Reflection
Nursing Process Theory: Ida Jean Orlando (Pelletier)
Chapter 16
Overview of Orlando’s Nursing Process Theory
Stresses reciprocal relationship between patient and nurse; what the nurse and patient say and do during their interaction affects both of them
Imperative that nurses share their perceptions with patients to determine if their perception is congruent with the patient’s perception of need
Focuses on producing improvement in the patient’s behavior
Major Concepts of Nursing According to Orlando
Person: defines person in terms of patient or person with unmet needs
Environment: assumes that a nursing situation occurs when there is a nurse-patient contact
Health: assumes feelings of adequacy and well-being from fulfilled needs contribute to health
Nursing: profession functions autonomously; function to meet patient’s need for help
Assumptions of Orlando’s Nursing Process Theory About Nursing
Nursing is a distinct profession, separate from other disciplines
Professional nursing has a distinct function and product (outcome)
There is a difference between lay and professional nursing
Nursing is aligned with medicine
Assumptions of Orlando’s Nursing Process Theory About Patients
Each patient’s needs for help are unique
Patients have an initial ability to communicate their needs for help
When patients cannot meet their own needs they become distressed
The patient’s behavior is meaningful
Patients are able and willing to communicate verbally
Assumptions of Orlando’s Nursing Process Theory About Nurses
Nurse’s reaction to each patient is unique
Nurses should not add to the patient’s distress
Nurse’s mind is the major tool for helping patients
Nurse’s use of automatic responses prevents the responsibility of nursing from being fulfilled
Nurse’s practice is improved through self-reflection
Assumptions of Orlando’s Nursing Process Theory About Nurse-Patient Situation
The nurse–patient situation is a dynamic whole
The phenomenon of the nurse–patient encounter represents a major source of nursing knowledge
Propositions of Orlando’s Nursing Process Theory
There is a relationship between the patient’s presenting behavior and the presence of patient distress
There is a relationship between nurse’s use of Orlando’s distinct nursing function and the nurse’s ability to recognize the need for inquiry (deliberative nursing process) into the meaning of the patient’s presenting behavior
Propositions of Orlando’s Nursing Process Theory
The more competent the nurse is in labeling his or her perceptions, thoughts, and feelings, the more apt the nurse is to find out the nature of the patient’s distress
If the nurse explores his or her immediate reaction with the patient, the patient’s distress is lessened
Propositions of Orlando’s Nursing Process Theory
The nurse’s use of the deliberative nursing process will be less costly than the nurse’s use of automatic personal responses
Patients’ experiencing repeated improvement as result of deliberative nursing will have positive cumulative effects
Brief Critique of Orlando’s Nursing Process Theory
Developed inductively
Logical and applicable to nursing practice
Considered simple because it includes few concepts and relationships
Internally consistent and meets the criteria for testability for a middle-range theory
Effective practice theory that is especially helpful to new nurses as they begin practice
Orlando’s Theory as Framework for Nursing Practice: Five Interrelated Concepts
The organizing principle or professional nursing function
The problematic situation or the patient’s presenting behavior
The internal response or immediate reaction
Reflective inquiry or deliberative nursing process
Resolution or improvement
Orlando’s Theory as Framework for Nursing Practice
Assessment: nurse helps person express specific meaning of behaviors in effort to determine source of distress; next, the nurse should explore the distress to assess the help required. The process used to share and validate the nurse’s direct and indirect observations is known as the deliberative nursing process.
Planning: participation from nurse and patient
Orlando’s Theory as Framework for Nursing Practice
Implementation:
Direct help occurs when the patient is unable to meet need and the activity is confined to the nurse–patient
Indirect help occurs when activity to meet patient’s need extends to arranging services
Evaluation: focus not on nurse’s activity; rather, if nurse’s action helped patient communicate need for health and if need was met
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