Dorothea Orem’s Self-Care Theory

Orem Self Care Theory

One of America’s foremost nursing theorists and author, Dorothea Elizabeth Orem, is credited with developing the Orem Concept of Nursing or Nursing Model. She was born in 1914 and passed away in the year 2007. She described nursing as “The act of helping people achieve and maintain optimal human functioning through the provision and administration of self-care.

Dorothea Orem formulated the theory and concept of self-care. According to her, this theory is defined as the act of helping others maintain or increase human functioning at the home level of effectiveness by providing and managing self-care.

Biography of Dorothea Orem

Orem was involved in theory development throughout her career. And in January 2001, the sixth edition of her work was published by Mosby.

  • Early Years of Dorothea Orem

In 1931, Dorothea Orem earned her high school diploma from Seton High School in Baltimore. She studied nursing at the Providence Hospital School of Nursing in Washington, D.C., where she graduated in 1934. Dorothea went on to acquire a bachelor of science degree in nursing education in 1939 and a master of science or degree in nursing education in 1945.

Throughout her nursing career, Dorothea earned numerous honorary doctorate degrees, which serve as evidence of her career achievements. She was awarded honorary doctorates of science in 1976 at Georgetown University and in 1980 at Incarnate Word College. Additionally, in 1998, the University of Missouri in Columbia bestowed upon her the honorary degrees of Doctor Honoris Causa, and in the same year, Illinois Wesleyan University awarded her the honorary doctorate of humane letters.

  • Personal Life of Dorothea Orem

Dorothea Orem was born on July 15, 1914, in the city of Baltimore, in the United States of America. Her father worked as a construction worker, and her mother is a stay-at-home mother who looks after the family. In the family, she was the youngest.

Orem graduated from the Providence Hospital School of Nursing in Washington, D.C., in the early 1930s, with a diploma in nursing in her hand. She earned her Bachelor of Science in Nursing in 1939 and her Master of Science in Nursing in 1945 from the CUA (Catholic University of America) located in Washington, D.C., where she also worked as a clinical instructor.

  • Employment and Appointments of Dorothea Orem

Having a distinguished career in nursing, Dorothea filled in highly valued nursing positions from several esteemed places, such as the dictatorship in both nursing school and nursing department at the school she earned her diploma (Providence Hospital) located in Detroit in the year 1940 up until 1949.

Her job also entailed teaching biological sciences and nursing from the years of 1939 until 1941. Dorothea worked as an associate professor at the Catholic University of America from 1964 to 1970, as an assistant professor at the same institution from 1959 to 1964, and as the Dean of the school of nursing from 1965 to 1966.

The Office of Education, United States Department of Health and Welfare also hired her to fill in the role as a curriculum consultant for the Practical Nurse Section of the United States Department of Health, Education, and Welfare for three years. (1958-1960). Dorothea worked on the modification of the “Local Programs for Practical Nurse Exam” in 1960.

She also worked for the Division of Hospital and Institutional Services, the Indiana State Board of Health, in 1956. From 1969 to 1971, she worked for the Johns Hopkins Hospital’s Center for Experimentation and Development in Nursing, and from 1975 to 1976, she worked for the Johns Hopkins Hospital’s Director of Nursing at the Wilmer Clinic. From 1986 to 1987, she had consultant records at The Mississippi Methodist Hospital and Rehabilitation Center.

Apart from that, U of A (University of Alberta), George Brown College of Applied Arts & Technology, GU (Georgetown University), The Medical College of Virginia, Incarnate Word College, EPCC or El Paso Community College, and the Washington Technical Institute were some other institutions Orem served as a curriculum consultant. The following are other consulting records: ANA PRSO Project in the year 1975, Regional medical program in Washington, U.M School of Public Health, etc.

  • Works of Dorothea Orem

Among the publications, she assisted with were the “Guides for developing curricula for the education of practical nurses” in 1959. Orem’s Nursing: Concepts of Practice (A nursing textbook in its fifth edition), published in 1971, is the work in which she presents her nursing theory, the Self-care Deficit Theory of Nursing, which she developed.

The popularity of this work, as well as the theory it conveys, cemented Orem’s position as a key theorist of nursing practice and education. In 1973, she organized the work of the Nursing Development Conference Group, which she chaired, into a book titled Concept Formalization in Nursing (which was published in 1979). Throughout the 1970s and 1980s,

she published a slew of more articles and gave presentations on her work at conferences and seminars all over the world. As a means of advancing the study and advancement of Orem’s nursing theories, an international nursing society, the International Orem Society, was founded.

