Nursing Process Discipline

Ida Jean Orlando (Pelletier)

Ida jean Orlando
 A first-generation American of Italian descent
 Birth date : August 12, 1926
 Birthplace: New York
 Husband: Robert Pelletier
 (lived in Boston)
 Death date: November 28, 2007
 1947 - Diploma in Nursing, New York Medical
College
 1951 - B.S. in Public Health Nursing, St. John's
University, Brooklyn, New York
 1954 - M.A. in mental health consultation,
Columbia University, New York
 Nursing Career
•Staff nurse, varied specialties (OB, MS, ER)

•Supervisor in a General Hospital

•Research Associate & Principal Investigator of a Federal Project entitled “Integration

of Mental Health Concepts in a Basic Curriculum” at Yale University in New Haven,
Connecticut (1954-1961)

•Clinical Nursing Consultant in Mental Health, McLean Hospital in Belmont,

Massachusetts (1962-1972)

•Served on various committees at Harvard Community Health Plan in Boston,

Massachusetts since 1972

•Nurse Educator for Metropolitan State Hospital in Waltham, Massachusetts in 1981

•Assistant Director of Nursing for Education and Research at Metropolitan State

Hospital (September1987)
Retired in 1992
ATTAINMENTS & HONOR:
Books Published:
 1961 - “The Dynamic Nurse-Patient
Relationship: Function, Process and
Principles”
 1967 - “The Patients Predicament and
Nursing Function ” an issue of
Psychiatric Opinion
 1972 - “The Discipline and Teaching of
Nursing Process : An Evaluative Study”

 Conducted Training Programs at McLean Hospital

 Managed 60 workshops about her theory in USA and
Canada (1972-1981)
 Outstanding Nurse in the Hall of Fame of
Massachusetts Nurse’s Association in 2001
 Orlando’s Key Concept
She believes that nursing is unique and
independent because it concerns itself with an
individual’s need for help, real or potential, in
an immediate situation. The process by which
nursing revolves this helplessness in interactive
and is pursued in disciplined manner that
requires training. She believes one’s action
should be based on rationale not protocols.
 METAPARADIGM OF NURSING
PERSON
unique and developmental beings with needs, individuals have their own subjective
perceptions and feelings that may not be observable directly

HEALTH
is not well-defined but assumed as “freedom from mental or physical discomfort and
feelings of adequacy and well-being ”

NURSING
providing direct assistance to individuals in whatever setting for the purpose of
avoiding, relieving, diminishing, or curing the person’s sense of helplessness

ENVIRONMENT
is not clearly defined as well but assumed as 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
 Assumptions:

Assumptions about Nurses: Assumptions about Patients:

• “The nurse’s reaction to each patient is • “Patients’ needs for help are unique”
unique” • “Patients have an initial ability to
• “Nurses should not add to the patient’s communicate their needs for help”
distress” • “When patients cannot meet their own
• “The nurse’s mind is the major tool for needs they become distressed”
helping patients” • “The patient’s behaviour is meaningful”
• “The nurse’s use of automatic • “Patients are able and willing to
responses prevents the responsibility communicate verbally (and non- verbally
of nursing from being fulfilled” when unable to communicate verbally)”
• “Nurse’s practice is improved through
self-reflection”
 Assumptions about the nurse-
patient situation:
• “The nurse-patient situation is a
dynamic whole”
• “The phenomenon of the nurse-
patient encounter represents
major source of nursing
knowledge”
Assumptions about Nursing:
• “Nursing is a distinct profession
separate from other disciplines”
• “Professional nursing has a distinct
function and product (outcome)”
a • “There is a difference between lay
and professional nursing”
• “Nursing is aligned with medicine”
 Introduction to the Theory
"I can't move, I can't speak, I need help..."

