Bahirdar University: College of Medicine and Health Sciences School of Nursing

BAHIRDAR UNIVERSITY
COLLEGE OF MEDICINE AND HEALTH SCIENCES

SCHOOL OF NURSING
Ida Jean Orlando’s Nursing Process Theory
Prepared by:1. Tigist G/maryam (BscN)

2. Tiruye Menshaw (BscN)
Adviser: Gebre Yitayih
10/1/2019 Tigest & Tiruye 1

Group Member
Name ID. No
• Tigist , G/ Maryam BDU 1112960

• Tiruye , Menshaw BDU 1112 961

Presentation Out line
❖ Introduction
❖ Assumptions
❖ Meta-paradigm
❖ Concepts and Propositions
❖ Applicability
❖ Strength and Weakness
❖ Summary
❖ Case scenario
Objectives
At the end of the presentation the participants will be

able to :-
❖ Describe life story of Orlando
❖ Describe major assumptions of I.J. Orlando.
❖ Explain basic concepts of Orlando theory

❖ Describe the Meta-paradigm of the Theory
❖ Discuss the application of Orlando theory in nursing

Introduction
Background of the
theorist
Ida Jean Orlando was
born on August 12,
1926- in New York
Idea Jean
Orlando(1926-2007)

Educational background
▪ 1947 - Diploma in Nursing, New York
Medical College, Flower Fifth Avenue Hospital
School of Nursing .
▪ 1951 - B.S.C in Public Health Nursing, St.

John's University, Brooklyn, New York.
▪ 1954 - M.A. in mental health consultation,
Columbia University, New York.

Cont.….
Nursing Career
• Staff nurse, varied specialties (Obstetrics, Medical
Surgical and Emergency Room)
• 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”(1954-1961)
• Clinical Nursing Consultant in Mental Health,
McLean Hospital in Belmont, Massachusetts
(1962-1972)

Cont.…
• 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
(September 1987)
• Retired in1992
• Died in October 28, 2007
Cont.…
Attainment and 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”

Cont.…
• Conducted Training Programs at Boston
Hospital
• Managed 60 workshops about her theory in
USA and Canada (1972-1981)

Awards Cont.…
• She was awarded a federal grant and became a
research associate & the principal project
investigator of a National Institute of Mental health,
the grant entitled “Integration of Mental Health
Concepts in a Basic Curriculum.”
• In 1992, retired and received the Nursing Living
Legend award by the Massachusetts Registered
Nurse Association.
• Outstanding Nurse in the Hall of Fame of
Massachusetts Nurse’s Association in 2001
Initiation to develop the theory
❖ Orlando’s model was developed
after being dissatisﬁed with the
views that nurses were motivated
to act as a result of orders from
physicians, institutional policies, and
other reasons, none of which related
to nursing action based on meeting
10/1/2019
patients’ needs.
Tigest & Tiruye 13
Origin of theory
• Orlando developed her theory from a study
conducted at the Yale University School of
Nursing, integrating mental health concepts into
a basic nursing curriculum.
• In the late 1950s, Orlando developed her theory
inductively through an empirical study of nursing
practice.
• For 3 years, she recorded 2000
observations between a nurse and
patient interactions.
Cont…
• She then examined

the content of these
2,000 nurse-patient
records and only was
able to categorize
them into two
mutually exclusive
sets that she labeled
“good nursing” and
“bad nursing”.

Cont…
• Good nurse’s focus on the immediate verbal and non
verbal behavior of patient from the beginning
through the end of the contact(focus on deliberative
interpretation of the patient),
• where as bad nurse’s focus on something that had

nothing to do with the patient’s behavior(Automatic
nursing formulation)

Cont.….
• From these observations, she formulated the ”Del
iberative Nursing Process” which was published in
1961.
• Conducted research at McLean Hospital through
continuous tape recording of nurses with patients
and other health care members.
• Based on this research, her formulations were
validated, thus she extended her theory to include
the entire nursing practice system which then
evolved as “Nursing Process Discipline”

Cont.…
• Orlando's theory remains one the of the most
effective practice theories available.
• Many theory scholars utilized her concept as
basis for their further studies.
• Her work has been translated into different
languages and was contained in the
international section.

.
Terms
❖ Distress is the experience of a patient whose need has
not been met.
❖ Nursing role is to discover and met the patient
immediate need for help.
❖ Nursing action directly or indirectly provide for
patients immediate need.
❖ outcome is change in the behavior of patient
indicating in the relieve distress or unmet need.
Assumptions
Focuses on:
Nursing profession
Nurses
Patients
The nature of nurse-patient interaction

I)Assumptions about nursing
1. Nursing is a distinct profession separate from other
disciplines.
2. Professional nursing has a distinct function and outcome
3. There is a difference between lay and professional

nursing.
4. Nursing is aligned with medicine.

