Ida Jean Orlando
DELIBERATIVE NURSING
PROCESS THEORY
Biography
She was an internationally known psychiatric
health nurse, theorist, and researcher.
A first-generation Irish American born on
August 12, 1926. Retired from nursing in
1992.
She was recognized as a "Nursing Living
Legend" by the Massachusetts Registered
Nurse Association.
Married to Robert Pelletier and lives in the
Boston area. Project investigator of a National
Institute of Mental Health grant entitled:
Integration of Mental Health Concept in Basic
Nursing Curriculum
The result of the research is contained in her
1972 book titled: The Discipline and
Teaching of Nursing Process. Orlando has
served as a board member of Harvard
Community Health Plan.
Orlando’s Theory was developed in the late
1590’s from observations she recorded
between a nurse and patients. She was only
able to categorize the records as “good” and
“bad” nursing. It then dawned on her that both
the formulations for “good” and “bad” nursing
contained in the records. From these
observations she formulated the deliberative
nursing process.
Education
1947-She received a nursing diploma from
the Flower Fifth Avenue Hospital School of
Nursing in New York.
1951- She received a Bachelor of Science
degree in public health nursing from St.
John’s University in Brooklyn, New York.
1954- Orlando received her Master of Arts
degree in mental health consultation from
Teachers College, Columbia University.
Works
She wrote a book on her findings from Yale.
After working as a researcher, she wrote a
book on her findings from Yale, entitled
“The Dynamic Nurse-Patient Relationship:
Function, Process, and Principles.” Her
book was published in 1961. A year later,
she also continued her research studies
published her second book, “The Discipline
and Teaching of Nursing Process,” in
1972.
Orlando's Nursing Process Theory
➔ "Patients have their own meanings and
interpretations of situations and therefore
nurses must validate their inferences and
analyses with patients before concluding."
➔ That 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.
➔ Developed her theory from a study
conducted at the Yale University School of
Nursing, integrating mental health concepts
into basic nursing curriculum.
➔ Orlando's nursing theory stresses the
reciprocal relationship between patient and
nurse. What the nurse and the patient say
and do affects them both. She views
nursing's professional function as finding
out and meeting the patient's immediate
need for help
Assumptions
1. When patients cannot 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, the environment, and health.
6.Patients need help communicating
their needs; they are uncomfortable and
ambivalent about their dependency
needs.
7.People can 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 cannot state the nature
and meaning of his or her distress
without the nurse’s help or 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.
The Major Concept Of Orlando's
Nursing Process Theory
----------HUMAN BEING----------
She emphasizes individuality and the
dynamic nature of the nurse-patient
relationship. For her, humans in need are
the focus of nursing practice.
----------HEALTH----------
Health is replaced by a sense of
helplessness as the initiator of a
necessity for nursing. She stated that
nursing deals with individuals who
require help.
----------ENVIRONMENT----------
Orlando completely disregarded the
environment in her theory, only focusing
on the patient's immediate need, 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.
SUBCONCEPT
----------THE 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.
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. It is
concerned with providing direct
assistance to a patient in whatever
setting they are found to avoid, relieve,
diminishing,or curing the patient's sense
of helplessness.
----------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 patient's presenting
behavior, 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's behavior
stimulated a nurse's reaction, which
marks the nursing process discipline's
beginning.
Nurse's Action- When the nurse acts,
an action process transpires. This action
process by the nurse in a nurse-patient
contact is called the 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.
The following list identifies the criteria
for deliberative actions:
 Deliberative actions result from the
correct identification of patient
needs by validating 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
The nursing process discipline
is the investigation into the
patient's needs
The action process in a person-to-person
contact functioning in secret.
The action process in a person-to-person
contact functioning by open disclosure
----------IMPROVEMENT ------
Improvement is the resolution to the
patient's situation.
The nurse's own individuality and that of
the patient require going through this
each time the nurse is called upon to
render service to those who need him or
her.
5 STAGES OF THE DELIBERATIVE
NURSING PROCESS
----------ASSESSMENT ----------
 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
vsubjective and objective data
about the patient.

