therapeutic self-care demands, in determining the
degrees of development and operability of self-care
agency, and in estimating persons’ potential for reg-
ulation of the exercise or development of their
powers of self-care agency. Nurses’ capabilities ex-
tend to appropriately helping individuals with
health-associated self-care deficits to know and
meet with appropriate assistance the components
of their therapeutic self-care demands and to regu-
late the exercise and development of their powers
of self-care agency. These outcomes of nursing are
contributory to the life, health, and well-being of
individuals under the care of nurses. Outcomes, of
course, are related to the reasons why individuals
require nursing care.
Self-Care Deficit Nursing Theory, as it has been
developed, builds from expressed insights about the
powers and properties of persons who need nurs-
ing care and those who produce it, to the nature
and constitution of those properties, to the details
of the structure of the processes of providing nurs-
ing care for individuals, and to the processes for
providing nursing care in multiperson situations,
including family and community (Orem, 1995).
These are developments of nursing’s professional-
technological features. In the initial and later stages
of development of this general theory of nursing,
developers formally recognized that nursing is a
triad of interrelated action systems: a professional-
technical system,the existence of which is depend-
ent on the existence of an interpersonal system,and
a societal systemthat establishes and legitimates the
contractual relationship of nurses and persons who
require nursing care.
Nursing students should be helped to under-
stand and recognize in concrete nursing practice
situations the tripartite features of nursing systems
and the relationships among them. Theoretical
nursing science differentiates content that is specif-
ically interpersonal from professional-technological
content, and it specifies content that establishes
the link between interpersonal and professional-
technological features of nursing and content
that establishes the validity or lack of validity of a
societal-contractual system.
Societal systems usually begin or are established
by specifying the contracting parties and their le-
gitimate relationships. Initial relationships may or
may not endure or be legitimate throughout nurs-
ing practice situations. There may be or should be
changes in both nurses and persons contracting for
the care. The societal-contractual system legit-
imizes the interpersonal relationships of nurses
and persons seeking nursing and their next of kin
or their legitimate guardians. The interpersonal
system is constituted from series and sequences of
interaction and communication among legitimate
parties necessary for the design and production
of nursing in time-place frames of reference. The
professional-technological nursing system is the
system of action productive of nursing. It is de-
pendent upon the initial and continuing produc-
tion of an effective interpersonal system.
Comprehensive general theories of nursing ad-
dress whatnurses do,whythey do what they do,
whodoes what, and howthey do what they do. A
valid general theory of nursing thus sets forth nurs-
ing’s professional-technological features specific to
the production of nursing. A general theory of
nursing that addresses nursing’s professional-
technological features provides points of articula-
tion with interpersonal features of nursing and sets
the standards for safe, effective interpersonal sys-
tems. These features also point to the legitimacy
of, or need for change in, societal-contractual sys-
tems. For the initial expression of the tripartite
nature of nursing systems within the frame of Self-
Care Deficit Nursing Theory, see the Nursing
Development Conference Group’s (1979) develop-
ment of a “triad of systems.”BROADER VIEWS
Nursing-specific views of individuals fit within one
or more broader views of human beings. Consider,
for example, the conceptual element of self-care
agency in the Self-Care Deficit Nursing Theory.
Agency within this conceptual element is under-
stood as the human power to deliberate about,
make decisions about, and deliberately engage in
result-producing actions or refrain from doing so.
The self-careportion of the conceptual element
specifies that agency in this context is specific to de-
liberating about, making decisions about, and pro-
ducing the kind of care named “self-care.” Thus the
concept and the term “self-care agency” stand for a
specialized form of agency that demands the devel-
opment of specialized knowledge and action capa-
bilities by humans. However, the power of self-care
agency is necessarily attributed to human beings
viewed as persons,for it is individuals as persons
who investigate, reason, decide, and act, exercising144 SECTION III Nursing Theory in Nursing Practice, Education, Research, and Administration