Early in her career, Orem gained experienced as a staff nurse in a variety of hospitalclinical settings. While serving as director of nursing service at a Detroit hospital, she recallsthat she was asked a substantive question and didn’t have an answer because she “had noconceptualization of nursing” (McLaughlin-Renpenning & Taylor, 2002, p. xii).Orem goes on to say while working at Indiana University where her goal was to upgradethe quality of nursing in general hospitals throughout the state, she noted that nurses haddifficulty articulating needs to hospital administrators in the face of demands made upon themregarding such issues as length of stay, scheduling admissions and discharges, etc.(McLaughlin-Renpenning and Taylor, 2002). As a result, Orem recognized a need to look for the uniqueness of nursing. Specifically she was looking for an answer to questions such as“What is nursing?”, ‘What is the domain and what are the boundaries of nursing as a field of practice and a field of knowledge?”, and “What condition exists when judgments are made that

people need nursing?” In a 1996 newsletter to the International Orem Society she puts it thisway, “What do nurses encounter in their worlds as they design and produce nursing for others?What meaning can and should nurses attach to persons, things, events, conditions, andcircumstances they encounter?” In 1978, Orem (cited in Fawcett 2005) commented that the task required identification of the domain and boundaries of nursing as a science and an art. After reflecting upon her own nursing experiences, Orem says the answer came to her as a “flash of insight, an understanding that the reason why individuals could benefit from nursing was theexistence of…self care limitations” (Orem, 1978, cited in Fawcett, 2005, p. 230). Oremsummarized her initial ideas about nursing in an Indiana State Board of Health report