DOROTHEA OREM’S
SELF-CARE DEFICIT NURSING
THEORY
By: Tracy Clarke & Jeanine Grossman
Purpose
Orem’s purpose for developing the Self-Care
Framework was two-fold: To find the meaning of
nursing and to develop a body of nursing
knowledge based on research.
According to McLaughlin-Renpenning and Taylor
(2002, p. 301), Orem states that “my work in
theory development has focused on the beginning
development of scientific knowledge in the field of
nursing.”
Orem’s theory
Orem produced conceptual models and theories in
an attempt to answer the following question
(Hartweg, 1991, p. 4):
What condition exists in an individual or a group when
judgments are made that nursing is required, that a
nurse or nurses should now be related to this person or
group as health care providers?
Theory description
The theory rests upon:
The reality of the human condition of social
dependency that casts members of a social group into
the roles of the one in need of help and the helper
The reality that adults do deliberately care for
themselves and their dependents (Orem, 2003, p 103)
Orem’s Theory of Self Care
Each person has a need for self care in order to
maintain optimal health and wellness
Each person possess the ability and responsibility
to care for themselves and dependants.
Theory is separated into three conceptual theories:
self care, self care deficit, and nursing system.
Theory Description
Orem’s Self-care deficit theory of nursing
(SCDTN) is a general theory composed of the
following three interrelated theories: (Hartweg,
1991, p. 14)
Self-care: Describes why and how people care for
themselves.
Self-care deficit: Describes & explains why people can
be helped through nursing.
Theory of nursing systems: Describes & explains
relationships that must be maintained for nursing to be
produced.
Major Concepts
SCDTN is composed of six basic concepts: self
care, self-care agency, therapeutic self-care
demand, self-care deficit, nursing agency, and
nursing system (Berbiglia & Banfield, 2006, p.
260-272)
The concepts of self-care, self-care agency,
therapeutic self-care demand, and self care deficit
are related to the patient, while nursing agency &
nursing system are related to the nurses and their
actions.
Definitions of major concepts:
Theory of Self Care
Self-care is the practice of activities that
individuals initiate & perform on their own behalf
in maintaining life, health, and well being
(Hartweg, 1991, p. 24).
Self care is learned behavior, it is goal directed
with a purpose in mind.
Three components: universal self care needs,
developmental self care needs, and health
deviation.
Definitions of major concepts:
Theory of Self Care Agency
The power of individuals to engage in self-care and
the capability for self-care (Hartweg, 1991, p. 17).
Acquired ability that is affected by conditions &
factors in the environment.
Ability to engage in self-care that develops from
childhood reaches maturity in adulthood, and
declines with old age
Definitions of major concepts:
Therapeutic Self -Care Demand
This includes activities which are essential to
health and vitality (Hartweg, 1991, p. 20-21).
These are universal requirements that all humans
share throughout our life-cycle.
Includes: air, water, food, elimination, activity and
rest, solitute and social interactions, prevention of
harm and promotion of normalcy,
Definitions of major concepts:
Self-care Deficit Theory
Every mature individual has the ability to meet self-
care needs, a deficit may exist with a current
inadequacy (Hartweg, 1991, p. 23).
Individuals may benefit from nursing interventions
when situations inhibit their ability to perform self-care
or their abilities are limited and not sufficient to
maintain health (Hartweg, 1991, p. 23).
Nursing action focuses on the deficit and implementing
appropriate interventions to meet the patient’s needs
(Hartweg, 1991, p. 23).
Definitions of major concepts:
Theory of Nursing Agency
Comprises developed capabilities of persons
educated as nurses that empower them to represent
themselves as nurses (Hartweg, 1991, p. 24).
To help others know their therapeutic self
demands.
To help others regulate the development of their
self-care agency.
Definitions of major concepts:
Theory of Nursing System
All actions and interactions of nurses and patients in
practice settings (Hartweg, 1991, p. 27).
Three types of compensatory nursing systems:
Wholly: Pt unable to perform/control actions.
Ex: Pt in a coma. Pt has advanced Alzheimer's disease
Partial: Nurse & patient share the responsibility.
Ex: Pt performs most of self care tasks, but needs assistance
Supportive/educative: Pt performs all self care actions
related to ambulation & movement. The nurse provides
education & is supportive.
Ex: Nurse provides info & supports the new mom re:
breastfeeding, but the mom performs the action.
Major relational statements
Nursing science is concerned with the exploration
of relationships between entities.
Orem’s triad of relations constitute SCDNT:
(1) Self-care agency as related to self-care demands
(2) Self-care agency as related to self-care
(3) Self-care as related to self-care demands
Relationships
SCDNT:
General theory of nursing, it represents a complete
picture of nursing (Berbiglia & Banfield, 2006, p.
273):
Theory of self-care is the foundation of all theories.
Expresses the purpose, method, and outcome of
taking care of self.
Theory of self-care deficit develops the reason why
a person may benefit from nursing.
Theory of nursing systems is the unifying theory
and includes all essentials elements.
Assumptions
Five premises underlying the general theory of nursing
(Berbiglia & Banfield, 2006, p. 272):
(1) Human beings require continuous deliberate inputs
to themselves and their environments to remain alive
and function in accord with natural human endowments.
(2) Human agency, the power to act deliberately, is
exercised in the form of care of self and others in
identifying needs for and in making needed inputs.
Assumptions
(3) Mature human beings experience privations in the form of
limitations or action in care of self and others involving and making of
life sustaining and functioning- regulating inputs.
(4) Human agency is exercised in discovering, developing, and
transmitting to others ways and means to identify needs for and make
inputs to self and others.
(5) Groups of human beings with structures relationships cluster tasks
and allocate responsibilities for providing care to group members who
experience privation for making required deliberate input to self and
others
Basic Structure with Model
Theory Synthesis
According to Chinn and Kramer (2008), Orem’s
emphasized that self-care maintains wholeness.
Dorothea Orem's theory of Self-Care Deficit
involves the client, known as the patient as the
main focus in providing care. It is the role of the
nurse to provide care based on the patients inability
and incapacity to perform self-care related to health
problems.
Origins of theory
Evolved over a period of four decades from individual work
and collaboration with several groups (students,
practitioners, researchers, educators etc).
Searched for the meaning of nursing using her own unique
experiences and observations (Hartwell, 1991, p. 3-4).
Orem originally searched for the answer to the question,
“What is nursing and what condition exist when judgments
are made that people need nursing?”
The answer she found stated, “The inabilities of people to care for
themselves at times when they need assistance because of their
state of personal health.”
Origins of the model (1949-1959)
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 (Hartwell, 1991, p. 4).
1958-1960: U.S. Department of Health, Education
and Welfare where she help publish "Guidelines for
Developing Curricula for the Education of Practical
Nurses" in 1959 (Hartwell, 1991, p. 4).
Origins of the model (1949-1959)
1959: Served as acting dean & assistant professor of
nursing at CUA. She continued to develop her concept
of nursing and self care during this time (Hartweg,
1991, p. 4).
1965: Members of the Nursing Models Committee at
CUA helped to further define & formalize the concept
of nursing.
Orem’s Nursing: Concept of Practice was first
published in 1971 and subsequently in 1980, 1985,
1991, 1995, and 2001.
Orem continued to develop her theory after retirement
in 1984.
Clarity
Theoretical terms are defined precisely.
Theoretical language is consistent with 21st century
language.
Terminology of the theory is congruent throughout.
Ex: The term self-care has multiple meanings; Orem
defined the term & elaborated the structure of the
concept to be unique to this theory while also
congruent with other interpretations (Berbiglia &
Banfield, 2006, p. 276).
Simplicity
Theory is expressed in limited terms.
Complexity of Orem’s theory is viewed as a balance
between highly complex and parsimonious.
• Terms are defined & used consistently within the theory
(Berbiglia & Banfield, 2006, p. 276).
Ex: The self-care deficit theory of nursing is a synthesis of
knowledge comprising eight concepts:
The relationship between & among these concepts can be
presented in a simple diagram.
The structure of the theory can be identified within these
concepts.
The depth & complexity of the concepts is necessary to describe
& understand the human practice discipline.
Generalizability/Usefulness
Orem stated:
“The self-care deficit theory of nursing is not an
explanation of the individuality of a particular
concrete nursing practice situation, but rather the
expression of a singular combination of
conceptualized properties or features common to
all instances of nursing. As a general theory, it
serves nurses engaged in nursing practice, in
development and validation of nursing knowledge,
and in teaching and learning nursing (Berbiglia &
Banfield, 2006, p. 276).”
Testability
Instrument development plays an important role in building
nursing knowledge (Berbiglia & Banfield, 2006, p. 277)
Research instruments to measure Orem’s concepts are
currently being used, developed, & tested.
Ex: American Society of Anesthesiologist examines relationship
btwn basic conditioning factors & self-care agency.
Ex: Moore’s self care questionnaire used to measure the self care
practice of children and adolescents.
Ex: Campbell’s danger assessment tool measures women at risk
for battering
Ex: The nursing care plan is an example of how self care theory
can be applied to the nursing process
Testability
Concepts of SCDNT are complex & based on real
(empirically based) nursing situations (Berbiglia &
Banfield, 2006, p. 277) .
