IDA JEAN ORLANDO (August 12,1926 – November 28, 2007)

Deliberate Nursing Process Theory

 Intentionally known psychiatric health nurse, theorist and researcher
 Born 1926
 Nursing diploma from New York Medical College at the Lower Fifth Avenue Hospital School of
Nursing
 Bachelor of Science in Public Health from St. John’s University in Brookly
 Master of Arts Degree in Mental Health Nursing from Teachers College, Columbia University
 Associate Professor at Yale School of Nursing; served as the Director of the Graduate
Program in Mental Health Psychiatric Nursing.
 Project investigator of National Institute of Mental Health grant in Yale. The research from this
grant led to Orlando’s development of the Deliberative Nursing Process published in the
Dynamic Nurse-Patient Relationship: Function, Process, and Principles in 1961
 1981- became an educator at Boston University School of Nursing and Held administrative
position from 1984 to 1987 at Metropolitan State Hospital in Waltham, Masachussets
 987 – became the assistant director of nursing for Education and Research at the said
institution
 Also a project consultant for the Mental Health Project for Associate Degree Faculties created
by the New England Board of Higher Education
 1992 – retired and received the Nursing Living Legend award by the Masachussets Registered
Nurse Association

Nursing Defined
Nursing is unique & independent because it concerns itself with individual’s need for help, real or
potential in an immediate situation, the process by which nursing resolve this helplessness is
interactive and is persuaded in discipline manner that requires training.
Key Concept
 Nursing is unique & independent concerned on individuals need for help, real or potential
 It is interactive and in disciplined manner that requires training
 Patient is the focus of nursing. Who is unique, who suffer & anticipate a sense of helplessness
 Immediacy of nursing situation
 Nursing action is INTERACTIVE & DISCIPLINED requiring training
Patient Behavior
Types of Distress:
1. Physical Limitation
2. Adverse Reaction
3. Inability to communicate effectively

Verbal and Nonverbal

Patient Behavior  Nurse Reaction  Nurses action
3 sequential parts
- Perceived/ perception
- Thoughts
- Automatic feelings
3 criteria for nuse successful exploration
1. What nurse say matches all the itetms
contained in the immediate reaction
o Should be verbally expressed
2. Nurse communicate that the item
being communicated is herself
3. Nurse asks the individual
o Nurse should verify (clarification
and validation)
capitalize on clarification and verification
Nurse Action
 Automatic action
 Deliberate action
o Actions decided upon after ascertaining a need and then meeting this need

Deliberate Action
 Correct identification of patients needs by validation of nurses reaction to patients behavior
 The nurse explores the meaning of action with the patient and its relevance in meeting his
needs
 The nurse validates the action’s effectiveness imemdiately after completing it
 The nurse is free of stimuli unrelated to the patients need when she acts
Nursing Process
Patients behavior  ASSESSMENT
Nurses Reaction  DIAGNOSING PLANNING
Nurses Action  IMPLEMENTATION EVALUATION

4 METAPARADIGM
PERSON
Unique and dynamic but with need
HEALTH
Implied, related to concept of the need for help or state of helplessness
ENVIRONMENT/SOCIETY
 Neglected concept
  Places patient lived
 Individual between individual
 Nothing mentioned about family and groups
NURSING
 Unique & independent and its concen in for an individual’s need for helpin immediate situation
Strength
Limitation
High Five
ERNESTINE WIEDENBACH (August 18, 1900- march 8, 1998)
(the Helping Art of Clinical Nursing)
 Born in Hamburg, Germany
 Education
o BA from Wellesley College in 1922
o RN from John Hopkins chool of Nursing 1925
o MA from Teachers College, Columbia University in 1934
o Certifivate in nure-midwifery from the Maternity Center
o Association School for Nurse-Midwives in New York in 1946

Prescriptive Theory
1. Central Purpose in Nursing
o Nurse Philosophy, reason for being, her mission
- Reverence ofnnthe “gift of life”
- Repect fot Dignity, Worth, Autonomy, Individuality of
each Human Being
- Resolution to Act dynamically in relation to Ones belief
2. Prescriptions
o Plan of action for the fulfillment of the central
purpose
- Mutually undderstood and agreed
- Recipient directed
- Practitioner directed
3. Realities
o All factors that are at play inn situation in nursing action
1. Agent – character of the nursse
2. Recipient – characteristics of the patient
3. Goal – desired outcome that the nurse wished to achieve
4. Means – nursing actions/activities
5. Framework – all extraneous factors & facilities in the situation that affect the ability to
obtain the desired results
WIEDENBACK CONCEPTUALIZATION OF NURSING PRACTICE AND PROCESS
3 COMPONENTS OF NURSING PRACTICE
1. Identification of Patient’s need for help
o Nurse observe for inconsistencies
o Clarify the meaning inconsistencies
o Cause of inconsistencies
o Validate with the patient that help is needed
2. Ministration of the Help Needed
o Doing and plan of action
3. Validation of the Action
 o Is it helpful to the patient

3 Principles of Helping
1. Principle of Inconsistency/Consistency
2. Principle of Purposeful Perseverance
a. Desire to hep
3. Principle of Self-Extenstion
a. To ask help of others when with
limitation

7 levels of awareness
 Involuntary response (Involuntary action)
1. Sensation
2. Perception
3. Assumption

 Deliberate Response (Voluntary Action)

4. Realization
5. Insight
6. Design
7. Decision
Metaparadigm
- Person/Human
o Unique potential; strives towards self-direction & needs stimulation
o Patient requires self-awareness & self-acceptance
- Health
o Not defined but support the WHO
- Environment
o Realities specifically framework
- Nursing
o Clinical discipline
o Goal-directed ability
o Helping process that will restore the patients ability to cope with demands in the
situation

STRENGTH
- Describe the nurse as a helping art
- Altruistic nature of nursing
- Nurses Philosophy epitomized
LIMITATION
- The need for help needs to be verified--- limited for coherent & responsive of nurses
- Very brod concept that may vary
 High Five
Clarity
- Structural
- Semantic
Generality
Simplicity
Derivable Consequences
Empirical Precision