marriage, retirement
Maturational, which are associated with developmental processes and derived from a condition
Situational, which are associated with an event E.g. adjusting to a new job or adjusting to body changes
Needs are: Maintaining good health and promoting human development/maturation ,Preventing or treating illness and disease
that affects human development/maturation
3. Health deviation requisites ;Needs and conditions arising from 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 treatments ,Being aware of and attending to side effects of
treatment ,Modifying self concepts in accepting oneself in a particular state of health ,Learning to live with effects of illness and
medical treatment (Orem,).
Theory of Self Care Deficit & Theory of Nursing Systems
*Theory of Self Care Deficit : Self care deficit occurs when patient or parents of dependents are unable to meet self care
requisites. Therefore, nursing help is needed . Nursing care is used to help people enhance self-care abilities needed for survival,
well-being, and quality of life. Orem identifies 5 methods nurses use to help patients meet their self-care deficits : (used alone or
in conjunction with another) . Acting for and doing for another . Guiding and directing . Providing physical or psychological
support .Providing and maintaining an environment that supports personal development . Teaching (Orem, 2001, as cited in
Masters, 2011, p. 183)
*Theory of Nursing Systems: Describes how the patients self care needs will be met by the nurse , the patient, or both . Nursedesigned based on assessment of individuals self-care needs and ability to perform self care needs . defines nurses role in
patient care . 3 systems nurses use to meet patients self- care requisites or needs :.Wholly compensatory . Partially compensatory
. Supportive-educative
The three systems of nursing
1. Wholly compensatory . Patient is unable to perform any self-care activities; nurse accomplishes most or all of care
2. Partially compensatory . Self-care activities are performed by both nurse and patient to meet self-care requirements; nurse
assists with care
3. Supportive-educative . Patient performs own self-care, but nurse is required for support, education, knowledge, decisionmaking to promote the patient as a self-care agent
How are the three theories related?
The theory of self care delineates the demands of self-care requisites that an individual needs to meet in order to stay healthy or
get better from illness. When a person cannot meet these self-care demands, or when self-care requisites exceeds self-care
capabilites, nursing is needed. Nurses can help patients meet their self-care needs by utilizing the 5 methods in the Theory of Self
Care Deficit. However, the nurse must properly assess the level of self-care a patient requires so that the nurse can utilize the
nursing system (as stated in the Theory of Nursing System) that best fits the patient's ability to perform self-care. In the end, the
nurse assists the patient in meeting his/her self-care needs so that he/she is healthy and free of illness.

LETS PICTURE IT!

Major Concepts of Nursing according to Orem

Nursing theories have four concepts that are central to their metapardigm: person, environment, health, and nursing. However,
each nurse theorist defines these concepts differently, depending on their fit into the theory.
Major Concepts of Nursing
FOUR key concepts:.Interrelated .Person (Patient or parent of dependent) .Environment .Health .Nursing
Person . The patient whom the nurse cares for . Capable of self care . Possesses developmental,universal, and health deviation
needs . A functioning whole or unity that is viewed socially, biologically, and symbolically
Environment . Provides the context within which the person exists . Subcomponent of the person . Along with the person, makes
an integrated system, given that the environment affects a patients health needs . Can be modified by the nurse to meet patients
needs . Components consist of environmental elements, conditions, factors, and developmental environment
Health . a state characterized by soundness or wholeness of developed human structures and of bodily and mental functioning
(Orem, 1995, p. 101) . Dependent on environment, therefore, health definition varies . Includes ability to achieve a level of innate
potential while living within social, biological and physical environments
Nursing . Encompasses actions by nurses used to assist patients . to accomplish therapeutic self-care, . move towards responsible
self-care, . or maintain care with supervision and consultation . Helps patients maintain a state of health . Assists the patient with
disease or injury to regain normal or near normal state of health . Stabilizes, controls, or minimizes the effects of chronic poor
health or disability . Goal is to provide patient or family members the necessities needed to meet the patients self care needs
Terms related to Nursing . Nursing client . Person 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. (Nursing Theories, 2011) .
Nursing problem . deficits in health-related conditions, including universal and developmental dimensions
. Nursing process . system used to determine why a person requires care, plan of care, and implementation of care
. Nursing therapeutics . Actions that are systematic and purposeful
How are the four concepts related?
The person (or patient) is the central focus of nursing care. According to Orem, the person's health state is mediated by his/her
environment. A person, who is healthy, is capable of self-care. When there is illness in the person's health state, the person is not
able to complete all self-care requisites. When this occurs, nursing care is needed to assist the person in completing his/her selfcare. Nurses must assess the person's ability to provide his/her own self care and the environmental context of the person in order
to overcome health-associated
limitations.

