Grand Nursing Theorist Dorothea Orem


Dorothea Orem developed one of the major grand theories of nursing in the 1960s and continued to contribute to perfecting it with the help of the nursing academic community. Her self-care deficit theory created a new edge to the scientific and practical interpretation of the nursing profession and inspired care providers around the world to establish a new understanding of a patient (O’shaughnessy, 2014). The high value of the theory as an instrument to improve care due to its visionary and practical qualities is the central reason to present it to this committee.

Elements of Self-Care Deficit Theory

Orem’s theory of nursing was based on an understanding that certain adults and children are unable to provide themselves with an adequate level of self-care to keep their health inadequate condition (Chen et al., 2014). Therefore, self-care encompasses practices and actions performed by a patient himself or herself aimed at maintaining their life, health, and wellbeing. Certain adverse effects occasionally undermine people’s ability to perform self-care, which creates therapeutic self-care demand. The existence of the nursing profession is to help healthcare institutions and other professional caregivers to meet that demand (“Dorothea Orem self-care theory,” n.d.). Yet, Orem also believed that it is paramount to advocate and improve patients’ ability to care for themselves participating in their education.

One of the central concepts in the theory is self-care deficit (“TBNP,” 2014). It is defined as the need for a health care provider to help a patient burdened by a disease or condition that impairs his or her ability to care for himself or herself. Self-care agency is the ability of a patient to perform actions to maintain life, health, and wellbeing of self. This agency is influenced by basic conditioning factors such as age, social and cultural orientation, environment, lifestyle, etc. The nursing system is also a key construct of the theory. It represents the complexity of the relationship between a patient and a nurse, which is produced when patients’ self-care agency is insufficient. There are three nursing systems that relate to different functions of a nurse in relation to a patient (Younas, 2017). The wholly compensatory system is engaged when the self-care agency is severely undermined, and a person has to rely on others’ support. The partly compensatory system is in action when a patient can delegate certain aspects of care to a nurse while maintaining control of the other self-care actions. The third system is called supportive-educative. It is aimed at helping a patient to become more effective at his or her self-care agency.

Application of Orem’s Theory to Practice

Orem’s theory of self-care deficit is an excellent theoretical explanation of a practical role of a nurse. It establishes a clear system of relationship between a nurse and a patient defining their roles in relation to maintaining or restoring perfect health conditions of the latter. The theory postulates the main self-care requisites give a nurse an understanding of what a patient’s health consists of. These requisites can be established as evaluation criteria for the adequacy of nursing performance in meeting the self-care needs of the patient. It also gives nurses a clear, practical goal – achieving a state of normalcy in a patient’s life, health, and wellbeing.

Another practical application of self-care deficit theory is furthering education and understanding in interns (Younas, 2017). Orem’s theory provides a solid theoretical framework that explains the relationships between nurses and patients, explains the purpose of nursing practice, and gives certain criteria of which to be mindful of. For an aspiring professional this theory could serve as guidance, moral and practical reference. Advanced nurses can also find self-care deficit theory useful. By accepting and applying it, they can improve their personal quality of care due to the existence of clear priorities in practice and relationships with patients. Understanding the nursing systems developed by Orem can lead to the better application of various nursing services. Adequate choice of intervention often defines the effectiveness of assistance action a nurse can perform. The theory teaches all nurses that patients are able to care for themselves, and a nurse who respects a patient and believes in their abilities can be more effective at delivering the best care. In a hospital environment, this can improve patient satisfaction with the clinic’s services, as nurses are the face of the hospital and manage most of the client flow.

Many nurses experience difficulties in the provision of patient education. This initiative is believed to be a highly effective preventative measure, and Orem’s theory could help nurses be more effective at educating patients (Mohammadpour et al., 2015). As such, it inspires the belief that patients are able beings capable of maintaining their health and wellbeing. Regarding patients as participants of that process, a different approach based on mutual respect can be elaborated. It could be more effective than patient education without the knowledge and understanding of collaboration principles and the roles of a nurse and a patient.


All things considered, a proposition that Orem’s theory of self-care deficit should be adopted in this hospital appears to be grounded in practice. Its relevance, simplicity, and holistic nature contribute to its usability in a clinical setting. Both young and mature nursing specialists can benefit from it. It has an excellent potential to improve the quality of service and patients’ satisfaction with the clinic’s services. Therefore, it will be a wise decision to acquaint all nurses with this theory.


Chen, A. M., Yehle, K. S., Albert, N. M., Ferraro, K. F., Mason, H. L., Murawski, M. M., & Plake, K. S. (2014). Relationships between health literacy and heart failure knowledge, self-efficacy, and self-care adherence. Research in Social and Administrative Pharmacy, 10(2), 378-386.

Dorothea Orem self-care deficit nursing theory explained. (n.d.). Web.

Mohammadpour, A., Rahmati Sharghi, N., Khosravan, S., Alami, A., & Akhond, M. (2015). The effect of a supportive educational intervention developed based on the Orem’s self‐care theory on the self‐care ability of patients with myocardial infarction: A randomised controlled trial. Journal of Clinical Nursing, 24(11-12), 1686-1692.

O’shaughnessy, M. (2014). Application of Dorothea Orem’s theory of self-care to the elderly patient on peritoneal dialysis. Nephrology Nursing Journal, 41(5), 495.

Theory based nursing practice (TBNP). (2014). Web.

Younas, A. (2017). A foundational analysis of Dorothea Orem’s self-care theory and evaluation of its significance for nursing practice and research. Creative Nursing, 23(1), 13-23.

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