Ida Jean Orlondo

Nursing Process Theory- interaction between a patient and a nurse by which nursing
resolves this helplessness through interaction
The Dynamic Nurse–Patient Relationship
 “to identify the factors which enhanced or impeded the integration of mental
health principles in the basic nursing curriculum”
 This research resulted in the identification that a nurse’s statement of her
perception, thought, or feeling about the patient’s behavior differentiated between
effective and ineffective communication.
 The Discipline and Teaching of Nursing Process (1972), in which she was
concerned with the specific definition of nursing function and with incorporating
nursing activities beyond the nurse–patient relationship into a total nursing
system.

Nursing Process Discipline

 Jean Orlando Pelletier describes a nursing process based on the interaction
between a patient and a nurse. Her nursing process discipline was developed
through research and presented in two books. Her initial work,The Dynamic
Nurse–Patient Relationship: Function, Process and Principles, was originally
published in 1961 and reprinted in 1990.The Discipline and Teaching of Nursing
Process.

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 resolves this helplessness is interactive and is
pursued in a disciplined manner that requires training. She believes one’s actions
should be based on rationale, not protocols.
 She believes that the use of general principles from other fields is not sufficient
to help the nurse in her interaction with patients. She identifies nursing’s role as
follows: “It is the nurse’s direct responsibility to see to it that the patient’s needs
for help are met either by her own activity or by calling in the help of others”
 Orlando (1972) also suggests that nursing’s failure to establish its uniqueness is
a result of the lack of a clearly identifiable function, which leads to inadequate
care and insufficient attention to the patient’s reactions to his immediate
experiences.
 She identifies nursing’s function as being “concerned with providing direct
assistance to individuals in whatever setting they are found for the purpose of
avoiding, relieving, diminishing, or curing the individual’s sense of helplessness”
 Orlando’s theory focuses on the patient as an individual. Each person, in each
situation, is different. To be appropriate, nursing actions for two patients with the
same presenting behavior, or the same patient at different times, are to be
individualized.
 Nurses cannot automatically act only on the basis of principles, past experience,
or physicians’ orders. They must first ascertain that their actions will meet the
patient’s specific need for help.
 The immediacy of the nursing situation is a vital concept in Orlando’s theory.
Each patient’s behavior must be assessed to determine whether it expresses a
need for help.
 Orlando describes a nursing process discipline that is totally interactive. It
describes, step-by-step, what goes on between a nurse and a patient in a
specific encounter.
 A patient behavior causes the process discipline to begin. The process discipline
involves the nurse’s reaction to this behavior and the nurse’s consequent action.
The nurse shares her reaction with the patient to identify the need for help and
the appropriate action. The nurse also verifies that the action met the need for
help.
 Orlando’s principles are meant to guide the nurse at various stages of the
interaction. She emphasizes the importance of interaction when she writes,
“Learning how to understand what is happening between herself and the patient
is the central core of the nurse’s practice and comprises the basic framework for
the help she gives to patients”

ORLANDO’S NURSING PROCESS DISCIPLINE

 “Process by which any individual acts” to meet the patient’s immediate need for
help. The purpose here is to understand how the professional and job
responsibilities of each affect the other.

1. Patient Behavior
 All patient behavior, no matter how seemingly insignificant, must be considered
an expression of need for help until its meaning to a particular patient in the
immediate situation is understood.
 When the patient experiences a need that he cannot resolve, a sense of
helplessness occurs.
 Patient behavior may be verbal or nonverbal. Verbal behavior encompasses all
the patient’s use of language. It may take the form of “complaints, requests,
questions, refusals, demands, and comments or statements”. Nonverbal
behavior includes physiological manifestations such as heart rate, perspiration,
edema, and urination and motor activity such as smiling, walking, and avoiding
eye contact. Nonverbal patient behavior may also be vocal, including such
actions as sobbing, laughing, shouting, and sighing.
 When the behavior does not communicate the need, problems in the nurse–
patient relationship can arise.
 The nurse’s reaction and action are designed to resolve ineffective patient
behaviors as well as to meet the immediate
need.

2. Nurse Reaction
 The patient behavior stimulates a nurse reaction, which marks the beginning of
the nursing process discipline. three sequential parts: First, the nurse perceives
the behavior through any of her senses. Second, the perception leads to
automatic thought. Finally, the thought produces an automatic feeling leads to
automatic thought. Finally, the thought produces an automatic feeling.
 Perception (sees the grimace), thought (thinks he is in pain), and feeling (feels
concern) occur automatically and almost simultaneously.
 the process becomes logical rather than intuitive and thus disciplined rather than
automatic. The nurse is able to use her reaction for the purpose of helping the
patient.

three criteria to ensure that the nurse’s exploration of her reaction with the
patient is successful:
1. What the nurse says to the individual in the contact must match (be consistent
with) any or all of the items contained in the immediate reaction, and what the
nurse does nonverbally must be verbally expressed and the expression must
match one or all of the items contained in the immediate reaction;
2. The nurse must clearly communicate to the individual that the item being
expressed belongs to herself;
3. The nurse must ask the individual about the
item expressed in order to obtain correction or verification from that same
individual.
The sharing of the nurse’s immediate reaction creates a climate in which the
patient is more able to share his own reaction.

