Running head: CRITIQUE AND ANALYSIS OF A THEORY

Critique and Analysis of a Theory Useful in Family Nursing:

Orems Theory of Self Care
Learning Team B: Cynthia Kaletka, Susan Mateo, and Agnes Petrucci
NUR/542
March 23, 2015
Dominic Koh

CRITIQUE AND ANALYSIS OF A THEORY

Critique and Analysis of a Theory Useful in Family Nursing

Orems Theory of Self Care
Dorothea Orems Theory of Self Care is one of the nursing models especially suited to
the practice of family nursing. Orems theory was published in 1971 and put forth the central
thought that nursing care is needed when a person is unable to sufficiently perform the self care
required to sustain life, maintain health, recover from disease or injury or cope with the effects
of disease or injury (Friedman, Bowden, & Jones, 2003, p. 67). Originally, Orem considered the
family only from the perspective that nurses would have to work with them to help the patient
meet self care needs. By 1985, she expanded this view to state that a person receives health care
not only as an individual, but also as a member of a multi-person unit, the family. At this point,
Orem expanded her theory to include the family as the context in which the individual achieves
self care. Others continued to expand Orems theory in the decades following to apply the
concepts of self care to the family unit. This view holds that the family as a whole (which may in
actuality be only one or several or all members at one time) can initiate and perform self care
behaviors. These behaviors are based on attitudes and abilities learned in relationship, by
communication, by social and cognitive interactions, and culture that are specific to the family
(Friedman, Bowden, & Jones, 2003). For example, a family may have a healthy diet because the
mother is the primary food shopper and ensures only healthy foods are purchased for meals and
snacks. Or, a family may have an unhealthy diet because each person secures their own meals at
their own discretion, and the choices on the whole, are fast food and ready made meals.
Major Concepts
Orems theory of self care includes concepts related to self care, self care deficits and
nursing systems that cover deficits to support self care needs. The definition of self care is tasks

CRITIQUE AND ANALYSIS OF A THEORY

performed by a person to maintain life, health and well-being. Self care agency is the persons
ability to perform the self care tasks. Therapeutic self care demand is the whole of the effort and
resources required to perform the entire routine of self care tasks over time. The tasks themselves
are called self care requisites and fall into three categories. The first is universal care (required of
all people) requisites such as air, water, food, and elimination of wastes; activity and rest;
solitude and socialization; promotion of human functioning and prevention from harm. The
second is developmental care requisites such as going to college, getting a new job, marriage,
having a child, or going through menopause. The third is health deviation care requisites such as
seeking appropriate health care, following prescribed treatments, recognizing and responding to
the signs and symptoms of health conditions, adjusting to a modified definition of healthy or ill,
reconciling self concept to that definition, and learning to live with the disease state (current
nursing.com, 2013).
Self care deficits are the places in care and tasks that the person, under normal
circumstances would do, but because of illness or injury cannot do. Self care deficits define
where nursing actions take place. There are five types of care nursing provides to meet the self
care deficit. These include: acting or doing for the person, guiding the person, supporting the
person, teaching the person, and providing the opportunity for personal development that will
enable the person to meet future demands (current nursing.com, 2013).
The provision of nursing care to meet the self care deficits is done through one of three
kinds of systems, or ways of interacting. These are wholly compensatory, partially compensatory
and supportive educative (current nursing.com, 2013). A person can move through all three
systems, or flow between them with the need for more or less support depending on the persons
health status at the moment. For example, a person with a recent hip surgery may initially need

CRITIQUE AND ANALYSIS OF A THEORY

wholly compensatory nursing for the self care deficit in urinary elimination. In this case, an
indwelling urinary catheter is in place and the nurse provides all care for urinary elimination.
Later, as the person regains strength, the catheter is removed and the nurse assists the person to a
bedside commode, a partially compensatory nursing intervention. Finally, the person is able to
use the bathroom commode unassisted, and the nursing becomes supportive-educative as the
nurse reminds the person about hip flexion limits and use of the call bell if assistance is needed.
Assumptions
The underlying assumptions of Orems theory were developed with the individual in
mind, but are easily enlarged to include the family as the focus of nursing care to whom the
assumptions would apply. The first assumption is that people are distinct entities and should be
self-reliant and responsible for their own care and the care of the members of their families. The
second assumption is that people need to know about potential health problems in order promote
self care behaviors. The third is that primary health promotion and illness prevention are the
result of successfully meeting universal and developmental self care requisites. Fourth, self care
(and dependent care) behaviors are learned within a socio-cultural setting. Lastly, nursing is an
action, specifically an interaction, between two or more people (current nursing.com, 2013). The
last three assumptions are the basis for applicability of Orems theory to families as well as
individuals. The family is the socio-cultural setting in which self care behaviors are learned and
practiced. It is the interactions of the family and the cooperative and collective achievement of
self care that promotes health and prevents illness. Finally, when nursing interactions take place
among and between two or more members of the family, the effect is care of the family.

