Orlando's Nursing Process Theory This page was last updated on 23/07/2010 INTRODUCTION

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Ida Jean Orlando, a first-generation American of Italian descent was born in 1926. She received her nursing diploma from New York Medical College, her BS in public health nursing from St. John's University, NY, and her MA in mental health nursing from Columbia University, New York. Orlando 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 she 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 1972 book titled: The Discipline and Teaching of Nursing Processes 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. Orlando's theory was developed in the late 1950s from observations she recorded between a nurse and patient. Despite her efforts, she was only able to categorize the records as "good" or "bad" nursing. It then dawned on her that both the formulations for "good" and "bad" nursing were contained in the records. From these observations she formulated the deliberative nursing process.

Questions
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What prompts nursing actions? What are the properties of dynamic nurse patient relationships that may lead to effective care?

nurses need to use their perception. it is focused on the process of care in an immediate experience. the help needed may not be what it appears to be. however.resolution FUNCTIONS OF PROFESSIONAL NURSING – ORGANIZING PRINCIPLE • Finding out and meeting the patients immediate needs for help Nursing….organizing principle Presenting behavior . diminishing or curing the individuals sense of helplessness • The purpose of nursing is to supply the help a patient requires for his needs to be met Nursing thought .problematic situation Immediate reaction . The patient's presenting behavior may be a plea for help. This process helps nurse find out the nature of the distress and what help the patient needs. Therefore. thoughts about the perception. relieving.Does the patient have an immediate need for . it is concerned with providing direct assistance to individuals in whatever setting they are found for the purpose of avoiding. or the feeling engendered from their thoughts to explore with patients the meaning of their behavior.internal response Nursing process discipline – investigation Improvement .Answer • Nurses were prompted in their actions for reasons other than the patients immediate experiences and needs INTRODUCTION TO THEORY • • • • The role of the nurse is to find out and meet the patient's immediate need for help. MAJOR DIMENSIONS OF THE THEORY • • • • • Function of professional nursing .is responsive to individuals who suffer or anticipate a sense of helplessness.

may represent a plea for help The presenting behavior of the patient.the function of professional nursing is achieved PRESENTING BEHAVIOR – PROBLEMATIC SITUATION • • • To find out the immediate need for help the nurse must first recognize the situation as problematic The presenting behavior of the patient.INVESTIGATION • • • • • Any observation shared and explored with the patient is immediately useful in ascertaining and meeting his need or finding out that he is not in need at that time The nurse does not assume that any aspect of her reaction to the patient is correct. and the nurses behavior causes a response in the patient IMMEDIATE REACTION –INTERNAL RESPONSE • • • • • • Person perceives with any one of his five sense organs an object or objects The perceptions stimulate automatic thought Each thought stimulates an automatic feeling Then the person acts The first three items taken together are defined as the person’s immediate reaction Reflects how the nurse experiences her or his participation in the nurse patient situation NURSING PROCESS DISCIPLINE . helpful or appropriate until she checks the validity of it in exploration with the patient The nurse initiates a process of exploration to ascertain how the patient is affected by what she says or does Automatic reactions are not effective because the nurses action is decided upon for reasons other than the meaning of the patients behavior or the patients immediate need for help When the nurse does not explore with the patient her reaction it seems reasonably certain that clear . regardless of the form in which it appears. causes an automatic internal response in the nurse.help or not? • If the patient has an immediate need for help and the nurse finds out and meets that need . the stimulus.

communication between them stops IMPROVEMENT . ASSUMPTIONS • • • • • • • • • • • • • When patients cannot cope with their needs without help.RESOLUTION • • • It is not the nurses activity that is evaluated but rather its result : whether the activity serves to help the patient communicate her or his need for help and how it is met In each contact the nurse repeats a process of learning how to help the individual patient. in its professional character . Nursing – is responsive to individuals who suffer or anticipate a sense of helplessness . perceptions. actions and reactions are influenced by both nurse and patient Human beings attach meanings to situations and actions that are not apparent to others Patients entry into nursing care is through medicine The patient cannot state the nature and meaning of his distress for his need without the nurses help or without her first having established a helpful relationship with him Any observation shared and observed with the patient is immediately useful in ascertaining and meeting his need or finding out that he is not in need at that time Nurses are concerned with needs that patients cannot meet on their own DOMAIN CONCEPTS 1. Her own individuality and that of the patient requires that she go through this each time she is called upon to render service to those who need her. environment and health Patient need help in communicating needs. they become distressed with feelings of helplessness Nursing . thoughts and feelings The nurse – patient situation is dynamic. does add to the distress of the patient Patients are unique and individual in their responses Nursing offers mothering and nursing analogous to an adult mothering and nurturing of a child Nursing deals with people. they are uncomfortable and ambivalent about dependency needs Human beings are able to be secretive or explicit about their needs.

