Theory of self care includes of self-care, self-care agency, self-care requisites and therapeutic self-care demand. This theory promotes the goal of self-care Self-Care: Activities performed independently by an individual to promote and maintain personal well-being throughout life.

1. Dorothea Orem’s Self
care Theory

2. Introduction
• Born 1914 in Baltimore, US
• Died on 2007
• Earned her diploma at Providence
Hospital-Washington, DC
• 1939 – BSN Ed., Catholic University of
America
• 1945 – MSN Ed., Catholic University
of America
Dorothea Elizabeth Orem
(1914-2007)

3. • Received doctorate of Science from 2 universities
(Georgetown University, Washington D.C in 1976 and
Incarnate Word College, San Antonio, Texas, in 1980); doctor
of humane letters (1988) and an honorary doctorate of
Nursing from university of Columbia, in 1998.
• Awards: Catholic University of America’s Alumni
• She worked as a staff nurse, private duty nurse, nurse educator
and administrator and nurse consultant.

4. Orem’s general theory of nursing
• Orem’s self-care deficit theory is a grand nursing theory
developed between 1959 and 2001.
• Also known as Orem’s Model of Nursing.
• It consists of 3 related theories:
1. Theory of Self- care
2. Theory of Self-care deficit
3. Theory of Nursing system

5. Statement of general theory
• According to Orem “ Nursing has as its special concern to the
individual’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 and injury, and cope with their effects.”

6. Theory of self care
•Theory of self care includes of self-care, self-
care agency, self-care requisites and
therapeutic self-care demand.
This theory promotes the goal of self-care
•Self-Care: Activities performed
independently by an individual to promote
and maintain personal well-being throughout
life.

7. •Self-Care Agency: is the individual’s
acquired power and ability to perform
self-care activities.
•It is affected by basic conditioning
factors such as age, developmental
state, health state, socio-cultural
background.

8. • Self-care requisites:
These are the group of needs or
requirements that orem identified
There are three categories of self-care
requisites or requirements.
1. Universal
2. Developmental and
3. Health deviation self-care requisites

9. 1. Universal self care Requisites: common to all
individuals such as
maintaining air, water and food intake,
elimination,
balancing activity, rest, solitude and social
interaction,
prevention of hazards and promoting normalcy.

10. 2. Developmental self-care
Requisites: specialized universal self-
care requisites that result from
maturation or new requisites that
develop as a result of a condition or
event such as
adjusting to the loss of significant
others,
adjustment to bodily changes.

11. 3. Health deviation self-care requisites:
Results from the illness, injury, or
disease or its treatment which include
actions such as:
seeking medical assistance,
carrying out a prescribed treatment
and
learning to live with the effects of
illness or treatment.

12. • Therapeutic self-care demand: It is totality
of the 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.
The therapeutic self-care demand is
modeled on deliberate action- i.e actions
intentionally performed by an
individual/society to benefit themselves or
others.

13. Care
measures
Care
measures
Therapeutic
self care
demand

14. Theory of self care deficit
• Central focus of Orem’s General Theory of Nursing
• Describes and explains how people can be helped through nursing.
• Self-care deficit arises when the self-care agency cannot meet self-
care requisites or when a patient himself is unable to perform his self
care activities.

15. • 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.
• Orem identifies 5 methods of helping:
• Acting for or doing for others
• Guiding others
• Supporting another (physically or
psychologically)
• Providing an environment promoting personal
development in relation to meet present or
future demands
• Teaching another

16. • The nurse may help the individual by using any or all of
these methods to provide assistance with self-care.
• If there are more demands than abilities, then nursing is
needed.
• The activities in which nurses engage when they provide
nursing care can be used to describe the domain of nursing.

17. • Orem has identified five areas of activity for nursing
practice:
1. Entering into and maintaining nurse-patient
relationships with individuals, families or groups until
patient can legitimately be discharged from nursing
2. Determining if and how patients can be helped through
nursing
3. Responding to patient’s request, desires and needs for
nurse contacts and assistance

18. 4. Prescribing, providing and regulating
direct help to patients and their
significant others in the form of nursing
5. Coordinating and integrating nursing
with the patient’s daily living, other
health care needed or being received
and social and educational services
needed or being received.

