Dorothea Orem

and
The Self Care Deficit Theory
-Introduction/ Recap-
• Concepts are the building blocks of theory, and can be
abstract ideas, mental images of
phenomena of reality

• Nursing theories address and specify relationships among

4 major concepts:
1.) Person or client
2.) Environment
3.) Health/illness
4.) Nursing

• Every theorist’s definition of each concept or theory

changes along with their personal philosophy, orientation,
experiences, and theoretical view on nursing.
-Dorothea E. Orem: Life and
Works-
• Creator/Theorist of “Self Care Theory”
• One of America’s foremost nursing theorists
• Born in Baltimore, Maryland in 1914
• Started nursing career at Providence Hospital School of
Nursing in 1930s
• BSN and MSN Education from Catholic University of
America, 1939, 1946
• Developed “Guides for Developing Curricula for the
Education of Practical Nursing”,
• 1959
• “Nursing: Concepts of Practice”, 1971
• “Concept Formalization in Nursing Concepts of Practice”,
1972-2001
-Theoretical Sources-
• The primary source for Orem's ideas about nursing was her
experiences in nursing.

• The question that directed Orem's thinking was, "What

condition exists in a person when judgment are made
when a nurse(s) should be brought into the situation?".

• The condition that indicates the need for nursing

assistance is "the inability of persons to provide
continuously for themselves the amount and quality of
required self-care because of situations of personal
health".
• Originally, three specific theories were articulated; the
theory of nursing systems, the theory of self-care deficits,
and the theory of self-care.

• Therefore, the SCDNT with its conceptual elements and 4

theories identifies the substance or content of nursing
science.

• An additional theory was added: the theory of

dependent-care.
4 Categories of Postulated Entities of the SCDNT.
• Persons in time-space localizations
• Attributes or properties of these persons
• Motion and change
• Products brought into being

5 Broad Views of Human Beings

• Person
• Agent
• User of Symbol
• Organism
• Object
-Major Terms-
1.) Self-Care 10.)Dependent Care
2.) Dependent Care Agency
3.) Self-Care Requisites 11.) Self Care Deficit
(SCR) 12.) Dependent Care
4.) Universal SCR Deficit
5.) Developmental SCR 13.) Nursing agency
6.) Health Deviation SCR 14.) Nursing Design
7.) Therapeutic Self-Care 15.) Nursing Systems
Demand 16.) Helping Methods
8.)Dependent Care 17.) Basic conditioning
Demand factors
-Metaparadigm in Nursing-

Focuses on “Self Care”, defined as goal

oriented activities set towards generating
interest in the part of the client to maintain
life and health development
1.) Person/Client:
• Human beings are different from other living
beings in terms of capacity. Humans can reflect
upon events, themselves, and environment. Orem
believes that individuals have the potential to be
developed and learned.

• A client can initiate/perform self-care activities on

own behalf to maintain life, health, and well-
being.
2.) Environment

“Environment is an external source of

influence in the internal interaction of a
person’s different aspects. Environment
is linked to the individual, forming an
integrated and interactive system.”
3.) Health/ illness:
• Orem supports WHO’s definition of health. Orem
believes that health should be perceived this way,
because aspects of health are inseparable.

• “State of complete physical, mental and social

well being and not merely the absence of disease
and infirmity”

• Orem presents health based on preventive health

care. This model of healthcare promotes
prevention of diseases and maintenance of health,
the treatment of disease or injury of prevention of
complications.
• Health is a state characterized by
soundness or wholeness of
developed structures and at bodily
and mental functioning.
4.) Nursing (Role)
• Nursing is a helping/assisting service to
people who need help; infants, sick
people, the elderly, and people who
cannot care for themselves at any level or
stature.

• Human beings help other human beings;

and such is a creative gift.
• Nurses help clients to establish/ identify
ways to perform self-care activities.

• Nurses’ actions are geared on patient

independence. If a person is dependent,
nurse will have to attend to the said
patient.

