orem theory

1. Dorothea Orem (1914-2007)
(Her theory was first published in Nursing: Concepts of Practice in 1971, second in 1980, in 1995,
and 2001.)
Introduction
 One of foremost nursing theorists. Dorothea Orem was born in 1914 in Baltimore, U.S.
 Earned her diploma at Providence Hospital – Washington, DC
 1939 – BSN Ed., Catholic University of America.
 1945 – MSN Ed., Catholic University of America.
 Was the leader of the Nursing Model Committee of the School of Nursing Faculty of the
Catholic University of America whose task was to develop a model that would express the
foundations for, and characteristics of, research in nursing. This committee developed,
reviewed, and tested several tentative generalizations about nursing and submitted its final
report to the School of Nursing (May 1968)
 Involved in nursing practice, nursing service, and nursing education. During her professional
career, she worked as a staff nurse, private duty nurse, nurse educator and administrator and
nurse consultant. She worked as a staff nurse, private duty nurse, nurse educator and
administrator and nurse consultant. She received honorary Doctor of Science degree in 1976.
 Received honorary Doctor of Science degree in 1976.

 Published first formal articulation of her ideas in Nursing: Concepts of Practice in 197,
second in 1980, and in 1995.
Development of Theory
 1949-1957 Orem worked for the Division of Hospital and Institutional Services of the
Indiana State Board of Health.
 Her goal was to upgrade the quality of nursing in general hospitals throughout the state.
During this time, she developed her definition of nursing practice.
 1959 Orem subsequently served as acting dean of the school of Nursing and as an assistant
professor of nursing education at CUA. She continued to develop her concept of nursing and
self-care during this time.
 Orem’s Nursing: Concept of Practice was first published in 1971 and subsequently in 1980,
1985, 1991, 1995, and 2001.
Major 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
 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
behaviours
 Self-care and dependent care are behaviours learned within a socio-cultural context
Definition of Domain Concept
Nursing-
According to Orem, nursing consists of actions deliberately selected and performed by nurses
to help individuals or groups under their care to maintain or change conditions in themselves
or their environment. She further viewed nursing as an art, community service and a

2. technology. As an art, it has a theoretical base which serves as the basis in providing self-care
towards improvement of one’s functioning and development. As a community service, it is
geared towards deliberative actions of assisting another in maintaining or reestablishing
balance between self-care abilities and demands also leading to improvement in one’s
functioning and development. As a technology, it has specialized methods or practice of
delivering self-care.
 To Orem, nursing arises through a mandate from society which defines scopes, limits, and
credentials of nursing practice (agency).
 Through the nursing process, the nurse can select the nursing model appropriate for the patient.
 It is a community service, an art, and a technology.
Nursing as a Service:
 It is a service of deliberately selected and performed actions to assist individuals or groups to
maintain self-care, including structural integrity, functioning, and development.
 It is the giving of direct assistance to a person when he is unable to meet his own needs.
 Requirements for nursing are modified and eventually eliminated when there is progressive
favourable change in the state of health of the individual, or when he learns to be self-directing
daily self-care.
 She also considered health service as an interpersonal process since it requires the social
interaction of nurse with a patient and involves transaction between them.
Nursing as an Art:
 The ability to assist others in the design, provision, and management of systems of self-care to
improve or maintain human functioning at some level of effectiveness.
 As an art, nursing has an intellectual aspect – the discernment of obstacles to care and planning
how these obstacles can be overcome.
Nursing as a Technology:
 Nursing has formalized methods or techniques of practice, clearly described ways of
performing specific actions so that some particular result will be achieved.
 Techniques of nursing must be learned and skill and expertness in their use must be developed
by persons who pursue nursing as career.
 Health- Orem defined health as a state of wholeness or integrity of a human being: a state
where one is structurally and functionally whole or sound. She further added that a healthy
being is one who has the necessary self-care ability to meet his/her changing self-care
demands. She supported the concepts of health promotion and health maintenance and
claimed that it is not just the individual’s responsibility, but also the society as a whole,
including its members.
 Health and healthy are terms used to describe living things …It is when they are
structurally and functionally whole or sound … wholeness or integrity includes that
which makes a person human……… operating in conjunction with physiological and
psychophysiological mechanisms and a material structure and in relation to and
interacting with other human beings.
 Environment
Environment components are enthronement factors, enthronement elements, conditions, and
developed environment.
 Orem viewed the environment as not just the elements external to man. She viewed
man and environment as an integrated system. It includes conditions that can
positively or negatively affect a person’s ability to provide self-care. She enumerated
certain conditions which are conducive for one’s development and includes the

3. following: opportunities to be helped; being with other persons or group where care is
offered; opportunities for solitude and companionship; provision of help for personal
and group concerns without limiting individual decisions and personal pursuits;
shared respect and trust; recognition and fostering of developmental potential.
 Nursing client - A human being 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.
 A human being is the focus of nursing only when a self –care requisites exceed self-
care capabilities. Orem viewed man as an integrated whole composed of an internal
physical, psychologic, and social nature with varying degrees of self-care ability.
He/she has the potential for learning and development as he/she is gifted with rational
ability and capacity to reflect on his/her experience and use symbols (ideas and
words). Under normal conditions, man is self-reliant, responsible and capable
continuous self-care, not only of himself/herself, but also oh his/her dependents.

