what type of nursing system is appropriate in a
given nursing practice situation rests with the
answer to the question, “Who can and should
perform the self-care operations?” (Orem, 2001,
p. 350). When the answer is the nurse, a wholly
compensatory system of helping is appropriate.
When it is concluded that the patient can and
should perform all self-care actions, the nurse as-
sumes a supportive-educative role and designs a
nursing system accordingly. In nursing practice
situations, the goal of nursing is to empower
the person to meet their self-care requirements by
doing for (wholly compensatory system), doing
with (partly compensatory system), or developing
agency (supportive-educative system).
This chapter focuses on the extent to which
Orem’s theory is offering direction to nurse schol-
ars and scientists in advancing nursing science and
professional practice. Dorothy Johnson (1959), in
her treatise on nursing theory development, viewed
this attribute of a theory as its value for the profes-
sion, its social utility.
Research
Dorothea Orem’s theory is offering clear direction
to nurses in the advancement of nursing science in
this millennium. Orem describes nursing as a prac-
tical science that is comprised of both theoretical
and practical knowledge, a point of view that is
grounded in modern realism (2001, p. 170). There
are parallels between Orem’s description of nursing
as a practical science and Donaldson and Crowley’s
discussion of nursing as a professional discipline.
Recall that Donaldson and Crowley (1978) stated
that the aim of professional disciplines is to know
and to useknowledge to achieve the practical goal
of the discipline. Both perspectives address the
need for nurses to develop both theoretical and
practical knowledge.
Orem (2001, p. 170) has identified a model
comprised of five stages for nursing science devel-
opment. Each stage is intended to yield different
kinds of knowledge about persons with existent or
potential health-related self-care deficits. Stages 1
and 2 of this developmental schema for science
focus on the advancement of the theoretical com-
ponent of nursing science. The theory is the result
of Stage 1. Stage 2 is described as the study of con-
current variations between the concepts proposed
within the Self-Care Deficit Nursing Theory for the
purpose of verifying and further explicating the
propositions (Orem, 2001, p. 171). The proposi-
tions of the Self-Care Deficit Nursing Theory pro-
vide direction to nursing researchers who aim to
focus their inquiry in theory-based research.
Numerous examples of research illustrating sci-
entific inquiry at the Stage 2 level of development
are contained in the nursing literature. The aspect
of the Self-Care Deficit Nursing Theory that has
generated the most research of this type is the
relationship posited between basic conditioning
factors and self-care agency. The basic condition-
ing factors were identified initially by the Nursing
Development Conference Group (1979) and were
formalized later in a proposition linking them to
self-care agency. The second proposition listed in
the Self-Care Deficit Nursing Theory states that in-
dividuals’ abilities to engage in self-care (self-care
agency) are conditioned by age, developmental
state, life experiences, sociocultural orientation,
health, and available resources (Orem, 2001,
p. 167). This proposition offers direction to nurses
interested in engaging in theory-based research.
Basic conditioning factors are defined as “condi-
tions or events in a time-place matrix that affect the
value of person’s abilities to care for themselves”
(Orem). It is important to note that the influence of
the basic conditioning factors on self-care agency is
not assumed to be operative at all times. Nor are all
the basic conditioning factors assumed to be oper-
ative at all times. Because the influence of these fac-
tors occurs within a time-place matrix, research is
necessary to identify those nursing practice situa-
tions in which the factors are operative and to ex-
plain the nature of their influence on self-care
agency. Based upon research findings, relationships
between the basic conditioning factors and the sub-
stantive structure of self-care agency can then be
made explicit. Programs of research designed in
this way can verify the existence of linkages be-
tween these concepts and can explain the nature of
the linkages. Scholarly work of this type is vital to
the advancement of the theoretical knowledge of
nursing science.
Over the past decade, nurse researchers have
studied the influence of basic conditioning factors,
singularly and in combination, on individuals’ self-
care abilities. Foremost among the basic condition-150 SECTION III Nursing Theory in Nursing Practice, Education, Research, and Administration