THEORETICAL FOUNDATION IN NURSING
Professional nursing function-
Orlando’s Theory of Deliberate Nursing
Process
“Nursing Process Theory”
“Nursing is a profession that seeks to find out
and meet the patient’s immediate need for
help”
Three Basic Elements of Nursing Process
1. The Behavior of the patient
2. The reaction of the nurse
3. The nursing actions which are designed
for the patients benefit
Ida Jean Orlando (1961)
 The role of the nurse is to find out and
to meet the patient’s immediate need
for help.
 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 the nurse find out the
nature of the distress and what help
the patient needs.
History and Background
 First-generation American of Italian
descent was born in 1926.
 Received her nursing diploma from
New York Medical College, her BS in
public health nursing from St. John’s
University, NY
 MA in mental health nursing from
Columbia University, New York.
 An Associate Professor at Yale School
of Nursing where she was Director of
the Graduate Program in Mental
Health Psychiatric Nursing.
 Project investigator of a National
Institute of Mental Health grand
entitled: Integration of Mental Health
Concepts in a basic Nursing
Curriculum.
 Developed her theory which was
published in her 1961 book: “The
Dynamic Nurse-Patient Relationship”.
Overview of Orlando’s Nursing Process Theory
The major dimensions of Orlando’s Nursing
Process Theory are as follows:
1.
organizing principle.
2. The patient’s presenting behavior-
problematic situation.
3. Immediate reaction-internal response.
4. Deliberative nursing process-reflective
inquiry.
5. Improvement- resolution.
1. Professional Nursing Process
Function- Organizing Principle
 The nurse’s unique function is “finding
out and meeting the patient’s
immediate needs for help.” (Orlando,
1972, p. 20)
 The central core of the nurse ‘s
practice is to understand what is
happening between the patient and
nurse that provides framework for the
help the nurse gives the patient
(Orlando, 1961).
2. The patient’ Presenting Behavior-
Problematic Situation
 The reaction comprises is nurse’s
perception, thoughts about the
perceptions, and the feelings evoked
from the thoughts; they cannot be
controlled.
3. Immediate Reaction- Internal
Response
 The reaction comprises the nurse’s
perceptions, thoughts about the
perceptions, and the feelings evoked
from the thoughts; they cannot be
controlled.
 Regardless of the extent of nurse’s
accuracy, the perceptions that evoked
the thoughts are communications from
the patient and represent the raw data
for the nurse to use in investigating or
exploring the patient’s behavior.
(Orlando, 1961)
4. Deliberative Nursing Actions
 The deliberative nursing process views
the nurse-patient situation as a
dynamic whole.
 The deliberative nursing process
describes as follows: “Whatever the
 nurse perceives about the patient with the other individual through the
any one of the five sense organs and observation action (Orlando, 1972).
thinks and feels about the perception
must, at least in part be verbally
expressed as self-designated to the
patient and the asked about.
(Schmieding 1993, p.25).
5. Improvement
 When the patient’s immediate need
for help have been determined and
met, there is improvement (Orlando,
1961).
 If patient’s behavior has not changed,
the function of nursing has not been
met and the nurse continues with the
inquiry process until there is
improvement (Orlando,1961)
 This change is observable both
patient’s verbal and nonverbal
behavior.
Assumptions
 When patient cannot cope with their
needs without help, they become
distressed with feelings of
helplessness.
 Patients are unique and individual in
their responses.
 Any observation shared and observed
with the patient is immediately useful
is ascertaining and meeting his need or
finding out that he is not in need at
that time.
 Nurses are concerned with the needs
that patients cannot meet on their
own.
 The action process in a person-to
person contacts functioning 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. (Orlando,1972)
 The action process in a person-to
person contacts functioning by open
disclosure. The perceptions, thoughts,
and feelings of each individual are
directly available to the perception of