BIOGRAPHY OF IDA JEAN

ORLANDO
Ida Jean Orlando-Pelletier (August
12, 1926 – November 28, 2007) was
an internationally known psychiatric
health nurse, theorist, and researcher
who developed the “Deliberative
Nursing Process Theory.” Her theory
allows nurses to create an effective
nursing care plan that can also be
easily adapted when and if any
complications arise with the patient.
 IDA JEAN ORLANDO’s
CONTRIBUTION TO NURSING
THEORY DELIBERATIVE
NURSING PROCESS
Ida Jean Orlando developed her theory from a study
conducted at the Yale University School of Nursing,
integrating mental health concepts into a basic nursing
curriculum. She proposed that “ patients have their own
meanings and interpretations of situations and therefore
nurses must validate their inferences and analyses with
patients before concluding.”
The Deliberative Nursing Process has five stages:
assessment, diagnosis, planning, implementation, and
evaluation. Nurses use the standard nursing process in
Orlando’s Nursing Process Discipline Theory to produce
positive outcomes or patient improvement. Orlando ’ s key
focus was the definition of the function of nursing. The
model provides a framework for nursing, but her theory
does not exclude nurses from using other nursing theories
while caring for patients.
 STAGES OF DELIBERATIVE NURSING
PROCESS
Assessment stage
In the assessment stage, 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 stage
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 risk factors found in the patient ’ s assessment.
The planning stage addresses each of the problems
identified in the diagnosis. Each problem 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.
 Plannning stage
The planning stage addresses each of the problems
identified in the diagnosis. Each problem 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 stage
In the implementation stage, the nurse begins using the
nursing care plan. Finally, in the evaluation stage, the
nurse looks at the progress of the patient toward the goals
set in the nursing care plan. Changes can be made to the
nursing care plan based on how well (or poorly) the
patient is progressing toward the goals. If any new
problems are identified in the evaluation stage, they can
be addressed, and the process starts over again for those
specific problems.
 Evaluation stage
Finally, in the evaluation stage, the
nurse looks at the patient’s progress
toward the goals set in the nursing care
plan. Changes can be made to the
nursing care plan based on how well (or
poorly) the patient is progressing
toward the goals. If any new problems
are identified in the evaluation stage,
they can be addressed, and the process
starts over again for those specific
problems.
Analysis
Compared to other nursing theories, which
are task-oriented, Orlando gave a clear-cut
approach to patient-oriented nursing theory.
It uplifts the integrity of individualized
nursing care. This strengthens the role of the
nurse as an independent nurse advocate for
the patient. The nurse-patient interaction’s
dynamic concept was justified since the
patient’s participation in the relationship was
sought. The whole process is in constant
revision through continuous validation of the
nurse’s findings with that of the patient.
Because the nurse has to explore her
reactions with the patient constantly, it
prevents inaccurate diagnosis or ineffective
plans. Since the model is applied to an
immediate situation, its applicability to a
long-term care plan is not feasible.
The concept of interaction also limits
it to individuals capable of
conversing, a shared limitation with
other nurse-client dynamic theories –
this theory does not cover
unconscious patients

Strengths
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 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.The
Deliberative Nursing Process helps nurses
achieve more successful patient outcomes
such as fall reduction. Orlando’s theory
remains a most effective practice theory
that is especially helpful to new nurses as
they begin their practice.
Conclusion
Orlando’s nursing theory stresses the reciprocal
relationship between patient and nurse. What the
nurse and the patient say and do affects them both.
Orlando views nursing’s professional function as
finding out and meeting the patient’s immediate
need for help. She was one of the first nursing
leaders to identify and emphasize the nursing
process elements and the critical importance of the
patient’s participation in the nursing process.
Orlando’s theory focuses on how to produce
improvement in the patient’s behavior. Evidence
of relieving the patient’s distress is seen as
positive changes in the patient’s observable
behavior. Orlando may have facilitated the
development of nurses as logical thinkers
 MAJOR CONCEPTS
The nursing metaparadigm consists of four concepts:
person, environment, health, and nursing. Of the four
concepts, Ida Jean Orlando only included three in her
theory of Nursing Process Discipline: person, health, and
nursing.

• Human Being
Orlando uses the concept of human as she emphasizes
individuality and the dynamic nature of the nurse-patient
relationship. For her, humans in need are the focus of
nursing practice.
• Health
In Orlando’s theory, 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
• 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.
 ASSUMPTIONS
Ida Jean Orlando’s model of nursing makes the following
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.he 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
 NURSING PROCESS DISCIPLINE
The nursing process discipline is the
investigation into the patient’s needs. Any
observation shared and explored with the patient
is immediately useful in ascertaining and meeting
his or her need or finding out they have no needs
at that time. The nurse cannot assume that any
aspect of his or her reaction to the patient is
correct, helpful, or appropriate until he or she
checks its validity by exploring it with the
patient. The nurse initiates this exploration to
determine how the patient is affected by what
they say and do. Automatic reactions are
ineffective because the nurse’s action is
determined for reasons other than the meaning of
the patient’s behavior or the patient’s immediate
need for help. When the nurse doesn’t explore
the patient’s reaction with him or her, it is
reasonably certain that effective communication
between nurse and patient stops.
The nurse decides on appropriate action to resolve the
need in cooperation with the patient. This action is
evaluated after it is carried out. If the patient’s
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 to clarify the patient’s behavior or the
appropriate nursing action.

The action process in a person-to-person contact

functioning in secret. The perceptions, thoughts, and
feelings of each individual are not directly available
to the other individual’s perception through the
observable action.
 GOAL OF IDA ORLANDO’S NURSING
THEORY
Ida Jean Orlando’s goal is to develop a theory of
effective nursing practice. The theory explains that
the nurse’s role is to find out and meet the patient’s
immediate needs for help. According to the theory,
all patient behavior can be a cry for help. Through
these, the nurse’s job is to determine the nature of
the patient’s distress and provide the help he or she
needs.
Nursing care has to be flexible. Not only does a
nursing care plan depend on the needs of the patient
at the time of admittance, but it also needs to be able
to change when and if any complications come up
during the treatment and recovery process. Ida Jean
Orlando’s Deliberative Nursing Process directly
addresses this need for flexibility, and helps nurses
focus on the patient rather than simply sticking to a
nursing care plan no matter what.