Ida Jean Orlando’s Deliberative Nursing Process Theory
Kurt Cyryll Cubelo, Marianne Casama, Jolina
Parin, Zariah Constante
One important thing that nurses do is converse
with the patients and let them know what the
plan of care for the day is going to be. However,
regardless of how well thought out a nursing
care plan is for a patient, unexpected problems
to the patient’s recovery may arise at any time.
With these, the job of the nurse is to know how
to deal with those problems so the patient can
continue to get back and reclaim his or her
well-being. Ida Jean Orlando developed
her Deliberative Nursing Process that
allows nurses to formulate an effective nursing
care plan that can also be easily adapted when
and if any complexity come up with the patient.
Orlando’s theory stresses the reciprocal
relationship between patient and nurse. It
emphasizes the critical importance of the
patient’s participation in the nursing process.
Orlando also considered nursing as a distinct
profession and separated it from medicine
where nurses as determining nursing action
rather than being prompted by physician’s
orders, organizational needs and past personal
experiences. She believed that the physician’s
orders are for patients and not for nurses.
She proposed that “patients have their own
meanings and interpretations of situations
and therefore nurses must validate their
inferences and analyses with patients before
drawing conclusions.”
Goal
Orlando’s goal is to develop a theory of
effective nursing practice. The theory explains
that the role of the nurse 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 find out the nature of the
patient’s distress and provide the help he or
she needs.
Assumptions
Orlando’s model of nursing makes the
following assumptions:
1. When patients are unable to 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, environment, and health.
6. Patients need help communicating
their needs; they are uncomfortable
and ambivalent about their
dependency needs.
7. People are able to 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. The patient is unable to state the
nature and meaning of his or her
distress without the help of the nurse,
or without 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.
Major Concepts
 Ida Jean Orlando’s Deliberative Nursing Process Theory
The nursing metaparadigm consists of four
concepts: person, environment, health, and
nursing. Of the four concepts, 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 are in need of help.
Environment
Orlando completely disregarded environment
in her theory, only focusing on the immediate
need of the patient, 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
environment could have on the patient was
never mentioned in Orlando’s theory.
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.
Subconcepts
Orlando described her model as revolving
around the following five major interrelated
concepts: function of professional nursing,
presenting behavior, immediate reaction,
nursing process discipline, and improvement.
Function of Professional Nursing
The function of professional nursing is the
organizing principle. This means finding out
and meeting the patient’s immediate needs for
help. According to Orlando, nursing is
responsive to individuals who suffer, or who
anticipate a sense of helplessness. It is focused
on the process of care in an immediate
experience, and is concerned with providing
direct assistance to a patient in whatever
setting they are found in for the purpose of
avoiding, relieving, diminishing, or curing the
sense of helplessness in the patient. The
Nursing Process Discipline Theory labels the
purpose of nursing to supply the help a patient
needs for his or her needs to be met. That is, if
the patient has an immediate need for help,
and the nurse discovers and meets that need,
the purpose of nursing has been achieved.
Presenting Behavior
Presenting behavior is the patient’s
problematic situation. Through the presenting
behavior, the nurse finds the patient’s
immediate need for help. To do this, the nurse
must first recognize the situation as
problematic. Regardless of how the presenting
behavior appears, it may represent a cry for
help from the patient. The presenting behavior
of the patient, which is considered the
stimulus, causes an automatic internal
response in the nurse, which in turn causes a
response in the patient.
Distress
The patient’s behavior reflects distress when
the patient experiences a need that he cannot
resolve, a sense of helplessness occurs.
Immediate Reaction
The immediate reaction is the internal
response. The patient perceives objects with his
or her five senses. These perceptions stimulate
automatic thought, and each thought
stimulates an automatic feeling, causing the
patient to act. These three items are the
patient’s immediate response. The immediate
response reflects how the nurse experiences his
or her participation in the nurse-patient
relationship.
 Ida Jean Orlando’s Deliberative Nursing Process Theory

reasons other than the meaning of the patient’s

Nurse Reaction
The patient behavior stimulated a nurse
reaction, which marks the beginning of the
nursing process discipline.
Nurse’s Action
When the nurse acts, an action process
transpires. This 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.
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 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

Deliberative Nursing Actions are actions

decided upon after ascertaining a need and
then meeting this need
The following list identifies the criteria for
deliberative actions:

 Deliberative actions result from the

correct identification of patient needs
by validation of the nurse’s reaction
behavior gets worse, the process recycles with
to patient behavior.
new efforts to clarify the patient’s behavior or
 The nurse explores the meaning of
the appropriate nursing action.
the action with the patient and its
relevance to meeting his need.
The action process in a person-to-person
 The nurse validates the action’s
contact functioning in secret. The perceptions,
effectiveness immediately after
thoughts, and feelings of each individual are
completing it.
not directly available to the perception of the
 The nurse is free of stimuli unrelated
other individual through the observable action.
to the patient’s need when she acts.
The action process in a person-to-person
Nursing Process Discipline contact functioning by open disclosure. The
The nursing process discipline is the perceptions, thoughts, and feelings of each
investigation into the patient’s needs. Any individual are directly available to the
observation shared and explored with the perception of the other individual through the
patient is immediately useful in ascertaining observable action.
and meeting his or her need, or finding out he
or she has no needs at that time. The nurse
Improvement
cannot assume that any aspect of his or her
Improvement is the resolution to the patient’s
reaction to the patient is correct, helpful, or
situation. In the resolution, the nurse’s actions
appropriate until he or she checks the validity
are not evaluated. Instead, the result of his or
of it by exploring it with the patient. The nurse
her actions are evaluated to determine whether
initiates this exploration to determine how the
his or her actions served to help the patient
patient is affected by what he or she says and
communicate his or her need for help and how
does. Automatic reactions are ineffective
it was met. In each contact, the nurse repeats a
because the nurse’s action is determined for
 Ida Jean Orlando’s Deliberative Nursing Process Theory
process of learning how he or she can help the
patient. The nurse’s own individuality, as well
as that of the patient, requires going through
this each time the nurse is called upon to
render service to those who need him or her.
5 Stages of the Deliberative Nursing
Process
The Deliberative Nursing Process has five
stages: assessment, diagnosis, planning,
implementation, and evaluation.
Assessment
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
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.
Planning
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
In the implementation stage, the nurse begins
using the nursing care plan.
Evaluation
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.
Strengths
The guarantee that patients will be treated as
individuals is very much applied in Orlando’s
theory of Deliberative Nursing Process. Each
patient will have an active and constant input
into their own care.
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 the operational definitions of
society or environment was evident which
limits the development of research hypothesis.
Orlando’s work focuses on short term care,
particularly aware and conscious individuals
and on the virtual absence of reference group
or family members.
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 the
professional function of nursing 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 elements of nursing
process 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.
 Ida Jean Orlando’s Deliberative Nursing Process Theory

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.

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.