Self-Care Deficit theory
Mrs.Resmi.C.R
Asst.Professor

Self-Care Deficit Nursing Theory
Dorothea Elizabeth Orem

Introduction to the theorist
•Theorist : Dorothea Orem (1914-2007)
•Born 1914 in Baltimore, US
•Received her diploma at Providence Hospital,
Washington, DC in 1934
•1939 – BSN Ed. And Master of science in nursing
education (1945) from Catholic University of
America, Washington D.C.

Introduction cont…
• Her clinical practice included staff nurse in the
operating room, paediatrics and adult medical
surgical units.
• She also did private-duty nursing in private homes
and the hospital and was an emergency room
supervisor.
• She taught biological sciences and later served as
director of nursing service and director of the
school of nursing at Providence Hospital,
Michigan.
• Received several honorary degrees.

Introduction cont…
• Orem’s concept of nursing as the provision of
self- care was first published in 1959.
• Orem continued to develop her nursing concepts
and her self-care deficit theory of nursing. In 1971
she published Nursing: Concepts of practice.
• The 2nd
, 3rd
, 4th
, 5th
and 6th
editions of this book were
published in 1980, 1985, 1991, 1995 and 2001
respectively

Orem’s general theory of nursing
Its related parts:-
• Theory of self care
• Theory of self care deficit
• Theory of nursing system

1. Theory of self care
Based on the concepts of:
– SELF-CARE
– SELF-CARE AGENCY
– SELF-CARE REQUISITES
– THERAPEUTIC SELF-CARE DEMAND

Self Care
Definition: the
performance of
activities that
individuals initiate
and perform on their
behalf to maintain
life, health, and
well-being.

Self-Care Agency
• Definition: the individual’s ability to perform self-care
activities.
Consists of 2 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)
• Affected by basic conditioning factors

Self-Care Requisites
Definition: reasons for which self-care is done; these
express the intended or desired results
• Consists of 3 categories:
– Universal - requisites/needs that are common to all
individuals (e.g. air, water, food, elimination, rest,
activity, etc.)
– Developmental - needs resulting from maturation or
develop due to a condition or event (e.g. adjustment to
new job, puberty)
– Health Deviation - needs resulting from illness,
injury & disease or its treatment (e.g. learning to
walk with crutches after a leg fracture)

Therapeutic Self-Care Demand
• Definition: the totality of “care measures”
necessary at specific times or over a duration of
time for meeting an individuals self-care
requisites by using appropriate methods and
related sets and actions.”

2. Theory of self care deficit
• It is the central focus of Orem’s general theory of
nursing.
• It describes how people can be helped through
nursing.

Theory of self-care deficit
• ROLE OF THE NURSE
Acting (or) doing for another
Guiding and directing
Providing physical (or) Psychological support
Providing and maintaining environment that
support personal development
Teaching another

Theory of self-care deficit
• Coordinating nursing care
• Establishing the kind and amount of immediate
and continuing care needed
• Coordinating the care with other services, such as
other health care, social, or educational services,
needed or being received.
• Discharging patients from nursing care when they
have regained their abilities to perform their own
self-care needs

3. Theory of Nursing Systems
It describes how the patient’s self care needs will be
met by the nurse, the patient, or both.
• If there is a self-care deficit- that is, if there is a
difference between what the individual can do
(self-care agency) and what needs to be done to
maintain optimum functioning (therapeutic self-
care demand)- nursing is required.

Classification of nursing system
It identifies 3 classifications of nursing system to
meet the self care requisites of the patient:-
• Wholly compensatory system
• Partly compensatory system
• Supportive – educative system

Wholly compensatory system
NURSE
ACTION
ACCOMPLISHES
PATIENT’S
THERAPEUTIC
SELF CARE
COMPENSATES FOR
PATIENT’S INABILITY
TO ENGAE IN SELF
CARE
SUPPORT AND
PROCETS
PATIENT’S
PATIENT
ACTION
LIMITED

Partly compensatory system
NURSE
ACTION
PERFORMS SOME SELF CARE
LIMITAIONS OF PATIENT’S
COMPENSATES FOR SELF
CARE LIMITATIONS OF
PATIENT
ASSIST PATIENT’S AS REQUIRED
PREFORMS SOME SELF CARE
MEASURES
REGULATES SELF CARE
AGENCY
ACCEPTS CARE AND
ASSISTANCE FROM NURSE
PATIEN
T
ACTION

Supportive – educative system
NURSE
ACTION
ACCOMPLISHES
SELF CARE
REGULATES THE
EXERCISE AND
DEVELOPMENT OF
SELF CARE
AGENCY
PATIENT’S
ACTION