CRITIQUE AND ANALYSIS OF A THEORY

Rationale for Selection

The team selected Orems theory for two reasons. First, the theory has clear and concrete
components that are readily understood. Second, it was chosen for its flexibility of application to
various specialties and levels of nursing practice. Orems theory has been used in specialties
from pediatrics to geriatrics, in settings from ambulatory to acute care to long term care, and
from entry level nursing (CNA, LPN) through advanced practice. It is easily implemented for
direct individual care, indirect dependent care and care of the caregiver, and to the care of whole
families.
Evidence of Use in Family Nursing: Support From Literature
Family nursing as a separate specialty is a fairly recent development. As such, theories
specific to family nursing are still under construction and or current theories are being updated or
modified to address family nursing as separate from disease state specialties (Friedman, Bowden,
& Jones, 2003). However, a search of the University of Phoenixs library returns the following
literature support for Orems theory. Moore and Beckwitt, (2006) used Orems theory in their
research into determining what self-care and dependent-care operations families performed to
address childrens self-care requisites, and identifying their perceptions about nursing
interventions that promoted these operations. The goal of the investigation was to encourage
nurses to design a systematic method for determining appropriate nursing interventions that
better families in caring for children with cancer at home. Pierce and colleagues qualitatively
examined the universal self care requisites of stroke patients and their caregivers learning needs,
using Orems self-care theory to address the needs of the family in both knowledge and self care
abilities (Briggs, 2008). Lawang, Horey, Blackford, Sunsern, & Riewpaiboon (2013), describe a

CRITIQUE AND ANALYSIS OF A THEORY

group of studies that addressed support interventions for caregivers of disabled persons
(primarily, families). The theoretical framework most often used was Orems self-care theory.
Orem and the Nursing Process
The components of the nursing process are assessment, planning, implementing and
evaluating. Orems theory intertwines with the nursing process neatly. In the assessment phase,
Orems theory calls for determining what self care requisites are and are not being met starting
with universal and developmental requisites and continuing through the health deviation
requisites. The patients therapeutic self care demand is determined. In the planning phase, the
nurse determines which nursing actions and interactions (operations) are needed and these are
those operations in Orems theory that may be wholly or partially compensatory or supportive
educative. In the implementation phase, Orems theory is still concurrent with the nursing
process as this is when the physical nursing interactions take place. In the evaluation phase, the
nurse determines which nursing actions need to remain at the wholly compensatory level and
which may need progression to partially compensatory or supportive-educative. In addition,
depending on the patients response to treatments and the progress of the disease state, there may
need to be regression of the interventions back to wholly compensatory (current nursing.com,
2013).
Family Assessment Process Using Orems Theory of Self Care
An interesting example of Orems theory of self-care applied to family nursing is when
grandmothers raise their grandchildren born from mothers with substance abuse problems. The
grandmothers are getting older and are having more health problems themselves. The family
needs to recognize these needs and step in to care for each other (Lange & Greif, 2011). In this
case, the family consists of the grandmother, the substance addicted mother, and the children.

CRITIQUE AND ANALYSIS OF A THEORY

Initially, the universal requisites for all family members must be determined. Interviewing the
grandmother to determine if they have adequate food, shelter, clothing, home utilities (water,
power, phone, gas) is primary. Next would be determining if they had adequate space for sleep,
solitude, and socialization. Are there any threats of harm because of the neighborhood or the
mothers involvement with substance abuse? Next would be the developmental requisites, for the
children, are they in school, do they have adequate support there? For the grandmother, how is
she coping with the situation of caring for the children at her age and how is she coping with the
impacts of the mothers behaviors and substance abuse.
Finally, the health deviation requisites would be addressed. For the children, are they
immunized, do they have colds, allergies, asthma or other health issues, how are they coping
with their mothers behaviors and substance abuse? For the mother, is she going to rehab or
actively using still? What is her general health and is she interested in getting care? Are her
behaviors related to her substance abuse interfering with the rest of the familys ability to meet
their needs (i.e. is she stealing the grocery money)? For the grandmother, is she having any
health issues like hypertension, diabetes, arthritis, heart or kidney disease that need to be
addressed? Who is her support when she needs help with the children or the mothers behaviors?
Once the self care needs are known and where the deficits are, then a plan can be
developed that provides care and resources to support the familys ongoing therapeutic self care
demand. Some may be wholly compensatory such as home health nursing for hypertension and
diabetes management, others partially compensatory such as support groups for the grandmother
and children, and some supportive educative such as teaching the children how to recognize
signs of high and low blood sugars. By addressing the needs of the individual by way of the