II) Assumptions about patient
1. Patients’ needs for help are unique.
2. Patients have an initial inability to

communicate their needs for help.
3. When patients cannot meet their own needs they
become distressed.
4. The patient’s behavior is meaningful.

III) Assumptions about Nurses
1. The nurses reaction to each patient is unique.
2. Nurses are responsible for helping patients to avoid

or alleviate distress.
3. The nurses mind is the major tool for helping
patients.
4. A nurse’s practice is improved through

self-reflection.

IV) Assumptions about the nature
of Nurse-Patient interaction
1. The nurse-patient situation is a dynamic whole.
2.The phenomenon of nurse-patient encounter
represents a major source of nursing knowledge.

Meta-paradigm
✔ The nursing meta-paradigm consists of four
concepts: person, environment, health, and
nursing. Of the four, Orlando included three in
her theory of Nursing Process: person, health,
and nursing.

Cont…
❖ Human being – Individual with needs,
individuals have their own subjective perceptions and
feelings that may not be observable directly.
For her, humans in need are the focus of nursing practice.
❖ 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.

Cont…
❖ Nursing as unique and independent in its concerns for
an individual’s need for help in an immediate situation.
❖ Environment
•Environment is not clearly defined as well in Orlando’s
nursing theory 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

Concepts
The five major concepts:
1. Professional nursing function
2. The patient’s presenting behavior
3. Immediate reaction
4. Deliberative nursing process
5. Improvement
1. Professional Nursing Function
• Organizing principle
• She envisions the nursing function as ’’finding
out and meeting the patient’s immediate need for
help’’.
• If the patient is in need and the need for help is
met by the nurse, the professional function has
been fulfilled.
2. The Patient’s Presenting Behavior
Problematic situation
“The presenting behavior of the patient, regardless
of the form in which it appears, may represent a
plea for help’’
Patient’s behavior can be manifested in the
following forms:
✔ Verbal, such as asking a question or making a
statement to the nurse;
Cont…
✔ Vocal: such as coughing, moaning, crying,
wheezing, shouting
✔ Non-verbal: such as Tears in the eyes, skin
color, reddened face, clenched fist, or
physiological manifestations like BP,Pulse
(Orlando 1961).

3. Immediate Reaction
❖ Internal response
❖ Person perceives with any one of his five sense organs
an object.
Nurse Reaction- The patient behavior stimulated a nurse
reaction, which marks the beginning of the nursing
process discipline.

Nursing situation is composed of:
Patient behavior
Nurse reaction
Nurse action
Cont.…
❖ Nurse’s Action – the 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.
Deliberative Nursing Actions - are actions decided

upon after ascertaining a need and then meeting this
10/1/2019
need Tigest & Tiruye 34
4. Deliberative Nursing Process
Investigation
Deliberative nursing process formulations
reflect the nurse- patient situation as a dynamic
whole; the patient’s behavior affects the nurse
and the nurse’s behavior (action) affects the
patient.

The use of a deliberative nursing action requires a
shared communication process between the nurse
and the patient in order to determine:
• The meaning of the patients behavior,
• The help required by the patient ,and
• Whether the patient was helped by the
nurse’s action

5.Improvement
• Resolution
• This refers to improvement in the patient’s
behavior
• According to Orlando, If the nurses activity
meets the patient’s immediate needs for help,
the patient’s behavior improves.
• If behavior of the patient doesn’t change, the
nursing function has not been met.

5 Stages of the Deliberative Nursing Process
❑ Assessment in this stage, the nurse completes a

holistic assessment of the patient’s needs.
.

Cont…
❑ 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
Writing goals and objectives and deciding about

appropriate action.
Cont.…
• The planning stage addresses each of the problems
identified in the diagnosis.
• By the end of this stage, the nurse will have a
nursing care plan.
❑ Implementation
Final selection and carrying out planned action .
The nurse begins using the nursing care plan.

Cont…
❑ 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 the patient is progressing toward the goals.
If any new problems are identified in the evaluation stage,
the process starts over again for those specific problems.

