Dorothea Orem
Nursing Theory
Dorothea Orem
Early 1930’s - AD from Providence School of
Nursing, Washington, D.C.
 1939 – BSN completed
 1945 - MS in nursing education
 1958 - consultant to the Office of Education
where she began working on her SELF-CARE
THEORY

Dorothea Orem
1959 - first published her theory in “Guides for
Developing Curricula for the Education of
Practical Nurses” (a government publication)
 1976 - honorary Doctorate of Science from
Georgetown University
 1999 - last edition of her theory was published

Orem’s Definition of
Nursing

Nursing is the provision of self-care which is
therapeutic in sustaining life and health, in
recovering from disease or injury, or coping with
their effects.
 Nursing is a service to people, not a derivative of
medicine.
 Nursing promotes the goal of patient self-care.
Orem’s Nursing Process
Consists of 3 steps:

Step 1: determine why a patient needs care
 Step 2: design a nursing system & plan the
delivery of care
 Step 3: management of nursing systems planning, initiating, & controlling nursing
actions
Orem’s General Theory of
Nursing

Consists of three related theories
collectively referred to as “Orem’s
General Theory of Nursing”:
1.
Self-care Theory: 3 types of self-care requisites
(needs) or categories
2.
3.
Self-care Deficit Theory: 5 Methods of Assistance
Nursing Systems Theory
Orem’s Self-care Theory

Based on the concepts of:
 SELF-CARE
 SELF-CARE AGENCY
 SELF-CARE REQUISITES
 THERAPEUTIC SELF-CARE DEMAND
Self-care Definition
 Self-care
comprises those activities
performed independently by an individual
to promote and maintain personal wellbeing throughout life.
Orem’s Self-care Agency
Definition: the individual’s ability to perform
self-care activities
 Consists of TWO agents:

– Self-care Agent - person who provides the self-
care
– Dependent Care Agent - person other than the
individual who provides the care (such as a parent)
Orem’s Self-care Requisites (also
called Self-care Needs)

Definition: the actions or measures used to provide selfcare
 Consists of THREE categories:
– Universal - requisites/needs that are common to all
individuals
– Developmental - needs resulting from maturation or
develop due to a condition or event
– Health Deviation - needs resulting from illness,
injury & disease or its treatment
Orem’s Self-care Deficit
Theory

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Is the central focus of Orem’s Grand Theory of Nursing
Explains when nursing is needed
Describes and explains how people can be helped
through nursing
Results when the Self-care Agency (patient) can’t meet
her/his self-care needs or administer self-care
Nursing meets these self-care needs through five
methods of help
Five Methods of Nursing
Help

Acting or doing for
 Guiding
 Teaching
 Supporting
 Providing an environment to promote the
patient’s ability to meet current or future
demands
Orem’s Nursing Systems
Theory Describes...

Nursing responsibilities
 Roles of the nurse and patient
 Rationales for the nurse-patient relationship
 Types of actions needed to meet the
patient’s demands
Orem’s Nursing Systems
Theory

Refers to a series of actions a nurse takes to meet
a patient’s self-care needs
 Is determined by the patient’s self-care needs
 Is composed of THREE systems:
– Wholly compensatory
– Partly compensatory
– Supportive-educative
Three Nursing Systems
Wholly Compensatory: a patient’s self-care
agency is so limited that s/he depends on others
for well-being
 Partly Compensatory: a pt can meet some selfcare requisites but needs a nurse to help meet
others
 Supportive-educative: a pt can meet self-care
requisites but needs help in decision-making,
behavior control, or knowledge acquisition

Orem’s Theory & Nursing’s
Metaparadigm - PERSON

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The recipient of nursing care
A being who functions biologically, symbolically, and
socially
Has the potential for learning & development
Is subject to the forces of nature
Has a capacity for self-knowledge
Can engage in deliberate actions, interpret experiences,
and perform beneficial actions
Can learn to meet self-care needs (requisites)
Orem’s Theory & Nursing’s
Metaparadigm - PERSON

Human beings are distinguished from other
living beings by their capacity to:
– Reflect upon themselves and their environment
– Symbolize what they experience
– Use symbolic creations (ideas, words) in thinking,
communicating, and guiding efforts to make things
that are beneficial for themselves and/or for others
Orem’s Theory & Nursing’s
Metaparadigm - ENVIRONMENT

Environmental Conditions - external physical &
psychosocial surroundings
 Developmental Environment - promotion of
personal development through motivation to
establish appropriate goals & to adjust behavior
to meet those goals
 Can positively or negatively impact a person’s
ability to provide self-care
Orem’s Theory & Nursing’s
Metaparadigm - NURSING

A service geared towards helping the self and
others
 Is required when self-care demands exceed a
patient’s self-care ability (agency)
 Promotes the patient as a self-care agent
 Has several components
Components of NURSING

NURSING ART: the theoretical base of nursing and
other disciplines such as sciences, art, humanities
 NURSING PRUDENCE: the quality that enables the
nurse to seek advice in new or difficult situations, to
make correct judgements, to decide to act in a particular
manner, and/or to act
 NURSING SERVICE: a helping service
 NURSING AGENCY: the ability of the RN
Orem’s Theory & Nursing’s
Metaparadigm - NURSING

ROLE THEORY: the role of the nurse & patient are
complementary as they work together to achieve selfcare
 SPECIAL TECHNOLOGIES:
– Social & Interpersonal technologies communicating, coordinating, establishing &
maintaining therapeutic relations, rendering
assistance
– Regulatory technologies - maintaining and
promoting life processes, growth/development, and
psycho-physiologic modes of functioning
Orem’s Theory & Nursing’s
Metaparadigm - HEALTH

Supports health promotion and health
maintenance
 Supports the premises of holistic health in that
both RN and patient promote the individual’s
responsibility for self care
Orem’s Key Contribution To
Nursing
 The
continued evolution of original
ideas to further delineate nursing
practice, functions, self-care needs, and
nursing systems based on research.