IDA JEAN ORLANDO – DELIBERATIVE NURSING PROCESS

THEORY
(PREPARED BY: GIANINA MARCELO)

“patients have their own meanings and interpretations of situations

and therefore nurses must validate their inferences and analyses with
patients before drawing conclusions.”

 Stressed the reciprocal relationship between patient and nurse. It emphasizes the critical
importance of the patient’s participation in the nursing process
 Orlando also considered nursing as a distinct profession and separated it from medicine
where nurses as determining nursing action rather than being prompted by physician’s
orders, organizational needs and past personal experiences. She believed that the
physician’s orders are for patients and not for nurses
 Goal: to develop a theory of effective practice
 According to the theory, all patient behavior can be a cry for help. Through these, the
nurse’s job is to find out the nature of the patient’s distress and provide the help he or
she needs.

Assumptions

1. When patients are unable to cope with their needs on their own, they become
distressed by feelings of helplessness.
2. In its professional character, nursing adds to the distress of the patient.
3. Patients are unique and individual in how they respond.
4. Nursing offers mothering and nursing analogous to an adult who mothers and nurtures
a child.
5. The practice of nursing deals with people, environment, and health.
6. Patients need help communicating their needs; they are uncomfortable and ambivalent
about their dependency needs.
7. People are able to be secretive or explicit about their needs, perceptions, thoughts, and
feelings.
8. The nurse-patient situation is dynamic; actions and reactions are influenced by both
the nurse and the patient.
9. People attach meanings to situations and actions that aren’t apparent to others.
10. Patients enter into nursing care through medicine.
11. The patient is unable to state the nature and meaning of his or her distress without the
help of the nurse, or without him or her first having established a helpful relationship
with the patient.
 12. Any observation shared and observed with the patient is immediately helpful in
ascertaining and meeting his or her need, or finding out that he or she is not in need at
that time.
13. Nurses are concerned with the needs the patient is unable to meet on his or her own.

Major Concepts

*The nursing metaparadigm consists of four concepts: person, environment, health, and nursing.
Of the four concepts, Orlando only included three in her theory of Nursing Process Discipline:
person, health, and nursing.

Human Being

Orlando uses the concept of human as she emphasizes individuality and the dynamic nature of
the nurse-patient relationship. For her, humans in need are the focus of nursing practice.

Health

In Orlando’s theory, health is replaced by a sense of helplessness as the initiator of a

necessity for nursing. She stated that nursing deals with individuals who are in need of help.

Environment

Orlando completely disregarded environment in her theory, only focusing on the immediate
need of the patient, chiefly the relationship and actions between the nurse and the patient
(only an individual in her theory; no families or groups were mentioned). The effect that the
environment could have on the patient was never mentioned in Orlando’s theory.

Nursing

Orlando speaks of nursing as unique and independent in its concerns for an individual’s
need for help in an immediate situation. The efforts to meet the individual’s need for help are
carried out in an interactive situation and in a disciplined manner that requires proper training.

Subconcepts

Orlando described her model as revolving around the following five major interrelated concepts:
function of professional nursing, presenting behavior, immediate reaction, nursing process
discipline, and improvement.

Function of Professional Nursing

The function of professional nursing is the organizing principle. This means finding out and
meeting the patient’s immediate needs for help. According to Orlando, nursing is responsive to
individuals who suffer, or who anticipate a sense of helplessness. It is focused on the process
of care in an immediate experience, and is concerned with providing direct assistance to a
patient in whatever setting they are found in for the purpose of avoiding, relieving, diminishing,
or curing the sense of helplessness in the patient. The Nursing Process Discipline Theory labels
the purpose of nursing to supply the help a patient needs for his or her needs to be met. That is, if
the patient has an immediate need for help, and the nurse discovers and meets that need, the
purpose of nursing has been achieved.

