The Self-Care Deficit Theory by Dorothea Orem

Self Care Deficit Theory


Dorothea Elizabeth Orem was a leading theorist in the nursing of the 20th century. She developed the Self-Care Deficit Nursing Theory, a theory that is still used as a nursing curriculum, research, and training basis. According to Orem’s Nursing theory, Nursing is the act of helping others in the management and provision of self-care to improve and maintain human functioning in the most effective manner (Taylor, Lillis, & Priscilla, 2015).  It focuses on a person’s ability to take care of themselves to maintain health, wellbeing, and life. Since the development of the Self-care Deficit Theory, medical doctors, researchers, and nurses have majorly borrowed ideas from it and have gone further to apply its principles in their line of duty. The theory is relevant to the future of healthcare, and the application of its concepts can help patients and their families to cope with illnesses and other healthcare challenges easily.

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Theorist’s Background

             Dorothea Elizabeth Orem was born on 15th July 1914 in Baltimore in Maryland and died on June 22nd, 2007.  She was brought up by a mother, who was a homemaker, and a father who worked in the construction site. Orem graduated from Seton High school, Baltimore, in 1931.  In 1934 she attained a diploma from Providence Hospital School of nursing, and in 1939 she earned a B.S. from the Catholic University of America (Taylor, Lillis, & Priscilla, 2015).  She furthered her education to the level of attaining Doctorate Honoris Causae in 1998 from the University of Missouri, Colombia.  Orem was one of the earliest nursing theorists to develop the self-care nursing theory, which is also called the Orem Model of nursing.

The thought of developing a theory came into Orem’s mind in the 1930s when she got into the field of nursing.  During this period, the profession was wrongly defined.  She aimed to develop a theory that would help to improve nursing as well as develop a nursing practice framework. The method was developed over the years, with numerous editions being done to make it better. Besides significant accomplishments in education, Orem also got many honors as a result of her contribution to nursing (Taylor, Lillis, & Priscilla, 2015). Even after her retirement from the field of nursing, Orem did not stop to work on her theory. She also became a lecturer and a consultant on matters related to self-care and nursing in general. Her approach has been very usable and beneficial in the field of nursing to date.

Phenomenon of Concern

The event of concern on Orem’s theory was a concern on the need for people’s self-care and ability for self-management during disease recovery, in sustaining proper health, and in the effort to cope with consequences of the disease.  The developer of the theory was worried that many people were not able to overcome the limitations of conditions.  The Self-care theory designs a way through which a nurse is ready to assist a patient in a way that he or she can develop self-care abilities. The ability of a patient to meet the self-care needs determines the success of nursing care.

Theory Description

The Self-Care Deficit Theory by Dorothea Orem defines nursing as an act of helping others in the management and provision of self-care to improve the functioning of people.  The theory focuses on the ability of people to take care of themselves and maintain their well-being.


             The main concepts in Orem’s theory include nursing, humans, environment, health, and self-care. Nursing, according to Orem, is an art that enables practitioners to provide specialized care to people with disabilities, helping them to cope and be in a position to take care of themselves (Hagra & Fakharany, 2015).  Nurses further participate in medical care when the patient is still under the examination of the physician. Humans include people that get attention either as social units or as individuals. They are the main objects of nurses, among other healthcare providers who give direct care. The environment comprises biological, physical, and chemical features, and also includes community, culture, and family. The concept of health involves the ability of a person to reflect on themself and to communicate with others effectively. Lastly, self-care is the voluntary practice or performance of activities to maintain health, well-being, and life.


Interrelationship between Concepts


Orem’s theory assumes that nurses purposefully and deliberately perform their duty to help others. The second assumption is that people are capable and willing to take care of themselves, hence becoming dependent. Third, Health, human development, and well-being are dependent on the ability of a person to self-care.  Education and culture have a significant influence on how a person behaves.  Self-care can be taught through human interaction and communication. Systematic and deliberate actions help to achieve self-care. Every single individual in the world has specific powers, capabilities, values, talent, personal disposition, and interests. Every person is responsible and self-reliant for own care and care of other family members’ needs.



Dorothea Orem saw nursing as an art, a technology, and a community service.  Community, according to this theory, is a group of people and families that share the same environment and have similar interests.  The theorists viewed nursing as a health service, where a nurse should have a social encounter with the patient based on the community’s values (Hagra & Fakharany, 2015). Lastly, Orem saw nursing as art because nurses help patients and their families through design, management, and provision of self-care systems to improve their life quality.


According to Orem, health goes beyond the physical state to the way a person can function in daily activities.  Health is seen in this theory to be progressive growth towards a higher level of functioning and integration.


The environment and person, according to Orem, are a functional unit that has a reciprocal exchange and mutual influence. Persons are seen as a significant part of the situation and cannot be separated from it(Hagra & Fakharany, 2015). The environment that consists of physical, social, biological, and chemical features have a significant impact on the wellbeing and health of the patient and the family.


The person represents the nursing care recipient. He or she is a being who operates biologically, socially, and symbolically.   A person can learn and develop as subjected to natural forces. A person, according to Orem’s theory, can participate in deliberate actions, perform beneficial acts, and interpret life experiences. A person can effectively meet self-care needs.


The theory by Orem has made several assumptions. One of the premises is that nurses intentionally and purposefully offer their services as a way to help the needy.  The theory also assumes that people are willing and able to perform activities that encourage self-care.  Another assumption by Orem is that a person’s ability to participate in activities that promote self-care is determined by the person’s health, well-being, and development.  The self-care theory also indicates that culture and education profoundly affect people and that through communication and interaction, a person can learn how to take care of themself. Based on the above assumptions, the theory displays several strengths and weaknesses.

