ture, constitution, and nature of the powers and
properties of individuals who require nursing
and individuals who produce it. Harré (1970) iden-
tifies a theory as a “statement-picture” complex that
supplies an account of the constitution and behav-
ior of those entities whose interactions with each
other are responsible for the manifested patterns of
behaviors. The Nursing Development Conference
Group’s 1971 Theory of Nursing System and the
general theory of nursing (the Self-Care Deficit
Nursing Theory) express both the nature of the en-
tities and the interactions of the entities responsible
for the processes, the patterns of behavior, known
as nursing. Both theoretical expressions had their
beginning in understandings of their formulators
about the reasons why individuals need and can
be helped through nursing. Such understanding
marks the beginning of nursing science.
It is posited that in valid general theories of nurs-
ing, the named nursing-specific conceptualizations
are the human points of reference that reveal the
human properties and powers—the entities investi-
gated in nursing science. For example, in Self-Care
Deficit Nursing Theory, individuals throughout
their life cycles are viewed as having a continuing
demand for engagement in self-care and in care of
self; the constituent action components of the de-
mand together are named the “therapeutic self-care
demand.” The Theory of Self-Care (Orem, 1995) of-
fers a theoretical explanation of this continuing ac-
tion demand. Individuals also are viewed as having
the human power (named “self-care agency”) to de-
velop and exercise capabilities necessary for them to
know and meet the components of their therapeu-
tic self-care demands. Nursing is required when in-
dividuals’ developed and operational powers and
capabilities to know and meet their own therapeutic
self-care demands, in whole or in part and in time-
place frames of reference (that is, their self-care
agency), are not adequate because of health state or
health-care-related conditions.
The idea central to these nursing-specific views
of individuals is that mature human beings have
learned and continue to learn to meet some or all
components of their own therapeutic self-care de-
mands and the therapeutic self-care demands of
their dependents. Others can know the engagement
of mature and maturing human beings in self-care
and dependent-care by observing their actions in
time-place frames of reference and securing subjec-
tive information about what is done and what is
not done for self and dependents, including the
rationales for what is done or what is not done.
Both kinds of care are time-specific entities pro-
duced by individuals.
It is known that therapeutic self-care demands
and self-care agency vary qualitatively and quanti-
tatively over time for individuals. For this reason
they are identified in Self-Care Deficit Nursing
Theory as “patient variables” dealt with by nurses
and persons in need of nursing care within the
processes through which nursing is produced. As
the values of each vary, the relationship between
them varies. When, for health and health-care-
associated reasons, individuals’ self-care agency is
unequal in its development or operability for meet-
ing their existent and changing therapeutic self-
care demand, a self-care deficit exists (Orem, 1995).
The real or potential existence of such a health-
related deficit relationship between the care demand
and power of agency is the reason why individuals
require nursing care.
Self-Care Deficit Nursing Theory offers the ex-
planation that both internal and external condi-
tions arising from or associated with health states
of individuals can bring about action limitation of
individuals to engage in care of self (for example,
lack of knowledge or developed skills, or lack of en-
ergy) (Orem, 1995). The presence and nature of
such action limitations can set up action-deficit re-
lationships between individuals’ developed and op-
erational powers of self-care agency and the kinds
and frequencies of deliberate actions to be per-
formed to know and meet individuals’ therapeutic
self-care demands in time and place frames of
reference.
The power of nurses to design and produce
nursing care for others is the critical power that is
operative in nursing. This human power with its
constituent capabilities and disposition is named
“nursing agency.” The centrality of nursing agency
as exercised by nurses in producing nursing care is
made clear in the Nursing Development Confer-
ence Group’s concept of nursing system (see Table
12–1). The identification and development of the
power of nurses to design and produce nursing care
for others are essential elements in any valid general
theory of nursing. The investigation of this power
and the capabilities and conditions for its exercise
are critical components of nursing science.
Nurses must be knowledgeable about and skilled
in investigating and calculating individuals’CHAPTER 12 Dorothea E. Orem’s Self-Care Deficit Nursing Theory 143