Orem's Self-Care Deficit Theory of Nursing focuses on the concepts of self-care, self-care deficits, and the nursing system. The theory proposes that individuals require continuous care to maintain life and well-being. When individuals have limitations in meeting their self-care needs, nursing can intervene through one of three nursing systems: wholly compensatory, partly compensatory, or supportive-educative. Orem's theory provides a framework for assessing individuals' self-care needs and guiding appropriate nursing practice. The theory has been widely applied in nursing education and clinical practice.

1. JOFRED M. MARTINEZ, RN
Graduate School
University of San Agustin
General Luna Street, Iloilo City

3. BACKGROUND OF THE THEORIST
 Born in Baltimore, Maryland.
 Orem began her career at Providence
Hospital School of Nursing in Washington
DC,
 Orem received a B.S.N.E. from the Catholic
University of America (CUA) in 1939 and, in
1946; she received an M.S.N.E. from the
same university.

4. Providence Hospital School of
Nursing Washington DC

5. Catholic University of America (CUA)

6.  Orem held the directorship of both the
nursing school and department of nursing at
Providence Hospital in Detroit from 1940 to
1949.
 Orem worked in Indiana working in the
Division of Hospital and Institutional Services
of Indiana State Board of Health (1949 to
1957) .
 In 1957, Orem moved to Washington, DC;
the office of education, U.S. Department of
health, Education and Welfare (DHEW)
employed her as a curriculum consultant
from 1958 to 1960.

7.  Orem held the directorship of both the
nursing school and department of nursing
at Providence Hospital in Detroit from 1940
to 1949.
 Orem worked in Indiana working in the
Division of Hospital and Institutional Services
of Indiana State Board of Health (1949 to
1957) .
 In 1957, Orem moved to Washington, DC;
the office of education, U.S. Department of
health, Education and Welfare (DHEW)
employed her as a curriculum consultant
from 1958 to 1960.

8. Nursing: Concepts of Practice

9.  Honorary Doctor of Science, Incarnate
Word College, 1980; Doctor of Humane
Letters, Illinois Wesleyan University (IWU),
1988; Linda Richards Award, National
League for Nursing, 1991; and Honorary
Fellow of the American academy of
Nursing, 1992.
 Doctor of Nursing Honoris Causae from the
University of Missouri in 1998.
 Orem retired in 1984 and resides at
Savannah, Georgia.

10. SELF-CARE DEFICIT THEORY
SELF-CARE
THEORY
SELF-CARE
DEFICIT
NURSING
SYSTEM

11. The practice of activities that maturing
and mature persons initiate and perform
within time frames, on their own behalf, and
in the interest of maintaining life and
healthful functioning and continuing
personal development and well-being.

12. A formulated and expressed insight
about actions to be performed that are
known or hypothesized to be necessary in
the regulation of an aspect(s) of human
functioning and development, either
continuously or under specified conditions
and circumstances.

13. A formulated self-care requisite names:
1. the factor to be controlled or managed to
keep an aspect(s) of human functioning
and development within the norms
compatible with life and health and
personal well being and
2. the nature of the required action.
Formulated and expressed self-care
requisite constitutes the formalized
purposes of self-care.

14. Universally required goals to be met
through self-care or dependent care have
their origins in what is known and what is
validated or what is in the process of being
validated about human structural and
functional integrity at various stages of the
life cycle.

15. Six self-care requisites are suggested:
a. The maintenance of a sufficient intake of
air, water, and food.
b. The provision of care associated with
elimination processes and excrements.
c. The maintenance of balance the balance
activity and rest.
d. The maintenance of balance between
solitude and interaction.

16. e. The prevention of hazards to human life,
human functioning, and human well-being.
f. The promotion of human functioning and
development within social groups in
accordance with human potential, known
human limitations, and the human desire to
be normal.

17. They promote processes of life and
maturation and prevent conditions
deleterious to maturation or those that
mitigate those effects.

18. The following are actions to be
undertaken that will provide developmental
growth:
1. Provision of conditions that promote
development.
2. Engagement in self-development
3. Prevention of the effects of human
conditions that threatens life.

19. These self-care requisites exists for
persons who are ill or injured, who have
specific forms of pathological conditions or
disorders, including defects or disabilities,
and who are undergoing medical diagnosis
and treatment.

20. The summation of care measures
necessary at specific times of over a
duration of time for meeting all of an
individual’s known self-care requisites
particularized for existent conditions and for
circumstances using methods appropriate
for:

21. 1. controlling or managing factors identified
in the requisites, the values of which are
regulatory of human functioning
(sufficiency of air, water, and food)
2. fulfilling the activity element of the requisite
(maintenance, promotion, prevention, and
provision)

22. Therapeutic self-care demand at any time:
1. describes factors in the patient or the
environment that must be held steady within
the range of values or brought within and
held within such a range for the sake of the
patient’s life, health or well-being
2. has a known degree of instrumental
effectiveness derived from choice of
technologies and specific techniques for
using changing, or in some way controlling,
patient or environmental factors.

23. The complex acquired ability of mature
and maturing persons to know and meet
their continuous requirements for deliberate,
purposive action to regulate their own
human functioning and development.

24. The person who engages in the course of
action or has the power to engage in a
course of action.

25. Maturing adolescents or adults who
accept and fulfill the responsibility to know
and meet the therapeutic self-care
demand of relevant others who are socially
dependent on them or to regulate the
development or exercise of these persons’
self-care agency.

