Fronk, BSN, RN
Orem’s Grand Theory of Nursing
Composed of three interwoven
Occurs when the
demand of self-care
is greater than
A deficit in self-care
brings about a need
for nursing care.
Activities that an
or assists with in
order to maintain
life and/or a higher
level of well-being.
Humans have an
innate desire to care
that the nurse and
client can take to
reduce or eliminate
Role of the
nurse and client.
Concepts of Self-Care
“A human regulatory
function that is a
deliberate action to
supply or ensure the
supply of necessary
for continued life,
and maintenance of
(McEwen & Wills, 2014, p. 144)
needed to bring
about or maintain
The ability to engage
in and/or perform
such as development,
factors, health and
Agent provides care
actions necessary to
meet the prescribed
self-care activities in a
given period in time
The agent utilizes
identified by the
R=relationship; <=deficit relationship, current or projected
(Alligood & Marriner-Tomey, 2002, p. 192)
Nursing – Deliberate actions that assist clients and their families in
regaining and/or maintaining optimal health.
Human being – Has developmental and universal health related needs.
Is capable of providing self-care. Is the object of nursing.
Environment – Influences self-care knowledge and behaviors.
Includes family and sociocultural factors.
Health – A dynamic state that may “impose new or different demands for
self-care on the person” (Fawcett, 2005, p. 250).
Nursing Client – Has a health related deviation and is incapable of
providing adequate self-care. Requires assistance from nursing.
Developmental self-care requisites – Occur due to a
health condition or life event. Includes disease processes,
injury, effects related to aging, etc..
Universal self-care requisites – Are common to all
human beings. Consists of basic life requirements such
as air, food, elimination, activity, etc.
Health deviation requisites – Actions necessary to
employ when a deficit in self-care exists. Procuring
medical treatment and nursing interventions.
Based on the philosophy that
“all patients wish to care for themselves”
(Paraska & Clark, 2012, p. 63).
Individuals can and should strive for optimal health and life through self-care
Individuals should care for themselves as well as their dependents
Each individual is distinct and separate from others and the environment
Nursing is deliberate and requires action as well as interaction
Achieving the universal and developmental requisites of self-care is integral
to attaining optimal health
Knowledge and the environment influences self-care behaviors and activities
The art of nursing is a therapeutic form of self-care that assists individuals in
recovery from disease and/or injury
Nursing enhances self-care behaviors and activities
Relationships & Influences
Nursing exists due to deficits in self-care.
Humans are self-reliant and desire to take responsibility
Health is a state of individual well-being that is influenced by the
nurse as well as the environment.
When a deficit or need for maintenance in self-care exists
the nurse and the environment can be modified to restore
and/or preserve the state of health.
Optimal performance of self-care requisites minimizes
the therapeutic self-care demand.
Universal, developmental and other conditioning
factors can alter the agent’s ability to complete
The nursing system is developed based upon the self-care
deficit identified by the nurse.
Self-care needs can be met by the nurse, the client or both.
1914: Born in Baltimore, Maryland
1939: BSN, Catholic University of America
1959: Experienced in many areas of nursing, including:
staffing, private duty, education, administration, and
consulting; Orem began developing her definition of nursing
practice and the concept of self-care
1971: First formal publication of Orem’s
Theory of Self-Care (Orem, 1971)
1976: Honorary Doctor of Science Degree
2001-2007: Orem refined and publish her theories
throughout the remainder of her life
Considered a “pioneer” of nursing theory
(McEwen & Wills, 2014, p. 142)
Orem developed her theory in the late 1960’s when tasked with
designing a national curriculum for practical nursing education.
Orem wished to revitalize nursing education in order to keep
it current with the healthcare needs of modern society.
The “scientific foundation for
healthcare” moved nursing
toward a more professional
role (Taylor & McLaughlin
Renpenning, 2003, p. 18)
The American Nurses
institutional education with
the baccalaureate degree
as the basic foundation for
The U.S. Public Health
increasing the quality
of patient care.
The Nurse Training Act
allocated millions of dollars
in government funds to
improve and enhance
nursing schools and
strived to build
their own body
Nurses were employed
in a variety of settings.
This increased the
number and complexity
of problems nurses
Passage of the
Civil Rights Act
Medicaid and Medicare
funded healthcare to
millions of Americans.
focused on equality in
pay and employment
Theory Origin & Support
Orem’s theory was developed and revised over the course of four decades.
