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Dorothea Orem and the Self-Care Deficit Nursing Theory

Orem’s Background: How the Philosophy Appeared

Merely providing the patient with nursing services is often not enough. Although offering regular assistance is part and parcel of a nurse’s job, offering round-the-clock assistance does not seem a possibility. Therefore, it is crucial to make sure that the patient is encouraged to engage in self-care, i.e., acquire, memorize, and use essential information that will keep them healthy. Dorothea Orem’s Self-Care Deficit Theory focuses on the idea of keeping the patient updated on the essential information about their disease or disorder, as well as offering them support in developing the habits that will help them maintain consistent health levels.

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In retrospect, Dorothea Orem’s background served as a perfect foil for developing the idea of self-care. Orem attended a school of nursing in Washington and graduated with a diploma. Later on, she enrolled into the Catholic University of America to become the Bachelor of Science in Nursing Education (1939). Therefore, it could be argued that she was determined at making a difference in the realm of nursing since the day when she started exploring the discipline. However, it was her unique experience as a member of the Division of Hospital and Institutional Services of the Indiana State Board of Health that became the pivotal point in her evolution as a nursing theorist (Alligood, 2013). Orem provided the services of a nursing consultant, thus, exploring the specifics of nurse-patient relationships and discovering a significant lack of contact between the two. Consequently, the connection between the patient’s awareness of the issues associated with general health principles and the unique properties of their health systems was established by Orem. As a result, the foundation for the theory and the prerequisites for its further development were designed (Gochman, 2013).

Theory Description: Essential Tenets and the General Framework

When considering Orem’s Theory, one must keep in mind that the framework was built on the preexisting theoretical foundations. Furthermore, the theory was built in several stages, each involving the creation of a new set of tenets on which the further theoretical principles would reside. As a result, the concept incorporated three other theories that provided a leeway for applying the framework to the unique needs of specific patients and, therefore, making it extremely pliable to increase its efficiency.

The Theory of Self-Care emerged as the foil for the further development of the comprehensive framework and concerned primarily the need to encourage independent care for one’s health. The concept of self-care is the cornerstone of the notion, and it incorporates the activities and behaviors that the patient must initiate in order to maintain health at the required level. Although it is assumed that the need for self-care is inherent in everyone, people still need directions for healthcare experts so that their efforts in maintaining proper health levels could have a tangible effect. The ability of the patient to cater to their own needs and recognize them successfully is defined as the self-care agency in Orem’s framework. The therapeutic self-care demand is the range of actions that needs to be taken in order to meet the required health standards, whereas the process of performing these actions is termed as the self-care requisites (Priest, 2013).

The Theory of Self-Care Deficit, in its turn, provides a different perspective, pointing to the fact that patients need active and extensive support from nurses to acquire the necessary information and learn more about both their needs and the means of meeting them. Therefore, the identified framework can be viewed as the attempt to promote cooperation between a patient and a nurse, therefore, improving the communication process between the two. Furthermore, the Theory of Self-Care Deficit clearly advocates the idea of a patient-centered approach seeing that it points to the necessity of identifying the unique characteristics and needs of the target audience. However, the theoretical framework under analysis is aimed primarily at nurses, shedding light on the significance of establishing a contact with the patient and promoting a better communication. Thus, the essential tenets of the theory include mostly the directions for an improved communication process and the focus on supporting the patient so that the latter could adjust to the process of learning. More importantly, the theory incorporates the elements of teaching frameworks seeing how tight the focus on the patient awareness is (Grove, Gray, & Burns, 2014).

Last but definitely not least, the Theory of Nursing Systems needs to be brought up as an essential component of Orem’s Theory of Self-Care. According to the main provisions of the specified theoretical element, it is crucial to systematize the existing knowledge about nursing so that a comprehensive approach toward managing patients’ needs could be created. The theory suggests that the existing frameworks should be split into several categories so that their purpose could be identified easily and that they could be used appropriately. The taxonomy that Orem suggests is fairly simple – she insists that the existing approaches should be defined as either social or regulatory. To be more specific, the social set of theories incorporates the approaches aimed at explaining the specifics of interactions between the people involved, whereas the regulatory ones concern mostly the provision of guidelines for maintaining the required standards of life and offering the patients the services of the finest quality. However, while being seemingly simplistic, the identified element of the Self-Care theory allows improving the communication process between the patient and the therapist to a considerable extent since it sheds light on the societal aspects of the learning process and at the same time systematizes the available tools for managing the process of care.

Therefore, it can be assumed that the theory designed by Orem can be used as the tool for both encouraging a more efficient communication process between a therapist and a patient and tan active promotion of independent learning among the target audiences. The combination of the frameworks has a strikingly positive effect on the overall well-being of the patients, which can be explained by the fact that the information management issues are addressed accordingly. Particularly, the patient is enabled to acquire information and the relevant habits on their own (Quieros, Vidinha, & Filho, 2014).

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Evaluation: Determining the Efficacy of the Strategy

When assessing the framework suggested by Orem, one must give credit to the extensive opportunities for enhancing the patient-nurse bond. The identified change in the nursing process is crucial since the misinterpretation of the data received when observing the patient’s behavior and symptoms, not to mention an omission of a certain symptom or characteristic, may have a deplorable effect on the patient’s recovery process, impeding it severely and even possibly making one develop additional health issues as a result of a poorly chosen strategy. Thus, it is imperative that a stronger emphasis should be placed on the interaction between a nurse and a patient. Orem’s theory, in its turn, promotes the concept of a patient-centered approach, therefore, making it clear that a nurse must encourage the communication and consider the feedback carefully (Mahmoudirad, Hoseini, & Madarshahian, 2015).

