The nurse theorists: 21st-century updates--Dorothea E. Orem.

Dorothea Orem, RN, MSN, Ed, FAAN, began to develop foundations for the selfcare deficit theory of nursing in the 1950s, when the curriculums of most nursing education programs were based on conceptual models from medicine, psychology, and sociology. Thus, Orem is a pioneer in the development of distinctive nursing knowledge. The development of the self-care deficit theory of nursing has been described in considerable detail (Nursing Development Conference Group, 1979; Orem, 1995, in press; Orem & Taylor, 1986). The initial impetus for public articulation of the foundations and essential elements of the self-care deficit theory of nursing was the need to upgrade curriculums for practical nursing programs (Orem, 1959). Orem (1978) commented that that task required identification of the domain and boundaries of nursing as a science and an art. Continued work on the self-care deficit theory of nursing was motivated by “dissatisfaction and concern due to the absence of an organizing framework for nursing knowledge and . . . the belief that a concept of nursing would aid in formalizing such a framework” (Nursing Development Conference Group, 1973, p. ix). In particular, the self-care deficit theory of nursing was formulated and developed as a solution to the problem of “the lack of specification of, and agreement about, the general elements of nursing that give direction to (1) the isolation of problems that are specifically nursing problems and (2) the organization of knowledge accruing from research in problem areas” (Nursing Development Conference Group, 1973, p. 6). Ideas that helped to shape the self-care deficit theory of nursing were formulated as Orem experienced a period of intensive exposure to nurses and their endeavors from 1949 to 1957, during her tenure as a nursing consultant in the Division of Hospital and Institutional Services of the Indiana State Board of Health. Her observations led to the idea that “nursing involved both a mode of thinking and a mode of communication” (Orem & Taylor, 1986, p. 41). Orem’s “interest in and insights about the domain and boundaries of nursing” (Orem, 1991, p. 60) progressed from a global focus on “preventive health care” (p. 60) to a formal search “to know nursing in a way that would enlarge and deepen its meaning” (Orem & Taylor, 1986, p. 39) and to identify a proper nursing focus. Her search for the meaning of nursing was structured by three questions: (1) What do nurses do and what should nurses do as practitioners of nursing? (2) Why do nurses do what they do? and (3) What results from what nurses do as practitioners of nursing? (Orem & Taylor, 1986, p. 39). The answers to those questions began to emerge when Orem (1956, 1959) first articulated a definition of nursing and, then, rudimentary elements of the self-care deficit theory of nursing. Orem (1959, 1995) always has stated that human limitations for self-care associated with health situations give rise to a requirement for nursing. Orem (1995) regards that statement as the articulation of the “proper object of nursing considered as a field of knowledge and a field of practice” (p. 433). The questions were answered more fully as Orem worked first with the Catholic University of America Nursing Model Committee and then with the Nursing Development Conference Group. Orem (1995) explained: