Running head: DOROTHEA OREMS SELF-CARE THEORY

Dorothea Orems Self-Care Theory

Courtney Queener
11/07/2014
NUR 500 Theoretical Foundation of Nursing Practice
State University of New York Polytechnic Institute

Dorothea Orems Self-Care Theory

One well-known nursing theorist who has been greatly influential in the world of nursing
is Dorothea Orem, who is recognized for her self-care deficit model. Orem was born in
Baltimore, Maryland in 1914. She received her nursing diploma from Washington D.C.s
Providence Hospital School of Nursing in the early 1930s. She went on to further her education
by completing her Bachelor of Science in Nursing degree in 1939 and her Masters degree in
1945; both of these degrees were received from the Catholic University of America in
Washington D.C. After receiving her graduate degree, Orem focused primarily on teaching,
research and administration. During her nursing career, Orem received several honorary
doctorate degrees from prestigious universities such as Georgetown, Incarnate Word College,
Illinois Wesleyan University and the University of Columbia. She also awarded multiple
recognitions during her career including the Catholic University of America Alumni

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Achievement Award for Nursing Theory, the Linda Richards Award from the National League for
Nursing and she was named an honorary fellow of the American Academy of Nursing
(Dorothea Orem: Nursing Theorist, 2013).
Orem began to develop her self-care deficit theory during her time as Director of Nursing
Service and Director of Nursing Education at Providence Hospital in Detroit in 1945. She began
forming her theory in reaction to issues regarding the lack of a substantive and structured body
of nursing knowledge (Dorothea Orem: Self-Care Deficit Theory, 2012). During this time she
also defined nursing practice with clear statements of the inherent distinction between the
practice of nursing and medicine (Dorothea Orem: Self-Care Deficit Theory, 2012). Orem
eventually returned to Washington D.C. to become the acting dean of the Catholic University of
America School of Nursing in 1959. During this time she continued developing her theory. In
1971, she published Nursing Concepts of Practice, which is the book that outlined her self-care
theory. The second edition of this book was published in 1980. After retiring in 1984, Orem
published a third edition in 1985 and a fourth in 1991 (Dorothea Orem: Self-Care Deficit Theory,
2012).
Dorothea Orems Self-Care model posits that nursing care is required when an adult is
unable to perform self-care sufficiently to sustain life, maintain health, recover from disease or
injury, or cope with the effects of disease or injury (Friedman, Bowden & Jones, 2003, p. 67).
The central philosophy behind this theory is that all patients want to care for themselves, and
they are able to recover more quickly and holistically by performing their own self-care as much
as they are able to do (Dorothea Orem: Nursing Theorist, 2013). This theory can be applied to
people of all ages and in all stages of their life because people who require nursing care are those
who are incapable of self-care related to an illness or injury, individuals who may require partial
nursing care as they recover from an illness or injury, and those who are self-care sufficient but

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need ongoing support and education (Simmons, 2009, p.419). This model is not only directed
towards the ill patient receiving the care and their self-care deficit, it may also be directed
towards the caregiver such as a parent or guardian caring for an ill child, which would be
dependent-care (Friedman, Bowden & Jones, 2003, p. 67). Adult patients should be encouraged
to perform all aspects of their care that they are mentally and physically able to do. This
participation in care gives patients a sense of control over their current situation and also benefits
patient outcomes. Caregivers will also require education regarding care practices that need to be
performed for the patient and what to do if complications arise. Caregivers may also require
support and information about coping mechanisms due to the stress of providing care for a loved
one. Because of the grand nature of this theory, it can be applied to all areas of nursing and
related to all nursing interventions. Nurses work with their patients on a daily basis to help
promote self-care and to educate the individual on any accommodations that need to be made in
order for the individual to maintain life and health.
There are six central concepts in Orems Self-Care Model which include self-care, selfcare agency, therapeutic self-care demand, self-care deficit, nursing agency and nursing systems
(Friedman, Bowden & Jones, 2003, p. 67). Self-care is defined as practice of activities that an
individual initiates and performs on their own behalf in maintaining life, health and well-being
(Dorothea Orems Self-Care Theory, 2012). Self-care agency is a human ability which is the
ability for engaging in self-care conditioned by age, development state, life experience,
sociocultural orientation, health and available resources (Dorothea Orems Self-Care Theory,
2012). Therapeutic self-care demand is a 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 (Dorothea Orems Self-Care Theory, 2012). Self-care deficit exists
when an adult (or in the case of a dependent, the parent) is incapable or limited in the provision