CRITIQUE AND ANALYSIS OF A THEORY

family, the care is integrated and interactive, allowing for members to eventually care for each
other.
Applicability, Feasibility, and Use in Advanced Practice Nursing
Originally, Orems Theory of Self-Care was developed for vocational nurses (George,
2011). However, Orems Theory of Self-Care can be applied to many aspects of nursing
including advance practice nursing. Nurse Practitioners in the Primary Care field can apply
Orems theory to their individual patient situations. Orems theory describes two types of
knowledge that can be applied to a Nurse Practitioners practice: speculatively practical
knowledge and practically practical knowledge. The first is based on theoretical knowledge and
the second is developed from real world experiences. It is these experiences that the advanced
practice nurse draws on in order to make clinical decisions (Geden, Isaramala, & Taylor, 2001).
The advanced practice nurse can use Orems theory in order to diagnose the patient. By
determining what the patient can and cannot do for themselves, the Nurse Practitioner can
determine what the person is afflicted with. The theory is used also for prescriptive purposes for
the patient. Each prescription must be integrated into each persons self-care routine and
abilities. It is also used for treatment options for the person determined by the nurse practitioner.
By determining what the patient can do for themselves, the nurse practitioner can design a plan
for treatments to help the patient where they cannot do for themselves. Lastly, the nurse
practitioner can use the theory for case management purposes. Again, knowing what the patient
is able to do themselves help make the plan of what help is needed to be ordered to get them to
their optimal level (Geden et al., 2001).

CRITIQUE AND ANALYSIS OF A THEORY

Applicability to Culturally Diverse Families

Orems Theory of Self-Care can also be applied to culturally diverse families. It
mostly applies to the individual and what their healthcare needs are, or what they are unable to
do themselves. Family nursing is applied because the family needs to meet those needs for the
person with an illness. Some cultures, such as Mexican-Americans, are very close to other
family members (Christianson, Zabriskie, Eggett, & Freeman, 2006), and therefore more likely
to be directly involved in their loved ones care. In the case of the grandmothers taking care of
their grandchildren from mothers with substance abuse problems, the grandmothers have their
own culture. The grandmother takes care of the daughter and the grandchild, but also has to
integrate self-care into their routine. This theory needs to be applied to each family culture
separately because each one has its own set of practices and ways of interacting. Orems theory
can be applied to any family in any culture recognizing that some cultures are not as involved in
their families care than other ones are.
Potential to Generate a Research Base for Advanced Practice Nursing
Orems Theory of Self-Care is a great starting point for advanced practice research.
Orems theory shows the importance of maintaining a persons independence with the help of a
caregiver providing the care the person cannot do. This would be a great topic for research into
case management strategies of the advanced practice nurse and what is most effective for the
person and their families. Another research topic for advanced practice nurses using Orems
theory would be the diverse way it is applied in the many different types of family situations.
Orems theory is a great base for nursing research because it is a solid basic nursing theory
describing the actual care given to the person. It can easily be applied to different types of
nursing like family nursing and different scopes of practice such as advanced practice nursing.

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Strengths and Weaknesses of the Orem Theory

Orems self-care deficit nursing theory and nursing practice positions itself in the direction
of representing a caring approach that uses knowledge of the art and science of nursing. The
body of knowledge includes both empirical and antecedent knowledge (Briggs, 2008). In
empirical knowledge, the experience is focused on events that are specific and related conditions
that relate back to health. It takes observation and then interrupts it and focuses back on what
course of action needs to take place. Antecedent knowledge folds in what was previously learned
through experience and then helps to identify specific knowledge, situations and conditions.
Some see the primary major role of the nurse practitioner as diagnosing and treating of illness by
the use of prescriptive pharmacological agents only (Gerden, Isaramala & Taylor, 2001).
Self-care deficit nursing theory makes available a framework for nursing to see a situation that is
particular to the patient while providing a language that helps to describe what nursing can offer
to the patients personal well-being and health (Gerden et al., 2001). In primary care the major
goal of nursing is to attempt to increase the patients ability to care for themselves and to develop
systems that support that self-care to produce positive health outcomes. The scope of the nurse
practitioner is extremely broad because it encompasses the patients concerns related to their
personal health development and well- being. The primary care setting has a broad spectrum that
includes patients who experience first contact care, care that is completely comprehensive as
well as care that is continuous and takes coordination. The advanced practice nurse, as well as
other health care providers, brings a different perspective to this setting because of the
uniqueness of their own discipline (Gerden et al., 2001). Orems self-care deficit nursing theory
can guide the advanced practice nurse in two strengths as it places emphasis on the patients selfcare system as well as integrating all self- care measures into the patients own systems of daily
living (Gerden et al., 2001). An example of how the advanced practice nurse can assess the