In 1980, an updated and revised version of the Concept of Practice (second edition) was released. Despite being retired four years after the second edition had been published, the third edition of Orem’s book was published in 1985. The fourth edition was completed in 1991. In the meantime, she worked on refining the theory behind Self-Care Deficit Nursing.

  • Awards and Honors of Dorothea Orem

Dorothea Orem also received numerous accolades throughout her career, including the CUA (Catholic University of America) Alumni Achievement Award for her Theory in Nursing in 1980, the NLN Linda Richards Award in 1991, and Honorary Fellowship in the AAN in 1992.

Additionally, she got honorary degrees from Georgetown University, Incarnate Word College, Illinois Wesleyan University, and the Mizzou (University of Missouri) located in Columbia for her services to nursing.

She was elected into the AAN and was recognized by the National League for Nursing and the Honor Society of Nursing (Sigma Theta Tau Intl.)

The Self-Care Deficit Theory of Dorothea Orem

The Self Care Deficit theory and concept of self-care is defined as the act of helping others maintain or increase human functioning at the home level of effectiveness by providing and managing self-care.

In this context, self-care is described as “Maintaining one’s health, life, and well-being via one’s efforts.”

A. Assumptions of the Self-Care Deficit Theory

  • Humans must constantly communicate with one another and with the rest of their environment if they are to survive and operate properly.
  • What is needed to make the right decisions is determined by behaving purposefully.
  • For mature human beings, this means making life-sustaining and function regulating acts to take care of themselves or others in the best possible way.
  • Finding, creating, and passing along methods for determining one’s own and others’ needs and providing inputs into them are all examples of human agency in action.
  • Care is provided by groups of human beings with established relationships who pool their resources and divide up the work of looking after one another.

B. Major Concepts of the Self-Care Deficit Theory

  • Nursing – As a form of art, nursing entails the provision of specialized care to people with disabilities or special needs who require more than just basic help to meet their most fundamental requirements. Additionally, the nurse frequently asks insightful questions of the doctor in addition to being actively involved in the patient’s medical treatment.
  • Health can be defined as the “structural and functional wholeness or soundness.” Self-awareness and interpersonal skills are also important components of human well-being. In the same way, good health entails both individual and collective well-being.
  • Environment – A person’s environment consists of physical, chemical, and biological characteristics. It is made up of the family, culture, and the people in the community.
  • Humans – Workers in the field of personnel care refer to people as “men, women, and children” who are either “cared for individually or collectively.”
  • Self-care agency – It is the human being’s aptitude or power to engage in self-care influenced by the most fundamental factors.
  • Self-care is the practice or performance of behaviors that people participate in on their own behalf to maintain their health, well-being, and vitality.

C. Subconcepts of the Self-Care Deficit Theory

  • Basic conditioning factors. Several elements influence a person’s health, such as age, gender, developmental state, health status, sociocultural orientation, healthcare service factors, dynamic systems factors, patterns of living, and external conditions.
  • Under this paradigm are the following derived middle-range theories:
  • Therapeutic Self-Care Demand – “Self-care tasks that must be carried out for a predetermined period to satisfy known self-care requirements.”
  • Self-care Deficit – Nursing is needed when there is a deficiency in a patient’s ability to function. When an adult (or parent or guardian) cannot or does not have the ability to regularly offer competent self-care, it is required to get nursing care.
  • Nursing Agency – By exercising and growing their self-care agency, nurses can satisfy the patient’s self-care requirements. The nursing agency comprises the characteristics that enable nurses to function, observe, and experience in a way that assists them in satisfying client/patient needs.
  • Nursing System – between bona fide nurse and client/patient, the nursing system is a result of a series of interactions between the two parties. There are times when a patient’s need for therapy outweighs their ability to care for themselves. Thus, it necessitates nursing care and interventions.

D. Theory of Self-Care

Activities that people conduct on their own behalf to maintain their health, well-being, and longevity fall under the purview of the theory of self-care. Self-care Provisions or requirements can be thought of as activities that one takes to ensure that one’s own well-being is met. There are three ways to look at these:

  1. Self-Care Requisites
  2. Universal self-care requisites
  3. Developmental self-care requisites

1. Universal Self-Care Requisites

The processes of life and the preservation of the structural and functional integrity of the human body are intimately linked to universal self-care requirements.

