vidual becomes more proficient in self care (Orem, Guides 41). Over the following 20 years, Orem continued to modify and refine her conceptual framework of nursing (Fawcett). During this period, Orem developed the idea that the art of nursing is creative, in that it requires the development on the part of the nurse of an ability to "envision valid modes of helping in relation to 'results' which are appropriate" (Orem, Nursing, 1st ed. 69). She added that the art of nursing is "expressed by the individual nurse through her (sic) creativity and style in designing and providing nursing that is effective and satisfying" (Orem, Nursing, 1st ed. 155).
By 1980, Orem's self care model of nursing had evolved into a conceptual framework and three theories of nursing. The conceptual framework consisted of six central concepts, as follows: (1) self care, (2), self care agency, (3) therapeutic self care demand, (4) self care deficit, (5) nursing agency, and (6) nursing system (Orem, Nursing, 2nd ed.). The three theories of nursing associated with the conceptual framework were the (1) theory of selfpcare, (2) theory of self care deficits, and (3) theory of nursing systems (Orem, Nursing, 2nd ed.). At this time, Orem (Nursing, 2nd ed.) stated that the unifying idea underlying her conceptual framework was that people may benefit from nursing whne they have health related limitations on their capacity to provide self care. She stated further that four assumptions provided a basis for the development of the self care conceptual framework. These assumptions were that (1) human beings require continuous and deliberate inputs to both themselves and their environments to both remain alive and to function effectively, (2) the power to act deliberately is exercised in the form of self care, in identifying self care needs, and in making the necessary inputs, (3) limitations in the ability to provide self care causes mature human beings to feel d...