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persons ability to engage in the self-care system would be to identify whether the patient can
read in order examine how one can orient to health. In order to measure the patients own system
of daily living, the advance practice nurse will assess what patterns of living the patient
experiences as it relates to their own health state. This will assist in understanding the ability of
the patient to produce the means to self-care. Within the Orem theory is the ability to exhibit the
knowledge of knowing what actions and the knowledge of actions that are necessary in any
specific nursing situation. The inexperienced advanced practice nurse has a deficit in this area of
knowledge and would be unable to bring forth the actions necessary to increase the ability of the
individual to care for themselves. A second weakness related to the theory is the limitations by
state legislation as it relates to specific medical acts of the advanced practice nurse. In the
complexity of health care, the patient may require continuous oversight from the physician that
can cause confusion to the patient as it relates to control of specific functioning goals of selfcare.
Research
The article presented by Taylor (2001) explores how family can assist in the care of an
individual who has limitations. This framework for this research shows how an interaction within
the family can occur in a variety of ways (Taylor, 2001). The learning of self-care occurs within
the family unit and the family is used as a resource in the managing of self-care. The functions of
a family do not always meet the self-care needs of all of its members. The meaning of family
from the perspective of nursing is produced by self care theory. Researchers cannot stop at doing
an observation of family as a unit. The analysis must stretch over the specific members of the
family and look to what value the family exhibits on the self-care of the members alone. The
interactions as well as the relationships among the members need to be seen as a whole. All

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relationships must be understood so that the nurse can use specifics strategies for the use of the
family unit. Although there is little research that has been completed that looks at the family as a
total unit, this study examines the system of care that exists within the family. Its limitation is
that it only encompassed two adults.
Future
The goal of the nursing system takes the framework and allows the NP to demomstrate
their expertise as a nurse. While patients need to be able obtain and access the needed knowledge
of their specific health problem that, in itself, does not help them to understand their health state
(Gerden et al., 2001). The NP must be able to provide interpretations and descriptions of patient
symptoms for self-care requirements to happen. Future research would be beneficial in the
continued use of self care theory by creating scripts in which the language would clearly define
the actions of the NP as well as the outcomes for the patients. The theory broadens the
understanding of nursing as well as defining primary care.

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References
Briggs, A. (2008). Orems self-care deficit nursing theory: Update on the state of art and
Science. Nursing Science Quarterly, 21(3). Retrieved from:
http://nsq.sagepub.com.contentproxy.phoenix.edu/content/21/3/200
Christianson, O. D., Zabriskie, R. B., Eggett, D. L., & Freeman, P. A. (2006). Family
acculturation, family leisure involvement, and family functioning among MexicanAmericans. Journal of Leisure Research, 38(4), 475-495. Retrieved from
http://search.proquest.com.contentproxy.phoenix.edu/docview/201182540?
accountid=458
Current nursing.com (2013). Application of Orem's Self-Care Deficit theory. Nursing theories: a
companion to nursing theories and models. Retrieved from:
http://currentnursing.com/nursing_theory/application_self_care_deficit_theory.html
Geden, E., Isaramala, S., & Taylor, S. (2001). Self-care deficit theory and the nurse practitioners
practice in primary care setting. Nursing Science Quarterly, 14(1), 29-33. Retrieved from
http://nsq.sagepub.com.contentproxy.phoenix.edu/content/14/1/29.2
George, J. B. (2011). Nursing theories: The base for professional nursing practice (6th ed.).
Boston: Person.
Lange, B., & Greif, S. (2011). An emic view of caring for self: Grandmothers who care for
children of mothers with substance use disorders. Contemporary Nurse : a Journal for
the Australian Nursing Profession, 40(1), 15-26. Retrieved from
http://search.proquest.com.contentproxy.phoenix.edu/docview/1022283286?
accountid=45

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Lawang, W., Horey, D., Blackford, J., Sunsern, R., & Riewpaiboon, W. (2013). Support
interventions for caregivers of physically disabled adults: A systematic review. Nursing &
Health Sciences, 15(4), 534-545. doi:10.1111/nhs.12063
Moore, J. B. and Beckwitt, A. E. (April, 2006) Self-care operations and nursing interventions for
children with cancer and their parents. Nursing Science Quarterly. 19 (2) pp147-156
doi: 10.1177/0894318406286594
Taylor, S. (2001). Orems general theory of nursing and families. Nursing Science Quarterly,
14(1). Retrieved from: http://nsq.sagepub.com.contentproxy.phoenix.edu/content/14/1/17
Full.pdf.html