Nursing Process Theory

Ida Jean Orlando

Background:

 Born in August 12, 1926

 Nursing diploma – New York Medical College
 BS in Public Health Nursing at St. John’s University, New York
 MA in Mental Health Nursing at Columbia University, New York
 Associate Professor at Yale School of Nursing and Director of the Graduate Program
in Mental Health Psychiatric Nursing
 Project investigator of a National Institute of Mental Health grant entitled:
Integration of Mental Health Concepts in a Basic Nursing Curriculum
 1961 – Published her book, The Dynamic Nurse-Patient Relationship
 1972 – Revised her book into The Discipline and Teaching of Nursing Processes
 A board member of Harvard Community Health Plan
Nursing Process Theory
 Allows nurses to formulate an effective nursing care plan that can also be easily
adapted when and if any complexity comes up with the patient
 Stresses the reciprocal relationship between patient and nurse
 It emphasizes the critical importance of the patient’s participation on 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

Major Dimensions
 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.

Goals

 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.
 All patient behavior can be a cry for help.
 The nurse’s job is to find out the nature of the patient’s distress and provide the
help he or she needs.
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.

Terms
 Distress - the experience of a patient whose need has not been met.
 Nursing role - to discover and meet the patient’s immediate need for help.
- Patient’s behavior may not represent the true need.
- The nurse validates his/her understanding of the need with the patient.
 Nursing actions - directly or indirectly provide for the patient’s immediate need.
 An outcome - a change in the behavior of the patient indicating either a relief from
distress or
an unmet need.
- Observable verbally and nonverbally.

Metaparadigm

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.

Concepts

1. Function of professional nursing - organizing principle

2. Presenting behavior - problematic situation
3. Immediate reaction - internal response
4. Nursing process discipline – investigation
5. Improvement - resolution

1. Function 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." - Orlando

2. 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
3. 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

4. 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.
 When the nurse does not explore with the patient her reaction it seems reasonably
certain that clear communication between them stops
5. 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.
Nursing Process

1. 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.

2. 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.

3. 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.

4. Implementation

- In the implementation stage, the nurse begins using the nursing care plan.

5. Evaluation

- 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.

Conclusion

 Focuses on the interaction between the nurse and the patient, perception
validation, and the use of the nursing process to produce positive outcomes or
patient improvement. Orlando’s key focus was to define the function of nursing.
 Orlando’s theory remains one of the most effective practice theories available.
 The use of her theory keeps the nurse’s focus on the patient.
 The strength of the theory is that it is clear, concise, and easy to use.
 While providing the overall framework for nursing, the use of her theory does not
exclude nurses from using other theories while caring for the patient.