IDA JEAN ORLANDO

Nursing Process Theory

 Born in August 12, 1926
 Nursing diploma - New York Medical College
 BS in public health nursing - St. John's University, NY,
 MA in mental health nursing - Columbia University, New York.
 Associate Professor at Yale School of Nursing and Director of the
Graduate Program in Mental Health Psychiatric Nursing.
 Project investigator of a National Institute of Mental Health grant entitled:
Integration of Mental Health Concepts in a Basic Nursing Curriculum.
 published in her 1961 book, TheDynamic Nurse-Patient Relationship and
revised 1972 book: The Discipline and Teaching of Nursing Processes
 A board member of Harvard Community Health Plan.

NURSING PROCESS THEORY

▪ Allows nurses to formulate an effective nursing care plan that can also be
easily adapted when and if any complexity comes up with the patient.
▪ Stresses 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.

MAJOR DIMENSIONS

▪ The role of the nurse is to find out and meet the patient's immediate need
for help.
▪ The patient's presenting behavior may be a plea for help, however, the
help needed may not be what it appears to be.
▪ Therefore, nurses need to use their perception, thoughts about the
perception, or the feeling engendered from their thoughts to explore with
patients the meaning of their behavior.
▪ This process helps nurse find out the nature of the distress and what help
the patient needs.

GOALS
▪ To develop a theory of effective nursing practice.
▪ The theory explains that the role of the nurse is to find out and meet the
patient’s immediate needs for help.
▪ All patient behavior can be a cry for help.
▪ The nurse’s job is to find out the nature of the patient’s distress and
provide the help he or she needs.

ASSUMPTIONS
▪ When patients are unable to cope with their needs on their own, they
become distressed by feelings of helplessness.
▪ In its professional character, nursing adds to the distress of the patient.
▪ Patients are unique and individual in how they respond.
▪ Nursing offers mothering and nursing analogous to an adult who mothers
and nurtures a child.
▪ The practice of nursing deals with people, environment, and health.
▪ Patients need help communicating their needs; they are uncomfortable
and ambivalent about their dependency needs.
▪ People are able to be secretive or explicit about theirneeds, perceptions,
thoughts, and feelings.
▪ The nurse-patient situation is dynamic; actions and reactions are
influenced by both the nurse and the patient.
▪ People attach meanings to situations and actions that aren’t apparent to
others.
▪ Patients enter into nursing care through medicine.
▪ 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.
▪ Any observation shared and observed with the patient isimmediately
helpful in ascertaining and meeting his or her need, or finding out that he
or she is not in need at that time.
▪ Nurses are concerned with the needs the patient is unable to meet on his
or her own.

TERMS
 Distress is the experience of a patient whose need has not been met.
 Nursing role is to discover and meet the patient’s immediate need for
help.
→ Patient’s behavior may not represent the true need.
→ The nurse validates his/her understanding of the need with the
patient.
 Nursing actions directly or indirectly provide for the patient’s immediate
need.
 An outcome is a change in the behavior of the patient indicating either a
relief from distress or an unmet need.
→ Observable verbally and nonverbally.

METAPARADIGM

Human
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

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.

CONCEPTS
▪ Function of professional nursing - organizing principle
▪ Presenting behavior - problematic situation
▪ Immediate reaction - internal response
▪ Nursing process discipline – investigation
▪ Improvement - resolution

Function of professional nursing - organizing principle

> Finding out and meeting the patients immediate needs for help
> "Nursing….is responsive to individuals who suffer or anticipate a sense of
helplessness, it is focused on the process of care in an immediate
experience,
> it is concerned with providing direct assistance to individuals in whatever
setting they are found for the purpose of avoiding, relieving, diminishing or
curing the individuals sense of helplessness." - Orlando

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, regardless of the form in which it
appears, may represent a plea for help
> The presenting behavior of the patient, the stimulus, causes an automatic
internal response in the nurse, 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

Nursing process discipline –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, helpful or appropriate until she checks the validity of it in
exploration with the patient

Improvement - 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.

NURSING PROCESS

Assessment
Diagnosis
Planning
Implementation
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
> NURSING PROCESS
Diagnosis
> The diagnosis stage uses thenurse’s clinical judgmentabout 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.

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

Evaluation
> 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.

CONCLUSION
> Focuses on the interaction between the nurse and patient, perception
validation, and the use of the nursing process to produce positive
outcomes or patient improvement. Orlando's key focus was to define the
function of nursing.
> Orlando's theory remains one the of the most effective practice theories
available.
> The use of her theory keeps the nurse's focus on thepatient.
> The strength of the theory is that it is clear, concise, and easy to use.
> While providing the overall framework for nursing, the use of her theory
does not exclude nurses from using other theories while caring for the
patient.