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DORTHEA OREM’S SELF-CARE DEFICIT NURSING THEORY
Nursing theories: Nursing Care Deficit
Melissa S. Kumm
NUR 410: Professional Roles, Ethical Issues, and Nursing Theories
Concordia University
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DOROTHEA OREM’S SELF-CARE NURSING THEORY
Nursing theories: Nursing Care Deficit
Dorothea Orem was born in Baltimore, Maryland in 1914 (Masters, 2013). She earned
her diploma in nursing in the 1930’s and a BSN in nursing education in 1946. She attended
college at the Catholic University for America. She worked in many different fields of nursing
including: pediatrics, adult medical and surgical units, emergency rooms, operating rooms and
private duty nursing (Masters, 2013). Orem also worked in different levels of nursing in these
fields, which included consultant, director, professor, theorist and author.
Orem worked on her nursing theory from the start of her nursing career and continued to
refine it throughout the different stages of her nursing profession. Her theory was first
introduced in 1956. In 1959 she introduced the basic ideas of the self-care theory. Orem’s first
book was published in 1971. It was titled Nursing: Concepts of Practice. She introduced the
three theories to her self-care deficit in 1985. In 1968 Dorothea retired from nursing and
ultimately passed away in 2007 (Masters, 2013).
The Self-care deficit nursing theory that Orem developed is one of the most commonly
used theories in the nursing field. Her theory originally began as a definition of nursing concern
and goals as part of her teachings. This original definition 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 (Masters, 2013, P. 180).”
Orem describes her theory as a general theory. There are three steps in Orem’s theory.
First a nurse must determine why a patient needs care; next they must develop an approach as to
how to provide that care and lastly implementing the plan of care. Her theory is compromised of
three theories that include the self-care deficit, nursing systems, and self care. Each theory
focuses on the different relations we face in the nursing field. According to Masters the theory
DORTHEA OREM’S SELF-CARE DEFICIT NURSING THEORY
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of self-care focuses on the patient, the self-care deficit theory focuses on the nurse to patient
relations and the nursing system focuses on the people in the community. Each of these
intertwines to make up her self-care deficit nursing theory.
The self-care theory is defined as how people care for themselves and states that nursing
is required when a patient is unable to provide such care. As stated by Masters this theory is
made up of three concepts including self-care agency, therapeutic self-care and basic
conditioning factors.
The self-care agency is how a person grows and develops the basics needs to provide
self-care to ones self. This is used to promote human functioning and development. This can be
broken down into three different elements: Development, operability and adequacy. The first
two can be described as a person’s ability to perform self-care tasks efficiently and consistently.
Adequacy is the number and kinds of tasks one can perform to meet the self-care needs.
The therapeutic self-care demand is the care that is needed to meet an individual’s needs.
Some examples of this would include: airway, water, nutrition etc. The basics of daily living
needed to survive.
Basic conditioning factors are the things that affects ones ability to perform the self-care
tasks. These would include: age, gender, developmental state, health state, pattern of living,
healthcare system factors, family system factors, sociocultural factors, availability of resources,
and external environmental factors (Masters, 2013).
There is the Universal self-care that is the basic needs of every individual. Such needs
would include breathing, intake of water and food, elimination of waste etc. These are the basic
needs of life. Developmental self-care requisites are the major life changes in one life that leads
to ones development of self-care activities. A health-deviation self-care requisite is when people
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obtain the help that they need when they need it to maintain and gain the health they need
(Masters, 2013).
Theory of self-care deficit is how an adult learns to care on one self and how thus person
can be helped through the nursing process. As stated in Masters nurses use five methods to meet
the self-care needs of patients. Including: acting for or doing for another, guiding and directing,
providing physical and psychological support, providing and maintaining an environment that
supports personal development and teaching.
Nursing systems theory is the relationships that a nurse must have to promote the end
product of a patient as defined by the nurse and patient in the development of the plan of care.
There are three different systems that a nurse can use to obtain this goal. The wholly
compensatory system is when a patient is unable to perform any self-care activities and relies
directly on the nurse. In the partially compensatory system is when a patient is able to perform
some tasks of self-care and relies on the nurse for the remainder. This is until the patient has
obtained the proficiency to be able to perform the task themselves and takes on more tasks.
Supportive-educative system is when a patient is able to perform the tasks themselves but needs
the education to do so as stated by Masters.
As a patient moves through the nursing theory the nurse must continually revise the plan
of care for thus individual to help promote the level of care that they need. An example of this
would be in the rehabilitation field. Initially out of surgery a patient requires many tasks to be
performed by the nurse. These may include transferring if they are non-weight bearing.
Educating on medications, dressing changes etc. As the patient progresses and heals they are
able to perform more of these tasks themselves and at the end of their stay will need supportiveeducation to be able to return to their previous living conditions.
