Dorothea Orem’s Theory of Grand Nursing


Each hospital patient, as well as any other person, has their particular needs, starting from basic ones, such as nutrition, to socialization. This concept can be referred to as self-care, and it was the area of intense interest in numerous studies. In general, it implies that each person aims at fulfilling their needs in all situations. However, in the case of hospital patients, self-care is not always possible due to specific medical reasons. In this scenario, it is a nurse’s duty to help the patient overcome the struggle and ensure maximum independence from their actions. This idea is at the center of Dorothea Orem’s theory of grand nursing. The purpose of this paper is to examine Orem’s theory in the context of the Doctorate in Nursing Practice’s (DNP) role in patients’ self-care assistance.

Personal Ideas in relation to the Nursing Metaparadigm

Today’s healthcare system can be characterized by profound transformation occurring in its various aspects. There is a shift toward considering each patient as a particular human being with their own needs, views, and backgrounds. This tendency is reflected in modern methods applied in healthcare, such as the patient-centered approach, widely used in different institutions and facilities throughout the world. Patient-centered care is directly connected to the nurses’ area of work, as it is their duty to be helpful and accommodating, providing patients with what they need during treatment. Alhalal et al. (2020) highlight the importance of this philosophy in today’s healthcare, as it remains “the heart of nursing care” (p. 1400). Indeed, the paradigm of patient-centered care meets modern criteria and correlates with the values of equal and inclusive care for all people. Generally, it dictates the importance of the patient’s wishes in the clinical setting. While there is no doubt regarding the expertise of medical practitioners, the patient-centered model requires that each individual’s needs should be recognized and considered by doctors and nurses. These aspects are crucial in the modern environment, allowing for deeper trust and effective treatment through communication.

While each individual may demonstrate a particular set of desires, their core needs exist within one primary paradigm. Every person wishes to have their needs met, with physical ones having the highest level of priority. Nevertheless, apart from food, water, and sleep, people aim at ensuring their safety, stability, success, and meaningful social interactions. Hospital patients may be unable to provide themselves with basic aspects of a comfortable life, thus experiencing a self-care deficit. In this case, one of the nurse’s primary objectives is to compensate for the lack of self-care with the intention to improve and accelerate their recovery.

This philosophical perspective focuses on the person component of the nursing paradigm, which is logical, as the person remains in the center of healthcare at all times. The environment also plays an important role in this model, as it aims at eradicating negative influence from the outside while promoting positive inner processes. Finally, health and nursing components are also considered since a patient-centered approach exists to contribute to people’s well-being, and nurses are crucial elements of this system. All four components are embedded in effective healthcare, as attention to one of them positively affects the others. The DNP would make a valuable contribution in this respect and further develop essential competencies required by this approach.

Dorothea Orem’s Theory of Grand Nursing

As mentioned above, particular health-related conditions may impair a person’s ability to care for themselves. According to Khademian et al. (2020), the nursing theory proposed by Dorothea Orem views nursing as one of the ways to compensate for the self-care deficit in the clinical setting. Orem’s model divides patients’ personal needs into three major subgroups, which are universal, ontogenesis-related, or disorder-conditioned (Smith, 2019). The first category comprises needs that every human being may demonstrate as the result of regular life processes. The ontogenesis-related subgroup includes aspects that emerge during particular stages of a person’s life and development. Finally, a range of mental and physical illnesses leading to the self-care deficit fall into the third category of disorder-conditioned needs (Smith, 2019). In fact, self-care remains the central concept of Orem’s theory and is understood by the actions an individual takes to maintain their desired quality of life and overall well-being. It is important to note that such actions are performed by the person’s own will and with a clear intention which corresponds with Orem’s other concept of the need for self-care.

As a matter of fact, Dorothea Orem devised the described self-care theory within a larger framework comprising the theory of self-care deficit and the theory of nursing systems as well. These theories provide an in-depth understanding of self-care in its relation to a potential deficit and a nurse’s role in this scenario. Generally, it is a nurse’s responsibility to compensate for the self-care deficit a patient may experience, while helping them regain their independence through effective treatment (Smith, 2019). In addition, Orem introduces the particular notion of self-care ability as well as its impossibility and limited form. The ability to self-care can be described as a set of personal traits and skills, allowing the individual to have their needs met through their own actions. Malekzadeh et al. (2018) note that such factors as motivation, knowledge, and experience serve as enablers of self-care ability. In the case when the ability is either limited or generally impossible, the person cannot achieve full satisfaction without outside assistance, such as the family’s help. Accordingly, this assistance is expected from a nurse in the clinical setting.