 Orem viewed a patient as an individual with health-related limitations that make
him/her incapable of continuous self-care or dependent care. His/ her self-care
requisites or demands are beyond his/her self-care abilities which can be attributed to
his/her lack of knowledge, skills, motivation or orientation.
OREM’S GENERAL THEORY OF NURSING
Orem’s general theory of nursing in three related parts:
 Theory of self-care
 Theory of self-care deficit
 Theory of nursing system
 Theory of Self Care deficit in the Nursing Practice
Dorothea Orem constructed her Self-Care Theory concept in the late 1950’sDeveloped the
Self-Care Theory to help encourage individuals to play an active role in their own care
(Black, 2014) 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.
Purpose Statement: Self-Care Theory contributes to positive patient outcomes by utilizing evidence-
based practice to improve the quality of care Understanding the four metaparadigm concepts
Improving health care practices on multiple levels.
This theory Includes:
 Self-care – practice of activities that individual initiates and perform on their own behalf in
maintaining life, health and well being
 Self-care agency – is a human ability which is "the ability for engaging in self-care" -
conditioned by age developmental state, life experience sociocultural orientation health and
available resources. Self-care agent is a person who provides self-care.

4.  Therapeutic self-care demand – It is the 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,
 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: Self-care requisites are
actions directed towards provision of self-care. 3 categories of self-care requisites are-
1. Universal
2. Developmental
3. Health deviation
1.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
2. 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.”
 Associated with developmental processes/ derived from a condition…. Or associated with an
event
 E.g., adjusting to a new job
 adjusting to body changes
3.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
Dorothea Orem (1914-2007)
(Her theory was first published in Nursing: Concepts of Practice in 1971, second in 1980, in 1995,
and 2001.)
Introduction
 One of foremost nursing theorists. Dorothea Orem was born in 1914 in Baltimore, U.S.
 Earned her diploma at Providence Hospital – Washington, DC
 1939 – BSN Ed., Catholic University of America.

5.  1945 – MSN Ed., Catholic University of America.
 Was the leader of the Nursing Model Committee of the School of Nursing Faculty of the
Catholic University of America whose task was to develop a model that would express the
foundations for, and characteristics of, research in nursing. This committee developed,
reviewed, and tested several tentative generalizations about nursing and submitted its final
report to the School of Nursing (May 1968)
 Involved in nursing practice, nursing service, and nursing education. During her professional
career, she worked as a staff nurse, private duty nurse, nurse educator and administrator and
nurse consultant. She worked as a staff nurse, private duty nurse, nurse educator and
administrator and nurse consultant. She received honorary Doctor of Science degree in 1976.
 Received honorary Doctor of Science degree in 1976.

 Published first formal articulation of her ideas in Nursing: Concepts of Practice in 197,
second in 1980, and in 1995.
Development of Theory
 1949-1957 Orem worked for the Division of Hospital and Institutional Services of the
Indiana State Board of Health.
 Her goal was to upgrade the quality of nursing in general hospitals throughout the state.
During this time, she developed her definition of nursing practice.
 1959 Orem subsequently served as acting dean of the school of Nursing and as an assistant
professor of nursing education at CUA. She continued to develop her concept of nursing and
self-care during this time.
 Orem’s Nursing: Concept of Practice was first published in 1971 and subsequently in 1980,
1985, 1991, 1995, and 2001.
Major 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
 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
behaviours
 Self-care and dependent care are behaviours learned within a socio-cultural context
Definition of Domain Concept
Nursing-
According to Orem, nursing consists of actions deliberately selected and performed by nurses
to help individuals or groups under their care to maintain or change conditions in themselves
or their environment. She further viewed nursing as an art, community service and a
technology. As an art, it has a theoretical base which serves as the basis in providing self-care
towards improvement of one’s functioning and development. As a community service, it is
geared towards deliberative actions of assisting another in maintaining or reestablishing
balance between self-care abilities and demands also leading to improvement in one’s
functioning and development. As a technology, it has specialized methods or practice of
delivering self-care.
 To Orem, nursing arises through a mandate from society which defines scopes, limits, and
credentials of nursing practice (agency).

