Self Care Theory in Nursing: Selected Papers of Dorothea Orem

By Katherine McLaughlin Renpenning; Susan G. Taylor | Go to book overview

As with any historical document, these papers need to be read with consideration of the historic and cultural context in which they were written or presented. For example, it should be noted that in the early years, the use of man or the pronoun he was acceptable when referring to the individual. Because of where Orem was working, the early focus is on hospital nursing, while in later years many settings were represented.


THE ROOTS OF DEVELOPMENT OF SELF-CARE
DEFICIT NURSING THEORY

In 1945, after working as a nurse in the operating room, emergency room, private duty, pediatrics, and adult medical/surgical nursing and teaching at The Catholic University of America (CUA), Orem accepted a position as Director of Nursing Service and Director of Nursing Education at Providence Hospital in Detroit. In a personal communication (11/20/97) she recounted an experience she had when she was director of the school.

We had a good program, good students. We were having a curriculum committee
meeting, and a question was asked; it was a substantive question. I had no
glimmer of an answer to it. I knew there was something missing. I was director
of the school. We had a good faculty. It was a question that raised questions in
my mind. What's the answer? I don't know. I knew that I should, but, if you
don't have a conceptualization of nursing there are certain things that you can't
answer. You're oriented to doing this and doing that and doing the other.

The lack of a substantive, structured body of nursing knowledge surfaced again when she was working in Indiana. She went to Indiana in 1949, with the Indiana State Board of Health, Hospital Division, to help in upgrading of nursing services in general hospitals. She worked closely with Ann Poorman Donovan, conducting studies of organizational structure of nursing services and variations in types of patients and length of stay. She described this period.

Some of the things we came up with included the demands placed on nurses
by length of stay of patients, by the scheduling of admission and discharges, by
how activities were planned throughout the day in nursing units … nurses had
difficulty representing their needs to hospital administrators. They didn't know
how to talk about nursing, they didn't know how to represent what they needed.
The same would be true in communicating with boards of trustees and with
physicians. But one of the things I found in talking with physicians was that if

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