Theorist : Dorothea Orem (1914-2007). She worked as a staff nurse, private duty nurse, nurse educator and administrator and nurse consultant. Kufa University - College of Nursing

1. Dorothea Orem - Self-care theory
Prepared by :
MSc. Student : Amjed A. Shraida
Kufa University – College of
Nursing
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2. • Theorist : Dorothea Orem (1914-2007).
• She worked as a staff nurse, private duty nurse,
nurse educator and administrator and nurse
consultant.
Introduction
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3. Derivation of theory
1. Orem generated a simple yet important question: Why
do people need nursing?
2. Her answer was the inability of persons to provide
continuously for themselves the amount and quality of
required self-care because of situations of personal
health.
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4. Nursing
Nursing is an art through which the practitioner of nursing gives
specialized assistance to persons with disabilities to meet needs of
self-care.
Humans
Humans are defined as “men, women, and children cared for
either singly or as social units,” and are the “material object” of
nurses and others who provide direct care.
Metaparadigm of the Self-Care
Deficit Theory
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5. Environment
The environment has physical, chemical and biological
features. It includes the family, culture, and community.
Health
Health is a state of physical–psychological, structural–
functional soundness and wholeness.
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6. Self-care deficit nursing theory : grand theory
originally composed of three interrelated theories:
A. the theory of self-care,
B. the theory of self-care deficit,
C. the theory of nursing systems.
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8. A) Theory of Self-Care (TSC) :
This theory Includes:
1. Self-care : practice of activities that individuals initiate and perform
on their own behalf in maintaining life, health, and well-being.
2. Self-care agency : is the human’s ability or power to engage in self-
care and is affected by basic conditioning factors.
Basic conditioning factors are age, gender, developmental state,
health state, sociocultural orientation, healthcare system factors,
family system factors, pattern of living, environmental factors, and
resource availability and adequacy
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9. 3. Therapeutic Self-care Demand : which is the total self-care actions
to be performed over a specific duration to meet self-care
requisites by using valid methods and related sets of operations
and actions;
4. Self-care Requisites or requirements can be defined as the purposes
or goals for which actions are performed for life, health, and well-
being. It is presented in three categories:
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10. Categories of Self-care Requisites or
requirements
a. Universal self-care requisites : requisites are necessary for all human
beings of all ages and in all conditions , include
 Sufficient intake of air , Water and Food
 Balance between activity and rest
 Balance between solitude and social interaction
 Prevention of hazard
 Promotion of normalcy : The goal is promotion of human functioning
and development within social groups in accord with human potential,
human limitations, and the human desire to be normal
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11. b. Developmental self-care requisites : Developmental self-care requisites
are associated with developmental processes, derived from a condition
or associated with an event.
c. Health deviation self-care requisites are required in conditions of illness,
injury, or disease. These include:
 Seeking and securing appropriate medical assistance
 Being aware of and attending to the effects and results of pathologic
conditions
 Effectively carrying out medically prescribed measures
 Modifying self-concepts to accept oneself as being in a particular state of
health and in specific forms of health care
 Learning to live with the effects of pathologic conditions.
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12. B) Theory of self-care deficit, specifies when nursing is needed.
According to Orem, nursing is required when an adult is incapable or
limited in the provision of continuous, effective self-care.
The theory identifies five methods of helping:
1. acting for and doing for others;
2. guiding others;
3. supporting another;
4. providing an environment promoting personal development in relation
to meet future demands;
5. teaching another.
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13. C) The theory of nursing systems describes how the patient’s self-care
needs will be met by the nurse, the patient, or by both.
Orem identifies three classifications of nursing system to meet the self-
care requisites of the patient:
1. Wholly compensatory system,
2. Partly compensatory system,
3. Supportive-educative system.
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14. Wholly compensatory system
Partially compensatory system
supportive-educative system
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15. 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 behaviors
 Self-care and dependent care are behaviors learned within a socio-
cultural context
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16. Strength
1. It is applicable for nursing by the beginning practitioner as well as
the advanced clinicians.
2. Provides a comprehensive basis for nursing practice, nursing
education and administration.
3. The terms self-care, nursing systems, and self-care deficit are
easily understood by the beginning student nurse
4. She specifically defines when nursing is needed
5. Self-care approach is contemporary with the concepts of health
promotion and health maintenance.
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17. Limitations
 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 in three static conditions
which she refers to a “concrete nursing system,” which connotes
rigidity.
 Throughout her work, there is limited acknowledgement of the
individual’s emotional needs.
 Health is often viewed as dynamic and ever-changing.
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18. Dorothea Orem’s Theory and The
Nursing Process
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.
 Production and management of nursing systems.
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19. 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
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20. Step 2 - Nursing Diagnosis & Care Plans
 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 combination of ways of helping that will be effective
and efficient in compensating for/overcoming patient’s self-care
deficits.
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21. Step 3 Implementation & Evaluation
 Nurse assists the patient or family in self-care matters to
achieve identified and described health and health-related
results. Collecting evidence in evaluating results achieved
against results specified in the nursing system design.
 Actions are directed by etiology component of nursing
diagnosis.
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22. Application of Orem’s theory to nursing
process
Nursing diagnosis Planning
Method of
helping
Interventions
Inability to maintain the ideal
nutrition related to inadequate
intake and knowledge deficit
To achieve optimal
levels of nutrition.
Guidance ,
support ,
teaching
Mutually planning and
identified the objectives
and make the patient
understand about the
required changes in the
behavior to have the
requisites met.
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