Propositions
❖ There is a relationship b/n the patient’s
presenting behavior and the presence of patient

distress (an immediate need for help).
✔ unmeet need > distress
✔Distress manifests through patients behavior

cont…
❖ There is a relationship between a nurse’s use of
distinct nursing function and the nurse’s ability to
recognize the need for inquiry into the patient’s
presenting behavior.
❖ The more competent the nurse is in labeling her or
his perception, thoughts, and feelings (immediate
reaction), the more she or he to find out the nature
of the patient distress.
Cont.…
❖ If the nurse explore her or his immediate
reaction with the patient, distress is
lessened (Improvement).
❖ The major aim of Orlando’s theory is to
bring about improvement in the patient’s
behavior.
❖ The nurse’s use of the deliberative nursing
process will be less costly than the nurse’s
use of automatic personal responses.

Applicability of Orlando's theory
Orlando’s Deliberative Nursing Process
theory focuses on the interaction between the
nurse and patient.
It is applicable in many situations

Application to Nursing Practice
• Orlando’s theory is characterized as a

practice theory, because:
1. It provides a framework to guide nurses’
actions.
2. It focuses on nurse’s-mind set.
3. Can easily understand and use everyday
practice.

cont…
• Use in Clinical Practice;
– Nursing care plan
– Case studies
– Progressive patient care
settings

cont.….
Application to Education
• Orlando nursing process theory was

recommended for
teaching BSN students and
conceptualize BSN curriculums

Strengths
❖ Prevent inaccurate diagnosis or in effective plan.
❖ The patient will be treated as individuals and they will

participate into their own care.
❖ Assertion of nursing’s independence as a profession

based on a sound theoretical frame work.
❖ Guides the nurse to evaluate their care in terms of

observable patient out come.

Weaknesses
❖ The lack of the operational definitions of society or

environment which limits the development of
research hypothesis.
❖ Orlando’s work focuses on short term care,

particularly aware and conscious individuals
❖ Absence of reference group or family members.

Summary
• Focuses on the interaction between the nurse -
patient 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 theory.
• The use of her theory keeps the nurse's focus on
the patient’s immediate need for help. .
Cont.…
• Identify and emphasize the elements of
nursing process and the importance of the
patient’s participation in the nursing
process
• The theory is clear, concise, and easy to
use.
• The most effective practice theory,
especially helpful to new nurses as they
begin their practice.
Case scenario
• Mrs. sosina is 38 years old married woman who
live in Bahir dar town. She has 3 children. she is
admitted in Felege Hiwot referral hospital in
surgical ward for small bowel obstruction
surgery . While, Sr, Alem is come to mrs Sosina
bed side to give pre-operative care; She is
Moaning , her eyes wide and her lips pressed
firmly together.

Cont.…
• When she takes her vital sign; BP is 140/90
mmHg, Heart rate is 105 beat per minute,
Respiratory rate is 20 breath/min and
Temperature is 38 oC .
• She observe the condition of the patient and
asks her if there is anything that she can do for
her to make her feeling more comfortable.
Mrs. Sosina responds “Yes, I feel worried
about surgery and I feel pain!

Cont.….
Mrs Sosina presenting behavior:-
What Sr. Alem has heard (verbal) as well as seen (non

verbal) attempt to meet Mrs. Sosina need.
Verbal behavior:-Feeling of worried about surgery and

have pain
Non- verbal: - , BP (140/90) , HR (105) and T(38 oC)
Vocal behavior : - Moaning

Sr Alem Reaction :-
Cont.…
“I understand how you are frightening. I want you to know that
it’s ok to be afraid, but I’m going to be with you the whole time. Is
that how you are feeling?”
Mrs. Sosina’s response “I feel some what a better feeling after

you come to me.”
Sr Alem response “I would like to tell you about what we’re

going to do from here, I am ready to help you whatever you want”.

Cont.….
Sr Alem’s action:
Allow Mrs. Sosina to join in a dialogue about the

surgery, sequence of events, what to expect. Mrs. Sosina
is invited to participate in her care. Attention is given to
her feelings as well as input on her ongoing anxiety or
any pain that she may be experiencing. With each step
or intervention her participation is actively pursued and
surgery proceeds with her wish.
Nursing process
Assessment
Subjective Data – Pain, fear
Objective Data –
BP (140/90)
HR (105) and
T(38 oC)
Moaning

Cont.…
Nursing Diagnosis (Patient Problem)
1. Acute pain related to the diseases process as
evidenced by patient verbalization.
2. Anxiety related to surgical procedure as evidenced
by patient verbalization .
3. Hyperthermia related to the inflammatory process
of bowel as manifested by body temperature is 38
Oc.

