Dorothea Orem
•Jennifer Ames
•Charles Dietrich
•Holly Leveille
Why do people need
nursing?
What if every individual adult has the capacity
for self-care; however, when a health problem
arises it is possible that this capacity is
insufficient to confront the situation, making it
then necessary to receive help from other
persons who compensate for this deficit
Dorothea
Orem’s
motivation for
developing her
self care theory
The theory begins to take shape

In 1957 while working for the US Department
of Health, Education and Welfare as curriculum
consultant, Dorothea attempted to plan a
nursing curriculum for licensed practical nurses.
She was searching for a pragmatic framework
to organize nursing knowledge. Her focus was
on the questions “What is nursing?” and “When
do people need nursing care?” and from this
she theorized that people need nursing when
they are unable to care for themselves.
Shape into a book
In 1971, she presented the Self- Care
Deficit Theory of Nursing (S-CDTN) in
the book Nursing Concepts of Practice
 She incorporates the medical model
rather than rejects it, centers on the
individual, is problem oriented, and is
easily adaptable in varied clinical
situations.

Orem’s Theory of Nursing
Theory of
self care
deficit
Theory of
self care
Theory of
nursing
system
Theory in depth
Theory of self care- Health deviation selfcare is required in conditions of illness, injury, or
disease
 Theory of self care deficit- nursing is
required when an adult is incapable or limited in
the provision of continuous, effective self-care.
 Theory of nursing system- is how the
patient's self-care needs will be met by the
nurse, the patient, or by both

 “It
is the existence of a self-care deficit
that indicates the need for nursing.”
(Banfield, 2001)
Orem defines nursing
Nursing is a service to people, not a
derivative of medicine.
 Nursing has responsibilities
 Roles of nurse and the patient
 Rational of nurse/patient relationship
 Type of actions needed to meet the patients
demands


Her theory helps make nursing a legitimate
science
Global Concepts
1.The human being
2.Environment
3.Health
4.Nursing
Human being
A person is composed of physical,
psychological, interpersonal, and social
aspects.
 They have the potential for learning and
develop a way to meet self care needs
 Symbolize what they experience

Environment
Is anything outside of or external to the
person.
 Can positively or negatively effect a
persons ability to function

Nursing
Promotes the health of self and that of
service of helping others.
 It is actions by the nurse to overcome or
prevent self care limitations.
 A nurse may have to provide service that
is wholly compensatory or partly
compensatory and also educate the client.

Nursing cont:



wholly compensatory nursing system- the nurse
supports and protects the client, compensates for the
client’s inability to care for self, and attempts to provide
care for the client.
partly compensatory nursing system- both the
nurse and client perform care measures.
supportive-educative nursing system- the nurse’s
actions are to help clients develop their own self-care
abilities through knowledge, support, and
encouragement
Health
Is the internal and external conditions
that permit self-care needs to be met
 The person as a whole
 It is a team effort by the nurse and
patient for the promotion of self care

Interpretation & Inferences
Goal of self care is to promote health and well
being.
 A human being is the focus of nursing only when
self care demand surpasses self care capabilities.
 Actions are deliberate, systematic, and purposeful.
 “Deliberate action refers to actions performed by
individual human beings who have intentions and
are conscious of their intentions to bring about,
through their actions, conditions or states of
affairs that do not at present exist” (Orem, 2001,
pp 62-63).

Interpretation & Inferences
A person needs to engage in behaviors that will
regulate self & the environment (Banfield, 2011).
 The environment can positively or negatively
affect the health and well being of individuals
(Orem, 2001).
 A nurse within the healthcare environment will
help patients develop their capabilities to meet
self care requisites.
 Patient and nurse variables are not determinants
of health rather can influence under various
circumstances at various points in time.

Implications & Consequences
The Institute of Medicine (IOM) called for
a redesign of the country’s healthcare
system.
 Shift from acute care to management of
chronic health problems.
 Six goals of healthcare identified:

◦ Safe, effective, patient centered, efficient,
timely, & equitable.
Implications & Consequences
These change will continue to influence a
patient’s self care demand and agency.
 Patients manage their health conditions,
not healthcare providers.
 Nurses influence will increase to assist
patients in developing their abilities to
meet their self care demand.

