NURSING THEORIST

Hildegard Peplau
Ida Jean Orlando
Virginia Henderson
Learning Objectives
1. Understand the nursing theory of Hildegard
Peplau, Ida Jean Orlando and Virginia
Henderson.
2. Explain the theoretical assertions
(metaparadigm) based on nursing,
personhood, health and environment.
3. Understand the application of the nursing
theory to the field of practice.
 Ida Jean Orlando – Nursing
Process Theory

❏ Nursing Process discipline is rooted in the interaction between a

nurse and a patient at a specific time and place
❏ The nurse then decides on an appropriate action to resolve the
need in cooperation with the patient.
❏ This action is evaluated after it is carried out.
➔ If the patient behavior improves, the action was successful and
the process is completed.
➔ If there is no change or the behavior gets worse, the process
recycles with new efforts
Major Dimensions of Orlando’s theory
Presenting Behavior - Problematic Situation
❏ Patient Behavior
This sets the nursing process discipline
in motion.
All patient behavior, no matter how
insignificant, must be considered an
expression of need for help until its
meaning to a particular patient in the
immediate situation is understood.
❏ Distress
The patient’s behavior reflects distress
when the patient experiences a need
that he cannot resolve, a sense of
helplessness occurs.
Some categories of patient distress are:
“physical limitations,... adverse reactions
to the setting and ... experiences which
prevent the patient from communicating
his needs”
 ❏ Nurse Reaction
The patient behavior stimulated a nurse
reaction, which marks the beginning of the
nursing process discipline.
This reaction is comprised of three sequential parts
(Orlando, 1972).
❖ First, the nurse perceives the behavior
through any of her senses.
❖ Second, the perception leads to
automatic thought.
❖ Finally, the thought produces an
automatic feeling.
Three criteria to ensure that the
nurse’s exploration of her reaction
with the patient is unsuccessful:
1. What the nurse says to the individual in the
contact must match any or all of the items
contained in the immediate reaction, and what
the nurse does nonverbally must be verbally
expressed and the expression must match one
or all of the items contained in the immediate
reaction.
2. The nurse must clearly communicate to
the individual that the item being
expressed belongs to herself.
3. The nurse must ask the individual about
the item expressed in order to obtain
correction or verification from that same
individu
 ❏ Nurse’s Action
Orlando (1990) includes “only what she [the
nurse] says or does with or for the benefit
of the patient” as professional nursing
action. “The nurse initiates a process of
exploration to ascertain how the patient is
affected by what she says or does.”
The nurse can act in two ways: automatic
or deliberative. Only the second manner
fulfills her professional function.
➔ Automatic actions are “those decided
upon for reasons other than the
patient’s immediate need,” whereas
➔ Deliberative actions ascertain and
meet this need.
Criteria for Deliberative Actions:
➢ Deliberative actions result from the
correct identification of patient
needs by validation of 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.
 Major Dimensions of Orlando’s theory
Orlando’s theory
Major Concepts

Human Being
➢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
➢not defined directly but implicitly in the immediate context for a patient
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.
Steps in 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 subjective and objective data about the patient.
Diagnosis
➢ the nurse’s clinical judgment about 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
➢ each of the problems identified in the diagnosis is given a specific goal or outcome, and each
goal or outcome is given nursing interventions to help achieve the goal. By the end of this
stage, the nurse will have a nursing care plan.
Implementation
➢ the nurse begins using the nursing care plan { Independent, Dependent, Collaborative}
Evaluation
➢ the nurse looks at the progress of the patient toward the goals set in the nursing care plan.
➢ E.g Met or Not Met
Assumptions of the Need Theory

➔ Nurses care for patients until they can care for themselves once again.
Although not precisely explained,
➔ Patients desire to return to health.
➔ Nurses are willing to serve, and “nurses will devote themselves to the
patient day and night.”
➔ Henderson also believes that the “mind and body are inseparable and are
interrelated.”