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Dorothea Orem: Self-Care Deficit Theory

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By Angelo Gonzalo, BSN, RN

Dorothea Orem is a nurse theorist who pioneered the Self-Care Deficit Nursing Theory. Get to know Orem’s biography and works, including a discussion about the major concepts, subconcepts, nursing metaparadigm, and application of Self- Care Deficit Theory.

Table of Contents

Biography of Dorothea E. Orem

Dorothea Elizabeth Orem (July 15, 1914 – June 22, 2007) was one of America’s foremost nursing theorists who developed the Self-Care Deficit Nursing Theory, also known as the Orem Model of Nursing.

Her theory defined Nursing as “The act of assisting others in the provision and management of self-care to maintain or improve human functioning at the home level of effectiveness.” It focuses on each individual’s ability to perform self-care, defined as “the practice of activities that individuals initiate and perform on their own behalf in maintaining life, health, and well-being.”

Early Life

Dorothea Orem was born on July 15, 1914, in Baltimore, Maryland. Her father was a construction worker, and her mother is a homemaker. She was the youngest among two daughters.

In the early 1930s, she earned her nursing diploma from the Providence Hospital School of Nursing in Washington, D.C. She completed her Bachelor of Science in Nursing in 1939 and her Master’s of Science in Nursing in 1945, both from the Catholic University of America in Washington, D.C.

Education

Dorothea Elizabeth Orem
Dorothea Elizabeth Orem

Dorothea Orem attended Seton High School in Baltimore and graduated in 1931. She received a diploma from the Providence Hospital School of Nursing in Washington, D.C., in 1934. She went on to the Catholic University of America to earn a B.S. in Nursing Education in 1939 and an M.S. in Nursing Education in 1945.

She had a distinguished career in nursing. She earned several Honorary Doctorate degrees. She was given Honorary Doctorates of Science from Georgetown University in 1976 and Incarnate Word College in 1980. She was given an Honorary Doctorate of Humane Letters from Illinois Wesleyan University in 1988 and a Doctorate Honoris Causa from the University of Missouri in Columbia in 1998.

Self-Care Theory

Dorothea Orem’s Self-Care Deficit Theory focuses on each “individual’s ability to perform self-care, defined as ‘the practice of activities that individuals initiate and perform on their own behalf in maintaining life, health, and well-being.'” The Self-Care or Self-Care Deficit Theory of Nursing is composed of three interrelated theories: (1) the theory of self-care, (2) the self-care deficit theory, and (3) the theory of nursing systems, which is further classified into wholly compensatory, partially compensatory and supportive-educative. It is discussed further below.

Appointments of Dorothea Orem

Photo of Dorothea Orem by Lynne Nickle, 1988
Photo of Dorothea Orem
by Lynne Nickle, 1988

Dorothea Orem occupied important nursing positions, like the directorship of both the nursing school and the nursing department at Providence Hospital, Detroit, from 1940 to 1949, where she also taught biological sciences and nursing from 1939 to 1941. At the Catholic University of America, Orem served as Assistant Professor from 1959 to 1964, Associate Professor from 1964 to 1970, and Dean of the School of Nursing from 1965 to 1966.

She also served as curriculum consultant to The Office of Education, United States Department of Health, Education and Welfare, Practical Nurse Section in 1958, 1959, and 1960, to the Division of Hospital and Institutional Services, The Indiana State Board of Health from 1949 to 1957, and to the Center for Experimentation and Development in Nursing, The Johns Hopkins Hospital, 1969-1971, and to the Director of Nursing, Wilmer Clinic, The Johns Hopkins Hospital, 1975-1976.

She was a group of nurse theorists who presented Patterns of Unitary Man (Humans), the initial framework for nursing diagnosis, to the North American Nursing Diagnosis Association in 1982.

Works of Dorothea Orem

Dorothea Orem helped publish the “Guidelines for Developing Curricula for the Education of Practical Nurses” in 1959.

In 1971 Orem published Nursing: Concepts of Practice, the work in which she outlines her nursing theory, the Self-care Deficit Theory of Nursing. This work’s success and the theory it presents established Orem as a leading theorist of nursing practice and education.

She also served as chairperson of the Nursing Development Conference Group, and in 1973 edited that group’s work in the book Concept Formalization in Nursing.

She authored many other papers and, during the 1970s and 1980s, spoke at numerous conferences and workshops around the world. The International Orem Society was founded to foster research and the continued development of Orem’s nursing theories.