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of continuous effective self-care (Dorothea Orems Self-Care Theory, 2012). Nursing agency
is viewed as a service focusing on the persons need for self-care action on a continuous basis to
sustain life (James, 1992, p.42). Nursing systems describe how the patients self-care needs
will be met by the nurse, the patient or both (Dorothea Orems Self-Care Theory, 2012).
Orem spoke of three main nursing systems: wholly compensatory, partly compensatory and
supportive-educative. The type of nursing system utilized is dependent upon how much help the
patient needs (James, 1992, p.42).
In her theory, Orem also discusses three different self-care requisites. A self-care requisite
is defined as an action directed towards provision of self-care (Dorothea Orem: Self-Care
Theory, 2012). These include universal self-care requisites, developmental self-care requisites
and health deviation self-care requisites. Universal self-care requisites are those applicable to all
people. They include intake of air, water and nutrition; eliminative function; balance of activity
and rest; balance of time alone and time with others; prevention of danger to self; and being
normal as determined by science, culture, and social values (James, 1992, p. 42).
Developmental self-care requisites are associated with developmental processes or events and
aimed toward prevention of developmental disorders and promotion of development according
to potential (James, 1992, p. 42). Health deviation self-care requisites are those that are required
during a time of illness or injury. They 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; modifying self-concepts in accepting
oneself as being in a particular state of health and in specific forms of healthcare; and learning to
live with effects of pathologic conditions (Dorothea Orems Self-Care Theory, 2012). The nurse
must assess all of these areas for a patient in order to determine if a self-care deficit exists. If

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there is a self-care deficit, the nurse must determine which nursing system is appropriate for the
patient: wholly compensatory, partially compensatory or supportive-educative.
The nursing metaparadigm consists of four concepts: person, health, environment and
nurse. In Orems theory, person is described as an integrated whole, a unity functioning
biologically, symbolically and socially. Persons are viewed as having the capacity for selfknowledge and for engagement in deliberate action (Hanucharurnkul, 1989, p. 367). Orem
viewed the person as an open system which interacts with the environment in order to perform
self-care. The person is an integrated whole, biopsychosocial being (Hanucharurnkul, 1989, p.
367). The second element, health, is defined as a state of wholeness or integrity of human
beings. Persons are said to be healthy when they are structurally and functionally sound or
whole (Hanucharurnkul, 1989, p. 367). Orems definition of health takes into account mental,
physical and emotional health simultaneously. She believed that all of these areas must be
functioning properly in order for the patient to successfully provide self-care (Hanucharurnkul,
1989, p.367). Environment is discussed in relation to developmental environment, which is
described as a set of conditions that motivate a person to establish appropriate goals and adjust
behavior to achieve the results specified by the goals (Hanucharurnkul, 1989, p.367). In her
definition, environment seems to be the external environment which consists of both physical
and psychosocial elements (Hanucharurnkul, 1989, p.367). The fourth element of the nursing
metaparadigm is that of nursing, which is defined in Orems theory as a helping service, an art
and technology. It is a creative effort of one human being to help another human being. Nursing
focuses on individuals abilities and requirements for self-care (Hanucharurnkul, 1989, p. 367).
According to Orem, nursing is differentiated from other professional services by its focus on
self-care. Nurses work with the individual to get the individual functioning to a point where they

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are able to provide self-care in a manner that sustains life and health (Hanucharurnkul, 1989, p.
369).
Orems self-care theory is applicable in all areas and levels of nursing. This theory can
be related to the body of nursing knowledge in that it uses assessment skills, builds a nursepatient relationship, plans how to meet the objective of self-care, implements interventions and
evaluates how effective the interventions were to attaining health and self-care, with changes as
needed (Simmons, 2009, p. 420). The first step in the nursing process is that of assessment. The
nurse must determine if there is a self-care deficit requiring nursing care. Once this is
determined, the nurse assesses the person for the reason he or she is unable to meet his or her
needs. Some of the possible reasons for this deficit include a lack of knowledge, skill or
motivation; a limited range of behaviors; or an overload of stimuli in relation to the persons
adaptation level (James, 1992, p. 43).
The next step in the process is planning. In this phase the nurse creates a plan of care
based on patient-centered goals using input from the patient and family members. It is in this
step that the nurse determines which nursing system is necessary. In an example of a wholly
compensatory nursing system the nurse acts for the client by adjusting the lighting, the
temperature of the room, the noise level or by coordinating activities that involve the client
(James, 1992, p. 43). Partially compensatory means that both the nurse and the patient are
involved in the care. For example, if a person can feed himself or herself, but is easily
distracted, the nurse can turn off the television, draw the curtain or close the room door to enable
to person to finish the meal (James, 1992, p. 43). The final nursing system is supportiveeducative. In this system, the person may be physically able to meet his or her needs, but may
have a hard time adapting to new physical limitations, role conflicts, or an altered self-concept.