Patient Behavior

Nurse Reaction

Nurse Action
 A) The nursing process is set in motion by the Patient Behavior
- All patient behavior:
a) verbal ( a patient’s use of language )
b) non-verbal ( includes physiological symptoms, motor activity, and nonverbal communication)
c) physical forms (vital signs)
- Must be considered an expression of a need for help and has to be validated .
- Ineffective assessment by the nurse leads nurse-patient relationship failure.
- Communication process is vital to acquire patient’s cooperation in achieving health.
Remember: When a patient’s need for help is not resolved even with the help of another, will result to sense
of helplessness.
B) The Patient Behavior stimulates a Nurse Reaction
- Nurse-patient relationship takes place.
- Correct evaluation of patient’s behavior by using the nurse reactions steps yields positive feedback
response from the patient.
The steps are as follows:
1) The nurse perceives behavior through any of the senses
2) The perception leads to automatic thought
3) The thought produces an automatic feeling
4) The nurse shares reactions with the patient to ascertain whether perceptions are accurate or inaccurate
5) The nurse consciously deliberates about personal reactions and patient input in order to produce
professional deliberative actions based on mindful assessment rather than automatic reactions.
 Remember : Exploration with the patient helps validate the patient’s behavior.
  
C) Critically considering one or two ways in implementing Nurse Action

Automatic Reaction (Non-Deliberative)

 stem from nursing behaviors that are performed to satisfy a directive other than the
patient’s need for help.
Example: The nurse who gives a sleeping pill to a patient every evening because it is ordered
by the physician, without first discussing the need for the medication with the patient.
Rationale : Giving of the pill has more to do with following medical orders (automatically) than
with the patient’s immediate expressed need for help.
Deliberative Reaction
 is a “disciplined professional response”, that all nursing actions are meant to help the client
and should be considered deliberative.
 The following criteria should be considered.
 Deliberative actions result from the correct identification of patient needs by validation of
the nurses’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 compelling it.
 The nurse is free of stimuli unrelated to the patient’s need (when action is taken).

Remember : For an action to have been truly deliberative, it must undergo reflective evaluation
to determine if the action helped the client by addressing the need as determined by the
nurse and the client in the immediate situation.
Orlando’s Nursing Process Discipline
 The role of the nurse is to find out and meet the patient's immediate need for help.
 The patient's presenting behavior may be a plea for help, however, the help needed may not be
what it appears to be.
 Therefore, nurses need to use their perception, thoughts about the perception, or the feeling
engendered from their thoughts to explore with patients the meaning of their behavior.
 This process helps nurse find out the nature of the distress and what help the patient needs.

MAJOR DIMENSIONS OF THE THEORY

Function of Professional Nursing - Organizing Principle

Presenting Behavior - Problematic Situation

Immediate Reaction - Internal Response

Nursing Process Discipline – Investigation

Improvement - Resolution
Major Dimensions of the Theory
FUNCTIONS OF PROFESSIONAL NURSING - ORGANIZING PRINCIPLE
• Finding out and meeting the patients immediate needs for help
• Nursing….is responsive to individuals who suffer or anticipate a sense of helplessness,
it is focused on the process of care in an immediate experience, it is concerned with
providing direct assistance to individuals in whatever setting they are found for the
purpose of avoiding, relieving, diminishing or curing the individuals sense of
helplessness
• The purpose of nursing is to supply the help a patient requires for his needs to be met
• Nursing thought - Does the patient have an immediate need for help or not?
• If the patient has an immediate need for help and the nurse finds out and meets that
need ,the function of professional nursing is achieved