19. n
A conceptual framework for nursing (R=
Relationship)

20. Theory of nursing system
• 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

21. • The design and elements of the nursing system defines:
• The scope of nursing responsibility in health care situations
• The general and specific roles of nurses and patients
• Reasons for nurse’s responsibilities with patients
• The kind of actions to be performed and performance
patterns and patients action in meeting their therapeutic self
care demands

22. 1. Wholly Compensatory Nursing System
• Used when a patient’s self-care agency is so limited that
the patient depends on others for his care and well-
being.
• Subtypes of wholly compensatory system are nursing
systems for people who are:
• Unable to engage in any form (e.g. coma)
• Aware but should not engage in self care (person with
C3 C4 fracture)
• Unable to do and make reasoned judgments about self
care (some forms of mentally retarded and senile
person).

23. Fig. Wholly compensatory system
Nurse
action
Patient
action
limited

24. 2. Partly compensatory system
• It exists when both nurse and patient collaborately perform care
measures. i.e patient is able to perform some of his self-care
measures.
• Eg. A patient with recent abdominal surgery might be able to wash
his face and brush his teeth but needs the nurse to change surgical
dressing or help him to ambulate for bath.

25. Fig. Partly compensatory system
Performs some self-care measures for patient
Compensates for self care limitations of patient
Assists patient as required
Nurse
action
Patient
action
Performs some self care measures
Regulates self care agency
Accepts care and assistance from nurse

26. 3. Supportive-Educative system
 Used when a patient can meet self-care requisites but needs
assistance with decision making, behavior control or knowledge
acquisition skills.
 Nurse’s role: to promote the patient as self-care agent.
 Eg. A patient with controlled HTN seeks additional diet information
from the nurse, in this system the nurse attempts to promote the
self-care agency by providing education about diet.

27. Fig. Supportive- educative system
Accomplishes self care
Regulates the exercise
and development of self-
care agency
Nurse
action
Patient
action

28. Orem’s theory and the four major concepts
1. Health
• Orem supports the definition of health as stated by WHO.
• Physical, psychological, interpersonal and social aspects of health are
inseparable in the individual.
• Health is described as a state characterized by soundness or
wholeness of bodily structure and function; illness is its opposite.

29. • Health includes promotion and maintenance of health,
treatment of illness and prevention of complications.
• According to Orem, well-being is also associated with health,
with success in personal endeavors and with sufficiency of
resources.
• She also discusses mental health of individual. She indicates
that over the course of a lifetime, an individual will continue to
seek positive mental health as a part of the process of maturing.

30. 2. Person
• Defines ‘person’-recipient of nursing care as a
being who functions biologically and socially and
who has the potential for learning and
development.
• An individual subject with capacity for self-
knowledge, can engage in deliberate action,
interpret experiences and perform beneficial
actions.

31. •Person is an individual who can learn to
meet self-care requisites; if, for some
reason, the person cannot perform self-
care measures, others must provide the
care.
•Factors that affect person’s learning are
age, mental capacity, culture, society and
emotional state of individual.

32. 3. Environment
• Has not clearly defined environment.
• Can positively or negatively affect a person’s ability to perform self
care.
• Linked to the individual forming an integrated and interactive
system

33. 4. Nursing
 A service geared towards helping the self and others.
 A helping or assisting service to persons who are wholly or partly
dependent when they, their parents/guardians or other adults
responsible for their care are no longer able to give or supervise
their care.
 Nursing is required when the therapeutic self-care demands
needed to meet self-care requisites exceed a patient’s self-care
agency.

34. • According to Orem, nursing is deliberate action, a function of the
practical intelligence of nurses and action to bring about humanely
desirable conditions in persons and their environments.
• She further defines nursing as a human service. Nursing is
distinguished from other services by its focus on persons with
inabilities to maintain continuous provision of health care.