Presenting Behavior

Presenting behavior is the patient’s problematic situation. Through the presenting behavior,
the nurse finds the patient’s immediate need for help. To do this, the nurse must first recognize
the situation as problematic. Regardless of how the presenting behavior appears, it may
represent a cry for help from the patient. The presenting behavior of the patient, which is
considered the stimulus, causes an automatic internal response in the nurse, which in turn
causes a response in the patient.

Distress

The patient’s behavior reflects distress when the patient experiences a need that he cannot
resolve, a sense of helplessness occurs.

Immediate Reaction

The immediate reaction is the internal response. The patient perceives objects with his or her five
senses. These perceptions stimulate automatic thought, and each thought stimulates an automatic
feeling, causing the patient to act. These three items are the patient’s immediate response. The
immediate response reflects how the nurse experiences his or her participation in the nurse-
patient relationship.

Nurse Reaction

The patient behavior stimulated a nurse reaction, which marks the beginning of the nursing
process discipline.

Nurse’s Action

When the nurse acts, an action process transpires. This action process by the nurse in a nurse-
patient contact is called nursing process. The nurse’s action may be automatic or deliberative.
Automatic Nursing Actions are nursing actions decided upon for reasons other than the patient’s
immediate need.

Deliberative Nursing Actions are actions decided upon after ascertaining a need and then
meeting this need

 criteria for deliberative actions:

 Deliberative actions result from the correct identification of patient needs by

validation of the nurse’s reaction to patient behavior.
 The nurse explores the meaning of the action with the patient and its relevance to
meeting his need.
 The nurse validates the action’s effectiveness immediately after completing it.
 The nurse is free of stimuli unrelated to the patient’s need when she acts.

Nursing Process discipline

  Nursing process discipline is the investigation into the patient’s needs
 Any observation shared and explored with the patient is immediately useful in
ascertaining and meeting his or her need, or finding out he or she has no needs at
that time.
 The nurse cannot assume that any aspect of his or her reaction to the patient is correct,
helpful, or appropriate until he or she checks the validity of it by exploring it with the
patient. 
 Initiates this exploration to determine how the patient is affected by what he or she says
and does. 
 When the nurse doesn’t explore the patient’s reaction with him or her, it is reasonably
certain that effective communication between nurse and patient stops.
 The nurse decides on an appropriate action to resolve the need in cooperation with the
patient. This action is evaluated after it is carried out. 
  If the patient behavior improves, the action was successful and the process is completed.
 If there is no change or the behavior gets worse,
the process recycles with new efforts to clarify
the patient’s behavior or the appropriate nursing
action.
 Contact functioning is in Secret. The
perceptions, thoughts, and feelings of each
individual are not directly available to the
perception of the other individual through the
observable action.
  When the person-person contact
functioning is by Open disclosure, the
perceptions, thoughts, and feelings of
each individual are directly available to
the perception of the other individual
through the observable action

5 Stages of the Deliberative Nursing Process

The Deliberative Nursing Process has five

stages: assessment, diagnosis, planning, implementation, and evaluation.

Assessment

In the assessment stage, the nurse completes a holistic assessment of the patient’s needs. This is
done without taking the reason for the encounter into consideration. The nurse uses a nursing
framework to collect both subjective and objective data about the patient.

Diagnosis

The diagnosis stage uses the nurse’s clinical judgment about health problems. The diagnosis can
then be confirmed using links to defining characteristics, related factors, and risk factors
found in the patient’s assessment.

Planning

The planning stage addresses each of the problems identified in the diagnosis. Each problem
is given a specific goal or outcome, and each goal or outcome is given nursing interventions to
help achieve the goal. By the end of this stage, the nurse will have a nursing care plan.

Implementation

In the implementation stage, the nurse begins using the nursing care plan.

Evaluation

Finally, in the evaluation stage, the nurse looks at the progress of the patient toward the goals
set in the nursing care plan. Changes can be made to the nursing care plan based on how well
(or poorly) the patient is progressing toward the goals. If any new problems are identified in the
evaluation stage, they can be addressed, and the process starts over again for those specific
problems.