The purpose of this research was to elaborate and validate the instrument Nursing Interview to collect data related to nursing care based on the Orem theory. The contents of this instrument and the supporting guidelines were referred to referees who analyzed the concordance among them by applying Cochran's Chi-Square test, which revealed a statistically significant difference regarding objectivity but the great number of positive answers indicated that the instrument also dealt with pertinent aspects. The descriptive analysis of concordance related to the supporting guidelines demonstrated that only objectivity obtained 50% of negative responses, suggesting that changes were required. Finally, we may conclude that this instrument collects data related to self-care in a systematic manner.59314-20