Long Term Impact on Nursing




Nurse-patient relationship was refocused to
include a more intertwined connection.
Nurses were given a sense of direction for the
development and management of the nursing
practice.
Provided framework for nurses to focus on the
individual’s self-care ability and ensuing plan of
care, not the disease process.
Dorothea Orem delineated the why, what, and
how of nursing especially in the notion of design
in the nursing process (Clarke et al, 2009).
Evaluation of the nursing model
“Orem’s work is widely used in nursing education
and practice” (Chitty & Black, 2011, pg 311). The
self-care theory framework was formulated as
Orem experienced a period of intensive exposure
to nurses and their activities from 1949 to
1957(Fawcett, 1995).
Orem’s self-care model addresses the four global
concepts of human being, environment, health, and
nursing but also adds in the nursing process of
problem identification and planning (why is the
person under care, what is the plan of care, and
implementation of care).
Evaluation of the nursing model
Orem’s self-care theory can be used in all settings because the theory
starts with maintenance of sufficient intake of air, water, and food. The
theory also focuses on elimination and balancing activity with rest.
Because these the necessities of the basic life functions, this theory
can be used in any department. The concepts are easily understood in
which the nursing process is used to determine the self-care deficit.
The self-care theory would be used in dealing with illness, injury, or
disease such as cancer, a heart attack, a stroke, or even adjusting to a
different job because of a condition.
Case Study

54 year old male is admitted to the floor with the diagnosis of acute
myocardial infarction. He lives in a rural community and lives with his wife
and two young children. He is a truck driver by trade who drives long
hours cross country daily. He admits to drinking lots of caffeine and living
mostly on fast food with little consumption of vegetables or fruit in his
diet. The patient’s past medical history is only significant for hypertension
while his surgical history is positive for total knee arthroplasty and
cholecystectomy. His father has a history of cardiovascular disease and
dies at the age of 62, while his mother has a history of breast cancer. The
patient experienced onset of symptoms at home while shoveling snow
after a large storm. Pt states he experienced chest tightness and shortness
of breath. He stated he took a break and symptoms stopped. He
continued then to finish shoveling and upon return to his home he became
increasingly short of breath, diaphoretic, and felt a gripping and twisting in
his chest. Upon arrival to the hospital the patient showed ST segment
changes and troponin levels were elevated. Pt was immediately taken to
the cath lab with successful surgical interventions. The patient is now
staying overnight for recovery. The patient tells the nurse he is depressed
and worries how he is going to manage his condition while on the road for
his job.
Questions
According to Orem’s theory nursing intervenes:
1.
a)
b)
c)
When the demands for self care are greater than the
individual is able to achieve on their own.
To reduce the stressors interacting with an individual.
To promote adaptation in the patient through modification.
2.
In utilizing the self care theory in this situation, the nurse
will provide interventions to improve the well-being of the
patient by having the opportunity to teach the patient to
help control the impact that cardiovascular disease can
have on his life. (T/F)
3.
According to Orem’s theory the patient will actively
participate in their own care by demonstrating conscious
actions to regulate his health and well-being. (T/F)
Questions
4.
In utilizing Orem’s theory of the nursing system, match the nursing
system with the action provided by the nurse.
___Supportive-educative
compensatory
a)
b)
c)
5.
6.
_____wholly compensatory
____partly
Monitor the patient’s ability for independent care and providing assistance until patient is
fully able to resume activities of daily living.
Reducing the patient’s pain post operatively through parenteral medications.
The nurse’s assessment identified key areas of his health condition and the adequacy of his
current activity/rest patterns. The patient identifies what activity and rest mean to them and
current exercise plan. Together they come up with an activity schedule and establish
priorities.
The nurse working with the patient regarding meal planning and dietary
restrictions while on the road is an example of a nursing intervention
utilizing the theory to help patient achieve their self care requisites.
(T/F)
The nurse, understand that environmental factors can positively or
negatively affect the health of an individual, will focus on the patient’s
ability to change environmental factors such as diet, exercise, and activity
rather than focusing on the cardiovascular disease process when utilizing
Orem’s theory. (T/F)
References
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Mosby Elsevier.
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