  • Consumption of a suitable amount of water
  • Maintaining a proper amount of air intake
  • Maintaining an adequate amount of food intake in the body
  • Maintaining a healthy work-life balance
  • Social connection and personal seclusion are maintained in equal measure.
  • Protecting people from harm (e.g., hazard) that could jeopardize their well-being
  • Assisting in the removal and excretion of excrements or body wastes
  • Elevation of human activity, behavior, or overall functioning and the growth under the potential and desire to be considered normal.

2. Developmental Self-care Requisites

Assessing an adult’s social interactions reveals developmental self-care requirements. Requirements specific to the developmental process may be modified versions of universal self-care requirements, but they may also be whole new requirements or demands resulting from a condition or an event.

3. Health deviation self-care Requisites

Health deviation self-care requirements may be necessary for the event of a disease, trauma, or ailment or as a result of medical operations to diagnose and remedy the problem.

  • Pursuing and obtaining the necessary medical attention
  • Actively following doctor-recommended diagnostic, therapeutic, rehabilitative, and intervention steps.
  • Attention to the impacts and outcomes of clinical manifestations or pathological states and instances.
  • Making a mental shift (changing self-concept) to accept that one’s health has deteriorated to the point where it necessitates the utilization of certain types of healthcare services
  • Identifying and dealing with the painful or adverse effects of medically prescribed interventions
  • The ability to cope and adapt to the repercussions of pathological diseases and medical diagnostic and therapeutic measures in a lifestyle that promotes personal growth

4. Clinical Application of the Self-Care Deficit Theory

On the basis of this theory and assumption, nursing intervention is required for patients or clients who are unable to meet their own basic needs. Limitations or impediments that prohibit people from satisfying their needs for wellness, well-being, improvement, and development are the root of this self-care deficit. Hence, Orem came up with a list of five solutions to help or to support self-care:

  • Providing for and doing for other people
  • Guiding or assisting other people
  • Supportive acts for others
  • Instructing/Educating another
  • Creating conditions that encourage personal growth to address the challenges and demands of the future

The Theory of Nursing System

Taking care of those who are unable to do it on their own is at the heart of this theory. It’s founded on the premise that a single person can’t take care of their basic necessities. There are times when a patient’s need for therapy outweighs their ability to care for themselves; hence, this system becomes engaged, resulting in the need for nursing service.

Assessment, planning, administration, and evaluation are the primary focuses of this approach. There are three main nursing systems under this:

  • Wholly Compensatory NS
  • Partial Compensatory NS
  • Supportive-Developmental or Supportive-Educative NS

Nursing System: Wholly Compensatory

This type of self-care incapacity may be described as “the inability to perform self-care activities that require self-directed and guided ambulation, or medical prescriptions to desist from such activity. Whereas people with severe disabilities are socially reliant on others for their survival and well-being.”

Examples: recuperation care for a patient who has undergone surgery, providing and caring for a newborn, etc

Nursing System: Partial Compensatory

In this case, both the nurse and the patient may have a key involvement in the performance of care measures that involve controlling tasks or promoting mobility. This system is employed when the patients are capable of executing tasks. However, they will require support in order to meet their basic necessities.

Examples are: Assisting the patient in ambulation following surgery delivering meals to patients who can eat on their own.

Nursing System: Supportive-Developmental

This system is utilized because of environmental or physical constraints. It is better described as “when individuals can meet their own requirements but are unable to grasp, perform the necessary skills or learn how to do so.”

Examples: Mother is shown by a nurse how to breastfeed her child, assisting an individual with psychiatric issues in developing more effective coping mechanisms

The Nursing Process and Dorothea Orem’s Self-care Deficit Theory


The Nursing Process establishes a framework for assigning responsibilities to caregivers or nurses in the event of a patient’s inability to adequately care for themselves.

  • Health care delivery system design and planning.
  • Determine the reason for the requirement for nursing care by doing a thorough assessment of the patient. Carefully consider the results of the analysis interpretation and evaluate pieces of evidence to make a sound judgment.
  • Nursing system formation and management.

