Dorothea Orem “identified distinctive nursing knowledge, defined boundaries of nursing, and theorized about when nursing is a legitimate service” (Rosenbaum, 1986, p. 409) in her general theory of nursing.  
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Orem’s General Theory of Nursing consists of three encapsulated theories: self-care theories, self-deficit theory, and nursing theory (McEwen& Wills, 2011).  



Self-Care Theory:
Orem’s self-care theory is based on the following concepts:

·  Self-care—a part of human life that is a practice of systematic activities that individuals initiate and perform to maintain life, growth, well-being, and human integrity. 

·  Self-care agency—a human capability to engage in actions that fulfill the self-care needs as well as care needs for dependent members of the family.

 · Self-care requisites—actions to be carried out by or for individuals in order to regulate factors influencing human functioning and development. There are three types of self-care requisites.

     1.     Universal self-care requisites—common to all individuals.

    2.     Developmental self-care requisites—essential for growth developmental processes.

     3.     Health deviation self-care requisites—needs resulting from health deficits

·  Therapeutic self-care demand—The sum of self-care actions/levels required to fulfill an individual’s specific self-care requites at the point in time. (Nefissa, n.d.; “Nursing Theories,” 2012; McEwen & Wills, 2011; Orem, 1997)

Self-Care Deficit Theory: Orem’s self-care deficit theory is the major focus of her grand
theory of nursing. The self-care deficit theory explains when nursing is necessary as it defines the relationship balance between self-care agency and the therapeutic self-care demand.  When self-care agency becomes incapable or limited in meeting his/her self-care demands, nurses’ therapeutic assistance is needed until self-care agency regains its availability. 
Nurses provide therapeutic assistance using five methods of helping: 1) acting/doing for patients, 2) guiding patients, 3) supporting patients, 4) modifying an environment and encouraging personal development in order to help patients meet future demands, 5) educating patients. (Nefissa, n.d.; “Nursing Theories,” 2012; McEwen & Wills, 2011; Orem, 1997)

Orem’s Theory and Nursing Process:
Nursing process demonstrates a method to find specific self-care deficits and determine the roles of nurses or patients to fulfill the self-care demands.  The each step within the process approach is the technical element of the nursing process (“Nursing Theories,” 2012).  Orem highlighted that the technical element has to be organized through social and interpersonal processes in the nurse-patient therapeutic relationship (“Nursing Theories,” 2012; Orem, 1997).

Assumptions: The major assumptions of Orem’s theory include:

 ·“All patients wish to care for themselves” (Paraska & Clark, 2012, p. 63).

 ·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 time.

 ·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.     (Nefissa, n.d.; “Nursing Theories,” 2012; Orem, 1997)

References:

Conceptual framework of Orem’s theory [Online image]. Retrieved from http://1.bp.blogspot.com/_c2VIUh4psKE/TE0R3xBuPNI/AAAAAAAAAY4/JYDtClHsG5s/s1600/orem03.jpg

Dorothea Elizabeth Orem [online image]. Retrieved from http://nanda-nurse-diary.blogspot.com/2012/11/history-of-self-care-deficit-theory.html

Hartweg, D. (1991). Dorothea Orem: Self-care deficit theory (Vol. 4). Newbury Park, CA: Sage Publications, Inc.

McEwen, M., & Wills, E. M. (2011). Theoretical basis for nursing. (3rd ed.). Philadelphia, PA: Lippincott Williams & Wilkins.

Nefissa, A. E. (n.d.). Self-care deficit nursing theory: Dorothea Orem. Retrieved from
http://ocw.up.edu.ps/repositories/pdf-archive/New%20orem%20theory.pdf

Nursing theories: Dorothea Orem’s self-care theory. (2012). Currentnursing.com. Retrieved from http://currentnursing.com/nursing_theory/self_care_deficit_theory.html 

Orem, D. E. (1997). Views of human beings specific to nursing. Nursing Science Quarterly, 10(1), 26-31.

Paraska, K. K., & Clark, C. C. (2012). Health promotion in nursing practice. Burlington, MA: Jones & Bartlett Publisher.

Rosenbaum, J. N. (2006). Comparison of two theorists on care: Orem and Leininger. Journal of advanced nursing, 11(4), 409-419.

 


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