BAHIR DAR UNIVERSITY

COLLEGE OF MEDICINE AND HEALTH SCIENCES

SCHOOL OF NURSING
DEPARTMENT OF ADULT AND PEDATRICS
NURSING
To: Gebre Y.(PhD fellow)

1
IDA JEAN ORLANDO
1926- 2007

NURSING PROCESS THEORY

01/30/2023 Orlando 2
Group Member
Name…………………….. . . . . .... . .ID
1. Amanuel Taye………………….BDU1207020PR
2. Eleni Dagnaw……………….. . .. BDU1207023PR
3. Fentahun Meseret………………BDU1207024PR
4. Mekides Tadesse………………..BDU1207028PR
5. Teshale Mengesha…………… ..BDU1207031PR
6. Tsegasew Embiale………….. . ..BDU1207032PR

01/30/2023 Orlando 3
 Presentation Out line
Back ground

Introduction

Major Concepts and Definitions

Major assumption

Meta-paradigm

 Applicability of the theory

Strength and Weakness

Summary

Reference

01/30/2023 Orlando 4
 Objectives
At the end of this presentation the students will be able to
:-
 Describe back ground of Orlando

 Describe major assumptions of I.J. Orlando.

 Explain basic concepts of Orlando theory

 Describe the Meta-paradigm of the Theory

 Discuss the application of Orlando theory in nursing

01/30/2023 Orlando 5
Background
Ida Jean Orlando was born on August 12, 1926- in
New York.
1947-Diploma in Nursing from New York
Medical College, Flower Fifth Avenue Hospital
School of Nursing.
1951-B.S.C in Public Health Nursing, St. John's
University, Brooklyn, New York.
1954-M.A.in mental health consultation in
Columbia University teachers collage.

01/30/2023 Orlando 6
Orlando's Experience
Various clinical nursing positions in medical, surgical and
emergency room.
Research Associate & Principal Investigator at Yale
University in New Haven”(1954-1961).
1961 – Her first book ”The Dynamic Nurse-Patient
relationship: Function, Process and Principles”

01/30/2023 Orlando 7
 Orlando's Experience …
1962- she become a clinical nursing consultant at Mclean
hospital.
1972 - Her second book "The Discipline and Teaching of
Nursing Process”
1987- Assistant director of nursing for education and
research at metropolitan hospital.
In 1992, Orlando received the Nursing Living Legend
award by the Massachusetts Registered Nurse Association.
Orlando 8
 Introduction
Orlando theory explains that the role of the nurse is to
find out and meets the patient’s immediate need.
Ida Jean Orlando’s goal is to develop a theory of
effective nursing practice.
According to the theory, 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.
She beliefs that care should be based on needs of the
patient and communication with the patient is essential.
01/30/2023 Orlando 9
 Initiation to develop the theory
Orlando’s model was developed after being dissatisfied
with the views that nurses were motivated to act as a
result of:
orders from physicians,

institutional policies, and other reasons,

none of which related to nursing action based on meeting

patients’ needs.

01/30/2023 Orlando 10
 Origin of theory
Orlando developed her theory while she was the principal
investigator at Yale University.
For three years she personally observed over 2,000 nurse-
patient interactions.
She took notes and classified each interaction as either
“good” or “bad” nurses.
Good nurse’s focus on the immediate verbal and non
verbal behavior of patient from the beginning through the
end of the contact(deliberative interpretation of the patient)
bad nurse’s focus on something that had nothing to do
with the patient’s behavior(automatic nursing action).

01/30/2023 Orlando 11
 Origin of theory…
From these observations, she formulated the ”Deliberativ
e Nursing Process” which was published in 1961.
Orlando`s theory was formulated in a time when the
exact role of a nurse was not written.
Her theory radically shifted the nurse`s focus from the
medical diagnosis, automatic activities and decided upon
without patient participation to deliberative nursing
action.

01/30/2023 Orlando 12
 Origin of theory….
She also Conducted research at McLean
Hospital through continuous tape recording of nurses
with patients and other health care members.
Based on this research, her formulations were
validated, thus she extended her theory to include the
entire nursing practice system which then evolved as
“Nursing Process Discipline”

01/30/2023 Orlando 13
 Terms definition
.


Distress is the experience of a patient whose need has not been met.


Nursing role is to discover and met the patient immediate need for
help.


Nursing action directly or indirectly provide for patients immediate
need.

Outcome is change in the behavior of patient indicating in the

relieve distress or unmet need.

