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Dorothea Orem’s Self-Care Deficit Nursing Theory


For the purposes of this assignment, Dorothea Orem’s self-care deficit nursing theory is chosen. It is based on several principal assumptions, which are the following: a “theory created for a practical science such as nursing encompasses not only the What and Why, but also the Who and How;” nurses and patients should have active and dynamic relationships; care for oneself “must be learned and be deliberately performed for life, human functioning, and well-being” (Hartweg, 2015, p. 107). The main concepts of the theory include six elements. Four of them are related to patients (self-care/dependent care, self-care agency/dependent-care agency, therapeutic self-care demand/dependent-care demand, and self-care deficit/dependent-care deficit), and other two are related to nursing professionals (nursing agency and nursing system) (Hartweg, 2015).

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The relationships between the mentioned concepts are comprehensive and complicated due to the theory’s elaboration (Bender, 2016). Primarily, the connections between the theory’s concepts are presented by the interaction between “the self-care agent (person receiving care)/dependent-care agent (family member/friend providing care)” and “the nurse (nurse agent)” (Hartweg, 2015, p. 109). The impact of different concepts on each other is largely determined by various conditioning factors, which include the following: age, gender, developmental and health state, socio-cultural orientation, healthcare system factors, family system factors, patterns of living, environmental factors, as well as resource availability and adequacy (Hartweg, 2015).

Origins of the Theory

It is possible to observe that the historical context, which influenced the scientist’s decision to develop her theory, was her working experience in the Indiana State Board of Health between 1949 and 1957 (Hartweg, 2015). As it is stated by Hartweg (2015), in the process of her practice, Orem noticed that nurses are able to “do nursing,” but they cannot “describe nursing.” Thus, it was her primary motivation to combine a solid theoretical approach with practical experience (Gordon, 2015). Orem’s personal values, her formal education as well as familiarity with works of such philosophers as Aristotle, Aquinas, Harre, and many other, contributed significantly to the development of her theory (Hartweg, 2015).

Orem used the scientific approach in developing her theoretical approach as she was well-acquainted with academic standards of theorization (Hartweg, 2015). In 1956, she published a report, which was entitled “The Art of Nursing in Hospital Service: An Analysis,” and in this report, the early provisions of self-care terminology in the form of “patient doing-for-self or the nurse helping to-do-for-self” had first appeared (Hartweg, 2015, p. 106). Further, she worked both independently and collaboratively in order to improve her theory.


It is possible to state the immense importance of the theory under discussion for nursing science as a whole and, particularly, for nursing practice. As it is mentioned by Hartweg (2015), the implementation of Orem’s theory or its particular provision in various clinical environments could hardly be overlooked, as it influenced significantly the development of contemporary nursing. Since the theory represents a very comprehensive and elaborated framework, it could be efficiently used to predict patient outcomes and also to guide the nurse’s work.

However, it is of high importance to exemplify the practical case, which is described by Hartweg (2015). The case is provided by Laureen M. Fleck, and the following situation is described: Marion W. is presented to a primary care office, and her nurse decides to implement three principal steps of Orem’s process of nursing. They include the following: diagnosis and prescription (first step), design and plan of the nursing system (second step), treatment, regulation, case management, control/evaluation (third step) (Hartweg, 2015).


The testability of the theory under discussion is highly significant. The theory’s propositions have generated immensely large research since its establishment. Propositions are defined by Hartweg (2015) as “statements about the concepts and their interrelationships” (p. 107). Hartweg (2015) mentions the literature review conducted by Biggs in 2008, which covered nursing literature from 1999 to 2007. As the result of this literature research, more than 400 articles, mentioning, applying, or elaborating on Orem’s theoretical provisions, were found (Hartweg, 2015). Hartweg (2015) also cites one particular example of the study, which was done by using the theory. This study was conducted by Casida and colleagues in 2009 (Hartweg, 2015). They used the theory to “formulate and develop the health-deviation self-care requisites of patients with left ventricular assist devices” (Hartweg, 2015, p. 106). They were also able to include study-specific aspects within the framework.

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Overall Evaluation

In overall, the conducted overview of principal aspects of the theory under discussion has revealed its comprehensive character. As it was identified in the previous section, the theory is specific enough to be used in considerably narrow fields of study, but it is also universal enough to be used in ordinary caregiving practice. The primary strengths of Orem’s theory are the following: it is significantly elaborated, it includes various patient and nurse-related components and factors, and it is also based on solid theoretical and practical provisions. Among its weaknesses, one could mention that the theory is not easily comprehended, and it is necessary to study it thoroughly to use efficiently. However, I would use this theory in advanced nursing practice because it is applicable to various specific clinical situations.


Bender, M. (2016). Conceptualizing clinical nurse leader practice: An interpretive synthesis. Journal of nursing management, 24(1), 1-16.

Gordon, S. C. (2015). Early conceptualizations about nursing. In M. C. Smith & M. E. Parker (editors), Nursing theories and nursing practice (4th ed.) (pp. 55-66). F. A. Davis Company.

Hartweg, D. L. (2015). Dorothea Orem’s self-care deficit nursing theory. In M. C. Smith & M. E. Parker (editors), Nursing theories and nursing practice (4th ed.) (pp. 76-81). F. A. Davis Company.

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