The combination of practice, experience, education and collegiate
collaboration influenced values and theory development.
Orem’s Values: Optimal health for every individual, independence in caring
for the self, the art of nursing is valuable to society
Orem refers to but has never directly credited an author or work as the
foundational basis for her theory.
Significant influential nurses referred to by Orem include: Rogers, Roy,
Nightingale, Henderson, Abdullah & Orlando.
Theoretical influences: Aristotle & Thomas Aquinas. Action Theory. An area
of philosophy concerned with “agent-causal” relationships. (O’Connor &
Sandis, 2010, p. 7).
While employed as a nursing
consultant, Orem began to question
the reality of nursing.
Orem was motivated by the ability
to perform yet not communicate
Orem wished to create a framework
that organized nursing knowledge
“What is the human
condition that occasions
requirements for nursing?”
Why do some individual’s
need nursing care and
What is the subject
matter of the discipline
Incorporates both inductive &
Deductive reasoning processes
Concepts were identified and
conceptualized based on
experience in practice
Worldview of reciprocal interaction
A Human Needs Theory
Orem utilized a developmental
model to conceptualize her theory
The theory can also be regarded
as an interaction model
Useful in everyday practice settings
Applicable across the lifespan
Contributes to nursing’s body of knowledge
Research findings can be applied to practice
Can guide interventions to enhance outcomes
Generate research & research instruments
Utilized by schools of nursing
as a base for curriculum
Generates testable hypothesis
for use in a multitude of settings
Identifies the focus of nursing
Practicality in Practice
Orem’s theory provides a practical means to guide and enhance
The theory can be utilized to positively influence the motivation
that drives the deliberate actions of self-care.
Patient outcomes can be enhanced through easily identifiable
requisites and interventions.
The self-care requisites within the theory encompass practical
concepts that can be developed to assist in daily practice.
Universal requisites are common to all humans; Eliminative functions of
self-care can be addressed by encouraging the patient to bathe daily.
Developmental requisites occur with growth and development; Proper
growth and development can be facilitated through skill and knowledge
Health Deviations occur due to internal and external forces; Primary,
secondary and tertiary interventions can be employed to maintain
and/or restore function.
Contribution to Care
Nurses make judgments for recommendations and adjustments in nurse-patient roles
Theory that uncovers self-care needs, requisites and demands as well as the
interventions to meet these requirements contribute to nursing’s body of knowledge.
Orem thoroughly describes each concept within the theory of self-care and predicts
relationships between them. This aids in determining outcomes.
Identification of inadequacies in the self-care
agency and within self-care requisites aids in
predicting the degree of disability and the
need for nursing activities.
Determines the effect and outcomes
of self-care activities
Identifies the needs of the patient
Evaluates the success of interventions
Identifies need for modification of interventions
Example in Practice
The theory of self-care can provide a theory-based
approach to assist nurses and patients in hospital burn units
Burn units significantly lack theory in care interventions
Wilson and Gramling suggest utilizing Orem’s Self-Care Model “as a valid basis for
delivering care and increasing the level of professionalism in this specialty area”
(Wilson & Gramling, 2009, p. 852). The authors also suggest that the application of
the theory in the practice of burn care units will provide a unique way to view this
phenomenon. Many theories present gaps in care due to lack of comprehensiveness.
Additional theories such as Roy’s Adaptation Model
can complement matters not addressed by Orem in
this specialty area of care. Orem’s theory however,
“is the most applicable to burn care and provides a
beginning point for theory usage in burn nursing
care” (Wilson & Gramlin, 2009, p. 852).
Despite the popularity and feasibility of the theory of self-care, a 1993 review
noted only 4 of 31 related research studies met the criteria for making
“‘adequate use’ of Orem’s theory” in testing (Spearman, Duldt & Brown, 1993, p. 1629).
Orem did not believe that “nursing research should be focused on testing her theory as much as on
developing knowledge related to the different components” of her theories (Meleis, 2011, p. 220).