The second edition of Nursing: Concept of Practice was published in 1980. Orem retired in 1984, but she continued to work on the third edition, published in 1985; the fourth edition of her book was completed in 1991. She continued to work on the conceptual development of Self-Care Deficit Nursing Theory.

Orem continued to be active in theory development. She completed the 6th edition of Nursing: Concepts of Practice, published by Mosby in January 2001.

Awards and Honors of Dorothea Orem

Dorothea Orem was also given many awards during her career: the Catholic University of America Alumni Achievement Award for Nursing Theory in 1980, the Linda Richards Award from the National League for Nursing in 1991, and an Honorary Fellow of the American Academy of Nursing in 1992.

She also received accolades for her contributions to nursing, including honorary degrees from Georgetown University, Incarnate Word College, Illinois Wesleyan University, and the University of Missouri-Columbia.

She was inducted into the American Academy of Nursing and received awards from the National League for Nursing and the Sigma Theta Tau Nursing Honor Society.

Death

Dorothea Orem died on June 22, 2007, in Savannah, Georgia, where she had spent the last 25 years of her life as a consultant and author. She was 92.

Dorothea Orem’s Self-Care Deficit Theory

There are instances wherein patients are encouraged to bring out the best in them despite being ill for a period of time. This is very particular in rehabilitation settings, in which patients are entitled to be more independent after being cared for by physicians and nurses. Between 1959 and 2001, Dorothea Orem developed the Self-Care Nursing Theory or the Orem Model of Nursing. It is considered a grand nursing theory, which means the theory covers a broad scope with general concepts applicable to all instances of nursing.

Description

Dorothea Orem’s 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 the home level of effectiveness.” It focuses on each individual’s ability to perform self-care, defined as “the practice of activities that individuals initiate and perform on their own behalf in maintaining life, health, and well-being.”

“The condition that validates the existence of a requirement for nursing in an adult is the absence of the ability to maintain continuously that amount and quality of self-care which is therapeutic in sustaining life and health, in recovering from disease or injury, or in coping with their effects. With children, the condition is the parent’s inability (or guardian) to maintain continuity for the child the amount and quality of care that is therapeutic.” (Orem, 1991)

Assumptions of the Self-Care Deficit Theory

Dorothea Orem’s Self-Care Theory assumptions are: (1) To stay alive and remain functional, humans engage in constant communication and connect among themselves and their environment. (2) The power to act deliberately is exercised to identify needs and to make needed judgments. (3) Mature human beings experience privations in the form of action in care of self and others involving making life-sustaining and function-regulating actions. (4) Human agency is exercised in discovering, developing, and transmitting to others ways and means to identify needs for, and make inputs into, self and others. (5) Groups of human beings with structured relationships cluster tasks and allocate responsibilities for providing care to group members.

Major Concepts of the Self-Care Deficit Theory

In this section are the definitions of the major concepts of Dorothea Orem’s Self-Care Deficit Theory:

Nursing

Nursing is an art through which the practitioner of nursing gives specialized assistance to persons with disabilities, making more than ordinary assistance necessary to meet self-care needs. The nurse also intelligently participates in the medical care the individual receives from the physician.

Humans

Humans are defined as “men, women, and children cared for either singly or as social units” and are the “material object” of nurses and others who provide direct care.

Environment

The environment has physical, chemical, and biological features. It includes the family, culture, and community.

Health

Health is “being structurally and functionally whole or sound.” Also, health is a state that encompasses both the health of individuals and groups, and human health is the ability to reflect on oneself, symbolize experience, and communicate with others.

Self-Care

Self-care is the performance or practice of activities that individuals initiate and perform on their own behalf to maintain life, health, and well-being.

Self-Care Agency

Orem's Self-Care Theory: Interrelationship among concepts. Click to enlarge.
Orem’s Self-Care Theory: Interrelationship among concepts. Click to enlarge.

Self-care agency is the human’s ability or power to engage in self-care and is affected by basic conditioning factors.

Basic Conditioning Factors

Basic conditioning factors are age, gender, developmental state, health state, socio-cultural orientation, health care system factors, family system factors, patterns of living, environmental factors, and resource adequacy and availability.

Therapeutic Self-Care Demand

Orem's Self-Care Theory - Conceptual Framework. Click to enlarge.
Orem’s Self-Care Theory – Conceptual Framework. Click to enlarge.