Orem’s theory can be applied in different scenario, including general ones. At the same time, the author of the model in question pays attention to the nurse’s role in care provision as well as their effective interaction with the patient. As far as nursing is concerned, there are three major categories of care distinguished by Orem (Gonzalo, 2019). First, a fully compensating system requires that the nurse should assist the patient in a large variety of situations, including basic procedures. Second, there is a partially compensating system where the nurse helps the patient satisfy their needs through cooperation. Finally, a supportive nursing system implies that a nurse’s role reminds one of a guide or a teacher who trains the patient to perform specific therapeutic actions. Overall, Orem’s generalized theory encompasses an array of human activity spheres explaining the importance of self-care and self-care deficit reduction for nurses.

The Theory of Grand Nursing within the Framework of Nursing Metaparadigm

Dorothea Orem’s theory is quite simple yet sophisticated in the way it explains the profound processes of human motivation and needs. It encompasses three important areas of self-care, self-care deficit, and nursing systems. These three concepts play a crucial role in determining the patient-centered care delivered by nurses. According to Khademian et al. (2020), Orem’s theory of self-care deficit embraces the nursing metaparadigm of including people, environment, health, and nursing.

As envisioned by the patient-centered philosophy, the theory in question considers the patient with their personality, wishes, and desires to be the priority of all healthcare processes. It is a nurse’s duty to distinguish their patient’s needs at a particular moment and take necessary actions aimed at helping them achieve autonomy through accurate care. The implementation of Orem’s theory may lead to lower healthcare costs, quality care development, and patient outcome improvements, which can bridge the “gap” between theory and practice (Malekzadeh et al., 2018). Indeed, all patients have an inherent desire to be capable of self-care, and assisting them in achieving this goal may have a positive effect on their overall conditions. As mentioned above, the correct implementation of patient-centered care following Orem’s model accelerates recovery and makes the patient’s stay at the hospital effective. In this scenario, nurses have a unique opportunity of achieving their ultimate goal of helping people regain the capability of self-care. As the primary purpose of nursing is to enable quality care, a patient-centered approach may prove to be extremely useful for nurses aspiring to attain the DNP.


In conclusion, the healthcare tendencies of the 21st century promote patients’ importance in the process, recognizing them as individuals with their particular sets of needs. According to this philosophical model, nurses play a crucial role being the bridge between their institution and the patient’s personality. The Doctorate of Nursing Practice provides nurses with a more in-depth understanding of the process and ensures high quality care. Dorothea Orem’s generalized theory corresponds with this vision, as it encompasses such important aspects as self-care, self-care deficit, and nursing systems. Orem’s model promotes self-care capability as a matter of great priority for all individuals. Overall, Dorothea Orem’s nursing theory reflects the modern values of inclusive and patient-centered care, making it a valuable instrument for medical practitioners.


Alhalal, E., Alrashidi, L. M., & Abdulrahman, N. A. (2020). Predictors of patient‐centered care provision among nurses in acute care setting. Journal of Nursing Management, 28(6), 1400–1409. Web.

Gonzalo, A. (2019). Dorothea Orem: Self-care deficit theory. Web.

Khademian, Z., Ara, F. K., & Gholamzadeh, S. (2020). The effect of self-care education based on Orem’s nursing theory on quality of life and self-efficacy in patients with hypertension: A Quasi-Experimental Study. International Journal of Community Based Nursing & Midwifery, 8(2), 140–149. Web.

Malekzadeh, J., Amouzeshi, Z., & Mazlom, S. R. (2018). A quasi-experimental study of the effect of teaching Orem’s self-care model on nursing students’ clinical performance and patient satisfaction. Nursing open, 5(3), 370–375. Web.

Smith, M. C. (2019). Nursing theories and nursing practice. F. A. Davis.

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