26. A relationship between the human
properties of therapeutic self-care demand
and self-care agency in which constituent
developed self-care capabilities within self-
care agency are not operable or not
adequate for knowing and meeting some or
all components of the existent or projected
therapeutic self-care demand.

27. The developed capabilities of persons
educated as nurses that empower them to
represent themselves as nurses and within
the frame of a legitimate interpersonal
relationship to act, know, and help persons
in such relationships to meet their
therapeutic self-care demands and to
regulate the development or exercise of
their self-care agency.

28. A professional function performed both
before and after nursing diagnosis and
prescription to which nurses, on the basis of
reflective practical judgments about
existent conditions, synthesize concrete
situational elements into orderly relations to
structure operational units.

29. A helping method from a nursing
perspective is a sequential series of actions,
which, if performed, will overcome or
compensate for the health associated
limitations of persons to engage in actions to
regulate their own functioning and
development or that of their dependents.

30. Health-associated action limitations:
a. Acting for or doing for another
b. Guiding and directing
c. Providing physical or psychological support
d. Providing and maintaining an environment
that supports personal development
e. Teaching

31. Series and sequences of deliberate
practical action of nurses performed at
times in coordination with actions of their
parents to know and meet components of
their patients’ therapeutic self-care
demands and to protect and regulate the
exercise or development of patients’ self-
care agency.

32. BASIC NURSING SYSTEMS
Nurse
Action
WHOLLY COMPENSATORY SYSTEM
Accomplishes patient's
therapeutic self-care
Compensates for patient's inability
to engage in self-care
Supports and protect the patient

33. NurseAction
PARTIALLY COMPENSATORY SYSTEM
PatientAction
Performs some self-care measures
for patient
Compensates for self-care
limitations of patients
Assists patients as required
Performs some self-care measures
Regulates self-care agency
Accepts care and assistance from
nurse

34. NurseAction
SUPPORTIVE-EDUCATIVE SYSTEM
PatientAction
Accomplishes self-care
Regulates the exercise and
development of self-care agency

35. SELF-CARE
ABILITIES
RESERVE
SELF-CARE
ABILITIES
HEALTH
DEVIATION
SELF-CARE
NEEDS
UNIVERSAL
SELF-CARE
NEEDS
BALANCE

36. SELF-CARE
ABILITIES RESERVE
SELF-CARE
ABILITIES
HEALTH
DEVIATION
SELF-CARE
NEEDS
UNIVERSAL
SELF-CARE
NEEDS
AN INDIVIDUAL NEEDING NURSING
INTERVENTIONS

37. PARADIGM OF THE MODEL / THEORY

38. DEFINITION OF MAN, HEALTH
ENVIRONMENT AND NURSING
• Human beings are very much different from
other living organisms in terms of their
capacity.
• Human functioning is an integrated system
comprised of physical, psychological,
interpersonal, and other aspects
• Individuals have the potential to be
developed and learned.

39. • Orem support’s the World Health
Organization’s definition of health.
• Orem presents health based on preventive
healthcare. This model of health care
includes the promotion and maintenance of
health, the treatment of disease or injury,
and the prevention of complications.

40. • Orem’s shows her view of the surrounding
environment as an external source of
influence in the internal interaction of a
person’s different aspects.

41. • According to Orem, nursing is helping to
establish or identify ways to perform self-
care activities.
• Further, Orem defines nursing as a human
service.
• She added that nursing is based on values.

42. IMPLICATIONS OF THE THEORY TO THE
NURSING COMMUNITY
• The first documented use of Orem’s theory
as the basis for structuring practice is found
in descriptions of nurse-managed clinics at
John Hopkins Hospital in 1973.

43. • Research articles on the use of SCNDT or
components in clinical practice include
teaching self-care to individuals with
diabetes mellitus, cardiac research, end-
stage renal failure, hemodialysis and
peritoneal dialysis, renal transplant, pain
assessment, and cancer management.
• Occupational health nursing and elderly
care also base their practice in SCDNT

44. • In addition to the use of the theory for theses
clinical populations, it has been used in a
variety of healthcare settings.
• SCDNT helps assist graduate nurses in
combining their school teachings with their
nursing work that occurs after graduation.
• Orem’s theory has been also used to
describe and define various roles for nurses
within multiple settings.

45. • There are a number of reports in the
literature describing the use of SCDNT as the
basis for the curriculum.
• At least 45 schools of nursing use SCDNT as
the basis for their curriculums.

46. • The Sinclair School of Nursing, University of
Missouri at Columbia that used SCDNT as the
framework for curriculum and teaching
since 1978.
• Oakland University, College of St. Benedict
and Anderson College are three schools
designed with curricula designed within
SCDNT.

47. • The first instrument to measure the exercise
of self-care agency (ESCA) was published in
1979.
• The SCDNT was the conceptual framework
for Kearney and Fleisher’s ESCA in 1979,
DSCAI in 1980, and Hanson and Bickel’s
Perception of Self-Care agency in 1981.

48. • The SCDNT was a pivotal construct in the
design of the Self-As-Career Inventory (SCI).
• The Appraisal of Self-Care Agency (AAA)
scale was developed to measure the core
concept of Orem’s SCDNT. The research
instruments used most frequently include the
DSCAI, DSCPI, ASA, and SCI. Other include
Maieutic Dimensions of Self-Care Agency
Scale (MDSCAS) and Moore and Gaffney’s
DCA questionnaire.