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Ida Jean Orlando
Transcript of Ida Jean Orlando
"NURSING PROCESS THEORY"
Prepared by: Ronnel Abigael C. de Guzman, RN
About the theory...
She was born in 1926 with an Irish American descent
She received her nursing diploma from New York Medical College, Lower Fifth Avenue Hospital, School of Nursing, her BS in public health nursing from St. John’s University, Brooklyn, NY, and her MA in mental health nursing from Teachers College, Columbia University, New York.
She was an Associate Professor at Yale School of Nursing where she was Director of the Graduate Program in Mental Health Psychiatric Nursing.
While at Yale she was project investigator
of a National Institute of Mental Health
grant entitled: Integration of Mental Health
Concepts in a Basic Nursing Curriculum.
It was from this research that Orlando
developed her theory which was published in
her 1961 book, The Dynamic Nurse-Patient Relationship.
She furthered the development of her theory when at
McLean Hospital in Belmont, MA as Director of a Research Project: Two Systems of Nursing in a Psychiatric Hospital.
The results of this research are contained in her 1972book titled: The Discipline and Teaching of Nursing Process. Orlando held various positions in the Boston area, was a board member of Harvard Community Health Plan, and served as both a national and international consultant.
She is a frequent lecturer and conducted
numerous seminars on nursing process.
She is married to Robert Pelletier and lives
in the Boston area.
Humans in need are the
focus of nursing practice.
Nursing deals with the individual whenever there is a need for help. Thus a sense of helplessness replaces the concept of health or illness as the initiator of a need for nursing.
Nursing as unique and independent in its concerns for an individual’s need for help in an immediate situation.
Need is defined as “a requirement of the patient which, if supplied, relieves or diminishes his immediate distress or improves his immediate sense of adequacy or well-being” (Orlando, 1990).
In the immediacy of nursing situation, each patient’s behavior must be assessed to determine whether it expresses as need for help.
• “The presenting behavior of the patient, regardless
of the form in which it appears, may represent a plea for help” (Orlando, 1990).
• Behavior is verbal and nonverbal-
• At times people can meet their own needs-
• Needs and level of needs can change
• Each person is unique, past
experience, social economically status, religious, beliefs and moral values.
• When a patient has a need for help that cannot be resolved without the help of another, helplessness results.
- The patient’s behavior reflects
when the patient experiences a
need that he cannot resolve, a
sense of helplessness occurs.
• This reaction is comprised of three sequential parts (Orlando, 1972). First, the nurse perceives the behavior through any of her senses. Second, the perception leads to automatic thought. Finally, the thought produces an automatic feeling.
• “The nurse does not assume that any aspect of her reaction to the patient is correct, helpful, or appropriate until she checks the validity of it in exploration with the patient” (Orlando, 1990).
• Orlando (1972) also provides three criteria to ensure
that the nurse’s exploration of her reaction with the patient is unsuccessful:
1. What the nurse says to the individual in the contact must match any or all of the items contained in the immediate reaction, and what the nurse does non verbally must be verbally expressed and the expression must match one or all of the items contained in the immediate reaction.
2. The nurse must clearly communicate to the individual that the item being expressed belongs to her.
3. The nurse must ask the individual about the item expressed in order to obtain correction or verification from that same individual.
• Exploration with the patient helps validate the patient’s behavior.
• Orlando (1990) includes “only what she [the nurse] says or does with or for the benefit of the patient” as professional nursing action. “The nurse initiates a process of exploration to ascertain how the patient is affected by what she says or does.”
• The nurse can act in two ways: automatic or deliberative. Only the second manner fulfills her professional function.
- those decided
upon for reasons other than the
patient’s immediate need; stem from
nursing behaviors that are performed
to satisfy a directive other than the
patient’s need for help.
– is a
“disciplined professional response”.
It can be argued that all nursing actions
are meant to help the client and should
be considered deliberative. However,
correct identification of actions from the
nurse’s assessment should be determined to achieve reciprocal help between nurse and patient’s health.
The following criteria should be considered.
1. Deliberative actions result from the correct
identification of patient needs by validation of
the nurse’s reaction to patient behavior.
2. The nurse explores the meaning of the action
with the patient and its relevance to meeting his need.
3. The nurse validates the action’s effectiveness immediately after completing it.
4. The nurse is free of stimuli unrelated to the
patient’s need when she acts.
NURSING PROCESS THEORY PURPOSE
* GOAL: to develop a theory of effective nursing
* Reciprocal relationships
* Patient Participation
* MD orders is shared by Nurse and patient
Five Interrelated Concepts
• The function of professional nursing (organizing principle)
• The presenting behavior of the patient (problematic situation)
• The immediate or internal response of the nurse (internal response)
• The nursing process discipline (investigation)
• Improvement (resolution)
METAPARADIGMS in Nursing
APPLICATION OF THIS THEORY TO PRACTICE
• The patient is the central point
• Find out the problem
• Meet the immediate needs of the patient
• Doing this relieves distress
CHARACTERISTICS OF THE THEORY
• Interrelated concepts
• Has a logical nature
• Is simple and applicable in the daily practice
• Contributes to the professional knowledge
• Applicable in nursing practice
• Use of her theory assures that the patient
will be treated as individuals and they will
have an active and constant input into their
• Assertion of nursing’s independence as a
profession and her belief that this independence
must be based on a sound theoretical frame work.
• Guides the nurse to evaluate her care in terms of objectively observable patient outcomes.
• Lack the operational definitions of society
or environment which limits the development
of research hypothesis.
• The theory focuses on short term care,
particularly aware and conscious individuals
and on the virtual absence of reference group
or family members.
• Gave clear cut approach of a patient oriented
• Uplifts the integrity of an individualized nursing care
• Strengthens the role of the nurse as an independent nurse advocate for the patient
• The dynamic concept of the nurse-patient interaction was justified
• Prevents inaccurate diagnosis or ineffective plans
• Since the model is applied to an immediate situation, its applicability to a long term care plan is not feasible.
• The concept of interaction also limits it to individuals capable of conversing, a shared limitation with other nurse-client dynamic theories – unconscious patients are not covered by this theory.