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There are four metaparadigm described in Orem’s nursing theory. According to Masters
these concepts are person, environment, health and nursing. Orem describes these as being
interrelated to each other. These interrelate by what makes up the person. This would include a
person’s environment and how it influences their beliefs on healthcare, health history, past
experiences with nursing, education and much more.
Person as described by Orem is the individual under nursing care. The person is viewed
biologically, symbolically and socially but still as a whole person (Masters, 2013). This person
is considered to be able to provide self-care. Environment is the physical, chemical, biologic and
social factors that make up who a person is. Also, included would be environmental factors,
elements, conditions and development (Masters, 2013). This influences a patients needs as
related to healthcare. Health as defined by Orem as “a state characterized by soundness or
wholeness of developed human structures and of bodily and mental functioning (Masters, 2013,
p. 185).” This is view is interrelated with a patients environment. Nursing is how a healthcare
professional develops a plan of care to meet the patient’s self-care needs as described in Orem’s
definitions of the wholly compensatory, partly compensatory and supportive-educative system as
described earlier in this paper. All of these interrelate to how a nurse is going to develop a plan
of care for the patient based on the patients background and a patients self-care needs and
education needs (Masters, 2013).
Orem’s self-care is made up of both explicit and implicit assumptions. The explicit
assumptions include: nursing is deliberate, purposeful helping service. A person must be willing
to perform the self-care tasks themselves or for a dependent family member. Self-care is a life
necessity for health, development and well being of an individual. The education and culture
and how it influences a patient. Self-care is learned through interactions and communications.
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Implicit assumptions states that people need to be self-reliant and responsible for their
own health as well as anybody who is dependent upon them i.e. children. People are individuals
who have developed from many different aspects in their life. Some examples of this would
include environment, culture, education and much more (Masters, 2013).
For the structure of the model Dorothea describes how nurses must be able form a
relationship with physicians, patients, family members as well as other healthcare providers as
stated by Masters. This is why nurses must possess great communications skills. By building
these relationships a nurse is able to incorporate others into the patient’s care as well as learn
more background about the patient. This allows the nurse to better understand where the patient
is coming from to better formulate a plan of care for thus patient.
Expanding upon the relationships that a nurse must have to provide care can further
generate this nursing model. It could expand on how a nurse develops those relationships and
maintains them. A nurse must be able to prove that they are knowledgeable enough to provide
the care a patient needs and be able to prove that they are willing to help as starters to building a
relationship.
The nursing theory is written simple and precisely to make it easy to understand. It is
also described in depth to make it easier to use in the nursing field. It is useful in a wide variety
of situations in the nursing practice. Orem’s theory allows for organization of previous
knowledge and the generation of new knowledge (Masters, 2013).
The first stage in utilizing Orem’s nursing theory is for the nurse to develop a relationship
with that of the patient. This is known as the diagnostic operations phase, or looking into what
the patient needs to determine the social significance to the patient. From this relationship the
two must work together towards social utilization by identifying current and potential self-care
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demands and developing a plan of care to achieve these goals to achieve social congruence.
Known as the prescriptive operations phase. The regulatory operations phase is putting the plan
that has been formulated into action. Last is the control operations phase, which is when the
nurse evaluates the course of action for appropriate outcomes for the patient and adjusts plan as
needed. During these phases is when the nurse and patient achieve social utilization or happiness
between the two groups (Masters, 2013).
Orem’s nursing theory can be used in many different nursing fields. In the article
Beginning the Recovery Journey in Acute Psychiatric care it describes how Orem’s self-care
deficit nursing theory is used in psychiatric nursing. It discusses how when a patient is in the
state of mental illness a nurse must step in and provide the activities of self-care for these
patients due to them not being able to do so mentally. During a state of mental unstabability a
patient may lack the insight or energy to perform the activities of self-care. This is where the
nurse would step in to provide this care until the patient is up to doing so again. While doing this
the nurse must build a trusting relationship with the patient to be able to help educate these
patients and to eventually promote them to perform these self-care acts themselves.
In the article Mitral valve prolapse and its effects. Orem’s nursing theory is used to help
evaluate a patient’s current knowledge to the disease and their perspective of their health. It
describes how a nurse must take both of these aspects into consideration and incorporate the
patient into the development of the nursing care to help promote a relationship with thus patient.
The nurse must develop a plan the helps to manage the patient’s symptoms to help to promote
personal self-care by the patient. Much of Orem’s nursing theory is used in the
communication/relationship between the nurse and patient to educate on ways to help manage
symptoms to be able to care for oneself.
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Orem’s theory of self-care is utilized in many different aspects of nursing. All patients
go through stages where they need help performing the basic self-care needs. It is also very
important for a patient to develop a trusting relationship with the nurse to be able to understand
and accept the education that the nurse provides. Also, the relationship is important to the nurse
to be able to understand where the patient is coming from such as their background or previous
experiences. By having this relationship the nurse can develop a plan of care that is
individualized to each patient.