Descriptive studies related to self-care practices
Assesses needs of clients
Development of interventions
To generate research instruments
To identify categories of self-care needs in specific
The self-care agency has been used to focus on the
development of research tools capable of measuring
aspects of self-care
To form a basis for the testing of a hypothesis
To identify relationships between the concept of the
self-care agent and other influencing concepts in a
variety of populations
Easily tested with a variety of
methods and in various settings
Has generated numerous dialogues
and stimulating thinking across
Broad clinical utility
The theoretical concepts of the
grand theory has been applied as a
whole and independently as well as
in coordination with other theories
to complement research studies
Computer-assisted reinforcement of instruction: effects on adherence in adult atopic
asthmatics. A randomized pretest-posttest experimental design to determine effects of an
intervention on adherence to dust mite avoidance in adults with atopic asthmatics (Huss, Salerno,
Huss, R., 1991).
Health and illness self-care in adolescents with IDDM: a test of Orem's theory.
Differentiates and proposes hypotheses related to adolescent diabetics and the various types of
self-care identified by Orem (Frey & Denyes, 1989, p. 67-75).
Orem's model used for health promotion: directions from research. Utilized Orem's theory
to test propositions associated to general health and health promotion (Denyes, 1988, p. 13-21).
Self-care agency as a function of patient-environmental factors among nursing home
residents. Examined the relationships of environmental and personal factors on the ability of
residents in nursing homes to provide self-care (Jirovec & Kasno, 1990, p. 303-309).
The effect of Orem's self-care model on nursing care in a nursing home setting.
Determine patient perspectives and outcomes of nursing staff utilizing Orem’s theory of self-care
compared to nursing staff employing other methods of assessments and goals (Faucett, Ellis,
Underwood, Naqvi & Wilson, 1990, p. 659-666).
Influence of selected factors and self-care behavior on abdominal distention in patients
with abdominal surgery. A descriptive and prospective study to explore self-care factors that
influence abdominal distention in patients with recent abdominal surgery (Wattanawech,
Srimoragot, Kasemkitwattana, Kimpee, 2003, p. 19-32).
Provides a general foundation for
the nursing discipline
Can be utilized to formulate
Can enhance the development of
nursing education, research and
Identifies when nursing is required
Contemporary with nursing trends
in health promotion and
Repetitive terms can be confusing
Psychological/emotional needs not
well developed within the theory
Assumes “all” are capable of self-
care activities and does not
address infants or the frail elderly
Oriented more toward illness than
Example: Case Study
A case study was performed to identify “facilitators and inhibitors
to clinical application of Orem’s theory of self-care” (Clark, 1986, p. 127).
Facilitators were described as factors that aided the utilization of self-care theory
while inhibitors deterred its use.
Subjects: Gerontological Patients
Setting: Community health nursing
Premise of theory: Individuals desire the ability and responsibility of self-care.
The nurse’s role is to identify self-care deficits and provide assistance with self-care activities to
enhance health and well-being.
Design: Following the nursing assessment, the individual’s ability to engage in identified self-care
requisites was evaluated. A nursing plan of care was implemented to achieve therapeutic self-care
demands. Contributing and inhibiting factors to the outcomes were communicated and evaluated.
Patient desire, attitude and beliefs
Positive nurse-patient relationship
Patient education, values, collaboration, communication
Nurse, knowledge, collaboration, advocacy, communication
Nursing plan of care
Managing large numbers of concepts within the theory
Lack of additional case studies and research to guide the study
Considerations: The study revealed numerous areas with potential for furthering nursing research.
(Clark, 1986, p. 127-135)
Descriptive studies - Focus on the comprehension, number and type of self-
care behaviors. Proposition: The nurse must assess and identify the client’s
ability and potential to complete self-care activities.
Correlational studies - Examine the relationships between self-care
variables. Proposition: The ability to perform self-care activities is influenced
by the self-care agency, requisites and demands.
Quasi-Experimental studies - Identifies causal relationships as well as the
significance of those relationships. They are necessary to determine the
effectiveness in fulfilling therapeutic self-care demands. Proposition: Self-care
deficits are balanced between therapeutic self-care demands and the ability of
the self-care agency to meet those demands. The inability to achieve optimal
self-care indicates a degree of dependency.
Experimental studies – Explore client outcomes related to the application of
interventions. Proposition: Nurses are tasked with identifying valid and reliable
interventions required to meet self-care needs.
The intertwined concepts of self-care, self-care requisites, the self-care
agency and therapeutic self-care demands must function in harmony for
optimal health and well-being to be realized.
Orem’s generalized theory of nursing consists of three interrelated
The self-care component of the general theory is “common
to the health professions and to all members of social groups.”