01/30/2023 Orlando 14
 Major Concepts
1. Professional nursing function

2. The patient’s presenting behavior

3. Immediate reaction

4. Deliberative nursing process

5. Improvement

01/30/2023 Orlando 15
Conceptual framework of the nursing process theory

01/30/2023 Orlando 16
 1, Professional Nursing Function
Organizing principle

She conceptualized the nurse’s unique function is finding

out and meeting the patient’s immediate need.
If the patient is in need and the need for help is met by the
nurse, the professional function has been fulfilled.

01/30/2023 Orlando 17
2, The Patient’s Presenting Behavior
Problematic situation
 The presenting behavior of the patient, regardless of the form in
which it appears.
 Patient’s behavior can be manifested in the following forms:
 Verbal , such as asking,

Vocal , such as coughing, crying, wheezing, shouting.

Non-verbal, such as Tears in the eyes, skin color, reddened
face or physiological manifestations like BP, Pulse.
01/30/2023 Orlando 18
 3. Immediate Reaction
Internal response

Patient reaction - is the internal response of patient after

perceiving things with his or her senses. These perceptions

stimulate automatic thought, and each thought stimulates

an automatic feeling, causing the patient to act.

Nurse reaction- the patient behavior stimulated a nurse

reaction, which marks the beginning of the nursing action.

Orlando 19
 Immediate Reaction …

Nurse’s Action – the 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

01/30/2023 Orlando 20
 4,Deliberative Nursing Process
Reflect the nurse- patient situation as a dynamic whole;
the patient’s behavior affects the nurse and the nurse’s
behavior (action) affects the patient.
The use of a deliberative nursing action requires a shared
communication process to determine:
The meaning of the patient’s behavior, the help required
by the patient, and whether the patient was helped by the
nurse’s action.
01/30/2023 Orlando 21
 5,Improvement
Resolution
This refers to improvement in the patient’s behavior

According to Orlando, If the nurses activity meets the

patient’s immediate needs for help, the patient’s behavior
improves.

01/30/2023 Orlando 22
5 Stages of the Deliberative Nursing Process
o Assessment

 The nurse completes a holistic assessment of the patient’s

needs by using subjective and objective data.

01/30/2023 Orlando 23
 Nursing Process…
o 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

signs/symptoms found in the patient’s assessment.

01/30/2023 Orlando 24
 Nursing Process…
o Planning

 Writing goals and objectives and deciding about appropriate

action.

 The planning stage addresses each of the problems identified

in the diagnosis.
o Implementation

 The nurse begins carrying out planned action .

01/30/2023 Orlando 25
 Nursing Process…
o Evaluation

The nurse looks at the progress of the patient toward

the goals set in the nursing care plan.
If any new problems are identified in the evaluation
stage, the process starts over again for those specific
problems.

01/30/2023 Orlando 26
 Assumptions
Focuses on:

 Nursing profession
 Nurses

 Patients

 The nature of nurse-patient interaction

01/30/2023 Orlando 27
 A. Assumptions About Nursing
1.Nursing is a distinct profession separate from other
disciplines.

2.Professional nursing has a distinct function and outcome

3.There is a difference between lay and professional nursing.

4. Nursing is aligned with medicine(Patients enter into nursing
care through medicine).

01/30/2023 Orlando 28
 B. Assumptions About patient
1.Patients’ needs for help are unique.

2. Patients have an initial inability to communicate their

needs for help.
3. When patients cannot meet their own needs they
become distressed.
4. The patient’s behavior is meaningful.

01/30/2023 Orlando 29
 C. Assumptions About Nurses

1. The nurses reaction to each patient is unique.

2. Nurses are responsible for helping patients to avoid

or alleviate distress.
3. The nurses mind is the major tool for helping
patients.
4. A nurse’s practice is improved through self-reflection.

01/30/2023 Orlando 30
D. Assumptions About Nurse-pateint interaction
1. The nurse-patient situation is a dynamic whole.

2.The phenomenon of nurse-patient encounter represents

a major source of nursing knowledge

01/30/2023 Orlando 31
 Meta-paradigm
 The nursing meta-paradigm consists of four concepts:
person, environment, health, and nursing.

person - Individual or person with unmeet needs.

Health - is replaced by a sense of helplessness as the

initiator of a necessity for nursing.
Nursing - as unique and independent in its concerns for
an individual’s need for help in an immediate situation.

01/30/2023 Orlando 32
 Meta-paradigm…
Environment- a nursing situation when there is a nurse-
patient contact and that both nurse and patient perceive,
think, feel, and act in the immediate situation.