3. Nurse Action
 Once the nurse has validated or corrected her reaction to the patient’s behavior
through exploration with him, she can complete the nursing process discipline
with the nurse’s action.
 The nurse must be certain that her action is appropriate to meet the patient’s
need for help.
 The nurse can act in two ways: automatic or deliberative. Only the second
manner fulfills her professional function. Automatic actions are “those decided
upon for reasons other than the patient’s immediate need,” whereas deliberative
actions ascertain and meet this need
 For example, a nurse administers a sleeping pill because the physician orders it.
Carrying out the physician’s order is the purpose of the action. However, the
nurse has not determined that the patient is having trouble sleeping or that a pill
is the most appropriate way to help him sleep. Thus, the action is automatic, not
deliberative, and the patient’s need for help is unlikely to be met.

The following list identifies the criteria for deliberative actions:

1. Deliberative actions result from the correct identification of patient needs by
validation of the nurse’s reaction to patient behavior.
2. The nurse explores the meaning of the action with the patient and its
relevance to meeting his need.
3. The nurse validates the action’s effectiveness immediately after completing it.
4. The nurse is free of stimuli unrelated to the patient’s need when she acts.
Automatic actions are most likely to be done by nurses concerned primarily with
carrying out physicians’ orders, routines of patient care, or general principles for
protecting health or by nurses who do not validate their reactions to patient
behaviors. Although any nursing action may be purported to have occurred with
the intention of helping the patient, deliberation
is needed to determine if the action achieved its purpose and to identify if the
patient was helped.

4. Professional Function
 conflicts will arise between the actions appropriate to the nurse’s profession and
those required by the job.
 Nonprofessional actions can prevent the nurse from carrying out her professional
function, and this can lead to inadequate patient care.
 Ideally, nurses should not accept positions that do not allow them to meet their
patients’ needs for help.
 If a conflict does arise, the nurse must present data to show that nursing
is unable to fulfill its professional function.
 Nurses must be constantly aware that their “activity is professional only when it
deliberately achieves the purpose of helping the patient”
 In many health care institutions, the potential demand for nursing skill and
judgment exceeds the availability of such qualities. As a result, nursing care
delivery systems may be evaluated and revised to enable the nurse to practice in
those situations or areas where she is most needed.
 These include nursing assessment at the time of admission
(Identify the need for help), planning and delivery of patient education based on
patient needs (deliberative action to meet the need), and preparation for
discharge (verifying that the need has been met).
 Nurses in acute care facilities are expected to use their professional skills and
knowledge to recognize and resolve the patient’s need for help.
 Orlando’s nursing theory stresses the reciprocal relationship between patient and
nurse. What the nurse and the patient say and do affects them both According to
Orlando (1961), persons become patients who require nursing care when they
have needs for help that cannot be met independently because they have
physical
limitations, have negative reactions to an environment, or have an experience
that prevents them from communicating their needs. Patients experience distress
or feelings of helplessness as the result of unmet needs for help
(Orlando, 1961).
 when individuals are able to meet their own needs, they do
not feel distress and do not require care from a professional
nurse.
 This article presents a study that used Orlando-Pelletier’s Nursing Process
theory to explore how nurse administrators respond to problematic situations.
Findings indicated that participants’ first thoughts when a problem arose were
seldom about staff response but rather focused on solving the problem alone or
telling a staff member what to do to solve the problem.

Orlando’s theory, although simple in nature, provides direction and focus for
identifying, understanding, and meeting the patient’s need in a potentially cost-
effective manner. If the needs identified by the patient are met, then less nursing
time should be involved than if the nurse uses primarily automatic actions and
must provide additional care when the need has not been met. Thus, the nursing
process discipline is set in motion by a patient behavior that may indicate a need
for help. The nurse reacts to this behavior with perceptions, thoughts, and
feelings. She shares an aspect of her reaction with the patient, making sure that
her verbal and nonverbal actions are consistent with her reaction, that she
identifies the reaction as her own, and that she invites the patient to comment on
the validity of her reaction. A properly shared reaction by the nurse helps the
patient to use the same process to more effectively communicate his need. Next,
an appropriate action to resolve the need is mutually decided on by the patient
and nurse. After the nurse acts, she immediately asks the patient if the action
has been effective. Throughout the interaction, the nurse makes sure that she is
free of any extraneous stimuli that interfere with her reaction to the patient.

In each of these situations, the use of Orlando’s theory would guide the nurse in
expeditiously meeting the patient’s need.
The nursing process is a systematic, rational method of planning and providing
individualized nursing care. Its purpose is to identify a client’s health status and
actual or potential health care problems or needs, to establish plans to meet the
identified needs, and to deliver specific nursing interventions to meet those
needs. The client may be an individual, a family, a community, or a group.