Major Assumptions
• All patients wish to care for themselves.
• Humans are capable and willing to engage in self-care and
care for dependent members of the family.
• Self-care and dependent care are learned behaviors
through human communication and interaction with each
other.
• Nursing is a deliberate helping actions performed by
nurses for the benefits of others over a certain period of

Continues…
• Humans are supposed to be self-reliant and
responsible for their self-care needs and care
needs for dependent members of the family.
• Humans are unique individuals that are
separated from each other and from their
environment

METAPARADIGM OF OREMS THEORY
1.Person
2.Health
3.Environment
4.Nursing

Person
• Person is defined by Orem as the patient (a
recipient of nursing care)- a being who functions
biologically, symbolically, and socially and who has
the potential for learning and development.
• Person is an individual, who is with the capacity
for self knowledge, who can engage in deliberate
action, interpret experiences, and perform beneficial
actions

Health
• A state characterized by soundness or wholeness of
bodily structure and function; illness is its opposite.
• It consists of physical, psychological, interpersonal
and social aspects; these aspects are inseparable.
• Health includes promotion and maintenance of
health, treatment of illness, and prevention of
complications

Environment
• Environment consists of environmental factors,
environment elements, environmental conditions
(external physical and psychological surrounding),
and developmental environment.

Nursing
• Orem defines the art of nursing as an intellectual
quality of the individual nurse; this quality is
related to creativity as well as analysis and
synthesis of information, all of which contribute to
development of nursing systems to assist
individuals or multiperson units.

NURSING PROCESS
ASSESS
MENT
NUR
SING
DIA
GNO
SIS
GOAL PLANNING IMPLENT
ATION
EVALU
ATION
NURSING DIAGNOSIS
AND
PRESCRIPTION
DESIGNING
THE
NURSING
SYSTEM
AND
PLANNING
FOR
DELIVERY
0FCARE
PRODUCTION AND
MANAGEMENT OF
NURSING SYSTEM

Orem’s work and characteristics of theory
•Theories can interrelate concepts in such a way as
to create a difference
•Orem’s theoretical constructs of self-care, self-
care deficits and nursing systems are interrelated in
her general comprehensive theory of nursing which
is unique phenomena.
•Orem’s theory follows a logical thought process.
She states her general theory, that presents the
central idea of each of the three interrelated
theories.

• Statements that describe a concept or explain and
predict relationship between two concept.
• The theory can be applied to all individual patients
and with further adaptation, to multiperson units.
• Theories can be used by practitioner to guide and
improve their practice
• Theory focuses on nursing a helping art that
assists an individual to meet self-care needs and
that is the foundation for nursing practice.
• Adds nursing’s body of knowledge

• Theories can be the bases for the hypothesis that
can be tested or for theory to be explained
• Theories must be consistent with other validated
theories, laws, principles but leave unanswered
questions that need to be investigated.
• Consistent with role theory, need theory, field
theory and health promotional concepts

Critiques of Orem’s Theory

Strengths
• Provides a comprehensive base to nursing practice
• It has utility for professional nursing in the areas of nursing
practice, curricula, education, administration, and research
• Specifies when nursing is needed
• Her self-care approach is contemporary with the concepts
of health promotion and health maintenance
• Expanded her focus of individual self-care to include
multiperson units

Limitations
• In general system theory, a system is viewed as
a single whole thing while Orem defines a
system as a single whole thing.
• Appears that the theory is illness oriented
rather with no indication of its use in wellness
settings.

APPLICATION OF OREM’S THEORY

Baseline data
Areas Patient details
Name
Age
Sex
Education
Occupation
Marital status
Religion
Diagnosis
Theory applied
Mrs. X
56 years
Female
No formal education
House hold
Married
Hindu
Rheumatoid arthritis
Orem’s theory of self care
deficit.

Case history
For Mrs. X….
She came to the hospital with complaints of pain over
all the joints, stiffness which is more in the morning and
reduces by the activities.
She has these complaints since 5 years and has taken
treatment from local hospital.
The symptoms were not reducing and came to Hospital
for further management.
Patient was able to do the ADL by herself but the way
she performed and the posture she used was making her
prone to develop the complications of the disease.
She also was malnourished and was not having
awareness about the deficiencies and effects.