• Nursing is a human service. It is

distinguished from other human services
and other forms of care by its focus on
human beings.
-Self Care Deficit theory of nursing-
• The said theory is a general
theory composed of four
theories:

1.) Self Care Theory

2.) Theory of Dependent Care
3.) Theory of Self-Care Deficit
4.) The Theory of Nursing Systems
1.) Self Care Theory
• explains why and how human beings
are able to take care of themselves, or
how such an activity promotes total
well-being. Self-care comprises of
practices and habits that an individual
does in importance and valuing their
life and maintaining such. Continues
as life goes on into maturity by
meeting Self Care Requisites.
a.) Universal Self-Care Requisites:
1.) air
2.) food
3.) water
4.) Provision of care associated with elimination
processes and excrement
5.) balance between activity and rest
6.) balance between solitude and social
interaction
7.) Prevention of hazards
8.) Promotion of human being functioning and
development within social groups.
b.) Developmental Self-Care Requisites:

1.) Provision of conditions that promote

development

2.) Engagement in self-development

3.) Prevention of or overcoming effects of human

conditions and life situations that can adversely
affect human development
c.) Health Deviation Self Care Requisites

Exists for individuals who are ill or injured, who have

pathological disorders, disabilities or defects, or
under medication or treatment. Care measures are
given to meet existent health deviations.

The number and complexity of an individual’s self-

care systems or modifications depend on the
number of health deviations the patient has, and
must be met with specific time frames.
2.) Theory of Dependent Care
• Explains how family members
and/or friends provide care for a
socially dependent person;
elaborates how the self-care
system is modified when it is
directed towards a socially
dependent person and needs
assistance.
Dependent Care Agency
• Refers to the acquired ability of a
person to know and meet the
therapeutic self-care demand of the
dependent person and/or regulate
the development and exercise of the
dependent’s self care agency.
3.) Theory of Self-Care deficit
• explains why and how people can be
help through nursing, asserts that
individuals benefit from nursing
because of client’s health related
limitations in providing self-care.
Limitations result in illness, injury, or
other forms /effects of medical tests or
treatments. Two variables affect these
deficits:
Self-Care Deficit
• Is the relationship between an
individual’s therapeutic care demand
and his/her powers of self care agency
in which the constituent-developed
self care capabilities within self care
are inoperable.
• a.) Self Care agency (complex acquired
ability of mature and maturing persons to
know and meet their requirements for
health)

• b.) Therapeutic Self Care demands

(measures of care required)

Self-Care deficits are results when self-care

agency is not adequate enough to meet the
known self-care demand.
Basic Conditioning Factors
• Affects the value of therapeutic self care demand. These
are circumstances or situational factors that affect actions
of care.
a.) Age
b.) Gender
c.) Developmental state
d.) Health state
e.) Pattern of living
f. ) Health car2e system factors
g.) Family system factors
h.) Sociocultural Factors
i. ) Availability of resources
j. ) External Environmental factors.
 Helping Methods
• Acting or doing for another
• Guiding, coaching, and directing
• Providing physical and psychological support
• Providing and maintaining a supportive
environment for personal development
• Teaching others
4.)The Theory of Nursing Systems

• Postulates that nursing systems form when

nurses prescribe, design, and provide
nursing that regulates therapeutic self-care
capabilities and meets therapeutic self-
care requirements. 3 types of nursing
systems are identified.
Nursing systems
• Series and sequences of deliberate
practical actions of nurses performed
at times in coordination with the
actions of their patients to know and
meet components of patients’
therapeutic self-care demands and to
protect and regulate the exercise of
patients’ self care agency.
• The design and elements of the nursing system make
clear:

a.) Scope of the nursing responsibility in health care

situation

b.) The general and specific roles of nurses, patients, and

others

c.) Reasons for nurses relationships with patients

d.) The bonds of actions to be performed and nurses’ and

patient’s actions in regulating self-care agency and in
meeting the therapeutic self-care demand.
 FURTHER DEVELOPMENT

• publication of the first edition of Nursing: Concepts of

practice was in 1971
• sixth and final edition was published in 2001
• two foci: nursing as unique field of knowledge and nursing
as practical science
• IOS was established in 1993 for the purpose of advancing
nursing science and scholarship
• in 2015 the official name of the organization became
Orem International Socirety of Nursing Science and
Scholarship