DIAGNOSIS ----------
 Uses the nurse's clinical judgment
about health problems.
----------PLANNING----------
 Addresses each of the problems
identified in the diagnosis.
 The lack of operational definitions
of society or environment was
evident, limiting the development of
the research hypothesis.
 Orlando's work focuses on short-
term care, particularly aware and
 conscious individuals, and the
virtual absence of reference groups
or family members.

----------IMPLEMENTATION----------

 The nurse begins using the nursing

care plan.

----------EVALUATION----------

 The nurse looks at the patient's

progress toward the goals set in the
nursing care plan.

Analyze the Deliberative Nursing

Process

Compared to other nursing theories,

which are task-oriented, Orlando gave
a clear-cut approach to patient
oriented nursing theory.

STRENGTH AND WEAKNESSES

 The guarantee that patients will be

treated as individuals is very much
applied in Orlando's theory of the
Deliberative Nursing Process. Each
patient will have an active and
constant input into their own care.
 The assertion of nursing's
independence as a profession and
her belief that this independence
must be based on a sound
theoretical framework.
 The model also guides the nurse to
evaluate her care in terms of
objectively observable patient
outcomes

Weaknesses
The Care, Core, Cure Theory
Lydia Eloise Williams - Hall
(September 21, 1906 - February 27,
1969)
• she was born on September 21, 1906,
in New York City as Lydia Eloise
Education
• In 1927 she graduated from York
Hospital School of Nursing.
• In 1937 she earned her Bachelor of
Science Degree in Public Health
Nursing at Columbia University in New
York
• In 1942 she received a Master’s
Degree in the Teaching of Natural Life
Sciences from Columbia University.
Career and Appointments
• In 1935 to 1940 she also had the
opportunity to work for the New York
Heart Association.
• In 1941 to 1947, she became a staff
nurse with the Visiting Nurses
Association of New York
• In 1950, she became a professor at
Teacher ’ s College at Columbia, where
she taught nursing students to function
as medical consultants.
• In 1950, she became a professor at
Teacher ’ s College at Columbia, where
she taught nursing students to function
as medical consultants.
• Hall authored 21 publications and bulk
of articles and addresses regarding her
theory.
Awards and Honors
• In 1967, Lydia Hall received the
Teacher ’ s College Nursing Education
Alumni Association (TCNEAA)
Achievement in Nursing Practice Award
and was their Nursing Hall of Fame
inductee.
• In 1984, she was inducted into the
American Nurses Association (ANA)
Hall of Fame.
The Care Circle
According to the theory, nurses are
focused on performing the noble task of
nurturing patients.
The Core Circle
The core, according to Hall’ s theory, is
the patient receiving nursing care. The
core has goals set by him or herself
rather than by any other person and
behaves according to their feelings and
values.
The Cure Circle
As explained in this theory, the cure is
nursing, which involves the
administration of medications and
treatments.
Metaparadigm
Person
The source of energy and motivation for
healing is the individual care recipient,
not the health care provider.
Health
Health can be inferred as a state of self-
awareness with a conscious selection of
optimal behaviors for that individual.
Environment
The concept of society or environment is
dealt with concerning the individual.
Nursing
ursing is identified as participating in the
care, core, and cure aspects of patient
care.
Assumptions
Hall’ s Care, Cure, Core Theory
assumptions are as follows:
(1) The motivation and energy necessary
for healing exist within the patient rather
than in the healthcare team.
(2) The three aspects of nursing should
not be viewed as functioning
independently but as interrelated.
3) The three aspects interact, and the
circles representing them change the
size, depending on the patient’ s total
course of progress.

