She began to develop foundations for the self-care deficit theory of nursing when she accepted the position as Director of Nursing Service and Director of Nursing Education at Providence Hospital in Detroit on 1945. Later on, when she was working with the Division of Hospital and Institutional Services of the Indiana State Board of Health as a nursing consultant from 1949-1957, she encountered more issues regarding the lack of a substantive and structured body of nursing knowledge. During this time, she made her definition of nursing practice with clear statements of the inherent distinction between the practice of nursing and medicine. Orem returned to Washington DC and worked with the Office of Education, Vocational Section of the Technical Division, where there was an ongoing project to upgrade practical nurse training.
Orem returned to the Catholic University of America School of Nursing in 1959. and became the acting dean of the school of Nursing and as an assistant professor of nursing education. She continued to develop her theory. She published her second book entitled Nursing Concepts of Practice in 1971 after completing her work on the Nursing Model Committee of the School of Nursing of the Catholic University of America. Then she left the university and started her own consulting firm called Orem and Shield’s Inc. at Chevy Chase, Maryland. Orem received the Catholic University of America Alumni Association Award for Nursing Theory in 1980. The second edition of Nursing: Concept of Practice was published in 1980. Orem retired in 1984 but continued to work on the third edition which was published in 1985. The fourth edition of her book was completed in 1991. (Anonuevo et al, 2000)
A Glimpse of Orem’s Accomplishments and Contributions:
• Dorothea Orem as a member of a curriculum subcommittee at Catholic University recognized the need to continue in developing a conceptualization of nursing.
• Orem’s Nursing: Concept of Practice was first published in 1971 and subsequently in 1980, 1985, 1991, 1995, and 2001.
• Nursing: Concepts of Practice was the original publication of the conceptual framework (Orem, 1971)
• 1949-1957 Orem worked for the Division of Hospital and Institutional Services of the Indiana State Board of Health. Her objective was to improve the quality of nursing in general hospitals and she was able develop the definition of nursing by this time
• 1958-1960 she help publish "Guidelines for Developing Curricula for the Education of Practical Nurses" in 1959.
• Washington D.C. in 1957, Orem further developed her ideas, first as a consultant in the Office of Education where her task was to improve the nursing component of a vocational nursing curriculum.
• Orem’s ideas were further formalized after her participation in the Nursing Development Conference Group (NDCG), the two were committed to the development of structured nursing knowledge and to nursing as a practice discipline” (Hartweg, 1995)
• Continues to develop her theory after her retirement in 1984
• Dr. Orem continues to be active in theory development. She completed the 6th edition of Nursing: Concepts of Practice, published by Mosby in January 2001.