35. OREM’S THEORY AND NURSING
PROCESS

36. • Orem’s theory in relation to nursing process presents
a method to determine the self-care deficits.
• Furthermore, it defines the roles of a person or a
nurse to meet the self-care demands of an individual.

37. • Nursing process presents a method to determine the self
care deficits and then to define the roles of person or
nurse to meet the self care demands.
• The steps within the approach are considered to be the
technical component of the nursing process.
• Orem emphasizes that the technological component must
be coordinated with interpersonal and social processes
within nursing situations.

38. Steps of Orem’s nursing process
1. Nursing diagnosis and Prescription
2. Designs for Regulatory Operation
3. Production-management of Nursing Systems

39. Nursing diagnosis and Prescription: Step 1
• The initial and continuing determination of why a person should be
under nursing care.
• Acquire data and accumulates facts about the patient’s self-care
agency and therapeutic self-care demand.
• Identify current and predicted future relationship between agency
and demand.
• Helps in defining the direction and nature of actions.

40. Within step 1, the nurse seeks answers to the
following questions:
1. What is the patient’s therapeutic care demand?
2. Does the patient have a deficit for engaging in self
care to meet the therapeutic self-care demand?
3. If so, what is its nature and the reasons for its
existence?
4. Should the patient be helped to refrain from
doing self-care or to protect already developed
self-care capabilites for the therapeutic
purposes?
5. What is the patient’s potential for engaging in
self-care at future time period?

41. Designs for Regulatory Operation:Step 2
• Determining the designing of a system of nursing and planning for
the delivery of nursing care according to the designed system.
• Choosing suitable ways to help the patient (wholly compensatory,
partly compensatory, or supportive-educative)
• It includes nurse and patient roles in relation to self-care tasks.

42. Production-management of Nursing Systems :
Step 3
• Creation and implementation of regulatory nursing system through
nurse’s interaction with the patient and takes consistent action.
• Nurse performs and regulates the patient’s self care tasks or assists in
doing so.
• Helps patients, families and others create and use systems of daily
living that meet self-care needs in satisfying way.

43. • Guides, directs, and supports patients in exercising or not exercising
self-care agency;
• Supports and guides the patient in adapting to the needs arising from
medical measures;
• Stimulates the patient’s interest in learning care problems;
• Monitors and assists in self-monitoring the performance and effects
of self-care measures and adjusts the nursing care system as needed.

44. Comparison of nursing process and
Orem’s nursing process
Nursing process Orem’s nursing process
1. Assessment Step 1 Diagnosis and prescription, determine
why nursing is needed. Analyze and
interpret- make judgments regarding
care
2. Nursing diagnosis Step 2
3. Plans with scientific rationale Design of a nursing system and plan for
delivery of care
4. Implementation Step 3
5. Evaluation Production and management of nursing
systems

45. Orem’s theory and practice
• Useful in health promotion and care of sick.
• Teaching self care to individuals e.g. renal failure, hemodialysis, renal
transplant, post stroke conditions.
• Gives definition and description of various roles of nurses as clinical
nurse specialist role, case management role, advanced practice role,
primary care giver role.

46. • Teaching this theory to multi-skilled workers and nurse aides
• Use of this theory in the development of clinical measurement
approaches

47. Orem’s theory and Research
• Has been used as the basis for development of research instrument
to assist researchers in using the theory.
• 1st Instrument based on Orem’s theory: Kearney and Flieshers (1979)
• Self care questionnaire developed and tested by Moore (1995) based
on Orem’s theory: for the special purpose of measuring the self care
practice of children and adolescents.

48. Orem’s theory and education
• Used as guideline for developing curriculum for the education of
practice nurses.
• Used for laying out structure of nursing knowledge and explicating
the domains of nursing knowledge.
• Has strong and effective framework for curriculum design.
• At least 45 schools of nursing are known to use this theory.

49. (Nursing process related to
Orem’s theory)

50. Situation:
Mrs. Harimaya, age 56,
•Complaints: pain over multiple joints, stiffness
severe in morning, reduced by activities.
•Duration of symptoms: 3 years
•Rx: Taken medication from different hospitals
and treatment centres.
•Symptoms: not subsided, came to hospital for
further management.

