Dorothea Orem (1914–2007) asked a simple question: why do people need nurses? Her answer became one of the most widely used nursing theories in the world. People need nursing when the demands of their self-care are greater than their ability to meet them, and nursing’s job is to close that gap until they can manage again.
This guide explains Orem’s self-care deficit theory, the three linked theories within it, the universal, developmental and health deviation self-care requisites, the three nursing systems, a worked example, and how to use it in care plans.
Imagine a 45-year-old taxi driver newly diagnosed with type 2 diabetes. On day one in hospital with high blood sugar, nurses check his glucose and give insulin. By day three, he is learning to check his own glucose while a nurse watches. At discharge, he has a plan for food, medicines and follow-up, and the nurse’s role becomes teaching and support by phone. Without naming it, the team has moved through Orem’s nursing systems.
Who was Dorothea Orem?
Orem was an American nurse, educator and consultant who developed her theory from the 1950s onwards and published it in Nursing: Concepts of Practice (first edition 1971), revised several times. Her ideas strongly influenced nursing education, rehabilitation, chronic disease management and community nursing worldwide.
Three linked theories
| Theory | Key question |
|---|---|
| Theory of self-care | What do people do to maintain life, health and wellbeing? |
| Theory of self-care deficit | When can people not meet these needs themselves, and why? |
| Theory of nursing systems | How should nurses respond to the deficit? |
Self-care requisites
1. Universal self-care requisites (needed by everyone)
- Sufficient air
- Sufficient water
- Sufficient food
- Care related to elimination
- Balance between activity and rest
- Balance between solitude and social interaction
- Prevention of hazards to life, functioning and wellbeing
- Promotion of normal human functioning and development (“normalcy”)
2. Developmental self-care requisites
Needs linked to life stages and events: pregnancy, infancy, adolescence, ageing, bereavement, migration, loss of a job.
3. Health deviation self-care requisites
Needs created by illness, injury or treatment: taking medicines, managing a stoma, monitoring blood glucose, wound care, adapting to disability.
Self-care agency and self-care deficit
Self-care agency is a person’s ability to perform self-care, influenced by age, health, knowledge, culture, family support and resources. A self-care deficit exists when the demand for self-care is greater than the person’s agency. That gap is where nursing is needed.
The three nursing systems
| System | Who does what | Example |
|---|---|---|
| Wholly compensatory | Nurse does almost everything for the patient | Unconscious ICU patient; immediately after major surgery |
| Partly compensatory | Nurse and patient share care | Patient washes face and hands; nurse helps with back and legs |
| Supportive-educative | Patient does self-care; nurse teaches, guides and supports | New diabetes diagnosis; learning stoma care before discharge |
Nursing methods of helping
Orem described ways nurses help: acting for or doing for the person; guiding; supporting (physically or psychologically); providing an environment that promotes development; and teaching.
Worked example: care plan using Orem
| Step | Example (adult after hip replacement) |
|---|---|
| Assess requisites | Universal: mobility, elimination, rest. Health deviation: wound care, anticoagulant injections, pain control |
| Assess agency | Motivated, lives alone, limited knowledge of injections, pain limits movement |
| Identify deficit | Cannot yet mobilise safely or self-inject |
| Choose system | Partly compensatory moving to supportive-educative |
| Interventions | Analgesia before physiotherapy; teach and observe self-injection; arrange home equipment |
| Evaluate | Walks with frame independently; demonstrates safe injection technique before discharge |
Where Orem’s theory works best
- Chronic disease management (diabetes, heart failure, COPD, HIV).
- Rehabilitation and orthopaedics.
- Community and home nursing.
- Patient education and discharge planning.
- Older adult care.
Strengths and criticisms
- Strengths: clear, practical, promotes independence, fits care planning and patient education, widely researched.
- Criticisms: strongly individual, may underplay cultural contexts where family or community provides care; terminology can feel complex; less focus on emotional and relational aspects.
Orem’s ideas echo Virginia Henderson’s 14 needs, which also emphasise helping people become independent.
Frequently asked questions
What is Orem’s self-care deficit theory?
A nursing theory stating that nursing is needed when a person’s self-care demands exceed their ability to meet them.
What are the three nursing systems?
Wholly compensatory, partly compensatory and supportive-educative.
What are the universal self-care requisites?
Air, water, food, elimination, activity and rest, solitude and social interaction, prevention of hazards, and promotion of normal functioning.
Where is Orem’s theory used?
Widely in chronic disease, rehabilitation, community nursing and patient education.
But what about cultures where families provide care?
This is a fair criticism. In many African, Asian and Middle Eastern settings, family members are central to care. Nurses can adapt Orem by assessing “dependent-care agency”: the ability of family carers, and teaching them alongside the patient.
Your next step: For one patient on your next shift, decide which nursing system you are using (wholly compensatory, partly compensatory or supportive-educative) and set one goal that moves them one step towards independence.
Related: Henderson’s 14 needs · Peplau’s interpersonal theory · Type 2 diabetes patient education
Sources: Orem DE. Nursing: Concepts of Practice (6th ed., 2001); nursing theory textbooks (e.g. Alligood, Nursing Theorists and Their Work); published applications of Orem’s theory in chronic disease nursing.
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