Dorothea Orem

Biography
Dorothea Elizabeth Orem was born in Baltimore,
Maryland, on July 15, 1914. She received her diploma in
nursing at Providence Hospital School of Nursing in
Washington, DC in the early 1930s. Orem received a bachelor
of science degree in Nursing Education from the Catholic
University of America (CUA) in 1939, and she received a
master’s of science degree in Nursing Education in 1946 from
the same university. She is known for her Self-Care Deficit
Nursing Theory, also known as the Orem Model of Nursing
and this made her one of America’s foremost nursing
theorists.

Career and Works

Orem’s early nursing experiences included operation room
nursing, private duty nursing (home and hospital), hospital staff
nursing on pediatric and adult medical and surgical units, evening
supervisor in the emergency room, and biological science teaching. From 1940 to 1949, she
became the director of both the Detroit Providence Hospital’s Nursing School and the
Department of Nursing. She left Detroit in 1949 and later worked at the Division of Hospital
and Institutional Services of the Indiana State Board of Health from 1949 to 1957. Her goal
was to upgrade the quality of nursing in general hospitals throughout the state and she
developed her definition of nursing practice during this time.

In 1957, Orem moved to Washington, DC, to be a curriculum consultant at the Office of

Education, U.S. Department of Health, Education, and Welfare. Orem worked on a project to
upgrade practical nurse training from 1958 to 1960 which stimulated the need to address the
question of “what is the subject matter of nursing?” This resulted in the development of
Guides for Developing Curricula for the Education of Practical Nurses. Orem served as an
acting dean of the School of Nursing and an associate professor of nursing education at CUA
later that year and this is also where she continued to develop her concepts of nursing and
self-care. The formalization of concepts was accomplished by Orem and members of the
Nursing Models Committee at CUA and the Improvement in Nursing Group, which later
became the Nursing Development Conference Group (NDCG). The NDCG also contributed
to the development of the theory in which Orem provided intellectual leadership.

Orem’s first published book was Nursing: Concepts of Practice in 1971 with succeeding
editions published in 1980, 1985, 1991, 1995, and 2001. She was an NDCG editor for the
preparation and revision of the Concept Formalization in Nursing: Process and Product. In
2004, a reprint of the second edition was produced and distributed by the International Orem
Society for Nursing Science and Scholarship (IOS). In 1984, Orem retired and continued the
development of the self-care deficit nursing theory.

Awards
Orem received several awards throughout her career. Some of the notable awards are
the honorary degree of Doctor of Science from Georgetown University in 1976, the CUA
Alumni Association Award for Nursing Theory in 1980, and Doctor of Nursing from the
University of Missouri in 1998.

Death
On June 22, 2007, Dorothea Orem’s life ended after a period of being bedridden at the age
of 92. She died at her residence on Skidaway Island, Georgia.

Self-Care Theory Introduction

Dorothea Orem’s Self-Care Theory focuses on an “individual’s ability to perform

self-care, which is defined as “the practice of activities that individuals initiate and perform
on their own behalf in maintaining life, health, and well-being.” The Self-Care or Self-Care
Deficit Theory of Nursing is composed of three interrelated theories: (1) the theory of
self-care, (2) the self-care deficit theory, and (3) the theory of nursing systems, which is
further classified into wholly compensatory, partially compensatory and
supportive-educative. It is considered a grand nursing theory, so the theory covers a broad
scope with general concepts applicable to all instances of nursing.

Theoretical Assumptions

Dorothea Orem’s Self-care Theory’s Major Assumptions are:

1. Human beings require continuous, deliberate inputs to themselves and their

environments to remain alive and function in accordance with natural human
endowments.
2. Human agency, the power to act deliberately, is exercised in the form of care for self
and others in identifying needs and making needed inputs.
3. Mature human beings experience privations in the form of limitations for action in
care for self and others involving the making of life-sustaining and
function-regulating inputs.
4. Human agency is exercised in discovering, developing, and transmitting ways and
means to identify needs and make inputs to self and others.
5. Groups of human beings with structured relationships cluster tasks and allocate
responsibilities for providing care to group members who experience privations for
making required, deliberate input to self and others.

Concepts and Model of the Theory

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Self-Care Agency – It is the human’s ability or power to engage in self-care, and it is

affected by the fundamental conditioning factors like age, gender developmental state, health
state, socio-cultural orientation, health care system factors, family system factors, patterns of
living, environmental factors, and resource adequacy and availability.

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Therapeutic Self-Care Demand - consists of the summation of care measures necessary at

specific times to meet all an individual’s known self-care requisites.

Self-Care Deficit - is the connection between an individual’s therapeutic self-care need and
his or her capabilities of self-care agency. Nursing is necessary when an adult is incapable of
providing continuous self-care.

Nursing Agency - comprises established qualities of persons educated as nurses that enable
them to act, know and help others therapeutic self-care necessities.