6.  Through the nursing process, the nurse can select the nursing model appropriate for the patient.
 It is a community service, an art, and a technology.
Nursing as a Service:
 It is a service of deliberately selected and performed actions to assist individuals or groups to
maintain self-care, including structural integrity, functioning, and development.
 It is the giving of direct assistance to a person when he is unable to meet his own needs.
 Requirements for nursing are modified and eventually eliminated when there is progressive
favourable change in the state of health of the individual, or when he learns to be self-directing
daily self-care.
 She also considered health service as an interpersonal process since it requires the social
interaction of nurse with a patient and involves transaction between them.
Nursing as an Art:
 The ability to assist others in the design, provision, and management of systems of self-care to
improve or maintain human functioning at some level of effectiveness.
 As an art, nursing has an intellectual aspect – the discernment of obstacles to care and planning
how these obstacles can be overcome.
Nursing as a Technology:
 Nursing has formalized methods or techniques of practice, clearly described ways of
performing specific actions so that some particular result will be achieved.
 Techniques of nursing must be learned and skill and expertness in their use must be developed
by persons who pursue nursing as career.
 Health- Orem defined health as a state of wholeness or integrity of a human being: a state
where one is structurally and functionally whole or sound. She further added that a healthy
being is one who has the necessary self-care ability to meet his/her changing self-care
demands. She supported the concepts of health promotion and health maintenance and
claimed that it is not just the individual’s responsibility, but also the society as a whole,
including its members.
 Health and healthy are terms used to describe living things …It is when they are
structurally and functionally whole or sound … wholeness or integrity includes that
which makes a person human……… operating in conjunction with physiological and
psychophysiological mechanisms and a material structure and in relation to and
interacting with other human beings.
 Environment
Environment components are enthronement factors, enthronement elements, conditions, and
developed environment.
 Orem viewed the environment as not just the elements external to man. She viewed
man and environment as an integrated system. It includes conditions that can
positively or negatively affect a person’s ability to provide self-care. She enumerated
certain conditions which are conducive for one’s development and includes the
following: opportunities to be helped; being with other persons or group where care is
offered; opportunities for solitude and companionship; provision of help for personal
and group concerns without limiting individual decisions and personal pursuits;
shared respect and trust; recognition and fostering of developmental potential.
 Nursing client - A human being 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.

7.  A human being is the focus of nursing only when a self –care requisites exceed self-
care capabilities. Orem viewed man as an integrated whole composed of an internal
physical, psychologic, and social nature with varying degrees of self-care ability.
He/she has the potential for learning and development as he/she is gifted with rational
ability and capacity to reflect on his/her experience and use symbols (ideas and
words). Under normal conditions, man is self-reliant, responsible and capable
continuous self-care, not only of himself/herself, but also oh his/her dependents.

 Orem viewed a patient as an individual with health-related limitations that make
him/her incapable of continuous self-care or dependent care. His/ her self-care
requisites or demands are beyond his/her self-care abilities which can be attributed to
his/her lack of knowledge, skills, motivation or orientation.
OREM’S GENERAL THEORY OF NURSING
Orem’s general theory of nursing in three related parts:
 Theory of self-care
 Theory of self-care deficit
 Theory of nursing system
 Theory of Self Care deficit in the Nursing Practice
Dorothea Orem constructed her Self-Care Theory concept in the late 1950’sDeveloped the
Self-Care Theory to help encourage individuals to play an active role in their own care
(Black, 2014) 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.
Purpose Statement: Self-Care Theory contributes to positive patient outcomes by utilizing evidence-
based practice to improve the quality of care Understanding the four metaparadigm concepts
Improving health care practices on multiple levels.
This theory Includes:
 Self-care – practice of activities that individual initiates and perform on their own behalf in
maintaining life, health and well being
 Self-care agency – is a human ability which is "the ability for engaging in self-care" -
conditioned by age developmental state, life experience sociocultural orientation health and
available resources. Self-care agent is a person who provides self-care.
 Therapeutic self-care demand – It is the 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,
 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: Self-care requisites are
actions directed towards provision of self-care. 3 categories of self-care requisites are-
4. Universal
5. Developmental
6. Health deviation

8. 1.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
2. 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.”
 Associated with developmental processes/ derived from a condition…. Or associated with an
event
 E.g., adjusting to a new job
 adjusting to body changes
3.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
B. Theory of 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.
 Specifies when nursing is needed
 Nursing is required when an adult (or in the case of a dependent, the parent) is incapable or
limited in the provision of continuous effective self-care.

9. Orem identifies 6 methods of helping:
1. Acting for and doing for others
2. Guiding and directing others
3. Supporting another-providing physical support
4. Providing psychological support
5. Providing an environment supportive to development
6. Teaching another
The nurse may help the individual by using any or all methods to provide assistance with self-care.
Orem presents a model to show the relationship between her concepts.
Nursing Agency-

10. 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.
C. Theory of Nursing Systems
 Describes how the patient’s self-care needs will be met by the nurse, the patient, or both
 Identifies 3 classifications of nursing system to meet the self-care requisites of the patient: -
 Wholly compensatory system
 Partly compensatory system
 Supportive – educative system
 Design and elements of nursing system define
 Scope of nursing responsibility in health care situations
 General and specific roles of nurses and patients
 Reasons for nurses’ relationship with patients and
 The kinds of actions to be performed and the performance patterns and nurses’ and patients’
actions in regulating patients’ self-care agency and in meeting their self-care demand
 Orem recognized that specialized technologies are usually developed by members of the
health profession
 A technology is systematized information about a process or a method for affecting some
desired result through deliberate practical endeavor, with or without use of materials or
instruments
Diagram
Self care deficit
Nursing system
Self care
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.

11.  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
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. Orem set nurses’ role in
maintaining health for the patient with great coherence following every individual’s life-sustaining
needs. 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. 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.

12.  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.