Both quantitative & qualitative research methods
are appropriate for the development of knowledge
related to SCDNT.
Quant: Test the relationship btwn Orem’s 3 central
concepts (self care, self care agency & basic
conditioning factors) in adolescent CF pts.
Qualt: Hemodialysis pts at risk for self-care deficits.
Testability
Current emphasis in SCDNT is on building a body
of knowledge based on nursing practice, rather than
engaging in theory testing (Berbiglia & Banfield,
2006, p. 277).
Additional descriptive studies of various pop. to
provide a solid base for the development of
instruments to measure the concepts of SCDNT
(Berbiglia & Banfield, 2006, p. 277).
Practice Implications
The application of Orem’s model to nursing practice
takes many forms (Hartweg, 1991, p. 35-38):
Philosophical guide to nursing practice.
Develop & guide nursing practice.
Self-care model used as a framework for clinical
practice & guide to nursing research.
Conceptual guide to develop nursing curricula in ASN
& BSN programs.
Nursing Metaparadigm
Person: Integrated whole. Has the capacity for self
knowledge and for engagement in deliberate action.
Health: State of wholeness. Physical, psychological,
interpersonal, and social aspects of health are
inseparable.
Environment: External surroundings that consists of
physical& psychosocial elements.
Nursing: Helping service. Focuses on an individuals’
abilities and requirements for self-care
(Hanucharurnkuls, 1989, p. 367).
Synthesis
The Self-Care Deficit Nursing Theory differentiates the
focus of nursing from other disciplines.
It gives directions to nursing-specific outcomes related
to knowing and meeting the therapeutic self-care
demands of individuals.
Guides nursing administration, and is useful in the
design of curriculums for nursing education programs.
Orem’s theory continues to be expanded through the
use of theory-based computer systems, assessment
forms, and the overall structuring of the delivery of
care. This will further attest to the usefulness of this
theory.
Synthesis
Orem’s 5 essential factors for development of
nursing science: (Berbiglia & Banfield, 2006, p.
278)
1) A model of practice science
2) A valid, reliable, general theory of nursing
3) Models of the operations of nursing practice
4) Conceptual structure of the theory
5) Integrated conceptual elements of the theory
Conclusion
The critical question-What is the condition that
indicates that a person needs nursing care?-was the
starting point for SCDNT.
Theory provides a foundation for organizing
existing nursing knowledge and for the
development of new knowledge (Berbiglia &
Banfield, 2006, p. 277).
Continued efforts to expand nursing knowledge will
continue to guide nurses in their provision of care.
Annotated References
Berbiglia, V.A. & Banfield, B. (2006). Self-care deficit theory of nursing. In
M.R. Alligood & A.M. Tomey ( Eds.), Nursing theorists and their work
(pp. 265-285). St. Louis, MO: Mosby, a division of Elsevier.
This book features 37 chapters grouped into six units that covers a
bibliography for the works of each theorist. Chapter 14 includes the
evolution of nursing theories, models and philosophies related to Dorothea
Orem. Primary and secondary sources are identified with appropriate
websites related to Orem and her works.
Chinn, P.L. & Kramer, M.K. (2008). Integrated knowledge development in
nursing. (7th ed.). St. Louis, MO: Mosby, a division of Elsevier.
This book written by Chinn and Kramer, provided the definitions and
framework used in this theoretical analysis. This book explained the steps
needed to critique the theory, and was the basis for the process used.
Annotated Reference
Hanucharurnkuls, S. (1989). Comparative analysis of Orem’s and King’s theories.
Journal of Advanced Nursing, 14(5), 365-372. Retrieved from
https://search.ebscohost.com/login.aspx?direct=true&db=c8h&AN=1989094611&site
=ehost-live
This article found on CINAHL is a comparative analysis of Orem’s and King’s theories.
This article compared the nursing metaparadigm concepts of Orem’s and King’s
theories.
Hartweg, D.L. (1991). Dorothea Orem: Self-care deficit theory: Notes on nursing
theories. Newbury Park, CA: Sage Publishing.
The purpose of this volume is to present a descriptive overview of Dorothea Orem’s
Self-Care Deficit Theory of Nursing. This book is primarily intended for use by
beginning students of Orem’s theory.
Annotated Reference
McLaughlin-Renpenning, K., & Taylor, S. G. (2003). Self-care theory
in nursing: Selected papers of Dorothea Orem. New York: Springer.
This book is a collection of 38 works of Dorothea Orem consisting
of her findings related to the nursing sciences, education and
practice with regards to the structure and content. The historical
and cultural context is described in chronological order with regards
to the development of Orem’s self care deficit theory.
