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CHAPTER 14 Dorothea E. Orem 249

and dependent care are parallel, with the main dif- operational or become operational in the production
ference that when providing dependent-care, the of nursing systems, systems of care for individuals
person is meeting the self-care needs of another or for dependent-care units or multi-person units
person. For the dependent-care agent, the demands served by nurses” (Orem, 1997, p. 31). The overall
of providing dependent care can influence or condition theory is logically congruent.
the agent’s therapeutic self-care demand and self-care
agency. The need for dependent-care is expected to
grow with the increasing age of the population and Acceptance by the Nursing Community
the number of persons living with chronic and/or Orem’s SCDNT has achieved a significant level of
disabling conditions. acceptance by the international nursing community,
as evidenced by the magnitude of published material
and presentations at the International Orem Society
Logical Form World Congresses (2008, 2011, and 2012). In research
Orem’s insight led to her initial formalization and using the SCDNT or components, Biggs (2008) found
subsequent expression of a general concept of nurs- more than 800 references. Berbiglia identified se-
ing. This generalization then made possible induc- lected practice settings and SCDNT conceptual foci
tive and deductive thinking about nursing. The from a review of more than 3 decades of use of the
form of the theory is shown in the many models SCDNT in practice and research and publicized
that Orem and others have developed, such as selected international SCDNT practice models for
those shown in Figure 14–1 and Figure 14–2. Orem the twenty-first century (in press).
described the models and their importance to the The SCDNT was introduced as the basic structure
development and understanding of the reality of for nursing management in German hospital DRG
the entities. These models are “. . . directed toward (diagnosis-related group) implementation. The move-
knowing the structure of the processes that are ment toward SCDNT-based nursing management in

Self-care

Conditioning factors Self-care Self-care factors Conditioning
demands
agency

Deficit

Conditioning factors Nursing

agency

FIGURE 14-2 A conceptual framework for nursing. R, Relationship; ,, deficit relationship, current
or projected. (From Orem, D. E. [2001]. Nursing: Concepts of practice [6th ed., p. 491]. St. Louis: Mosby.)