Therapeutic Self-care Demand is the totality of “self-care actions to be performed for some duration to meet known self-care requisites by using valid methods and related sets of actions and operations.”

Self-Care Deficit

Self-care Deficit delineates when nursing is needed. Nursing is required when an adult (or in the case of a dependent, the parent or guardian) is incapable of or limited in providing continuous effective self-care.

Nursing Agency

Nursing Agency is a complex property or attribute of people educated and trained as nurses that enables them to act, know, and help others meet their therapeutic self-care demands by exercising or developing their own self-care agency.

Nursing System

Nursing System is the product of a series of relations between the persons: legitimate nurse and legitimate client. This system is activated when the client’s therapeutic self-care demand exceeds the available self-care agency, leading to nursing.

Theories

The Self-Care or Self-Care Deficit Theory of Nursing is composed of three interrelated theories: (1) the theory of self-care, (2) the self-care deficit theory, and (3) the theory of nursing systems, which is further classified into wholly compensatory, partially compensatory and supportive-educative.

Theory of Self-Care

This theory focuses on the performance or practice of activities that individuals initiate and perform on their own behalf to maintain life, health, and well-being.

Self-Care Requisites

Self-care Requisites or requirements can be defined as actions directed toward the provision of self-care. It is presented in three categories:

Universal Self-Care Requisites

Universal self-care requisites are associated with life processes and the maintenance of the human structure and functioning integrity.

  • The maintenance of a sufficient intake of air
  • The maintenance of a sufficient intake of water
  • The maintenance of a sufficient intake of food
  • The provision of care associated with the elimination process and excrements
  • The maintenance of a balance between activity and rest
  • The maintenance of a balance between solitude and social interaction
  • The prevention of hazards to human life, human functioning, and human well-being
  • The promotion of human functioning and development within social groups in accord with human potential, known human limitations, and the human desire to be normal

Normalcy is used in the sense of that which is essentially human and that which is in accord with the genetic and constitutional characteristics and individuals’ talents.

Developmental self-care requisites

Developmental self-care requisites are “either specialized expressions of universal self-care requisites that have been particularized for developmental processes or they are new requisites derived from a condition or associated with an event.”

Health deviation self-care requisites

Health deviation self-care requisites are required in conditions of illness, injury, or disease or may result from medical measures required to diagnose and correct the condition.

  • Seeking and securing appropriate medical assistance.
  • Being aware of and attending to the effects and results of pathologic conditions and states
  • Effectively carrying out medically prescribed diagnostic, therapeutic, and rehabilitative measures.
  • Being aware of and attending to or regulating the discomforting or deleterious effects of prescribed medical measures
  • Modifying the self-concept (and self-image) in accepting oneself as being in a particular state of health and in need of specific forms of health care
  • Learning to live with the effects of pathologic conditions and states and the effects of medical diagnostic and treatment measures in a lifestyle that promotes continued personal development

Theory of Self-Care Deficit

This theory delineates when nursing is needed. Nursing is required when an adult (or in the case of a dependent, the parent or guardian) is incapable of or limited in providing continuous effective self-care. Orem identified 5 methods of helping:

  • Acting for and doing for others
  • Guiding others
  • Supporting another
  • Providing an environment promoting personal development about meet future demands
  • Teaching another

Theory of Nursing System

This theory is the product of a series of relations between the persons: legitimate nurse and legitimate client. This system is activated when the client’s therapeutic self-care demand exceeds the available self-care agency, leading to nursing.

Wholly Compensatory Nursing System

This is represented by a situation in which the individual is unable “to engage in those self-care actions requiring self-directed and controlled ambulation and manipulative movement or the medical prescription to refrain from such activity… Persons with these limitations are socially dependent on others for their continued existence and well-being.”

Example: care of a newborn, care of client recovering from surgery in a post-anesthesia care unit

Partial Compensatory Nursing System

This is represented by a situation in which “both nurse and perform care measures or other actions involving manipulative tasks or ambulation… [Either] the patient or the nurse may have a major role in the performance of care measures.”

Example: Nurse can assist the postoperative client in ambulating, Nurse can bring a meal tray for a client who can feed himself

Supportive-Educative System

This is also known as a supportive-developmental system. The person “can perform or can and should learn to perform required measures of externally or internally oriented therapeutic self-care but cannot do so without assistance.”