Cont.…
Planning
Goal Expected outcome
1. Pain will be relieved after 1
1. To relieve pain
hour.
2. To reduce anxiety
2. Anxiety will be reduced after 1
3. To normalize hour.
body temperature 3. Body temperature will be
normal after 30 minutes.

Cont.….
Implementation (Carrying Planned Action):
1. Give Diclofenac 50 mg IM.
2. Give advice (explains each step of intervention
about the surgery, Stay with the client and
offer reassurance of safety and security).
3. Apply cold compress and give paracetamol
1000 mg po.

Cont.….
Evaluation
1. Pain is relieved as evidenced by patients verbal
response
2. Anxiety reduced as evidenced by patients verbal
response
3. normal body temperature as evidenced by her body
temperature is 37 oC.

Cont.….
Improvement (Resolution):
Mrs. Sosina is relaxed; feeling satisfied that she has
overcome an anxiety and relief from pain and her need
is met.

Acknowledgement
❖ We would like to forward our deepest gratitude to our
Instructor Mr. Gebre.Y. (Assistant Professor) for providing us
this opportunity of discussion and guiding and gave us the
chance to deal with nursing theories and sharing experience.

REFERENCE
1. George B. Julia , Nursing Theories- The base for
professional Nursing Practice , 3rd ed. Norwalk, Appleton

& Lange.
2.Wills M.Evelyn, McEwen Melanie (2002). Theoretical
Basis for Nursing Philadelphia. Lippincott Williams&
wilkins.
3. Meleis Ibrahim Afaf (1997) , Theoretical Nursing :

Development & Progress 3rd ed. Philadelphia, Lippincott.

Cont.…
4.Reed PG, The force of nursing theory guided-
practice. Nurs Sci Q. 2006 Jul;19(3):225.
5.Faust C. .Orlando's deliberative nursing process

theory: a practice application in an extended care
facility. J Gerontol Nurs. 2002 Jul;28(7):14
6. Taylor Carol,Lillis Carol (2001)The Art & Science

Of Nursing Care 4th ed. Philadelphia, Lippincott

Thank You!!!

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BAHIRDAR UNIVERSITY

COLLEGE OF MEDICINE AND HEALTH SCIENCES

Prepared by:1. Tigist G/maryam (BscN)

Adviser: Gebre Yitayih

10/1/2019 Tigest & Tiruye 1

• Tigist , G/ Maryam BDU 1112960

10/1/2019 Tigest & Tiruye 2

❖ Strength and Weakness

At the end of the presentation the participants will be

❖ Explain basic concepts of Orlando theory

❖ Discuss the application of Orlando theory in nursing

10/1/2019 Tigest & Tiruye 5

10/1/2019 Tigest & Tiruye 6

▪ 1951 - B.S.C in Public Health Nursing, St.

10/1/2019 Tigest & Tiruye 7

10/1/2019 Tigest & Tiruye 8

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10/1/2019 Tigest & Tiruye 11

• She then examined

10/1/2019 Tigest & Tiruye 15

• where as bad nurse’s focus on something that had

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10/1/2019 Tigest & Tiruye 18

10/1/2019 Tigest & Tiruye 20

2. Professional nursing has a distinct function and outcome

3. There is a difference between lay and professional

4. Nursing is aligned with medicine.

10/1/2019 Tigest & Tiruye 21

1. Patients’ needs for help are unique.

2. Patients have an initial inability to

4. The patient’s behavior is meaningful.

10/1/2019 Tigest & Tiruye 22

2. Nurses are responsible for helping patients to avoid

4. A nurse’s practice is improved through

10/1/2019 Tigest & Tiruye 23

10/1/2019 Tigest & Tiruye 24

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2. The patient’s presenting behavior

4. Deliberative nursing process

10/1/2019 Tigest & Tiruye 31

❖ Person perceives with any one of his five sense organs

Nurse Reaction- The patient behavior stimulated a nurse

reaction, which marks the beginning of the nursing

10/1/2019 Tigest & Tiruye 32

Deliberative Nursing Actions - are actions decided

10/1/2019 Tigest & Tiruye 35

shared communication process between the nurse

and the patient in order to determine:

• The meaning of the patients behavior,

• The help required by the patient ,and

• Whether the patient was helped by the

10/1/2019 Tigest & Tiruye 36

10/1/2019 Tigest & Tiruye 37

❑ Assessment in this stage, the nurse completes a

10/1/2019 Tigest & Tiruye 40

Writing goals and objectives and deciding about

The nurse begins using the nursing care plan.

10/1/2019 Tigest & Tiruye 42

10/1/2019 Tigest & Tiruye 43