51. • Able to do her daily activities but the way she performed and
used the posture made her prone to develop complication of
disease.
• She was underweight and had little knowledge about the
treatment regimen and complication of disease.

53. 2. Universal Self Care Requisites
Air Breaths without difficulty, no pallor cyanosis
Water Fluid intake is sufficient.
Edema present over ankles.
Turgor normal for the age
Food Hb – 9gm%, BMI = 14.Food intake is not
adequate or the diet is not nutritious.
Elimination Voids and eliminates bowel without difficulty.
Promoting normalcy Has good relation with family members

54. Universal Self Care Requisites Contd…..
Activity/ rest Frequent rest is required due to pain.
Pain not completely relieved,
Activity level has come down.
Deformity of the joint secondary to the
disease process and use of the joints.
Social interaction Communicates well with family members and
hospital staffs.
Preventing hazards Need instruction on care of joints and
prevention of falls. Need instruction on
improvement of nutritional status.

55. 3. Developmental Self-Care Requisites
Maintenance of
developmental
environment
Able to feed self , Difficult to
perform the dressing, toileting
etc
Prevention/ management of
the conditions threatening
the normal development
Feels that the problems are
due to her own behaviours
and discusses the problems
with family members and
hospital staffs.

56. 4. Health Deviation Self Care Requisites
Adherence to medical
regimen
Reports the problems to the physician when
in the hospital. Not much aware about the
use and side effects of medicines
Awareness of potential
problem associated
with the regimen
Not aware about the actual disease process.
Not compliant with the diet and prevention
of hazards. Not aware about the side effects
of the medications

57. Contd…
Modification of self image
to incorporate changes in
health status
Has adapted to limitation in mobility.
The adoption of new ways for
activities leads to deformities and
progression of the disease.
Adjustment of lifestyle
to accommodate changes
in the health status and
medical regimen.
Adjusted with the deformities.
Pain tolerance not achieved

58. 5. Medical Problem and Plan
• Physician’s perspective of the condition:
Diagnosed with Rheumatoid Arthritis and is on the medications and
physical therapy.

59. Therapeutic self-care demand:
• Deficit area: food, activity, pain control, prevention of
hazards, knowledge
• Adequacy of self care agency: Inadequate
• Self-care requisites> Self-care Agency

60. Nursing diagnosis
•Inability to maintain the ideal nutrition related
to inadequate intake and knowledge deficit.
•Self care deficit: dressing, toileting related to
restricted joint movement, secondary to the
inflammatory process in the joint.
•Ineffective pain control related to lack of
utilization of pain relief measures.
•Potential for injury related to disease
condition.
•Knowledge deficit related to disease
process, complications and prevention of
hazards.

61. Goal of care
• The client will be able to improve nutrition/maintenance of a
balance diet as evidenced by stating the importance of
maintaining a balance diet, list the food items rich in iron which
is available in her own area.

62. • The client will improve self care as evidenced by performing the
dressing activities within limitation, utilizing the alternative
measures available for improving toileting, performing other
activities of daily living with minimal assistance.

63. • The client will remain free from injury as evidenced by absence
of signs and symptoms of fall or injury, explaining the methods
to prevent injury.
• The client will gain knowledge as evidenced by describing
process of disease, complication, treatment regimen,
prevention of hazards.

64. • The client will remain free from injury as evidenced by absence
of signs and symptoms of fall or injury, explaining the methods
to prevent injury.
• The client will gain knowledge as evidenced by describing
process of disease, complication, treatment regimen,
prevention of hazards.

65. Nursing Intervention
• Design of nursing system: Partly compensatory and supportive-
educative.
• Method of helping: direct nursing care, guidance, support,
teaching, providing developmental environment.

66. Evaluation
•The client understood the importance of
maintaining optimum nutrition and verbalized
the iron rich diet.
•Verbalized decreased level of pain.
•The client was free from injury.