Strengths
• Lydia Hall’ s model appears to be
completely and simply logical. Her work
may be viewed as the philosophy of
nursing.
Weaknesses
Lydia Hall’ s model is considered to be
plain and simple in its presentation.
• The age requirement for applying her
theory 16 years of age and above limits
the theory since it cannot be disregarded
that nurses are faced with pediatric
clients now and then.
(Interpersonal relations theory)
Hildegard Elizabeth Peplau
Hildegard Elizabeth Peplau (September
1, 1909 – March 17, 1999) was an
American nurse who is the only one to
serve the American Nurses Association
(ANA) as Executive Director and later
as President. She became the first
published nursing theorist since
Florence Nightingale.
Peplau was well-known for her Theory
of Interpersonal Relations, which helped
to revolutionize nurses’ scholarly work.
Her achievements are valued by nurses
worldwide and became known to many
as the “Mother of Psychiatric
Nursing” and the “Nurse of the
Century.”
Hildegard Peplau was born on
September 1, 1909. She was raised in
Reading, Pennsylvania, by her parents of
German descent, Gustav and Otyllie
Peplau.
Early life
She was the second daughter, having
two sisters and three brothers. Though
illiterate, her father was persevering
while her mother was a perfectionist and
oppressive. With her young age,
Peplau’s eagerness to grow beyond
traditional women’s roles was precise.
She considers nursing was one of few
career choices for women during her
time. In 1918, she witnessed the
devastating flu epidemicthat greatly
influenced her understanding of the
impact of illness and death on families.
EduCaTion
When the autonomous, nursing-
controlled, Nightingale era schools came
to an end in the early 1900s, schools
then were handled by hospitals, and the
so-called formal “book learning” was
put down. Hospitals and physicians
considered women in nursing as a
source of free or inexpensive labor.
Exploitation was widespread by nurse’s
employers, physicians, and educational
providers.
In 1931, she graduated from Pottstown,
Pennsylvania School of Nursing. Peplau
earned a Bachelor’s degree in
interpersonal psychology in 1943 at
Bennington College in Vermont. She
studied psychological issues with Erich
Fromm, Frieda Fromm-Reichmann, and
Harry Stack Sullivan at Chestnut
Lodge, a private psychiatric hospital in
Maryland. Peplau held master’s and
doctoral degrees from Teachers College,
Columbia University, in 1947.
Interpersonal relations theory
In 1952, Hildegard Peplau published her
Theory of Interpersonal Relations
influenced by Henry Stack Sullivan,
Percival Symonds, Abraham Maslow,
and Neal Elgar Miller. Her theory is
discussed further below.
Peplau’s original book from 1952 has
been translated into nine languages and
in 1989 was reissued in Great Britain by
Macmillan of London. In 1989, Springer
published a volume of selected works of
Peplau from previously unpublished
papers. Her ideas have, indeed, stood the
test of time. The archives of her work
and life are housed at the Schlesinger
Library at Harvard University.
Awards and Honors
Peplau was acknowledged with
numerous awards and honors for her
contributions to nursing and held 11
honorary degrees. She was awarded
honorary doctoral degrees from
universities including Alfred, Duke,
Indiana, Ohio State, Rutgers, and the
University of Ulster in Ireland.
She was named one of “50 Great
Americans” in Who’s Who in 1995 by
Marquis. She was also elected fellow of
the American Academy of Nurse and
Sigma Theta Tau, the national nursing
honorary society.
Hildegard Peplau’s
Interpersonal Relations Theory
Hildegard Peplau’s Interpersonal
Relations Theory emphasized the nurse-
client relationship as the foundation of
nursing practice.
Assumptions
Hildegard Peplau’s Interpersonal
Relations Theory’s assumptions are:
(1) Nurse and the patient can interact.
(2) Peplau emphasized that both the
patient and nurse mature as the result of
the therapeutic interaction.
(3) Communication and interviewing
skills remain fundamental nursing tools.
And lastly,
(4) Peplau believed that nurses must
clearly understand themselves to
promote their client’s growth and avoid
limiting their choices to those that
nurses value.
Major Concepts of the
Interpersonal Relations Theory
Person
a developing organism that tries to
reduce anxiety caused by needs.
Health
defined as a word symbol that implies a
forward movement of personality and
other ongoing human processes in the
direction of creative, constructive,
productive, personal, and community
living.
Environment
although Peplau does not directly
address society/environment, she does
encourage the nurse to consider the
patient’s culture and mores when the
patient adjusts to the hospital routine.
Nursing
Peplau considers nursing to be a
“significant, therapeutic, interpersonal
process”. She defines it as a “human
relationship between an individual who
is sick, or in need of health services, and
a nurse specially educated to recognize
and to respond to the need for help.”
Therapeutic nurse-client
relationship
A professional and planned relationship
between client and nurse focuses on the
client’s needs, feelings, problems, and
ideas.
Four phases of the therapeutic
nurse-patient relationship
1. Orientation Phase
The nurse’s orientation phase involves
engaging the client in treatment,
providing explanations and information,
and answering questions.
2. IDENTIFICATION PHASE
The identification phase begins when the
client works interdependently with the
nurse, expresses feelings, and begins to
feel stronger.
3. Exploitation Phase serving as a substitute for another such
as a parent or a sibling
In the exploitation phase, the client
makes full use of the services offered. COUNSELOR:

promoting experiences leading to health

for the client such as expression of
4. Resolution Phase feelings

In the resolution phase, the client no Technical Expert:

longer needs professional services and
gives up dependent behavior. The helping the client to learn formally or
relationship ends. informally

Subconcepts of the Additional roles include:

Interpersonal Relations Theory
Consultant
Peplau’s model has proved greatly used Health
by later nurse theorists and clinicians in teacher
developing more sophisticated and Tutor
therapeutic nursing interventions. Socializing agent
Safety agent
The following are the roles of the Manager of environment
Nurse in the Therapeutic relationship Mediator
identified by Peplau: Administrator
Recorder observer
STRANGER: Researcher

offering the client the same acceptance ANXIETY

and courtesy that the nurse would
respond to any stranger was defined as the initial response to a
psychic threat.
RESOURCE PERSON:
Four levels of anxiety
providing specific answers to questions
within a larger context Mild Anxiety

TEACHER: is a positive state of heightened

awareness and sharpened senses,
helping the client to learn formally or allowing the person to learn new
informally behaviors and solve problems. The
person can take in all available stimuli
LEADER: (perceptual field).

offering direction to the client or group Severe Anxiety

SURROGATE: involves a decreased perceptual field

(focus on the immediate task only); the
person can learn a new behavior or solve
problems only with assistance. Another
person can redirect the person to the task
Moderate Anxiety
involves a decreased perceptual field
(focus on the immediate task only); the
person can learn a new behavior or solve
problems only with assistance. Another
person can redirect the person to the task
Panic Anxiety
can involve loss of rational thought,
delusions, hallucinations, and complete
physical immobility and muteness. The
person may bolt and run aimlessly, often
exposing himself or herself to injury.
Interpersonal Theory and
Nursing Process
Peplau’s Interpersonal Relations Theory
and the Nursing Process are sequential
and focus on the therapeutic relationship
by using problem-solving techniques for
the nurse and patient to collaborate on to
meet the patient’s needs. Both use
observation communication and
recording as basic tools utilized by
nursing.
Assessment
 Continuous data collection and
analysis May not be a felt need
Orientation
 Non-continuous data collection
Felt need
Definite needs
Nursing diagnosis & planning
 Mutually set goals
Identification
 Interdependent goal setting
Implementation
 Plans initiated towards achievement
of mutually set goals
 May be accomplished by patient,
nurse, or significant other
Exploitation
 Patient actively seeking and
drawing help
 Patient-initiated
Evaluation
 Based on mutually expected
behaviors
 May led to termination and
initiation of new plans.
Resolution
 Occurs after other phases are
completed successfully
 Leads to termination
STRENGTHS
Its phases provide simplicity regarding
the nurse-patient relationship’s natural
progression, which leads to adaptability
in any nurse-patient interaction, thus
providing generalizability
WEAKNESSES
Though Peplau stressed the nurse-client
relationship as the foundation of nursing
practice, health promotion and
maintenance were less emphasized.