The Self-Care Deficit Theory provides the practice of nursing with a well-detailed foundation. The other strength of this theory is that it is used by professional nurses to practice, administrate, educate, and research and curricula (Hagra & Fakharany, 2015).  The method also clearly shows when nurses should help patients and when they should take care of themselves.  It also provides continued education to nurses in their endeavor. It also contains modern concepts in the approach of self-care in terms of health maintenance and health promotion.  Importantly, the self-care approach puts more focus on multi-person unit, rather than just on individual self-care.  Besides the strengths, the self-care deficit theory has several weaknesses.  Health is, in many cases, viewed as ever-changing and dynamic. Nevertheless, Orem’s theory presents the systems of nursing as constant and fixed, hence implying that health constitutes of three permanent conditions. The method also seems to be more oriented on illnesses, rather than on wellness.


            Generally, the self-care deficit theory by Orem is clearly defined and well-articulated.  The major concepts of the method are well stated and specified for better understanding. These concepts include nursing, human, health, person, problem, and process of nursing.  The approach is also very comprehensive and well organized, making it easy to follow through and to apply.  It is simple, logical, and, therefore, easy to understand(Shah,  Abdullah, & Khan, 2015.  It also gives nurses, among other healthcare providers, a good base for their practice. Researchers, nursing students, and nurse educators can also apply this theory in their field with easy.  It is indeed an excellent guide to improving the practice of nursing since it provides room for improvement.  The purpose and definitions of this theory are consistent and full of clarity.  There is also a good connection of concepts something that makes it easy to apply in real-life situations


            The self-care theory is a general theory that applies to many locations, emergency departments, rehabilitation, medical-surgical, and intensive care unit, among other sectors.   It is congruent with all areas where self-care is needed and is the driving force to full recovery (Hagra & Fakharany, 2015). The theory is applied by nurses of different departments to different situations in which people have the challenge of meeting their self-care requests. Nevertheless, the approach has been criticized for not covering mental health issues. In her last modification, Orem discussed and emphasized the need for having positive mental health.



The self-care deficit theory can be applied when making significant decisions about the nursing process. As such, Orem’s approach can be used in different levels that include assessment, planning, diagnosis, evaluation, and implementation (Shah,  Abdullah, & Khan, 2015).  Assessment in nursing involves the determination of a patient’s status of health and the immediate health requirements of the patient.  In diagnosis, the nurse determines the needs of the patient regarding self-care.  The understanding level of the patient to self-care is used as the basis to devise a plan to assist with scientific guidelines. Orem’s theory can be applied in all levels of healthcare, and to patients of all ages. It can also be used in almost all health conditions except for mental health conditions. Nurses, educators, students, and all types of providers in healthcare can also effectively apply this theory in their operations.


The self-care theory by Dorothea Orem is applicable by new nursing students, just like it is applicable by advanced practitioners. It provides a comprehensive foundation for practice, hence becoming a great asset in the nursing profession.  Administrators, educators, and practitioners can equally benefit and use Orem’s theory. Self-care, self-care deficit, and nursing systems are terms that nursing students understand with ease and ones that provide the student with a lot of experience and knowledge. As such, the theory is efficient in improving the skills and knowledge of nursing students. Indeed, the theory of self-care is critical when it comes to helping patients recover from diseases and injuries, as well as cope with infections. It is also necessary when a person is not able to maintain health or sustain life. The approach of this theorist is in line with the current health maintenance and health promotion concepts.


The self-care theory is generally viewed as a single entity because the developer of the method developed it as such. While the theory seems to be very simple, it is also very complex.  The application of self-care in many terms such as self-care demand, self-care agency, universal self-care, and self-care requisites causes a lot of confusion to some readers(Shah,  Abdullah, & Khan, 2015).  The definition of health as per the self-care theory is confined in three conditions that are also known as a concrete nursing system. This form of the static condition is negative since they connote rigidity. All through Orem’s work, there is little acknowledgment of the emotional needs of people. She views health as ever-changing and dynamic.


The self-care deficit theory is centered on recognizing the general foundation of self-care processes that the majority of the people can perform. These universal processes include taking in enough oxygen, nutrition, and water, preventing self from hazards, and improving social group development (Shah,  Abdullah, & Khan, 2015). As people develop and come across disease, injury, and illness,  the need for care increases, and therefore they seek medical attention. There is nevertheless always a need to have self-care abilities if a person is to recuperate from the illness successfully.

The self-care theory is expected to grow more in the future since the complexity of diseases is being experienced.  With the proper application of Orem’s approach, people will be able to take care of themselves more, and they will also recover better from diseases and injuries.  Nurses and practitioners are more likely to give more guidance to patients in the future, provide more support to patients, and provide a better environment to recover as well as promote personal development. It is also highly likely that nurses will take action on behalf of patients more in the future, considering that nurses are advocates for their patients.  Also, nurses are more likely to teach patients on coping strategies more than it is happening today.


Hagran, A. & Fakharany, E. (2015). Critique of Orem’s Theory. J. Middle East North Afr. sci, 1(5), 12-17]. (pISSN 2412- 9763) – (e-ISSN 2412-8937).

Shah, M., Abdullah, A., & Khan, H. (2015). Compare and Contrast of Grand Theories: Orem’s Self-Care Deficit Theory and Roy’s Adaptation Model. INTERNATIONAL JOURNAL OF NURSING5(1).

Taylor, C. R..,  Lillis, C. L. & Priscilla, L. P. (2015). Fundamentals of Nursing. Philadelphia: Wolters Kluwer Health. p. 74. ISBN 978-0-7817-9383-4.



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