In the rehabilitation field of nursing Orem’s theory of self-care is widely used. Nurses
generally are only seeing their patients for a short period of time before they heal and move onto
their future plans. During this time the nurse must be able to form a relationship with the patient,
family, physician and other healthcare providers. Through each of these relationships they must
be able to then formulate a plan of care based on a patients needs, their plans for the future, past
history etc. When the patient is first out of surgery they rely on the nurse to perform more
activities of self-care. In this process the patient may begin in the wholly compensatory system
and progress through the partially compensatory system to eventually end in the supportiveeducative system.
The wholly compensatory system is where the patient relies on the nurse to perform selfcare activities as stated by Masters. In rehab this might include helping the patient to the
bathroom, transferring. If they have just had shoulder surgery helping them brush their hair,
dressing changes, etc.
In the partially compensatory system the patient is also participating in the self-care
activities. The patient slowly takes on more and more tasks as they begin to heal. An example
of this is when the patient begins to have more weight bearing status they begin to take some of
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the workload off of the nurse as they become stronger with their transfers as they strive for
independence. Also, as their shoulder begins to heal after surgery they may begin to be able to
brush their own hair etc.
With the supportive-educative system the patient is able to perform the self-care tasks
they just need help with the decision-making process, and knowledge (Masters, 2013). This may
include teaching a patient about dressing changes or about how to control blood glucose in a
newly diagnosed diabetic. The goal is to educate the patient to be able to perform the self-care
activities to be able to return to independence or move to long-term care as needed.
Even though the nurse may only work with a patient for a short period of time in rehab
the relationship the nurse forms has to be a trusting one for the patient to be able to trust thus
nurse and look to them for support. The nurse is often providing a great deal of education on
how to perform self-care to these patients to help promote self-care. This may be how to provide
self-care following a stroke with right-sided weakness. This patient must learn everything again
especially if they were right-handed. Thus patient must learn how to perform these tasks with
their left side. A trusting relationship will help the patient to better accept the teaching that the
nurse is providing to them. This in turn helps the healing process occur faster.
When the patient is first admitted to the rehab setting the nurse must first go through the
diagnostic operations phase and develop a relationship with the patient and other members of the
team as well as the family. They must then proceed to assess the patient for what kind of care
they require and how much care is required.
The nurse then moves onto the prescriptive operations phase and begins to develop a plan
of care based upon the individual’s personal needs. Nurses need to include the patient in this
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plan of care to see what they feel is most important and where they eventually want to be in the
end or what their goals are. The nurse then prioritizes the self-care needs of the patients.
Regulatory operations phase is the implementation of the plan of care as determined by
the patient and nurse. This is the plan of care in action. With the nurse and patient working
towards the final product as determined in the plan of care.
Control operations phase in rehab is when the plan of care is evaluated for its
effectiveness as according the Masters. The nurse must adjust the plan of care based upon how
the patient is performing self-care needs, and how they are progressing through the plan of care.
In conclusion This paper has described the nursing theorist Dorothea Orem’s background
as well as how she developed her nursing theory, and continued to change and implement her
nursing theory. The breakdown of her nursing theory is described and how they all intertwine to
make up the self-care deficit nursing theory. This would include the steps to build a plan of care.
The different stages a patient goes through as they progress towards their ultimate goal. It
describes how a nurse builds a relationship with patients and other members of the team to
develop a plan of care to promote the self-care for a patient. Examples of the self-care nursing
theory are used to help show how this theory is used in the field of nursing. Also, how a patient
progresses through the phases and how the nurse helps the patient through theses steps towards
the goal that was laid out by the nurse patient relationship.
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Resources
Masters, K. (2012). Nursing theories: a framework for professional practice. Sudbury, MA:
Jones & Bartlett Learning.
Seed, M., & Torkelson, D. Beginning the Recovery Journey in Acute Psychiatric Care: Using
Concepts from Orem’s Self-Care Deficit Nursing Theory. Issues in mental health
nursing. Retrieved, from
http://web.a.ebscohost.com.vproxy.cune.edu/ehost/pdfviewer/pdfviewer?side=ba30fe5592fa-4b26-a2f5-0e1893449c7d%40sessionmgr400
Ramos, M. C. Mitral valve prolapse and its effects: a programme of inquiry within Orem’s SelfCare Deficit Theory of Nursing. Journal of Advanced Nursing, 742-751. Retrieved May
18, 2014, from:
http://web.b.ebscohost.com.vproxy.cune.edu/ehost/pdfviewer/pdfviewer?sid=7d4a49b43a5d-4ddf-8437-2b303a239a7b%40sessionmgr110&vid=2&hid=122