2. Nursing process – the interaction of 1)the behavior of the patient. for avoiding.Disciplined and professional activities – automatic activities plus matching of verbal and nonverbal responses. Automatic activities – perception by five senses. Nursing problem – distress due to unmet needs due to physical limitations. 12. Environment – not defined directly but implicitly in the immediate context for a patient 6. Health – sense of adequacy or well being . relieving. adequacy in better care of self and improvement in patients behavior 4. Nurse – patient relations – central in theory and not differentiated from nursing therapeutics or nursing process 11. Indirect function – calling for help of others . adverse reactions to the setting or experiences which prevent the patient from communicating his needs 9. increase in ability. Process of care in an immediate experience…. 2) the reaction of the nurse and 3)the nursing actions which are assigned for the patients benefit 10. Sense of comfort 5. diminishing or curing the individuals sense of helplessness. Human being – developmental beings with needs. Nursing therapeutics – Direct function : initiates a process of helping the patient express the specific meaning of his behavior in order to ascertain his distress and helps the patient explore the distress in order to ascertain the help he requires so that his distress may be relieved. individuals have their own subjective perceptions and feelings that may not be observable directly 7. matching of thoughts and feelings with action 14. whatever help the patient may require for his need to be met 13. Goal of nursing – increased sense of well being. Finding out meeting the patients immediate need for help 3. Nursing therapeutics . automatic thoughts. automatic feeling.. Nursing client – patients who are under medical care and who cannot deal with their needs or who cannot carry out medical treatment alone 8. validation of perceptions. Fulfilled needs. action THEORY ANALYSIS PARADIGMATIC ORIGINS .

laws.• • • • • Paplau’s focus of interpersonal relationships in nursing Paplau acknowledged the influence of Harry Stack Sullivan on the development of her ideas Symbolic interactionism – Chicago school Use of field methodology John Dewey’s theory of inquiry ORLANDO'S WORK AND CHARACTERISTICS OF A THEORY • • • • • • • Theories can interrelate concepts in such a way in such a way as to create a different way of looking at a particular phenomenon Theories must be logical in nature Theories should be relatively simple yet generalizable Theories can be the bases for hypotheses that can be tested Theories contribute to and assist in increasing the general body of knowledge within the discipline through the research implemented to validate them Theories can be utililized by practitioners to guide and improve their practice Theories must be consistent with other validated theories. and principles but will leave open unanswered questions that need to be investigated INTERNAL DIMENSIONS • • • • • • Analyzed 2000 nurse – patient interactions to identify the properties. dimensions and goals of interactions Use of field approach Focus on describing psychosocial aspects of nurse patient interaction Used a mixture of operational and problematic methods of theory development Focus on how to deliver care not on what care to be given Nursing process theory of low to medium level abstraction STRENGTHS • • Use of her theory assures that patient will be treated as individuals and that they will have active and constant input into their own care Prevents inaccurate diagnosis or ineffective plans .

• • • • because the nurse has to constantly explore her reactions with the patient 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 Make evaluation a less time consuming and more deliberate function. particularly aware and conscious individuals and on the virtual absence of reference group or family members LIMITATIONS • • Highly interactive nature Orlando's theory makes it hard to include the highly technical and physical care that nurses give in certain settings Her theory struggles with the authority derived from the function of profession and that of the employing institution’s commitment to the public EXTERNAL COMPONENTS • • • • Value of nursing shifted from task oriented to patient oriented nursing process Theory is culturally bound Misinterpretation of continuous validation as lack of knowledge and expertise The uniqueness of individuals assumed by the theory could counteract automatic responses of nurses COMPARISON WITH NURSING PROCESS THEORY TESTING . the results of which would be documented in patients charts Nursing can pursue Orlando's work for retesting and further developing her work THEORY CRITIQUE • • • Lack of operational definitions for concepts – limits development of research hypothesis Theory is more congruent in guiding nurse – patient interactions for assessing needs and in providing nursing therapeutics deemed necessary to patient care Focus on short term care.