(Basavanthappa, 2007, p. 85)
It identifies broad, comprehensive activities that
are required by the individual to maintain health.
It can be applied across the lifespan and within
a variety of settings yet focus is on the ill.
The scope is more specific when applied to
administration, education and research.
The concepts are simple and easy to understand.
Simple * Logical * Organized
Theory in Practice
As a provider I will utilize this theory to identify
appropriate and validated measures required by
Professional nursing practice is based on the
assumption that patient’s desire and need the
self-care agency. The ability to engage in
self-care activities is innate as well as learned.
As a provider, I will assist patients in learning as
well as performing self-care activities.
My role is to facility the self-care agency of the patient. Utilizing the
theory of self-care, along with the theories of self-care deficit and
nursing systems, I will be able to identify self-care deficits and the
degree and competency of the patient’s self-care requisites and abilities.
With this data, the appropriate nursing system of action with
interventions can be implemented.
This theory will assist me in identifying and encouraging appropriate self-
care activities across the lifespan.
Alligood, A., & Marriner-Tomey, A., (2002). Nursing Theorists and Their Work. (5th Ed.). St. Louis: Mosby.
Allison, S. (2007). Self-care requirements for activity and rest: an Orem nursing focus. Nursing Science Quarterly, 20(1), 68-76.
Basavanthappa, BT. (2007). Nursing Theories. New Delhi: Jaypee Brothers Publishers.
Clark, M. (1986). Application of Orem's theory of self-care: a case study. Journal of Community Health Nursing, 3(3), 127-135.
Denyes, M. (1988). Orem's model used for health promotion: directions from research. Advances In Nursing Science, 11(1), 13-21.
Fawcett, J. (2005). Contemporary Nursing Knowledge: Analysis and Evaluation of Nursing Models and Theories (2nd ed.). Philadelphia, PA: F. A. Davis
Faucett, J., Ellis, V., Underwood, P., Naqvi, A., & Wilson, D. (1990). The effect of Orem's self-care model on nursing care in a nursing home setting.
Journal Of Advanced Nursing, 15(6), 659-666.
Frey, M., & Denyes, M. (1989). Health and illness self-care in adolescents with IDDM: a test of Orem's theory. Advances In Nursing Science, 12(1), 67-75.
Huss, K., Salerno, M., & Huss, R. (1991). Computer-assisted reinforcement of instruction: effects on adherence in adult atopic asthmatics. Research In
Nursing & Health, 14(4), 259-267.
Jirovec, M., & Kasno, J. (1990). Self-care agency as a function of patient-environmental factors among nursing home residents. Research In Nursing &
Health, 13(5), 303-309.
McEwen, M. & Wills, E. (2014). Theoretical basis for nursing. (4th ed.). Philadelphia: Wolters Kluwer. Lippincott Williams & Wilkins.
Meleis, Afaf Ibrahim. (2011). Theoretical Nursing: Developmengt and Progress. (5th ed., p. 220). Philadelphia: Wolters Kluwer. Lippincott Williams &
O’Conner, T., & Sandis, C. (2010). A companion to the philosophy of action. Oxford, Wiley-Blackwell.
Orem, D.E. (1971). Nursing: Concepts of Practice. McGraw-Hill, New York.
Paraska, K., & Clark, C. (2012). Health promotion in nursing practice. Burlington, MA: Jones & Bartlett Publisher.
Simmons, L. (2009). Dorthea Orem's self-care theory as related to nursing practice in hemodialysis. Nephrology Nursing Journal, 36(4), 419-421.
Spearman, S., & Duldt, B., & Brown, S. (1993). Research testing theory: a selective review of Orem's self-care theory, 1987-1991. Journal Of Advanced
Nursing, 18(10), 1626-1631.
Taylor, S., & McLaughlin Renpenning, K. (2003). Self-Care Theory in Nursing: Selected Papers of Dorothea Orem (p. 18). New York: Springer Pub.
Wattanawech, T., Srimoragot, P., Kasemkitwattana, S., & Kimpee, S. (2003). Influence of selected factors and self-care behavior on abdominal distention
in patients with abdominal surgery. Self-Care, Dependent-Care & Nursing, 11(3), 19-32.
Wilson, J., & Gramling, L. (2009). The application of Orem's Self-Care Model to burn care. Journal Of Burn Care & Research, 30(5), 852-858.