1. Self-Care Deficit Nursing Theory
Dorothea Elizabeth Orem
Shrooti shah
Lecturer
National Medical College
Nursing Campus

2. Introduction to the theorist
• Theorist : Dorothea
Orem (1914-2007)
• Born 1914 in Baltimore, US
• Received her diploma at
Providence Hospital –
Washington, DC in 1934
• 1939 – BSN Ed. And Master
of science in nursing
education (1945) from
Catholic University of
America, Washington D.C.

3. Introduction cont…
• Her clinical practice included staff nurse in the
operating room, paediatrics and adult medical
surgical units.
• She also did private-duty nursing in private homes
and the hospital and was an emergency room
supervisor.
• She taught biological sciences and later served as
director of nursing service and director of the
school of nursing at Providence Hospital,
Michigan.
• Received several honorary degrees.

4. Introduction…
• Orem’s concept of nursing as the provision of self-
care was first published in 1959.
• Orem continued to develop her nursing concepts
and her self-care deficit theory of nursing. In 1971
she published Nursing: Concepts of practice.
• The second, third, fourth, fifth and sixth editions
of this book were published in 1980, 1985, 1991,
1995 and 2001 respectively.

5. Introduction
• 1st edition: focus on individual
• 2nd edition: include multiperson units (families,
groups and communities)
• 3rd edition: Orem’s general theory of nursing,
comprised of three related theoretical constructs:
self-care, self-care deficit and nursing system
• 4th edition: fully developed the ideas presented
• 5th edition: Provided an increased emphasis on
multiperson situation
• 6th edition: continued development of orem’s
ideas

6. Orem’s general theory of nursing
Orem’s general theory of nursing in three related
parts:-
• Theory of self care
• Theory of self care deficit
• Theory of nursing system

7. Relationship of Orem’s concept to the
three theories
Theory of self -
care
Theory of self-
care deficit
Theory of nursing
system
Self-care When therapeutic
self-care demand
exceeds self-care
agency, a self-care
deficit exists and
nursing is needed.
Nursing agency
Self-care agency Nursing systems
Wholly
compensatory
Partly
compensatory
Supportive
education
Self care requisites
Universal
Developmental
Health
Deviation
Therapeutic self-
care demand

8. Theory of self-care
• Self –care is the performance or practice of
activities that individuals initiate and perform on
their own behalf to maintain life, health and well-
being.
• When self-care is effectively performed, it helps to
maintain structural integrity and human
functioning and contributes to human
development.

9. Self care agency
• Self-care agency is the human’s acquired powers
and capabilities to engage in self care.
• The ability to engage in self-care is affected by
basic conditioning factors.
• The basic conditioning factors are age, gender,
developmental stat, health state, socio-cultural
orientations, health care system factors, pattern of
living etc.

10. Therapeutic self-care demand
• Total of care activities needed, either at an
identified moment or over a period of time,
to meet a person’s known requirements for
self-care.

11. Self-care requisites
• Actions directed towards provision of self-
care.
• Three categories of self-care requisites are:
– Universal self care requisites
– Developmental self care requisites
– Health deviation self care requisites

12. Universal self care requisites
• Associated with life processes and the
maintenance of the integrity of human
structure and functioning.
• A common term for these requisites is
activities of daily living.

13. Universal self care requisites
Orem identifies self-care requisites as follows:
• The maintenance of a sufficient intake of air.
• The maintenance of a sufficient intake of water.
• The maintenance of a sufficient intake of food.
• The provision of care associated with elimination
processes and excrements
• The maintenance of a balance between activity
and rest.

14. Universal self care requisites
• The maintenance of a balance between
solitude and social interaction.
• The prevention of hazards to human life,
human functioning, and human well-being
• The promotion of human functioning and
development within social groups in accord
with human potential. Known human life,
human functioning and human well-being.

15. Developmental self-care requisites
• More specific to the processes of growth
and development and are influenced by
what is happening during the life cycle
stages; such influence may be positive or
negative.
• Ex: Adjusting to new job or adjusting to
body changes.