Texas.. thoughts and feelings is essential for enhancing the congruence between patient’s needs and the care given Results indicate unique nursing process is more effective than other approaches in dealing with pain. in relieving distress to experienced by patients during the process of admission to a hospital Used in describing the responsibilities of nursing students to distressed patients A number of studies focused on explicating the properties and components of nurse – patient interactions Perceptions was used as a frame work to describe needs of grieving spouses Gillis supported Orlando’s differentiation between presenting problems as perceived by the nurse and those as perceived and validated by patients Used as a framework to research nursing administration USES OF THEORY Use in Education • • Midwestern State University in Wichita Falls.• • • • • • • Validation of perceptions. negotiated more effectively in resolving conflict among staff nurses and between staff and physicians. Implementation of Orlando’s theory produced substantial benefits. is using Orlando's theory for teaching entering nursing students. Its use increased effectiveness in meeting patient needs. Boston. NE and Boston City Hospital. in understanding patient’s needs. including determining what constituted nursing versus non-nursing functions. improved decision-making skills among staff nurses. South Dakota State University in Brookings. and influenced a more positive nursing identity and unity among . SD has been using Haggerty’s (1985) description of the communication based on Orlando’s theory for entering nursing students as well as re-enforcing it in their junior year Uses in Administration Schmieding successfully used Orlando's theory in two major hospitals for both practice and administration (Lincoln General Hospital. in reducing stress. Lincoln. MA).

Gavin. decreased hospital stay. In a pilot study. Potter and Bockenhauer (2000) found positive results after implementing Orlando’s theory. and Bauer (1987) used Orlando’s theoretical model with patients (N = 76) having a bipolar disorder. and a decrease in patient’s immediate distress. reduction of emergency services. Use in Clinical Practice • • • Nursing care plan Case studies Progressive patient care settings Nursing process • • • • • Assessment Diagnosis Planning Implementation Evaluation SUMMARY • • • • • • • • • • • • Theorist – IDA JEAN ORLANDO Development of theory Dimensions of theory Assumptions Concepts Theory analysis Characteristics of a theory Paradigmatic origins Strengths and limitations Internal and external components Comparison with nursing process Theory testing and uses of theory . and increased satisfaction. RI Shea. Use in Research In an Veterans Administration (VA) ambulatory psychiatric practice in Providence. patient-centered outcomes. a model for staff to use to approach patients. These included: positive.staff. McBride. Their research results indicate that there were: higher patient retention.

Philadelphia. Lippincott. 3.M. 3rd ed. 2006 Jul. The condition is more often in women than men and occurs in several form. Norwalk. Theoretical Nursing : Development & Progress 3rd ed. Vandemark L. McEwen Melanie (2002). the use of her theory does not exclude nurses from using other theories while caring for the patient. and easy to use. and hyperactivity of the sympathetic nervous system. 2006 Jul. 4. 2. Most of the clinical manifestations result from increased metabolic rate. While providing the overall framework for nursing.The base for professional Nursing Practice . Meleis Ibrahim Afaf (1997) . Awareness of self & expanding consciousness: using Nursing theories to prepare nurse – therapists Ment Health Nurs. George B. Wills M. 5. Nursing Theories.muscular and cardiovascular activity. Perry G Anne (1992) Fundamentals Of Nursing –Concepts Process & Practice 3rd ed. Nurs Sci Q. Lippincott. Reed PG. London Mosby Year Book.Lillis Carol (2001)The Art & Science Of Nursing Care 4th ed. 6. Theoretical Basis for Nursing Philadelphia. 27(6) : 605-15 7. The force of nursing theory guided.19(3):225.practice. Appleton & Lange. The strength of the theory is that it is clear.CONCLUSION TO THEORY • • • • Orlando's theory remains one the of the most effective practice theories available. Hypertrophy and hyperplasia of the thyroid gland occur with increased vascularity. concise. REFERENCES 1. Philadelphia.Evelyn. Lippincott Williams& wilkins. Potter A Patricia. Julia . Taylor Carol. . Hyperthyroidism is an over production of thyroid hormone. increase neuro. The use of her theory keeps the nurse's focus on the patient. which creates far reaching metabolic effects. excessive heat production.

Increased bowel movements 7.Common signs and symptoms : 1. Muscle weakness 13. Palpitations 2. Light or absent menstrual periods 8. Fatigue 9. Hair loss 15. Warm moist skin 14. Heat intolerance 3. Weight loss 12. Staring gaze NCP – Hyperthyroidism . Trembling hands 11. Insomnia 5. Breathlessness 6. Nervousness 4. Fast heart rate 10.

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