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In this situation, the nurse may help the client expand his or her adaptation level through
instruction, counseling or emotional support (James, 1992, p. 43).
The intervention phase is the third phase of the nursing process. This phase is when the
plan that was created for the patient based on their goals is put into action. The interventions
performed in this phase can vary greatly based on the nursing system that is most appropriate for
the patient. These interventions can take several forms including doing and acting for the
person; guiding or directing the person; providing physical support; providing psychological
support; providing an environment that supports and promotes development; and teaching the
person (James, 1992, p. 43).
The final phase of the nursing process is evaluation. In this time, the nurse must
determine if the interventions have been successful in treating the patients needs. The ideal
outcome is for the client to meet successfully his or her own needs without nursing
intervention (James, 1992, p. 43). Reassessment may be necessary if a self-care deficit still
exists and new goals and interventions will be planned. This process will continue until the
client has reached the maximum potential of independent self-care obtainable for that individual
(James, 1992, p. 43).
This article Dorthea Orems Self-Care Theory as Related to Nursing Practice in
Hemodialysis by Laurie Simmons discusses how Orems theory can be used in the treatment
and education of patients on hemodialysis. Dialysis patients must make many lifestyle changes in
order to manage their own care and health. These changes include dietary and fluids
restrictions, medication regime, recognizing signs and symptoms associated with potential
complications and vascular access care (Simmons, 2009, p. 420). A self-care deficit occurs
when a new hemodialysis patient does not possess the knowledge for self-care. It is up to the
nurse to work with the patient on learning to manage their disease. The nurse must first work to
build a trusting relationship with the patient by providing support and knowledge. Focus on the

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individual and patient-specific care are very important for the formation of this relationship. The
patient should be included in the planning process which allows them to be more involved in
their care and give them a sense of control over their situation (Simmons, 2009, p. 420). The
nurse should also evaluate the patient for successful coping mechanisms and work with the
patient to improve any deficits in this area. The article discusses the possibility of patients being
non-compliant with their care as a way to exhibit control over their situation. Nurses working
with these dialysis patients can educate patients to help with the control of their disease and the
impact it can have on life (Simmons, 2009, p. 420). Patient education is vital in getting patients
to a point where they are able to manage their own self-care. Education is continuous and
repeated over and over with a little different twist each time, it reinforces what has already been
learned by the individual, keeping them self-care sufficient (Simmons, 2009, p. 420). The
article proposes that knowledge helps patients on hemodialysis to regain a sense of control over
their experience and environment and helps reduce feelings of vulnerability (Simmons, 2009, p.
420). Encouragement of participation is the final way to promote self-care in patients on dialysis.
Patients may be given the opportunity to learn how to insert their own needles for treatment
and may learn to prepare the dialysis machine prior to the initiation of therapy (Simmons,
2009, p. 420). The application of self-care theory is appropriate in the treatment of hemodialysis
patients because the goal of nursing practice is to assist patients to become adequately prepared
to engage in their own care, thereby improving patient outcomes and quality of life (Simmons,
2009, p. 420).
Dorothea Orems self-care deficit theory is universally recognized as one of the most
influential theories in the world of nursing. This theory can be applied to all areas of nursing and
to all patients that require some form of nursing care. Orem proposes that the goal of nursing is
to get the patient functioning at a level in which they are able to manage their own care and that

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patient outcomes are improved when patients perform their own care. The nurse must use the
concepts within this theory in her nursing practice in order to educate the patient on their
condition and the interventions necessary to maintain life and health. The patient should be
included in all steps of the nursing process to ensure that the patient feels in control of their
situation. These steps are repeated and adjusted as necessary to ensure that the patient is
functioning at the best of their ability.

References
(2012). Dorothea Orem: Self-Care Deficit Theory. Retrieved from
http://oremselfcaredeficittheory.blogspot.com/p/dorothea-orem.html
(2013). Dorothea Orem: Nursing theorist. Retrieved from http://www.nursingtheory.org/nursing-theorists/Dorothea-E-Orem.php
(2013). Dorothea Orems self-care theory. Retrieved from
http://currentnursing.com/nursing_theory/self_care_deficit_theory.html

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Friedman, M.M., Bowden, V.R., & Jones, E.G. (2003). Family nursing: Research, theory and
practice (5th ed.). Upper Saddle River, NJ: Prentice Hall.
Hanucharurnkul, S. (1989). Comparative analysis of Orem's and King's theories. Journal of
Advanced Nursing, 14(5), 365-372. doi:10.1111/1365-2648.ep8527085
James, L. (1992). Nursing theory made practical. Journal of Nursing Education, 31(1), 42-44.
Simmons, L. (2009). Dorothea Orem's self-care theory as related to nursing practice in
hemodialysis. Nephrology Nursing Journal: Journal of The American Nephrology Nurses'
Association, 36(4), 419-421.