THEORY-BASED EXEMPLAR PAPER 1
Theory-Based Exemplar Paper
Amber Diers, BSN, RN
Department of Nursing, Liberty University
Ruth Anne Kuiper
502 Nursing Theory
October 5, 2025
Theory-Based Exemplar Paper
Nursing is both an art and a science that centers on helping individuals achieve and
maintain optimal health through compassionate, evidence-based care. Nursing theories form
the essential framework for professional practice. They provide structured ways to understand
patient needs, guide clinical interventions, and improve nursing knowledge. One of the most
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influential theorists is Dorothea Orem’s Self-Care Nursing Theory. This theory emphasizes the
importance of nurses supporting patients when they are unable to care for their own needs. It
not only outlines nursing practice but also stresses the importance of patient autonomy,
independence, and empowerment (McEwen & Wills, 2023) (Yip, 2021).
By using Orem’s theory as a framework, nurses can systematically identify deficits, tailor
interventions, and empower individuals and families in their health journeys. This exemplar will
demonstrate how Orem’s Self-Care Deficit Nursing Theory can be applied in practice, illustrating
its usefulness in addressing patient needs and reinforcing nursing’s unique contribution to
holistic, patient-centered care.
Overview of Nursing Theory
Dorothea Elizabeth Orem was an influential American nursing theorist whose
work significantly shaped modern nursing practice. Dorothea was born in 1914 and grew up in
Maryland. She completed her undergraduate and graduate degrees by 1945. Orem had a rich
nursing career. She worked as a staff nurse, private duty nurse, consultant, educator, and
administrator. Her interest in nursing theories increased in 1971 when she worked with
colleagues to develop a nursing curriculum. From the insight of her career, she articulated a
theory that defined nursing as a deliberate action to help individuals maintain or regain their
ability to care for themselves (McEwen & Wills, 2023).
Orem’s Self-Care Theory is part of the Grand Nursing Theories of Human Needs, which
focuses on meeting patients' nursing care needs. This theory is particularly valuable in complex
care settings where patients face significant physical and emotional challenges that limit their
ability to manage their health independently. The theory underscores that patients should play
an active role in managing their health and illnesses through self-care. Orem believed that
people have a natural ability and duty to care for themselves. However, when patients cannot
meet these needs on their own, nursing intervention becomes necessary. The main principle of
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the theory is simple yet broad enough to apply to many situations and patient interactions
(McEwen & Wills, 2023).
Orem identified three nested theories: theories of self-care, self-care deficit, and nursing
systems. The theory of nursing systems surrounds the theory of self-care deficit, and the theory
of self-care is a part of the theory of self-care deficit (McEwen & Wills, 2023, pg. 147). The
theory of self-care describes how people engage in activities to maintain life and well-being. The
theory of self-care deficit explains when nursing help is needed. The theory of nursing systems
explains how nurses can support patients with wholly compensatory, partly compensatory, or
supportive-educative care. Once a condition has been diagnosed, the nurse decides on the
appropriate intervention or system to help the patient regain their ability to perform self-care.
These frameworks guide nurses by focusing on the balance between patients' abilities and their
healthcare needs (McEwen & Wills, 2023).
Orem’s theory is widely used across various populations and settings. It provides a
structured approach for nursing assessments, care planning, and interventions, aiming to
promote patient independence and optimal health. The focus is on empowerment, education,
and personalized care, which makes it practical and adaptable to modern nursing practice
(McEwen & Wills, 2023).
Exemplar
During my time as a bedside nurse on the Pediatric Bone Marrow Transplant (BMT)
Unit, I became the primary nurse for a resilient, spirited six-year-old patient, referred to here as
B.D. Throughout his oncology treatment, B.D. consistently struggled with medication adherence.
Following prolonged chemotherapy regimens, many pediatric patients develop gastrointestinal
sensitivity, making oral medication particularly difficult to tolerate. For BMT patients, however,
strict adherence to prescribed medications is critical, as noncompliance can carry life-
threatening consequences. This reminded me of Proverbs 4:20-22, which states, “My son, pay
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attention to what I say; turn your ear to my words. Do not let them out of your sight, keep them
within your heart; for they are life to those who find them and health to one’s whole body”
(NIV, 1973/2011). Just as Scripture emphasizes discipline in receiving what brings life, my role as
his nurse was to help him embrace the healing process, even when it felt overwhelming.
Early in his treatment course, I recognized that B.D. required a sense of control over his
care to engage more fully in the process. On one shift, I began exploring his fears and
preferences through conversation. At that time, his morning regimen consisted of approximately
15 medications, which typically took three to four hours to complete and often resulted in
vomiting, further prolonging the process. When asked how he would prefer to take his
medications, B.D. explained that he needed a one-minute break between each dose. While
unconventional, I agreed and allowed him to set a one-minute timer on his iPad between
medications. This strategy not only empowered him but also significantly improved adherence,
reducing his medication routine to approximately 20–30 minutes. In this, I was reminded of
Philippians 4:13, “I can do all things through Christ who strengthens me” (NIV, 1973/2011).
With a slight shift in approach and encouragement, B.D. demonstrated strength far beyond his
years.
