Heather Gulian, Lara Kim, Angela Kramer, Beth Smith

‡ How does this patient make you feel? ‡ What do you think they need? ‡ What would you do for them as a nurse?

Mental Health Nursing Columbia University. John's University. NY ` MA.` Nursing diploma New York Medical College ` BS.Public Health Nursing St. NY ` Director of Mental Health Psychiatric Nursing Graduate Program Yale SON. CT .

and its desired outcome? GOAL: ³To develop a µtheory of effective nursing practice¶ that would identify a distinctive role for the professional nurses that would provide a systematic foundation for the study of nursing. 2006.` NIMH ± Research grant Integration of Mental Health Concepts in Basic Nursing Curriculum ` Observed patient-nurse interactions ³Good´ ± effective ³Bad´ ± ineffective ` ` How can you analyze ³good´ and ³bad´ nursing without defining nursing. its function. 433) .´ (Schmieding.

nd. Process. and Principles of Professional Nursing Practice 1962 ± Employed as a Clinical Nurse Consultant at McLean Hospital in MA Grant to develop a nursing training program based on her theory McLean ital.` ` 1961 ± The Dynamic NursePatient Relationship: Function. ` 1972 ± The Discipline and Teaching of Nursing Process: An Evaluative Study .

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

Immediate needs may include assisting the patient to comply with the doctor¶s orders. MD¶s orders are assigned to patients not to nurses. If nurses focus on orders (versus immediate patient needs).` Shifted from care based on medical diagnoses to care based on patients¶ immediate needs. ` . it keeps the nurse dependent.

Patient¶s Behavior ‡ May represent an unmet need Nurse¶s Reaction ‡ Perception ‡ Thoughts ‡ Feelings Nurse¶s Explicit Reaction ‡ Validate/correct understanding of the need Nurse¶s Action ‡ Meet the patient¶s immediate need .

. 1968. each need are unique.Pelletier. 1968. Pelletier. out for reasons other than ‡ Nurse seeks verification or correction of meeting the patient¶s immediate his/her thoughts with the patient. ‡ Stresses the reciprocal relationship ‡ Automatic actions are carried between the nurse and patient. needs. ‡ Patients¶ needs and nurses¶ reactions to ‡ Prevents the responsibility of nursing from being performed.

2000) .(Potter & Tinker.

(Schmieding. The nurse initially feels frustrated and that the patient doesn¶t want to help himself. the nurse also realizes that something else may be going on. 1984) . The nurse asks.` A patient is frequently asking the nurse to do things for him that he could do for himself. Is there something else you need?´ The patient replied that when he was upset it was reassuring to have a nurse come into the room. However. ³I feel like you could be doing many of these things on your own.

1984. Disease Prevention & Treatment Open communication with patient in order to determine their healthcare needs and develop effective diagnoses and care plans Teenage female requesting birth control (Sylvia Wood) ` Nurse-Patient Relationship Promotes effective communication between nurse and patient ` Teaching-Coaching Evaluating patient¶s needs. (Schmieding. I won¶t be able to do my job. p761) .` Health Promotion & Protection.´ (Schmieding. 1984. p761) Nursing accountability Understanding supervisee true needs: A nurse¶s request for a weekend off may represent his/her dissatisfaction with another nurse that is scheduled to work that weekend as well. evaluating outcomes with the patient ` Professional Role Allows for autonomy in nursing role Interdisciplinary boundaries: ³If I do that. promoting behavioral changes. which is to observe the patient and find out and meet the patient¶s needs for help.

After removing the adhesive. 1961) ` Monitoring and ensuring the quality of health care practice Validating that needs are met and that nursing action provided a positive outcome ` Cultural competence Keeps the nurse from labeling patients and staff . and the nurse explores the pain sensation. (Orlando. and the nurse sees the discomfort may be due to the old tape adhesive. the patient states that the area feels much better and that the codeine she had received the night before had been ineffective. not unnecessary tasks Patient requests codeine. The patient shows the nurse the afflicted area.` Managing/Negotiating health care delivery systems Control costs by focusing care on immediate needs.


` ` Concepts are observable. nursing process. questionnaires. anxiety. nurse empathy. and other tools which measure patient outcome. however these vary from case to case as outcomes are based on both patients and nurses perception of the interaction Research tools are specific to the outcome being measured (i. pain) Surveys. and patient perceived empathy.e. .

` Studies supporting the theory Pilot study (2000) ± implemented Orlando¶s theory resulting in: x Positive. Results indicate: x x x x Higher patient retention Reduction of emergency services Decreased hospital stay Increased patient satisfaction . patient-centered outcomes x A staff-patient approach model x Decreased patient (immediate) stress VA study (1987) ± implemented theoretical model with bipolar patients.