16. Health deviation self-care requisites
• Changes in human structure and function,
out of the range of normal, and may be
associated with genetic variations or other
defects.
• May deal with the effects of defects or
deviations and the effects of efforts to
diagnose and treat them.

17. Health deviation self-care requisites
The health deviation self-care requisites are as
follows:
• Seeking and securing appropriate medical
assistance
• Being aware of and attending to the effects and
results of pathologic condition and states
• Effectively carrying out medically prescribed
diagnostic, therapeutic and rehabilitative measures

18. • Modifying the self-concept in accepting oneself as
being in a particular state of health and in need of
specific forms of health care.
• Learning to live with the effects of pathologic
conditions and states and the effect of medical
diagnostic and treatment measures in a life-style
that promotes continued personal development.

19. Theory of self care deficit
• It is the central focus of Orem’s general theory of
nursing.
• It describes how people can be helped through nursing.
• Orem identifies 5 methods of helping:
– Acting for and doing for others
– Guiding and directing
– Providing physical or psychological support
– Providing an environment promoting personal
development
– Teaching

21. Theory of self-care deficit
• Orem has identified work operations of
nurses in clinical nursing practice:
– Entering into and maintaining nurse-patient
relationships with individuals, families, or
groups
– Designing, planning for, instituting, and
managing systems of nursing care
– Responding to patients’ requests, desires and
needs for nurse contact and assistance.

22. Theory of self-care deficit
• Coordinating nursing care
• Establishing the kind and amount of immediate
and continuing care needed
• Coordinating the care with other services, such as
other health care, social, or educational services,
needed or being received.
• Discharging patients from nursing care when they
have regained their abilities to perform their own
self-care needs

23. C. Theory of Nursing Systems
• This theory describes how the patient’s self care
needs will be met by the nurse, the patient, or
both.
• If there is a self-care deficit- that is, if there is a
difference between what the individual can do
(self-care agency) and what needs to be done to
maintain optimum functioning (therapeutic self-
care demand)- nursing is required.

24. Classification of nursing system
It identifies 3 classifications of nursing
system to meet the self care requisites of the
patient:-
• Wholly compensatory system
• Partly compensatory system
• Supportive – educative system

25. Wholly compensatory system
• Represented by a situation in which the individual
is unable to carry out needed self-care actions,
either through inability to be self-directed or due
to medical prescription.
• Those who have such limitations are dependent
upon others for their well-being and even their
very existence.

26. Wholly compensatory system
• Subtypes of this system are:
o unable to engage in self care(person in coma).
o aware but could not engage in self-care(person
with C3-C4 vertebral fracture)
o Include persons who are severely mentally
impaired (senile persons, some forms of mental
retardation).

27. Partly compensatory system
• It is used when a patient can meet some
self-care requisites but needs a nurse to
help meet other needs; the nurse and the
patient play major role in performing self-
care.
• For example: a patient undergone
abdominal surgery.

28. Supportive – educative system
• It is used when a patient can meet self-
care requisites but needs assistance with
decision making, behavior control, or
knowledge acquisition skills.
• For e.g, patient with controlled HTN who
seeks additional diet information from the
nurse: in this system, the nurse attempts
to promote the self-care agency.

29. Orem states that one or more of these
three types of nursing systems may be
used with a single patient over a
period of time

32. Major Assumptions
• All patients wish to care for themselves.
• Humans are capable and willing to engage in self-care and
care for dependent members of the family.
• Self-care and dependent care are learned behaviors through
human communication and interaction with each other.
• Nursing is a deliberate helping actions performed by
nurses for the benefits of others over a certain period of
time.

33. Major Assumptions
• Humans are supposed to be self-reliant and responsible for
their self-care needs and care needs for dependent
members of the family.
• Humans are unique individuals that are separated from
each other and from their environment.