Furthermore, the issue of awareness needs to be addressed. While providing the patients with more freedom as far as their health choices are concerned may be viewed as questionable, there is no possible doubt that people need information about the current threats to their health, as well as the data concerning the ways of addressing the existing dangers. The focus on enhancing patient’s independence and promoting self-care techniques to the latter, in its turn, is likely to serve as the foil for the further self-directed learning process among the identified members of the population. Consequently, the patients will be able to recognize the trustworthy sources of data and learn the crucial information about the areas of their concern, as well as gain general knowledge about the current threats and opportunities related to health, in an efficient and uninhibited manner. Thus, the target audience gains the chance at developing the habit of lifelong learning as far as their health and the related issues are concerned.

Therefore, the theory can be viewed as quite efficient. It serves its purpose of determining the problems and gaps in knowledge that the patients have about a specific health problem, as well as outlining the ways of improving the quality of care by enabling the patients to learn more. Furthermore, it can be assumed that the theory in question is about to gain an increasingly huge importance given the fact that the present-day patients live in the realm of digital information are. In other words, the current focus of technology and innovations is on the enhancement of the communication process, which can be viewed as a significant advantage to the evolution of Orem’s theory. Particularly, the perspective on the communication process between a patient and the therapist factors in the current idea of information management and the enhancement of data processing must be mentioned.

Naturally, the framework has its problems. The approach could use a simplification of the model and the connection between the concepts. While it is necessary to realize that every single element of the theory is linked directly to the others, it is necessary to introduce a simplified model of these relationships so that a set of efficient strategies for promoting self-care among patients could be designed. As is, the approach does not allow for a lot of flexibility, which makes the theory rather hard to implement.

Nevertheless, Orem’s model of care must be viewed as one of the most important developments in the area of nursing in the 20th and the 21st century. Because of the role that technology plays in the contemporary environment, Orem’s theory must be introduced to the area of nursing as the framework that can improve the communication process by incorporating the latest technological advances and stressing the need to focus on the unique needs of patients.

Application: The Role of the Theory in Nursing Practice

As explained above, the recent innovative technologies that have made the communication process incredibly easy and comfortable must be viewed as part and parcel of Orem’s theory implementation. Without the use of the IT tools that will enable nurses to receive feedback from patients in a more timely and efficient manner, an increase in the quality of care, not to mention the promotion of a patient-centered approach, does not seem a possibility. Thus, it is imperative that nurses should receive the information, instructions, and appropriate training to use the available data management tools.

Furthermore, the application of Orem’s Theory of Self-Care will require that the patient’s history and health records should be analyzed carefully. Therefore, the data management system that will help keep the patient’s records in order will be necessary.

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Finally, the process of creating a bond between a nurse and a patient needs to be motioned as one of the primary goals of the treatment. While the data provided directly by the customer is crucial in identifying the short-term goal, in shaping the long-term ones, a nurse must consider the factors that have been affecting the patient throughout their entire life. As a result, a more detailed description of the key events in the patient’s life will be required, which is only possible once a bond is established between the parties in question.

The issues associated with the process of bonding between a nurse and a patient, a=as well as the general retrieval of the necessary information and feedback from the latter, may also require that the healthcare experts in question should be taught the basics of emotional intelligence. In light of the fact that patients may be unable to deliver essential information within the required amount of time for some reason (e.g., a speech impairment, etc.), a nurse must be capable of identifying the data that will be crucial in diagnosing a problem and determining the means of managing it. Thus, it is crucial that a nurse should be able to use the EI principles in the context of different environments, ranging from a consultation to an emergency room. Hence, a nurse must be able to develop EI skills to identify the problem that the patient may be having (e.g., determine the severity of pain based on the patient’s facial expression), and come up with a strategy that will help address short-term objectives appropriately.

The theory, therefore, can be viewed as a crucial addition to the contemporary nursing practice. The modern environment of healthcare needs a reminder about the significance of a patient-centered approach, as will as a careful management of the available data. Thus, Orem’s framework, which encourages a more efficient communication process, should be viewed as an essential addition to the general nursing framework. Furthermore, the fact that Orem’s theory focuses on the promotion of awareness and skills acquisition in patients clearly is a huge step in the right direction. By offering patients the tools and strategies that will help them maintain the required health levels independently, one will contribute to a significant increase in life expectancy and the quality of nursing services. As a result, the opportunities for building a healthier community will be created. As long as people know how and where to acquire the relevant information, as well as how to use it appropriately the health rates can be increased significantly, and the threats to people’s health can be managed successfully.


Alligood, M. (2013). Nursing theory: Utilization and application. New York, NY: Elsevier Health Sciences.

Gochman, D. S. (2013). Handbook of health behavior research iv: Relevance for professionals and issues for the future. New York, NY: Springer.

Grove, S. K., Gray, J. R., & Burns, N. (2014). Understanding nursing research: Building an evidence-based practice. New York, NY: Elsevier Health Sciences.

Mahmoudirad, J., Hoseini, M., & Madarshahian, F. (2015). The effect of teach-back education on foot self-care among patients with type II diabetes mellitus. Modern Care Journal, 12(1), 1-7.

Priest, H. (2013). An introduction to psychological care in nursing and the health professions. New York, NY: Routledge.

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Quieros, P. J., Vidinha, T. S. S., & Filho, A. G. A. (2014). Self-care: Orem’s theoretical contribution to the Nursing discipline and profession. Revista de Enfermagem Referência, 4(3), 157-163.

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