` ` The relative simplicity of the theory lends itself well to internal consistency. Semantic inconsistency: Theory Title: x Deliberative Nursing Process (1961) x Nursing Process Discipline (1972) Nursing action: x Good Effective (Deliberative) x Bad Ineffective (Automatic) .

Unrealistic to expect all nurses to internalize this model. ` Compatible with expectations for nursing practice: May appear more time consuming initially. .` Requires education to implement: Orlando¶s 1972 book introduces and evaluates a training program. ` Very applicable to real-world nursing situations improve patient outcomes Every face-to-face interaction. ` Feasibility: Feasible to teach. but assists the nurse in meeting true needs the first time. ` Favorable outcomes: Patient needs are met Research shows deliberative nursing process is more likely to produce favorable outcomes then automatic nursing process.

` ` ` ` ` Care is patient-focused Patients are treated as individuals Patients assume active role in their care The theory can be learned Applicable in various settings clinical/educational/administrative Facilitates cultural understanding and respect Needs are met regardless of cultural or language barriers ` Allows cost and time-saving measures as actions are based on meeting ³immediate needs´ and avoiding unnecessary tasks .


Dewey¶s Theory of Inquiry (philosophy. and philosophical claims: Present and clearly stated. and Behavioral Theory (psychology) . but not explicitly identified in a systematic manner Implicit and not completely clear on how they were derived ` No bibliographic references: Some feel the vast majority of her work was Orlando¶s original thought. Symbolic Interaction (sociology). concepts. propositions.` Conceptual model: Emphasizes the internal reaction of the nurse Needs to expand more on the process of validation ` Metaparadigm. not stemming from antecedent knowledge Others feel her theory incorporates the underpinnings of multiple theories including: Peplau¶s Interpersonal Relationships (nursing). psychology).

No: x Some concepts are expanded upon in a second book. propositions. and variables. .` Clear and Concise Yes: x Limited in concepts.


` ` ` Focus is on short-term care Requires training from a qualified nurse Does not apply to all patients Pediatrics Unconscious Mentally-ill/impaired ` ` Does not address the family/caregiver Simplicity of theory masks the intricacy of the nurse-patient dynamic .

` ` ` ` Defined nurses¶ role focusing on patients¶ need rather than MD¶s orders Provide nurse¶s with autonomy Enriches nursing¶s unique body of knowledge Strengthens nurse/patient relationship Positive patient outcomes .

` Apply to other fields in order to validate the needs of clients Psychology: counseling Customer service ` ` Develop a unique/modifiable tool that applies this theory in various clinical settings to achieve positive outcomes Focus on long-term care needs .

R. Put power in nurses' hands: Orlando's nursing theory supports nurses simply. Potter. (2006). N. 357-365. J. July. Potter. NY: National League for Nursing. J. Journal of Advanced Nursing. Schmieding. Philadelphia: Lippincott Williams & Wilkins. (1990). Orlando Pelletier [Motion picture]. St. and Principle. & Tinker. & Bockenhauer. M. N. M. Implementing Orlando's nursing theory: A pilot study. Louis: Mosby Elsevier. J. Putting Orlando¶s theory into practice.pdf. J. 759-761. 14-21. 15. & Bredow. Journal of Advanced Nursing. 38(3). T. I. Putnam¶s Sons. March.M. (2000). J. A. 12. Analysing managerial responses in face-to-face contacts. Domains and core competencies of nurse practitioner practice. Deliberative nursing process. United States: Samuel Merritt College Studio Three. (1989). Nursing process theory. Journal of Advanced Nursing. Orlando.edu/access/content/group/NURS523_01_20233_FALL2009/Articles/CoreComps. (2009). B. S. Schmieding. Process. Access October 25.). . In Peterson. Schmieding. The Discipline and Teaching of Nursing Process: An Evaluative Study.) Middle Range Theories: Application to Nursing Research (2nd ed). Orlando.P. Schmieding. N. 463-467. (2000). The Dynamic Nurse-Patient Relation: Function. J. (1972). I. An integrative nursing theoretical framework. M. (Eds. National Organization of Nurse Practitioner Faculties (2006).J. In Tomey.L. S. Nursing Management. M. Nursing Theorists and their Work. N. Journal of Psychosocial Nursing & Mental Health Services. (1987). & Alligood. 40-41. (304-325). NY: G. S. (431-451).` ` ` ` ` ` ` ` ` ` ` Helene Fuld Health Trust (Producer) (1990). Potter. (Eds.plu. 84(6). The Nurse Theorists: Portraits of Excellence: Ida J. (1984). 2009 from https://sakai.

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