Example: Nurse guides a mother on how to breastfeed her baby, Counseling a psychiatric client on more adaptive coping strategies.

Dorothea Orem’s Theory and The Nursing Process

The Nursing Process presents a method in determining self-care deficits and defining the roles of persons or nurses to meet the self-care demands.

Assessment

  • Diagnosis and prescription; determine why nursing is needed. Analyze and interpret by making a judgment regarding care.
  • Design of a nursing system and plan for delivery of care.
  • Production and management of nursing systems.

Step 1 – Collect Data in Six Areas

  1. The person’s health status
  2. The physician’s perspective of the person’s health status
  3. The person’s perspective of his or health health
  4. The health goals within the context of life history, lifestyle, and health status.
  5. The person’s requirements for self-care
  6. The person’s capacity to perform self-care

Nursing Diagnosis & Care Plans

Step 2

  • The nurse designs a system that is wholly or partly compensatory or supportive-educative.
  • The two actions are: (1) Bringing out a good organization of the components of patients’ therapeutic self-care demands. (2) Selection of a combination of helping methods will be effective and efficient in compensating for/overcoming the patient’s self-care deficits.

Implementation & Evaluation

Step 3

  • A nurse assists the patient or family in self-care matters to identify and describe health and health-related results. Collecting evidence in evaluating results achieved against results specified in the nursing system design.
  • The etiology component of nursing diagnosis directs actions.

Analysis of the Self-Care Deficit Theory

There is a superb focus of Orem’s work which is self-care. Even though there is a wide range of scope seen in the encompassing theory of nursing systems, Orem’s goal of letting the readers view nursing care to assist people was apparent in every concept presented.

From the definition of health which is sought to be rigid, it can now be refined by making it suitable to the general view of health as a dynamic and ever-changing state.

The role of the environment in the nurse-patient relationship, although defined by Orem, was not discussed.

Orem set nurses’ role in maintaining health for the patient with great coherence following every individual’s life-sustaining needs.

Although Orem viewed the parent’s or guardians’ importance in providing for their dependents, the definition of self-care cannot be directly applied to those who need complete care or assistance with self-care activities such as the infants and the aged.

Strengths

  • A major strength of Dorothea Orem’s theory is that it is applicable for nursing by the beginning practitioner and the advanced clinicians.
  • Orem’s theory provides a comprehensive basis for nursing practice. It has utility for professional nursing in the areas of nursing practice, nursing education, and administration.
  • The terms self-care, nursing systems, and self-care deficit are easily understood by the beginning student nurse and can be explored in greater depth as they gain more knowledge and experience.
  • She specifically defines when nursing is needed: Nursing is needed when the individual cannot maintain continuously that amount and quality of self-care necessary to sustain life and health, recover from disease or injury, or cope with their effects.
  • Her self-care approach is contemporary with the concepts of health promotion and health maintenance.
  • Three identifiable nursing systems were clearly delineated and are easily understood.

Limitations

  • Orem’s theory, in general, is viewed as a single whole thing, while Orem defines a system as a single whole thing.
  • Orem’s theory is simple yet complex. The use of self-care in multitudes of terms, such as self-care agency, self-care demand, self-care deficit, self-care requisites, and universal self-care, can be very confusing to the reader.
  • Orem’s definition of health was confined to three static conditions, which she refers to as a “concrete nursing system,” which connotes rigidity.
  • Throughout her work, there is a limited acknowledgment of the individual’s emotional needs.
  • Health is often viewed as dynamic and ever-changing.

Conclusion

Orem’s theory is relatively simple but generalizable to apply to a wide variety of patients. It explains the terms self-care, nursing systems, and self-care deficit essential to students who plan to start their nursing careers.

Moreover, this theory signifies that all patients want to care for themselves. They can recover more quickly and holistically by performing their own self-care as much as they’re able. This theory is particularly used in rehabilitation and primary care or other settings where patients are encouraged to be independent.

Though this theory greatly influences every patient’s independence, the definition of self-care cannot be directly applied to those who need complete care or assistance with self-care activities such as infants and the aged.