Orem's Self-Care Deficit Nursing Theory as a THEORETICAL FRAMEWORK for Nursing Practice

Combining the three sub-theories and major concepts creates the general Self-Care Model, which outlines
Orems nursing process.
This process determines the self-care deficits and defines the person or nurses roles in meeting the self-care
demands

This nursing process has 3 steps, which is comparable to the currently used and taught nursing process

Nursing Process we are

familiar with

Assessment

Nursing diagnosis
Plans with scientific
rationale

Implementation
Evaluation

Orems Nursing Process

Diagnosis and prescription. Why is nursing needed? Analyze, interpret and make judgments
regarding patient care
Step 1- collecting data on:
Persons health status, requirements for self care and capacity to perform self care
Physicians and persons perspective of the persons health
Health goals within the context of life style, health status, and life history
Designing nursing system and plan for delivery of care
Step 2
Nurses design a system that is wholly compensatory, partly compensatory or supportiveeducative
Goals are to promote patients therapeutic self-care demands and compensate or
overcome patients self-care deficits
Production and management of nursing systems
Step 3
Nurse assists the patient or family in self-care needs to attain goals toward positive health
and health related outcomes
Actions are guided by rationale of nursing diagnosis
Evaluation of results achieved compared to planned outcomes

Nursing Process

Assumptions and Propositions

Assumptions:
Nurses deliberately and purposefully perform nursing as a helping service to others
People are willing and capable of performing self-care for themselves and for dependent family members (children).
Health, well-being, and human development is dependent on self-care as a necessity in life
Individuals are influenced by culture and education
Communication and human interaction fosters and teaches self-care
Deliberate and systematic actions are performed to meet self-care
Each person possesses interests, powers, talents, values, capabilities, and personal dispositions
Each individual is self-reliant and responsible for his or her own care and others in his or her family needing care
People are separate from their environment and others

Propositions:
Age, experiences, developmental state, and sociocultural background influences self-care abilities
Capabilities to provide own self-care and care for others are learned and recalled
Self-care capabilities and self-care demands should be balanced by self-care deficits

Life experiences, health, sociocultural orientation, resources, developmental stage, and age mediates self-care or
dependent care
Nurses, patients and others are involved in therapeutic self-care by meeting self-care needs and regulating self-care
capabilities
Nurses assess patients' abilities and potentials in meeting and performing their self-care needs
Nurses select reliable and valid processes, actions, and/or technologies in meeting needs for self-care

Using Orems Theory in Practice

Researchers have used Orems theory as a basis for the development of research instruments
Moore (1995) developed and tested a self care questionnaire to measure the self care practice of children and
adolescents
Orems theory has served as a conceptual framework in associate degree programs in many nursing schools
Orems theory can be applied to the three levels of prevention: primary, secondary, and tertiary
Primary when nursing care is aimed at developmental or universal self-care and when they are
therapeutic
Secondary or tertiary when nursing care is aimed at health-deviation self-care
It has a broad scope in clinical practice but has a lesser extent in research, education and administration

Who developed this theoretical model and what did they use the theory to examine?
bpage, the theoretical model was developed by Dorothea Orem
ting
those needs. Orem saw that in order for a person, in ill health, become healthy and well, certain self-care needs must be met. If a
person is not capable of providing any self care, the nurse would be responsible for providing most of the care. On the other hand,
if the person is fully capable of providing basic self care, the nurse would be the supporter/educator/faciliator of that self care.
themselves or with the help of the nurse.
References:
Cardinal and Stritch University Library. (2011). Dorothea Orem 1914- Self-care Framework. Retrieved
from:http://library.stritch.edu/research/subjects/health/nursingTheorists/orem.html
Masters, K. (2011). Nursing Theories: A Framework for Professional Practice. Sudbury, MA: Jones and Bartlett Learning, LLC.
Nursing Theories. (2011). Dorothea Orem's Self-care Theory. Retrieved from:
http://currentnursing.com/nursing_theory/self_care_deficit_theory.html
Orem, D. (1959). Guides for developing curriculum for the education of practical nurses. Washington, DC: U.S. Government
Printing Office.
Orem, D. (1990). A nursing practice theory in three parts, 1956-1989. In M. E. Parker (Ed.), Nursing theories in practice (p. 4760). New York: National league for Nursing.
Sitzman, K. L. & Eichelberger, L. W. (2011). Understanding the Works of Nurse Theorists: A Creative Beginning (2nd ed.).
Sudbury, MA: Jones and Barlett Learning, LLC.
. Masters, K. (2011). Nursing Theories: A Framework for Professional Practice.
Sudbury, MA: Jones and Bartlett Learning, LLC.
. Nursing Theories. (2011). Dorothea Orems Self-Care Theory. Retrieved from: http:
//currentnursing.com/nursing_theory/self_care_deficit_theory.html
. Orem, D. (1995). Nursing: Concepts of practice (5th ed.). St. Louis, MO: Mosby.
. Sitzman, K. L. & Eichelberger, L.W. (2011). Understanding the Work of Nurse

Theorists: A creative beginning (2nd ed.). Sudbury, MA: Jones and Bartlett Publishers,
LLC.
References
Masters, K. (2011). Nursing Theories: A framework for professional
practice. Sudbury, MA: Jones and Bartlett learning, LLC.
Nursing Theories. (2011). Dorothea Orems Self-Care Theory.
Retrieved from: http://currentnursing.com/nursing_theory/
self_care_deficit_theory.html
Orem, D. (1985). Nursing: Concepts of practice (3rd ed.). St. Louis,
MO: Mosby.
Sitzman, K. L. & Eichelberger, L.W. (2011). Understanding the Work
of Nurse Theorists: A creative beginning (2nd ed.). Sudbury, MA:
Jones and Bartlett Publishers, LLC.