As his treatment advanced, I anticipated additional challenges, particularly with the
increase to over 20 morning medications following transplant. Liquid formulations remained
especially difficult for him, so I initiated a conversation about transitioning to pill form. Although
hesitant at first, B.D. agreed to try with the support of occupational therapy, using specialized
cups and practicing initially with small candies. Over time, with consistent encouragement from
multiple nurses, he gained confidence in pill swallowing. This process reflected Galatians 6:2,
“Carry each other’s burdens, and in this way, you will fulfill the law of Christ” (NIV, 1973/2011).
Together as a healthcare team, we shared the burden of his struggle, ensuring he never faced it
alone. I will never forget the mother and father’s thankfulness to everyone who never gave up
on their son, even in the times that it.
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During one of my later shifts caring for B.D., his regimen through the BMT process had
increased to roughly 30 morning medications. Despite the challenge, he proudly announced his
determination to take them all, again using his one-minute timer to pace himself. Sitting at his
bedside, I encouraged and distracted him through the process, which he successfully completed
in 35–40 minutes—a remarkable improvement from his previous four-hour struggle. In those
moments, I reflected on Isaiah 40:29, “He gives strength to the weary and increases the power
of the weak” (NIV, 1973/2011). Indeed, the strength B.D. demonstrated was not his alone but a
reflection of God’s sustaining grace in the midst of suffering.
Application of Theory
Orem’s Self-Care Deficit Nursing Theory emphasizes that nursing is required when an
individual is unable to meet their own self-care demands and guide interventions that promote
independence. In the case of B.D., a six-year-old undergoing bone marrow transplant, his
inability to independently manage a complex medication regimen reflected a self-care deficit.
According to Orem, the nurse’s role is to assess the self-care demands, determine the extent of
the deficit, and implement supportive interventions that can empower the patient to meet
those needs.
For B.D., his self-care deficit was both developmental and situational. At his age, he did
not have the maturity to independently organize or adhere to a demanding medication
schedule, especially when he faces nausea, fatigue, and fear on a daily basis. The nursing
intervention aligned with Orem’s supportive-educative system where the nurse encourages
patient participation and autonomy while still offering guidance. By allowing B.D. to set his timer
and pace his medications, the nurse promoted a sense of control, which encouraged his
willingness to engage in his own care (Hartweg & Metcalfe, 2021).
Next, when he transitioned from liquid medications to pill swallowing, the nurse utilized
teaching, coaching, and collaboration with occupational therapy, which highlights Orem’s
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supportive-educative approach. The development of his pill-swallowing skill not only reduced
his physical discomfort but also lifted his confidence and his ability for self-care.
Ultimately, the nurse bridged the gap between B.D.’s self-care abilities and his self-care
demands. The nurse used Orem’s theory by adjusting strategies to meet B.D. at his
developmental stage, address his fears and consider his preferences. By applying Orem’s theory,
nurses can encourage a collaborative environment where the patients and families actively
participate in care decisions. In the pediatric population, it lifts their confidence and then their
ability to meet self-care needs. This approach will encourage holistic healing by assessing not
just the physical requirements of care, but also the emotional, cognitive, and developmental
components that impact self-care behaviors.
Conclusion
In conclusion, Orem’s Self-Care Deficit Nursing Theory provided a meaningful framework
that guided my nursing practice and deepened my understanding of the nurse-patient
relationship within my exemplar. This paper highlights the value of Orem’s Self-Care Deficit
Nursing Theory in guiding nursing practice with the pediatric population, which faces significant
treatment demands. By identifying B.D.’s self-care deficits and implementing a supportive
approach, I was able to empower him to take ownership of his medication routine by promoting
both adherence and a sense of control. This initially began as a daunting, four-hour struggle for
the patient, family, and nursing staff, but then transformed into a structured and achievable
process. By recognizing the child’s need for autonomy and creating a structured yet flexible plan,
both the patient and his family experienced reduced distress. At the same time, the healthcare
team observed improved efficiency and outcomes. This exhibits the power of individualized,
theory-driven nursing care. It affirms that when nurses integrate theory into clinical
decisionmaking, they strengthen their ability to deliver holistic, patient-centered care that
encourages healing, growth, and long-term self-management.
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Beyond the theoretical framework, this experience also reflects the biblical truth that
Gode equips us to serve others in their weakness. As Paul reminds us in 2 Corinthians 12:9, “My
grace is sufficient for you, for my power is made perfect in weakness” (NIV, 1973/2011). In my
life, nursing is not just a profession; it is a ministry of grace, and I appreciate meeting patients at
their greatest need and supporting them and their families as they heal. The practice of nursing
is both a science and a calling; it is rooted in evidence-based frameworks and sustained by the
love and strength that come from God.
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References
Hartweg, D. L., & Metcalfe, S. A. (2021). Orem’s self-care deficit nursing theory: Relevance and
need for refinement. Nursing Science Quarterly, 35(1), 70–76.
https://doi.org/10.1177/08943184211051369
McEwen, M., & Wills, E. M. (2023). Theoretical basis for nursing. Wolters Kluwer.
The Holy Bible, New International Version. (1984). International Bible Society. (Original work
published 1973).
Yip, J. Y. (2021). Theory-based Advanced Nursing Practice: A practice update on the application
of Orem’s self-care deficit nursing theory. SAGE Open Nursing, 7.
https://doi.org/10.1177/23779608211011993
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