Nursing Systems - are series and sequences of deliberate practical actions of nurses
performed at times.

Theories – The self-care theory of nursing is composed of three interrelated theories:

Self-care, Self-care deficit and nursing system.

Theory of Self-Care – This theory describes why and how people care for themselves.

● Self-care Requisites - is a developed and expressed insight about actions to be

undertaken that are known or assumed to be essential in managing an aspect of human
functioning and development, continually or under specified settings and conditions.
● Universal Self-Care Requisites - Universally required goals are to be met through
self-care or dependent care.

The universal self-care requisites:

1. The maintenance of a sufficient intake of air

2. The maintenance of a sufficient intake of water
3. The maintenance of a sufficient intake of food
4. The provision of care associated with the elimination process and excrements
5. The maintenance of a balance between activity and rest
 6. The maintenance of a balance between solitude and social interaction
7. The prevention of hazards to human life, human functioning, and human
well-being
8. The promotion of human functioning and development within social groups in
accord with human potential, known human limitations, and the human desire to
be normal

● Developmental self-care requisites – It is the specific expression of universal

self-care requisites that have been established for developmental processes.
○ Provision of conditions that promote development
○ Engagement in self-development
○ Prevention of or overcoming effects of human conditions and life situations
that can adversely affect human development

● Health deviation self-care requisites - exist for those who are sick or injured, who
have special types of pathological ailments or problems.
○ Seeking and securing appropriate medical assistance.
○ Being aware of and attending to the effects and results of pathologic
conditions and states
○ Effectively carrying out medically prescribed diagnostic, therapeutic, and
rehabilitative measures.
○ Being aware of and attending to or regulating the discomforting or deleterious
effects of prescribed medical measures
○ Modifying the self-concept (and self-image) 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
effects of medical diagnostic and treatment measures in a lifestyle that
promotes continued personal development

The Theory of Self-Care deficit – is the relation between an individual’s therapeutic

self-care need and his or her powers of self-care agency. Nursing is required when the patient
is incapable of providing continuous self-care.

There are five identified helping methods:

1. Acting for and doing for others

2. Guiding others
3. Supporting another
4. Providing an environment promoting personal development about meet future
demands
5. Teaching another

The Theory of Nursing systems - This theory is a series and sequences of deliberate
practical actions of nurses performed at times. This theory is implemented when the client
therapeutic self-care demand surpasses the self-care agency that leads to nursing. There are
three categorizations of nursing systems: Wholly compensatory nursing theory system,
Partial compensatory nursing system and Supportive-Educative System.

● Wholly Compensatory Nursing System - The wholly compensatory nursing system

comprises complete care to the patient by the nurse because the patient cannot
conduct any of their self-care tasks.
Example: Infants, coma patients and patients under post-anesthesia unit need the
wholly compensatory nursing system.

● Partial Compensatory Nursing System - comprises the administration of some care

when the patient can perform some of his/her self-care obligations but not all the
necessary self-care activities.
Example: Giving assistance in an ambulance and patient who is acutely ill are
examples of partial compensatory nursing systems.

● Supportive-Educative System - referred to as the developing nursing system. The

nurse gives assistance and information to support the patient's self-care abilities and
activities.
Example: Teaching the client about the essential aspects of daily living such as
personal care and hygiene, dressing, and eating and educating the patient about
instrumental activities like shopping, meal preparation, communication, and
transportation.

Nursing Metaparadigms

Person

Orem perceives a person as a physical, social, and psychological character with

varying self-care capacities. Also, a person is the recipient of care needed, has potential for
learning and development, and could learn how to meet self-care needs. They use creative
ideas and words in thinking, communicating, and making efforts to improve things, which are
beneficial for them or others. Orem emphasizes that every individual has distinct needs that
should be examined and fulfilled to guarantee that they are satisfied in the self-care activities
vital to their wellbeing.

Health

Health is the major metaparadigm, which Orem describes as physical, mental, and
social wellbeing. Her hypothesis addresses the limits concerned in satisfying the requirements
for self-care and the impact on health. The essential goal of any nurse is to try to acquire the
integrity that makes a person enjoy their life. Self-care is the essential factor of health that
guarantees the patient to care for himself/herself and attain the desirable results through the
performance of duties that will benefit the development of the client's body.
Environment

The environment is the primary element in Orem's theory. Orem stated that person
and environment are different things that require education to interpret them as a single unit.
All components play a significant part in providing care that affects the way patients feel.
Orem offered various environmental aspects and divided them into four types: physical,
chemical, biological, and social aspects. In Orem's theory, the notion of the environment has
broad associated aspects that affect the individual's ability for self-care and the desire for
self-care. Situations and other elements emerging during the cooperation between a health
provider and an individual should be given attention to avoid discomfort and diminished
ability to engage in self-care activities. Orem’s idea emphasizes that the environment can
support better results of the stated actions by affecting patients in good ways.