34. Four Major Concepts of Orem’s
Theory
• Person
• Health
• Environment
• Nursing

35. Person
• Person is defined by Orem as the patient (a
recipient of nursing care)- a being who functions
biologically, symbolically, and socially and who
has the potential for learning and development.
• Person is an individual, who is with the capacity
for self knowledge, who can engage in deliberate
action, interpret experiences, and perform
beneficial actions

36. Health
• A state characterized by soundness or
wholeness of bodily structure and function;
illness is its opposite.
• It consists of physical, psychological,
interpersonal and social aspects; these aspects
are inseparable.
• Health includes promotion and maintenance of
health, treatment of illness, and prevention of
complications.

37. Environment
• Environment consists of environmental factors,
environment elements, environmental conditions
(external physical and psychological surrounding),
and developmental environment.
• Environment can positively or negatively affects
the person’s ability to provide self care.

38. Nursing
• Orem defines the art of nursing as an intellectual
quality of the individual nurse; this quality is
related to creativity as well as analysis and
synthesis of information, all of which contribute to
development of nursing systems to assist
individuals or multiperson units.

39. Nursing
• Orem further defines nursing as a human service.
• Nursing is distinguished from other human
services by its focus on persons with inabilities to
maintain the continuous provision of health care.

40. Nursing cont…
Goal of nursing is:
• to render the patient or members of his family
capable of meeting the patient’s self care needs
• to maintain a state of health
• to regain normal or near normal state of health in
the event of disease or injury
• to stabilize ,control ,or minimize the effects of
chronic poor health or disability

42. Comparison of Orem’s Nursing Process
and Nursing process
Nursing Process Orem’s Nursing Process
1. Assessment
2. Nursing
Diagnosis
3. Plans with
scientific
Rationale
4. Implementation
5. Evaluation
Step I: Diagnosis and prescription,
determine why nursing is needed.
Analyze and interpret- make
judgment regarding care.
Step II: Design of a nursing
system and plan for delivery of
care.
Step III: Production and
management of nursing systems.

43. Orem’s Theory and the Nursing
Process
The steps of Orem’s nursing process may be as
followed.
• Step I: nursing diagnosis and prescription: the
initial and continuing determination of why a
person should be under nursing care.
• Step II: the designing of the nursing system
and planning for the delivery of nursing care
• Step III: The production and management of
nursing systems, also labelled planning and
controlling.

44. Orem’s Theory and the Nursing
Process
Step 1-collect data in six areas:-
• The person’s health status
• The physician’s perspective of the person’s health
status
• The person’s perspective of his or her health
• The health goals within the context of life history
,life style, and health status
• The person’s requirements for self care
• The person’s capacity to perform self care

45. Orem’s Theory and the Nursing
Process
• 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

46. Orem’s Theory and the Nursing
Process
• 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

47. Patient Profile
Areas Patient details
Name
Age
Sex
Education
Occupation
Marital status
Religion
Diagnosis
Theory applied
Mrs. Yaita Maya Limbu
56 years
Female
No formal education
House hold
Married
Buddhist
Rheumatoid arthritis
Orem’s theory of self care
deficit.

48. History
• She came to the hospital with complaints of pain over
all the joints, stiffness which is more in the morning
and reduces by the activities.
• She has these complaints since 5 years and has taken
treatment from local hospital.
• The symptoms were not reducing and came to
NMCTH for further management.
• Patient was able to do the ADL by herself but the way
she performed and the posture she used was making
her prone to develop the complications of the disease.
• She also was malnourished and was not having
awareness about the deficiencies and effects.

49. Basic conditioning factors
Age 56 years
Gender Female
Health state Disability due to health condition
Development state Ego integrity vs despair
Socio-cultural orientation No formal education, Nepali, Buddhist
Health care system Treatment from local hospital and
Medical College
Family system Married, husband Labourer
Patterns of living At homewith partner
Environment Rural area, items for ADL not in easy
reach, no special precautions to
prevent injuries
Resources Husband, daughter, son

50. 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 Food intake is not adequate.
Elimination Voids and eliminates bowel without difficulty.
Activity/ rest Frequent rest is required due to pain.
Pain not completely relieved,
Activity level has come down.
Social interaction Communicates well with neighbors and calls the daughter
by phone, need for medical care is communicated to the
daughter.
Prevention of hazards Need instruction on care of joints and prevention of
falls. Need instruction on improvement of nutritional status.
Prefer to walk bare foot.
Promotion of normalcy Has good relation with daughter

51. 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
husband and daughter.