PRESENTING BEHAVIOR – PROBLEMATIC SITUATION

• To find out the immediate need for help the nurse must first recognize the situation as
problematic
• The presenting behavior of the patient, regardless of the form in which it appears, may
represent a plea for help
• The presenting behavior of the patient, the stimulus, causes an automatic internal
response in the nurse, and the nurses behavior causes a response in the patient
IMMEDIATE REACTION –INTERNAL RESPONSE
• Person perceives with any one of his five sense organs an object or objects
• The perceptions stimulate automatic thought
• Each thought stimulates an automatic feeling
• Then the person acts
• The first three items taken together are defined as the person’s immediate reaction
• Reflects how the nurse experiences her or his participation in the nurse patient situation
NURSING PROCESS DISCIPLINE - INVESTIGATION
• Any observation shared and explored with the patient is immediately useful in ascertaining and meeting his
need or finding out that he is not in need at that time
• The nurse does not assume that any aspect of her reaction to the patient is correct, helpful or appropriate
until she checks the validity of it in exploration with the patient
• The nurse initiates a process of exploration to ascertain how the patient is affected by what she says or does
• Automatic reactions are not effective because the nurses action is decided upon for reasons other than the
meaning of the patients behavior or the patients immediate need for help
• When the nurse does not explore with the patient her reaction it seems reasonably certain that clear
communication between them stops
IMPROVEMENT - RESOLUTION
 It is not the nurses activity that is evaluated but rather its result : whether the activity serves to help the
patient communicate her or his need for help and how it is met
 In each contact the nurse repeats a process of learning how to help the individual patient.
 Her own individuality and that of the patient requires that she go through this each time she is called upon
to render service to those who need her
 Conceptual Framework
Distinguish the Theory Analyze the Theory
 Acceptance by the
Nursing
Community
RESEARCH
The diversity of the research
using the theory attests to its
breadth of application. It also
indicates its utility for
application of the findings in:
• Perioperative Nursing
•Studying Nurse-Patient
Relationships
•Advanced-Nursing Practice
and Administrations
•Responses to distressed
patients
•Mental Illnesses
•Positive Patient-Centered
Outcomes
ACCEPTANCE by the
ACCEPTANCE by the
Nursing Community:
Nursing Community
EDUCATION PRACTICE
Orlando’s nursing process
Orlando’s nursing process discipline reflects the elements of
theory was recommended the therapeutic relationships
for teaching BSN students which include expression of
and conceptualize BSN empathy, warmth, and
curriculums which has an genuineness that would increase
emphasis on the the therapeutic effectiveness of
interaction process and nursing having applied
its goal on communication throughout various nursing
and psychosocial departments: Operating Rooms,
foundations which may Mental Health Units,
translate into more Administrations and Public
effective exploratory Health departments
skills in the students. Use in Clinical Practice:
Nursing care plan, Case studies,
Progressive patient care settings
Nursing process: A-D-P-I-E
 Strengths
Use of her theory assures that
patient will be treated as
individuals and that they will
have active and constant
input into their own care .
Prevents inaccurate
diagnosis or ineffective
plans because the nurse has
to constantly explore her
reactions with the patient
Assertion of nursing’s
independence as a
profession and her belief
that this independence must
be based on a sound
theoretical frame work
Limitation
s
Highly interactive nature
Orlando's theory makes it
Nursing can pursue
Orlando's work for hard to include the highly
retesting and further technical and physical
developing her work care that nurses give in
certain settings
Make evaluation a less
time consuming and more Her theory struggles with
deliberate function, the the authority derived
results of which would be from the function of
documented in patients profession and that of the
charts employing institution’s
commitment to the public
Guides the nurse to
evaluate her care in terms
of objectively observable
patient outcomes
 Assessing a Patient by using Orlando’s Theory to guide the Nurse’s Process

The nurse’s focus is on the patient and free of distracting thoughts

1. Guiding Principle
Finding out and -The nurse recognizes cues that a patient problem may exist before
meeting the the next step in the process.
-The nurse identifies his or her immediate perception, thoughts,
patient’s
feelings (Immediate reaction)
immediate need
for help -The nurse uses terms the patient can understand and explores
immediate reactions with the patient to discover physical/nonphysical
problems. As the problem is identified, the nurse asks the patient to
2. Problematic confirm or refute its accuracy.
situation and -The nurse explores the disagreement to determine its basis
immediate
reaction(s) -With the patient, the nurse determines action(s) needed and develops
plans for each problem.
-The nurse explores whether the patient agrees with or refutes the
3. Inquiry-Problem plan. The nurse explores and resolves the basis of disagreement. The
Determination patient verbally or nonverbally agrees. If not, the nurse continues the
inquiry for the basis.

4. Identifying specific -If the patient is unable, the nurse implements the plan and asks the
plans for each patient whether the action is helpful. If it is not, the nurse explores
problem the basis .
-The nurse helps the patient if he or she is unable to do it alone and
explores whether the patient was helped. The nurse inquires about his
5. Implement or her results.

The nurse asks the patient whether the action helped and observes
the patient’s verbal and nonverbal behavior. If he or she has
improved, the need for help was mer. If not, the nurse continues to
6. Improvement use the content of immediate reaction to explore with the patient until
a positive change is evident.