What Orem considers health to be: soundness of human structures and functioning

Rethinking health, not just diagnosing it

What if health isn’t simply “not sick”? If you’re brushing up on big nursing theories, you’ve probably spotted a few phrases that try to capture health in a single line. But some theories push us to look a little closer, to see health as something the person actively preserves and builds. One of those thoughtful perspectives comes from Dorothea Orem, the nurse theorist who gave us a clear roadmap for understanding how people care for themselves—and how nurses help them do that. Let’s unpack what Orem means by health and why it matters in real-life care.

Health through the lens of soundness

Here’s the core idea, stated plainly: health, for Orem, is a state characterized by the soundness of human structures and functioning. In other words, health isn’t merely the absence of disease. It’s about how well the body and mind work together to support everyday living. Think about it this way: when a person can perform the activities they consider essential—getting dressed, feeding themselves, moving around, managing emotions, thinking clearly—that person is operating from a place of functional integrity. That sense of “I can do what I need to do” is, in Orem’s view, health.

This perspective invites us to see health as an ongoing, dynamic achievement. It’s not a static trophy you earn and display; it’s a continuous process of maintaining structure (the body) and functioning (how well the mind and body work together). You don’t have to be perfectly free of illness to be healthy. You can have a chronic condition, for example, and still be healthy if you’re empowered to care for yourself and to adapt as needs change. The focus is on capacity, adaptability, and the ongoing practice of self-care.

A trio of ideas that frames the view

Orem builds her theory around three interrelated ideas, each helping to explain how health is sustained.

• Self-care: This is the active work people do to maintain their own health. It includes everyday activities like eating, bathing, moving, and managing meds, as well as the knowledge and skills that make those tasks possible. Self-care isn’t selfish or optional; it’s the foundation of staying well and functioning well.

• Self-care agency: This is the person’s ability to set goals, learn what they need to know, and carry out the tasks of self-care. It’s about capability, confidence, and the sense that you can influence your health through choices and actions.

• Self-care deficit and the nursing system: When people can’t meet their own self-care needs, there’s a deficit. That’s where nursing comes in—not as a gatekeeper of health, but as a partner who helps someone regain the ability to care for themselves. In Orem’s language, the nursing system can be wholly compensatory (doing for the person), partially compensatory (doing with the person), or supportive-educative (teaching and guiding). The aim is to restore or enhance the person’s self-care agency so they can return to functioning with soundness and independence.

Why this matters for care, not just theory

So what does this mean in day-to-day nursing? It means care isn’t just about fixing problems; it’s about empowering people to sustain their health over time. When a nurse helps a patient learn how to manage a new medication, monitor symptoms, set realistic activity goals, or adjust routines after a hospital stay, they’re strengthening self-care agency. When a nurse designs a plan that fits a patient’s life—considering their environment, family, finances, and cultural values—the plan supports the patient’s ability to care for themselves.

This framework also nudges us to look at the environment as part of health. Not in a heavy-handed, “the world is the problem” way, but in a practical sense: What tools, supports, and routines make self-care easier? A sturdy, accessible home setup; clear labeling on meds; simple, repeatable routines; reliable social support. All of these help maintain the soundness of structures and functioning. It’s comfort with nuance, not a blanket view that one size fits all.

Small, human examples that stick

Let me explain with a couple of everyday scenes.

• Scene one: A middle-aged person recovering at home after surgery. The self-care tasks aren’t glamorous, but they matter: remembering to take meds on time, keeping the incision clean, doing gentle leg exercises to prevent clots, and pacing activities. The nurse doesn’t do every task for them. Instead, they teach, demonstrate, and adjust the plan so the person can do as much as possible safely. The patient’s health thrives not because disease is gone but because their body and mind stay in balance—structures sound, functions in tune.

• Scene two: An elderly patient managing diabetes. Health here isn’t merely about glucose numbers; it’s about the ability to follow a routine—meal timing, checking blood sugar, recognizing when to seek help, and adapting when life gets busy. The nurse’s role is to support self-care agency: simplifying instructions, offering practical tools (like a simple pillbox or a reminder system), and aligning care with the patient’s daily life. When self-care becomes a habit, health remains robust even amid small bumps in the road.

Common misconceptions to clear up

You’ll hear a few misreadings of health through the lens of Orem’s ideas. Here are a couple and why they don’t fit.

• Health is the absence of illness. This one misses the mark because it frames health as something external and static, not as a dynamic state of functioning. Orem’s view invites us to see health as an internal capability—an ongoing capacity to care for oneself.

• Health is only about fixing problems in the body. Yes, addressing illness matters, but the theory places equal emphasis on the person’s ability to perform self-care. It’s about thriving, not just surviving.

• Health is a matter of environmental balance alone. The environment matters, but Orem’s core emphasis is the person’s own capacity to care for themselves, with support from others as needed. It’s a balance between internal ability and external support.

What students and future clinicians can take away

If you’re exploring Orem for the first time or revisiting it with fresh eyes, a few anchor ideas can simplify what you study and how you apply it.

• Health equals soundness of the whole person: body, mind, and social connectedness functioning together.

• Self-care is participatory: people are active players in maintaining their health.

• Support is adaptable: when self-care gaps appear, the right level of nursing support can help restore autonomy.

• Nursing care is about enabling, not just fixing: the goal is to strengthen self-care agency so the person can manage health over time.

Bringing theory into everyday care

Let’s connect the dots with a simple metaphor. Imagine health as a well-tuned orchestra. The musician sits at the center—the person—whose playing represents self-care. The conductor is the self-care agency, guiding the tempo and the courage to perform. When the musician struggles, the conductor asks the section to help or adjusts the tempo to prevent strain. The audience is the environment—the home, family, culture, and resources that shape what can be played. The nurse steps in as a coach, tuning instruments, teaching new skills, and making sure the score fits the player’s life. The result? A harmonious performance where health—the soundness of structures and functioning—stays in rhythm.

A quick, practical way to think about this theory

If you want a mental hook, try this: health = the ability to take care of yourself, plus the support you need when you can’t do it alone. That’s it in a sentence. Everything else—care plans, patient education, and collaboration with families—stems from that core idea.

A few closing thoughts

Orem’s concept of health invites us to look beyond disease and toward daily living. It honors resilience, learning, and partnership between people and caregivers. In the real world, health shines when people feel capable and supported to act on what matters most to them. That’s a powerful compass for nursing care, research discussions, and the everyday moments when care truly shows up.

If you’re curious to explore more about how different theories shape patient experiences, you’ll find that each lens offers a unique way to see strength, struggle, and hope. And honestly, that variety is what makes the study of nursing so rich—there’s always another angle to consider, another story to tell, another way to help someone live well within the realities they face.

Bottom line: health, in Orem’s view, is about soundness and functioning. It’s about what a person can do, with and without support, to stay well. And it’s a reminder that nursing is less about fixing a single problem and more about empowering a person to care for themselves across the twists and turns of life. That perspective isn’t just academic—it’s a practical, everyday path to compassionate, effective care.