Recommended books and resources to learn more about nursing theory:

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  • Nursing Theorists and Their Work (10th Edition) by Alligood
    Nursing Theorists and Their Work, 10th Edition provides a clear, in-depth look at nursing theories of historical and international significance. Each chapter presents a key nursing theory or philosophy, showing how systematic theoretical evidence can enhance decision making, professionalism, and quality of care.
  • Knowledge Development in Nursing: Theory and Process (11th Edition)
    Use the five patterns of knowing to help you develop sound clinical judgment. This edition reflects the latest thinking in nursing knowledge development and adds emphasis to real-world application. The content in this edition aligns with the new 2021 AACN Essentials for Nursing Education.
  • Nursing Knowledge and Theory Innovation, Second Edition: Advancing the Science of Practice (2nd Edition)
    This text for graduate-level nursing students focuses on the science and philosophy of nursing knowledge development. It is distinguished by its focus on practical applications of theory for scholarly, evidence-based approaches. The second edition features important updates and a reorganization of information to better highlight the roles of theory and major philosophical perspectives.
  • Nursing Theories and Nursing Practice (5th Edition)
    The only nursing research and theory book with primary works by the original theorists. Explore the historical and contemporary theories that are the foundation of nursing practice today. The 5th Edition, continues to meet the needs of today’s students with an expanded focus on the middle range theories and practice models.
  • Strategies for Theory Construction in Nursing (6th Edition)
    The clearest, most useful introduction to theory development methods. Reflecting vast changes in nursing practice, it covers advances both in theory development and in strategies for concept, statement, and theory development. It also builds further connections between nursing theory and evidence-based practice.
  • Middle Range Theory for Nursing (4th Edition)
    This nursing book’s ability to break down complex ideas is part of what made this book a three-time recipient of the AJN Book of the Year award. This edition includes five completely new chapters of content essential for nursing books. New exemplars linking middle range theory to advanced nursing practice make it even more useful and expand the content to make it better.
  • Nursing Research: Methods and Critical Appraisal for Evidence-Based Practice
    This book offers balanced coverage of both qualitative and quantitative research methodologies. This edition features new content on trending topics, including the Next-Generation NCLEX® Exam (NGN).
  • Nursing Research (11th Edition)
    AJN award-winning authors Denise Polit and Cheryl Beck detail the latest methodologic innovations in nursing, medicine, and the social sciences. The updated 11th Edition adds two new chapters designed to help students ensure the accuracy and effectiveness of research methods. Extensively revised content throughout strengthens students’ ability to locate and rank clinical evidence.

See Also

Recommended site resources related to nursing theory:

Other resources related to nursing theory:

References

References and sources for this study guide about Dorothea Orem:

  1. “Obituary: Dorothea Elizabeth Orem,” Savannah Morning News, June 24, 2007, retrieved June 17, 2014
  2.  Taylor, Carol R.; Lillis, Carol; LeMone, Priscilla; Lynn, Pamela (2011). Fundamentals of Nursing. Philadelphia: Wolters Kluwer Health. p. 74. ISBN 978-0-7817-9383-4.
  3. Orem, D. (1991). Nursing: Concepts of practice. (4th ed.). In George, J. (Ed.). Nursing theories: the base for professional nursing practice. Norwalk, Connecticut: Appleton & Lange.
  4. Orem, D. (1995). Nursing: Concepts of practice. (5th ed.). In McEwen, M. and Wills, E. (Ed.). Theoretical basis for nursing. USA: Lippincott Williams & Wilkins.
  5. Orem, D. (2001). Nursing: Concepts of practice. (6th ed.). In McEwen, M. and Wills, E. (Ed.). Theoretical basis for nursing. USA: Lippincott Williams & Wilkins.
  6. Taylor, S.G. (2006). Dorothea E. Orem: Self-care deficit theory of nursing. 
  7. Meleis Ibrahim Afaf (1997), Theoretical Nursing: Development & Progress 3rd ed. Philadelphia, Lippincott.

Further Reading

With contributions by Wayne, G., Ramirez, Q.

Angelo Gonzalo earned his Nursing degree in the year 2010 and continued his studies at St. Paul University Manila taking up Masters of Arts in Nursing Major in Clinical Management. He worked as an intensive care nurse for more than six years. He advocates for proper training and development of new nurses, quality assurance and compassionate care. He has also been involved in community development for 10 years steering programs on good governance, health, sports, and education. Angelo aims to build a good foundation for aspiring nurses. He would like to impart the importance of understanding nursing theories that he hopes to be translated successfully to practice.

12 thoughts on “Dorothea Orem: Self-Care Deficit Theory”

  1. What a wonderful resource. So nicely laid out yet very well detailed. Great job. Wish we had this back in the 70’s. Tatiana Retired RN

    Reply

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