52. Health deviation self care requisites
Adherence to medical
regimen
Reports the problems to the physician when in
the hospital. Cooperates with the medication,
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
Modification of self image
to incorporates 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

53. Priority of nursing problems according to orem’s
theory of self care deficit
• Air
• Water
• Food
• Elimination
• Activity/ Rest
• Solitude/ Interaction
• Prevention of hazards
• Promotion of normalcy
• Maintain a developmental environment.

54. Priority of nursing problem according
to Orem’s theory of self care deficit
• Prevent or manage the developmental threats
• Maintenance of health status
• Awareness and management of the disease
process.
• Adherence to the medical regimen
• Awareness of potential problem.
• Modify self image
• Adjust life style to accommodate health status
changes

55. Nursing Diagnosis
• Altered nutrition less than body requirement related to
inadequate intake and knowledge deficit
• Self-care deficit: dressing, toileting related to restricted
joint movement, secondary to the inflammatory process in
the joints.
• Pain related to lack of utilization of pain relief measures
• Risk for fall and injury related to joint pain.
• Risk for impaired skin integrity related to edema
• Knowledge deficit regarding disease condition and
treatment related to lack of information.

56. Application of Orem’s self-care deficit
theory in nursing practice, education and
research
Practice
• Many articles document the use of the self-care
theory as a basis for clinical practice.
• Orem’s self-care deficit theory has been used in
the context of the nursing process to teach patients
to increase their self-care agency to evaluate
nursing practice and to differentiate nursing from
medical practice.

57. Application of Orem’s self-care deficit
theory in nursing process
Education
• Orem’s self-care deficit theory has been the focus
of the curriculum in nursing education at many
schools of nursing.
Research
• The self-care theory provided conceptual
framework for many researches.

58. Orem’s work and characteristics
of theory

59. Theories can interrelate concepts in such a
way as to create a difference
• Orem’s theoretical constructs of self-care, self-
care deficits and nursing systems are interrelated
in her general comprehensive theory of nursing
which is unique phenomena.

60. Theories must be logical in nature
• Orem’s theory follows a logical thought process.
She states her general theory, that presents the
central idea of each of the three interrelated
theories.
• Statements that describe a concept or explain and
predict relationship between two concept.

61. Theories should be relatively simple yet
generalizable
• The theory is used by several colleges of nursing
as a theoretical foundation for students’ basic
preparation for practice.
• The theory can be applied to all individual patients
and with further adaptation, to multiperson units.

62. Theories can be the bases for the hypothesis that
can be tested or for theory to be explained
• Several researchers tested Orem’s theory in the
area of self-care agency including studies focused
on the development of tools to measure aspects of
self-care.

63. Theories can be used by practitioner to
guide and improve their practice
• Theory focuses on nursing a helping art that
assists an individual to meet self-care needs and
that is the foundation for nursing practice.
• Adds nursing’s body of knowledge.

64. Theories must be consistent with other validated
theories, laws, principles but leave unanswered
questions that need to be investigated.
• Consistent with role theory, need theory, field
theory and health promotional concepts.

65. Critiques of Orem’s Theory

66. Strengths
• Provides a comprehensive base to nursing practice
• It has utility for professional nursing in the areas of
nursing practice, curricula, education, administration,
and research
• Specifies when nursing is needed
• Her self-care approach is contemporary with the
concepts of health promotion and health maintenance
• Expanded her focus of individual self-care to include
multiperson units

67. Limitations
• In general system theory, a system is viewed as a
single whole thing while Orem defines a system as
a single whole, thing.
• Appears that the theory is illness oriented rather
with no indication of its use in wellness settings.