01/30/2023 Orlando 33
 Applicability of Orlando's theory
Application to Nursing Practice

Orlando’s theory is characterized as a practice theory,

because:
1. It provides a framework to guide nurses’ actions.
2. It focuses on nurse’s-mind set.
3. Can easily understand and use everyday practice.

01/30/2023 Orlando 34
 Applicability….
Use in Clinical Practice;
Nursing care plan

Case studies

Progressive patient care settings

01/30/2023 Orlando 35
 Applicability….
Application to Education

Orlando nursing process theory was recommended for

 Teaching students and

 Conceptualize curriculums

01/30/2023 Orlando 36
 Applicability…

Using in administration and Research

In administration and leadership roles nurses use

Orlando’s theory.
dynamic leadership-follower relationship model, which
proposed a leadership theory using Orlando’s theory.
It also applied in research area since Orlando’s theory
focus on problematic situations.

01/30/2023 Orlando 37
Case scenario
Almaz is a 29- year old female patient in surgical ward in
felege hiwot referral hospital. She was crying. The nurse
asked her why she was crying. Almaz said that I had pain
and she is asking analgesics. The Nurse ask her to rate her
pain score, almaz said 7 out of 10.
Using deliberative nursing process how we care this
patient??.
A, assessment,
 The nurse in almaz case assess why she is crying.
During reports, nurses speculated, “I think she is not
crying only pain”
Then the nurses asked her if there is anything annoying
her beside her pain.
The patient cried and said that she is thinking about her
kids in home.
B, Diagnosis
Acute pain related to surgical procedures evidenced by
patients expression
Interrupted family processes related to surgical
procedure.
C, planning
 to relieve pain with in 30 minute
To call her family with in 1 day
D, Implementing
 He give analgesic
Call her child
E, Evaluation.
 After patient’s need is known and need for help is met
and resolved there is improvement.
the nurse suggested to call them which the patients
consider. She called them and thanked the nurse and said
that she is not in need for analgesic any more.
Analysis from case
 Nurse will focus on the patient needs.
Together with the patient they make the plan.
The nurse helped the patient in implementation.
 Overall evaluation
Simplicity
The theory is simple, have few concepts and easy to apply.
Strengths

Prevent inaccurate diagnosis or in effective plan.

The patient will be treated as individuals and they will

participate into their own care.

Guides the nurse to evaluate their care in terms of

observable patient out come.

01/30/2023 Orlando 42
 Weaknesses

The lack of the operational definitions of society or

environment which limits the development of research
hypothesis.
Orlando’s work focuses on short term care, particularly
aware and conscious individuals
Absence of reference group or family members.

01/30/2023 Orlando 43
 Summary
Focuses on the interaction between the nurse - patient
to produce positive outcomes or patient improvement.
Orlando's key focus was to define the function of
nursing.
Orlando's theory remains one of the most effective
practice theory.
The theory is clear, concise, and easy to use.

01/30/2023 Orlando 44
 Summary…
The use of her theory keeps the nurse's focus on the
patient’s immediate need for help.
Identify and emphasize the elements of nursing process
and the importance of the patient’s participation in the
nursing process
The most effective practice theory, especially helpful to
new nurses as they begin their practice.

01/30/2023 Orlando 45
 Acknowledgement
 We would like to forward our deepest gratitude to our
Instructor Mr. Gebre.Y. (Assistant Professor, Phd fellow)
for providing us this opportunity of discussion and guiding
and gave us the chance to deal with nursing theories and
sharing experience.

01/30/2023 Orlando 46
 REFERENCE
1. George B. Julia , Nursing Theories- The base for

professional Nursing Practice , 3rd ed. Norwalk, Appleton &

Lange.

2.Wills M.Evelyn, McEwen Melanie (2002). Theoretical Basis

for Nursing Philadelphia. Lippincott Williams& wilkins.

3. Meleis Ibrahim Afaf (1997) , Theoretical Nursing :

Development & Progress 3rd ed. Philadelphia, Lippincott.

01/30/2023 Orlando 47
Reference.…
4.Reed PG, The force of nursing theory guided-
practice. Nurs Sci Q. 2006 Jul;19(3):225.
5.Faust C. .Orlando's deliberative nursing process
theory: a practice application in an extended care
facility. J Gerontol Nurs. 2002 Jul;28(7):14
6. Taylor Carol,Lillis Carol (2001)The Art & Science
Of Nursing Care 4th ed. Philadelphia, Lippincott

01/30/2023 Orlando 48
 10Q!!!
01/30/2023 Orlando 49