BASIC CONDITIONING FACTORS
Age 56 year
Gender Female
Health state Disability due to health condition,
therapeutic self care demand
Development state Ego integrity vs despair
Sociocultural orientation No formal education, Hindu
Health care system Institutional health care
Family system Married, husband working
Patterns of living At home with partner
Environment Rural area, items for ADL not in easy
reach, no special precautions to prevent
injuries
Resources Husband, daughter, sister’s son

UNIVERSAL SELF-CARE REQUISITES
Air Breaths without difficulty, no pallor cyanosis
Water Fluid intake is sufficient. Edema present over ankles.
Turgor normal for the age
Food Hb – 9.6gm%, BMI = 14.Food intake is not adequate or the diet is
not nutritious.
Elimination Voids and eliminates bowel without difficulty.
Activity/ rest Frequent rest is required due to pain.
Pain not completely relieved,
Activity level ha s come down.
Deformity of the joint secondary to the disease process and use of
the joints.
Social
interaction
Communicates well with neighbors and calls the daughter by
phone Need for medical care is communicated to the daughter.
Prevention of
hazards
Need instruction on care of joints and prevention of falls. Need
instruction on improvement of nutritional status. Prefer to walk bare
foot.
Promotion of
normalcy
Has good relation with daughter

DEVELOPMENTAL SELF-CARE
REQUISITES
Maintenance of
developmental environment
Able to feed self , Difficult to
perform the dressing, toileting
etc
Prevention/management of the
conditions threatening the
normal development
Feels that the problems are
due to her own behaviors and
discusses the problems with
husband and daughter.

HEALTH DEVIATION SELF CARE
REQUISITES
Adherence to medical regimen Reports the problems to the physician when in
the hospital. Cooperates with the medication,
Not much aware about the use and side
effects of medicines
Awareness of potential problem
associated with the regimen
Not aware about the actual disease process.
Not compliant with the diet and prevention of
hazards. Not aware about the side effects of
the medications
Modification of self image to
incorporates changes in health
status
Has adapted to limitation in mobility.
The adoption of new ways for activities leads
to deformities and progression of the
disease.
Adjustment of lifestyle to
accommodate changes in the
health status and medical regimen.
Adjusted with the deformities.
Pain tolerance not achieved

MEDICAL PROBLEM AND PLAN
Physician’s perspective of the condition:
Diagnosed with rheumatoid arthritis and is on the following
medications:
 T. Valus SR OD
 T. Pan 40 mg OD
 T. Tramazac 50 mg OD
 T. Recofix Forte BD
 T. Shelcal BD
 Syp. Heamup 2tsp TID
Medical Diagnosis: Rheumatoid arthritis
Medical Treatment: Medication and physical therapy.

AREAS AND PRIORITY ACCORDING TO OREM’S
THEORY OF SELF-CARE DEFICIT

Area of Inadequacy!!!!
Air Breaths without difficulty, no pallor cyanosis
Water Fluid intake is sufficient. Edema present over ankles.
Turgor normal for the age
Food Hb – 9.6gm%, BMI = 14.Food intake is not adequate or the diet is not nutritious.
Elimination Voids and eliminates bowel without difficulty.
Activity/ rest Frequent rest is required due to pain.
Pain not completely relieved,
Activity level ha s come down.
Deformity of the joint secondary to the disease process and use of the joints.
Social
interaction
Communicates well with neighbors and calls the daughter by phone Need for
medical care is communicated to the daughter.
Prevention
of hazards
Need instruction on care of joints and prevention of falls. Need instruction on
improvement of nutritional status. Prefer to walk bare foot.
Promotion
of normalcy
Has good relation with daughter

NURSING CARE PLAN
• Therapeutic self care
demand: Deficient area:
food
• Adequacy of self care
agency: Inadequate

NURSING DIAGNOSIS
•Inability to maintain the ideal nutrition related to
inadequate intake and knowledge deficit

OUTCOMES AND PLAN
Outcome:
improved nutrition
Maintenance of a balanced diet with adequate iron
supplementation.
Nursing Goals and objectives
Goal: to achieve optimal levels of nutrition.
Objectives: Mrs. X will:
 state the importance of maintaining a balanced diet.
 List the food items rich in iron , that are available in the locality.
Design of the nursing system:
supportive educative
Method of helping:
guidance
Support
Teaching
Providing developmental environment

IMPLEMENTATION
• Mutually planned and identified the objectives
and the patient were made to understand about
the required changes in the behavior to have the
requisites met.

EVALUATION
• Mrs. X understood the importance of maintaining
an optimum nutrition.
• She verbalized that she will select the iron rich
diet for her food.
• She listed the foods that are rich in iron and that
are locally available.
• The self care deficit in terms of food is decreased
with the initiation of the nutritional intake.
• The supportive educative system was useful for
Mrs. X .

Thank you