Dorothea Orem's self-care deficit theory and the nursing systems
- Fundamental
Orem says nursing is needed when a person cannot meet their own self-care demands, and the nurse covers only the gap.
What it is
Dorothea Orem, a US nurse, published her self-care deficit nursing theory in 1971 and refined it with her group for more than 50 years. It is a general theory made of three linked theories. The theory of self-care explains what people do, on purpose, to look after their life, health and wellbeing. The theory of self-care deficit explains when nursing is needed: when the person's ability to care for themselves falls short of what their situation demands. The theory of nursing systems explains how the nurse responds: by doing everything, sharing the work, or teaching and supporting. Colombian nursing programmes use it in teaching and practice.
Key points
- Self-care: deliberate actions a person takes to control internal or external factors that threaten life and development.
- Universal requisites: common to everyone, to keep the body's structure and function working (for example, getting enough air).
- Developmental requisites: linked to life stages and events, such as a new job, a loss or bodily changes.
- Health-deviation requisites: arise with illness or injury and its treatment.
- Self-care agency: the person's ability and power to care for themselves; a dependent-care agent does it for someone else.
- Basic conditioning factors (age, sex, life stage, health, resources, education, family, culture) shape both the demand and the ability.
What it is for
- Strength: simple, clear and logical; it gives a roadmap for sharing care between nurse and patient.
- Strength: it fits chronic illness, rehabilitation, older adults and health promotion.
- Limit: it says little about emotional needs and does not define the family clearly.
- Limit: its vocabulary takes time to learn; teachers who applied it reported much more class preparation at first.
Step by step
- Assess the self-care requisites — universal, developmental and health-deviation — so the full demand is known.
- Assess self-care agency: what the person knows, can do and wants to do — so the gap can be measured.
- Name the deficit as the gap between demand and ability — it shows where nursing is needed.
- Choose the nursing system that fits the deficit — so the nurse covers only what the person cannot do.
- Plan with the person and the family carer, and teach — the goal is to rebuild self-care agency.
- Re-evaluate and move to a less compensatory system as ability returns.
Orem's three nursing systems
| System | Who does the self-care | Typical situation |
|---|---|---|
| Wholly compensatory | The nurse does it for the person | Unconscious or deeply sedated patient |
| Partly compensatory | Nurse and patient share it | Patient after surgery who can eat but not wash alone |
| Supportive-educative | The person does it, with teaching and support | Person learning to manage a chronic illness at home |
In nursing practice
- Example: a woman newly diagnosed with diabetes cannot yet check her glucose or plan meals. The nurse starts partly compensatory and moves to supportive-educative as she learns.
- For a sedated patient in intensive care, the system is wholly compensatory; the family is prepared as dependent-care agents for discharge.
- In Colombia, a university (UDCA, Bogotá) organised its adult and older-adult nursing course around Orem, and a public university taught it in public health.
Common mistakes
- Using the wholly compensatory system for a patient who could do part of his own care.
- Assessing only health-deviation requisites and forgetting universal and developmental ones.
- Confusing the self-care deficit with a disease: it is a gap between demand and ability.
- Leaving the family carer out of the plan when they will be the dependent-care agent.
Test yourself
Think of the answer, then tap the question to see it.
What are the three theories that make up Orem's general theory?
The theory of self-care, the theory of self-care deficit and the theory of nursing systems.
What are the three kinds of self-care requisites in Orem's theory?
Universal, developmental and health-deviation requisites.
Which nursing system fits a person who can care for himself but needs teaching and support?
The supportive-educative system.
What is a self-care deficit in Orem's theory?
The gap between what the person's situation demands for self-care and what the person is able to do.
Connections
Educational content for students; it does not replace your institution's protocols, supervised clinical training or a prescriber's order. Dose-calculation examples use made-up numbers: they are educational, not a clinical order.
Sources: Cuidando al adulto y al anciano. Teoría del déficit de autocuidado de Orem (Aquichan, Universidad de La Sabana, 2003); Theory-Based Advanced Nursing Practice: A Practice Update on the Application of Orem's Self-Care Deficit Nursing Theory (SAGE Open Nursing (PubMed Central), 2021); Where and how does fundamental care fit within seminal nursing theories: A narrative review and synthesis of key nursing concepts (Journal of Clinical Nursing (PubMed Central), 2020); Enseñanza de la salud pública en la formación del pregrado de enfermería en una universidad colombiana (Revista de la Facultad de Medicina, Universidad Nacional de Colombia (Redalyc), 2019).
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Representative model, for educational purposes only.