Nursing

Orem introduced nursing as a specialized area of expertise and an action method,

which was practiced by health care professionals. According to her, nursing is the
intervention to fulfil the standard need for self-care and the requirement for professional care
of patients. Orem developed a nursing agency and nursing system to illustrate nursing. The
nursing agency is the personnel trained as nurses that give care. On the other hand, the
nursing system is the connection between nurse and patient and comprises the acts in the
patient's interest to meet the required self-care.

Application of the Theory in the fields of Practice and Research

The nursing theory aims to describe, predict and explain the phenomenon of nursing
(Chinn and Jacobs 1978). In addition to that, nursing theory assists nurses in better
understanding their roles and responsibilities in today's healthcare environment, which could
lead to improved patient outcomes. One of the notable nursing theories that helped many
people enhance their lives is the Self-Care Theory of Dorothea Orem. In a succinct
description, this theory focuses on each individual and “the practice of activities that
individuals initiate and perform on their own behalf in maintaining life, health, and
well-being.” In many cases, Orem’s theory has a significant application in the fields of
clinical practice and research.

In the field of clinical practice, Orem’s self-care deficit theory can be applied to nurse
practitioners’ work, as it provides a comprehensible description of the nurses’ role in terms of
treatment, prevention, and care. According to Orem, there are 5 actions performed by nurses
to re-establish the person’s capacity for self-care: performing care actions, guiding patients,
providing physical or psychological aid, ensuring a positive environment for growth and
development, and teaching (Jarošová, 2014). Hence, the self-care deficit theory clarifies the
roles and responsibilities of a nurse while providing a clear objective of nursing care.

For example, nurses are required to apply their knowledge when caring for elderly
patients to determine the required self-care activities that patients should perform.
Recognizing that some of these activities are not performed by the patient, the nurse's job is
to figure out the best way to make up for the deficiency. If a person lacks the physical
capacity to perform certain actions, the nurse can do so for him or her, thereby meeting the
patient's self-care needs. The nurse, on the other hand, must provide education if the patient
lacks knowledge or guidance.

Orem’s Nursing Theory is also being applied in the field of research. One example is
the research entitled, “The Effect of Self Care Education Based on Orem’s Nursing Theory
on Quality of Life and Self-Efficacy in Patients with Hypertension: A Quasi-Experimental
Study.” In this study, they emphasized the importance of the improvement of life’s quality
and self-efficacy of patients with hypertension. Moreover, the study aimed to determine the
effect of self-care education based on Orem’s nursing theory on the quality of life and
self-efficacy in patients with hypertension. This quasi-experimental study was conducted in
Mamasani, Iran, 2015 where a number of 80 patients were selected via convenient sampling
and divided equally into two control experimental groups. In the experimental group, they
conducted the educational program based on Orem’s nursing theory and according to the
needs of patients. The result of the conducted study showed that training self-care based on
Orem’s theory can improve the quality of life of patients with hypertension. With that being
said, this theory is recommended to be applied by nurses in outpatient care of patients with
hypertension.

To summarize all the gathered information, it evidently projects that the Self-Care
Theory of Dorothea Orem has a significant contribution in the fields of clinical practice and
research. As what has been elaborated previously in the clinical practice, it aids nurses in
determining what aspects of patient care they should concentrate on in a given scenario.
While in research, the theory helped the researchers to have a basis in terms of finding out
what possible actions should be conducted to help improve the quality of life of patients with
hypertension which resulted in a positive outcome.

References:
Book Reference:
Aligood, M.R. (2018). Nursing Theorists and their Works (9th Ed.). Elsevier.

Online References:
Gonzalo (2021). Dorothea Orem: Self-Care Deficit Theory. Retrieved October 11, 2021, from
https://nurseslabs.com/dorothea-orems-self-care-theory/#biography_of_dorothea_e_orem

Khademian, Z., Kazemi Ara, F., & Gholamzadeh, S. (2020). The Effect of Self Care
Education Based on Orem's Nursing Theory on Quality of Life and Self-Efficacy in Patients
with Hypertension: A Quasi-Experimental Study. International journal of community based
nursing and midwifery, 8(2), 140–149. https://doi.org/10.30476/IJCBNM.2020.81690.0
StudyCorgi. (2021, October 1). Orem’s Self-Care Deficit Theory in Nursing Practice.
Retrieved Oct. 10, 2021, from
https://studycorgi.com/orems-self-care-deficit-theory-in-nursing-practice/

Image source:
Nurselabs (n.d.). Dorothea Orem: Self-Care Deficit Theory. Retrieved October 11, 2021, from
https://nurseslabs.com/dorothea-orems-self-care-theory/#biography_of_dorothea_e_orem