Dorothea Orem

Nursing educator theorist

• Born: July 15, 1914
• Birthplace: Baltimore, Maryland
• Died: June 22, 2007
• Place of death: Savannah, Georgia

Education: Providence Hospital School of Nursing; Catholic University of America

Significance: Dorothea Orem developed the self-care deficit nursing theory, sometimes known simply as the self-care theory or the Orem Model of nursing, which redefined the role of nurses in health care by suggesting that when a formerly healthy person becomes a patient, nurses should address deficiencies in that patient’s ability to take care of themselves and their own health.

Background

Born on July 15, 1914, Dorothea Elizabeth Orem was raised in Baltimore, Maryland, in a comfortably middle-class environment. Her father worked in construction and her mother was a homemaker. The example of her mother tirelessly devoting her time and energy to maintaining the household and taking care of Orem and her older sister influenced Orem’s perception of the role of a nurse. Before she graduated from high school, she knew her life would be dedicated to service of others. Although she briefly considered becoming a nun or a teacher, she opted rather to pursue nursing.

She earned her nursing certification from the Providence Hospital School of Nursing in Washington, DC. At the time, such certification was considered ample education for an occupation that was perceived to be largely an administrator of doctors’ protocols. Orem was not content with that; after working for a brief stint as a nurse at St. John’s Hospital (now Saints Medical Center) in Lowell, Massachusetts, she decided to continue her education at the Catholic University of America in Washington, where she earned a BS in nursing education in 1939, followed by an MS in nursing education in 1945.

Developing Nursing Education

After working as a nurse for several years, Orem came to believe that the value of nursing began in the classroom, and she decided to devote herself to working with nursing students. In addition, she began to gather data on nurses and their function in hospital operations, original research at a time when little attention was paid to the role of nurses. She became the director of the Providence Hospital School of Nursing in Detroit, Michigan. She also taught there, working in biological sciences and nursing from 1945 to 1948. She then returned to Catholic University and taught there for more than a decade, serving for a time as the dean of the university’s school of nursing. Determined to develop teaching curricula that matched what she had observed as a practicing nurse, Orem worked as a nursing curriculum consultant for more than a decade, working with hospitals and nursing schools across the country.

By the 1970s, Orem was convinced that nurses had a critical role to play in patient treatment, a role that had yet to be clearly defined in the literature of the field. Orem was convinced that patients needed to be treated as people—individuals with medical histories, certainly, but also with families and friends, all of whom played a role in the treatment and recovery from illness. She published her landmark book, Nursing: Concepts of Practice, in 1971. The success of this book established Orem among the leading nursing theorists in America. Because of its flexibility, her theory has been used mostly for rehabilitation and primary care. The theory is based on the idea that patients wish to care for themselves and that they are more likely to recover if encouraged to do so.

Orem theorized that a person, by nature, desires self-reliance, to be empowered to control and direct their own life. Illness, of course, challenges that assumption. For Orem, nursing actually begins with the person maintaining a lifestyle that encourages health and well-being, taking care to provide themselves with adequate sustenance, for instance, to pursue generally healthy activities, and to maintain a safe lifestyle that balances social interaction and necessary solitude and that avoids self-destructive habits such as smoking and excessive eating. In addition, the individual needs to stay informed about potential symptoms, monitor their own health, take prescribed medications, and modify their lifestyle to adjust to any long-term medical conditions.

When catastrophic illness or accidents occur to disrupt that self-reliance, the person becomes a patient and suddenly faces a deficiency in their ability to care for themselves. That can be traumatic—and that is where the nurse comes in, to address that self-care deficit. The nurse’s goal then is to restore the patient’s independence and self-reliance through dedicated care, communication, and careful and methodical regimens designed specifically to assist that individual in their recovery of self-reliance. That is a process of necessary interaction—the nurse is part of the patient’s return to independence. That process necessarily involves, for Orem, the nurse using all the resources of the patient’s life: family, friends, even religious beliefs.

For Orem, then, the nurse’s role is divided into three basic stages: first, the nurse assesses the patient’s condition, and that assessment changes day to day under their care and must be informed by regular communication from the attending physicians and with the patient; second, the nurse diagnoses the patient’s specific responses to treatments and medications—everything from biological reactions to medications and treatments to overall psychological reactions, such as emotions and mood; and third, the nurse implements protocols and regimens that are tailored for that patient. In each stage, the nurse is dedicated to restoring the patient’s ability to care for themselves. For Orem, illness is itself an interruption of a healthy life—and the nurse’s job is to return the patient to the status of a person.

Impact

Orem tirelessly promoted her humanistic theory of nursing in numerous journal publications, in the classroom, and on the lecture circuit. Because the theory seemed self-evident, some criticized Orem for simplifying the recovery and treatment process and for assuming that people would maintain a healthy lifestyle when such a lifestyle was, in fact, quite demanding. But Orem staunchly defended her theory well into her seventies. She became an inspiration for nurses who saw nursing as compassionate and involved with patients as people. Orem retired to Georgia’s affluent Skidaway Island near Savannah and died there at the age of ninety-two in 2007.

Bibliography

Clarke, Pamela N., et al. "The Impact of Dorothea Orem’s Life and Work: An Interview with Orem Scholars." Nursing Science Quarterly 22.1 (2009): 41–46. Print.

"Dorothea Orem Collection." Alan Mason Chesney Medical Archives. Johns Hopkins Medical Inst., n.d. Web. 28 Aug. 2016.

Fawcett, Jacqueline. "The Nurse Theorists: 21st Century Updates—Dorothea E. Orem." Nursing Science Quarterly 14.1 (2001): 34–38. Print.

Orem, Dorothea E. "Views of Human Beings Specific to Nursing." Nursing Science Quarterly 10.1 (1997): 26–31. Print.

Pearson, Alan. "Dead Poets, Nursing Theorists and Contemporary Nursing Practice." International Journal of Nursing Practice 14.1 (2008): 1–2. Print.

Renpenning, Kathie McLaughlin, and Susan G. Taylor. Self-Care Theory in Nursing: Selected Papers of Dorothea Orem. New York: Springer, 2003. Print.

Wayne, Gil. "Dorothea E. Orem." Nurselabs. Nurselabs, 11 Aug. 2014. Web. 28 Aug. 2016.