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248 UNIT III Nursing Conceptual Models

providing care to group members who experience associated with the subjectivity of mature and
privations for making required, deliberate input to maturing persons to health-related or health care–
self and others (p. 140). related action limitations. These limitations render
Orem stated pre-suppositions and propositions for them completely or partially unable to know existent
the theory of nursing systems, the theory of self-care and emerging requisites for regulatory care for
deficit, and the theory of self care. These constitute the themselves or their dependents. They also limit the
expression of the theories and are summarized below. ability to engage in the continuing performance
of care measures to control or in some way manage
factors that are regulatory of their own or their
Theoretical Assertions dependent’s functioning and development.
Presented as a general theory of nursing, one that Self-care deficit is a term that expresses the rela-
represents a complete picture of nursing, the SCDNT tionship between the action capabilities of individuals
is expressed in the following three theories: and their demands for care. Self-care deficit is an
1. Theory of nursing systems abstract concept that, when expressed in terms of
2. Theory of self-care deficit action limitations, provides guides for the selection
3. Theory of self-care of methods for helping and understanding patient
The three constituent theories, taken together in roles in self-care.
relationship, constitute the SCDNT. The theory of
nursing systems is the unifying theory and includes Theory of Self-Care
all the essential elements. It subsumes the theory of Self-care is a human regulatory function that indi-
self-care deficit and the theory of self-care. The theory viduals must, with deliberation, perform themselves
of self-care deficit develops the reason why a person or must have performed for them to maintain life,
may benefit from nursing. The theory of self-care, health, development, and well-being. Self-care is an
foundational to the others, expresses the purpose, action system. Elaboration of the concepts of self-
method, and outcome of taking care of self. care, self-care demand, and self-care agency provides
the foundation for understanding the action require-
Theory of Nursing Systems ments and action limitations of persons who may
The theory of nursing systems proposes that nursing benefit from nursing. Self-care, as a human regulatory
is human action; nursing systems are action systems function, is distinct from other types of regulation of
formed (designed and produced) by nurses through human functioning and development, such as neuro-
the exercise of their nursing agency for persons with endocrine regulation. Self-care must be learned, and
health-derived or health-associated limitations in it must be performed deliberately and continuously
self-care or dependent care. Nursing agency includes in time and in conformity with the regulatory
concepts of deliberate action, including intentionality, requirements of individuals. These requirements are
and the operations of diagnosis, prescription, and associated with their stages of growth and develop-
regulation. Figure 14–1 shows the basic nursing sys- ment, states of health, specific features of health or
tems categorized according to the relationship between developmental states, levels of energy expenditure,
patient and nurse actions. Nursing systems may be and environmental factors.
produced for individuals, for persons who constitute
a dependent-care unit, for groups whose members Theory of Dependent-Care
have therapeutic self-care demands with similar com- The theory of dependent care “explains how the
ponents or who have similar limitations for engagement self-care system is modified when it is directed to-
in self-care or dependent care, and for families or other ward a person who is socially dependent and needs
multi-person units. assistance in meeting his or her self-care requisites”
(Taylor & Renpenning, 2011, p. 24). For persons
Theory of Self-Care Deficit who are socially dependent and unable to meet
The central idea of the theory of self-care deficit their therapeutic self-care demand, assistance from
is that the requirements of persons for nursing are other persons is necessary. In many ways self-care