Begin by obtaining data in six different areas:

  1. The individual/patient’s current health state
  2. Perspective on the patient’s health status from a medical professional
  3. The individual’s view of his or her own health
  4. A person’s health objectives in light of their personal history, way of life, and current health.
  5. The individual’s needs for self-care
  6. The individual’s ability to care for one’s own well-being

Diagnosis and Planning

  • The nurse devises a strategy that is either completely compensatory, partially compensatory, or supportive-developmental.
  • There are two actions included: (1) Organizing the various aspects of patients’ therapeutic self-care needs (2) Choosing strategies that will compensate or overcome the patient’s self-care inadequacies/deficits.

Implementation and Evaluation

  • The nurse helps the patient or family define and describe their own wellness and health-related outcomes. Data collection for assessing how well the therapeutic intervention is meeting its stated goals in the designed nursing system.
  • Nursing intervention is guided by the etiology aspect of the diagnosis.

Analysis of the Self-care Deficit Theory

Orem’s work has a strong focus on self-care. Every notion in Orem’s inclusive theory of nursing systems was designed to help the reader understand how nursing care may be used to help people.

A. Strengths

  • Student nurses who are just starting will have no trouble understanding the terms “self-care,” “nursing systems,” and “self-care deficit.” As they gain more knowledge and experience, they will be able to delve deeper into the subject.
  • Dorothea Orem’s idea can be applied by new nurses entering the profession and professionals in the nursing industry.
  • Nurses can rely on Orem’s concept as a stable foundation for their work. Its application in the following areas can benefit nurse practitioners: nursing care providers, academia, and management.
  • She specifies the circumstances in which nursing is required: Nursing is required when an individual is unable to maintain the amount and quality of self-care required to maintain life and health, recover from disease or injury, or manage the consequences of these events on a continual basis.
  • An easy-to-understand evaluation of three nursing systems was given.
  • Her methods and theory to self-care are in line with the current principles of health promotion and health maintenance.

B. Weaknesses

  • It is easy to understand, yet Orem’s idea can be tough to grasp in its entirety. As a reader, it might be difficult to keep track of all the different ways in which the term “self-care” is used in a variety of contexts and phrases. These include terms like self-care agency and self-care demand and deficit, and universal and obligatory self-care. When used in conjunction with other concepts, things get a lot more confusing.
  • Orem’s paradigm focuses on compensatory and therapeutic nursing treatments, but it ignores preventative and promotional nursing concepts.
  • Health is thought to be progressive and always evolving.
  • There is only a passing mention of the individual’s emotional requirements in her writings.
  • Mechanistic theories are criticized for not allowing for enough adaptability in light of a patient’s specific needs.


It’s easy to apply Orem’s idea to a wide range of patients because it’s universally applicable. A plethora of material on self-care, nursing systems, and self-care inadequacies may be found here to assist nursing students just starting in the profession.

Additionally, this method indicates that all patients prefer to be in charge of their care, which is a significant advantage for them. People who take responsibility for their well-being can speed up and improve the quality of their recovery to the greatest extent possible. It is especially beneficial in rehabilitation and primary care settings when patients are encouraged to be self-sufficient.

However, since newborns and geriatric patients require extensive care and assistance with self-care activities, this concept cannot be directly applied to them.

Nursing References

Ackley, B. J., Ladwig, G. B., Makic, M. B., Martinez-Kratz, M. R., & Zanotti, M. (2020). Nursing diagnoses handbook: An evidence-based guide to planning care. St. Louis, MO: Elsevier.  Buy on Amazon

Gulanick, M., & Myers, J. L. (2017). Nursing care plans: Diagnoses, interventions, & outcomes. St. Louis, MO: Elsevier. Buy on Amazon

Ignatavicius, D. D., Workman, M. L., Rebar, C. R., & Heimgartner, N. M. (2018). Medical-surgical nursing: Concepts for interprofessional collaborative care. St. Louis, MO: Elsevier.  Buy on Amazon

Silvestri, L. A. (2020). Saunders comprehensive review for the NCLEX-RN examination. St. Louis, MO: Elsevier.  Buy on Amazon


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This information is intended to be nursing education and should not be used as a substitute for professional diagnosis and treatment.

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Anna Curran. RN, BSN, PHN

Anna Curran. RN-BC, BSN, PHN, CMSRN I am a Critical Care ER nurse. I have been in this field for over 30 years. I also began teaching BSN and LVN students and found that by writing additional study guides helped their knowledge base, especially when it was time to take the NCLEX examinations.

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