IDA JEAN ORLANDO

(PELLETIER)NURSING

PROCESS THEORY

THEORETICAL SOURCES:

• Even though Orlando does not acknowledge any theoretical sources for the development of her theory, Schmeiding(1986) found similarities of her formulations to those of John Dewey and to some of nurse colleagues with whom Orlando was associated at Columbia.

MAJOR CONCEPTS AND DEFINITIONS

Her model revolves around the following five major interrelated concepts:

1. The function of proffesional nursing2. The presenting behavior of the patient3. The immediate or internal response of

the nurse4. The nursing process discipline5. Improvement

NURSES RESPONSIBILITY- whatever help the patient may

require for his needs to be met- see that the patient’s needs for

help are met, either directly by her own activity or indirectly by calling the help of others

NEED - situationally defined as a

requirement of the patient which, if supplied, relieves or diminishes his immediate distressor and improves his immediete sense of adequacy or well-being

PRESENTING BEHAVIOR OF PATIENT- any observable verbal or nonverbal

behaviorIMMEDIATE REACTIONS

- include both the nurse’s and patient’s perceptions, thoughts, and feelings

NURSING PROCESS DISCIPLINE- includes the nurse communicating

to the patient his or her own immediate reaction, clearly identifying that the item expressed belongs to the nurse and then asking for validation or correction

IMPROVEMENT- to grow better, to turn to profit, to

use to advantagePURPOSE OF NURSING

- “The purpose of nursing is to supply the help a patient requires in order for his needs to be met” (Orlando, 1990, p. 9)

AUTOMATIC NURSING ACTION- those nursing actions decided

upon for reasons other than the patients immediate need

DELIBERATIVE NURSING ACTION- actions decided upon after

ascertaining a need then meeting this need

- Orlando was the first nurse to develop her theory from actual nurse-patient situations. She recorded the content of 2000 nurse-patient contacts and created her theory based on the analysis of these data.

USE OF EMPIRICAL EVIDENCE

MAJOR ASSUMPTIONS

ASSUMPTIONS ABOUT NURSING:- Nursing is a distinct profession separate from other disciplines.- Professional nursing has a distinct function and product/outcome.-There is a difference between lay and professional nursing.- Nursing is aligned with medicine.

ASSUMPTIONS ABOUT PATIENTS:- Patient’s need for help are unique.- Patients have an initial ability to communicate their needs for help.- When patients cannot meet their own needs they become distressed.- The patient ‘s behavior is meaningful- Patients are able and willing to communicate verbally (and nonverbally when unable to communicate verbally)

ASSUMPTIONS ABOUT NURSES:- The nurse’s reaction to each patient is unique.- Nurses should not add to the patient’s distress.- The nurse’s mind is the major tool for helping patients.- Nurses’ use of automatic responses prevents the responsibility of nursing from being fulfilled.- Nurse’s practice is improved through self-reflection.

ASSUMPTIONS ABOUT HEALTH:- Freedom from mental or physical discomfort and feelings of adequacy and well-being contributes to health.

ASSUMPTIONS ABOUT ENVIRONMENT:- A patient may react with distress to any aspect of an environment that was designed for therapeutic and helpful purposes. When a nurse observes any behavior, it needs to be viewed as signal of distress.

THEORETICAL ASSERTIONS

Orlando views the professional function of nursing as finding out and meeting the patient’s immediate need for help.

Focuses on how to produce improvement in the patient’s behavior.

A person becomes a patient requiring nursing care when he or she has needs that cannot be met independently.

There is a positive correlation between the length of time the patient experiences the

unmet needs and the degree of distress. The action process by the nurse in a

nurse-patient contact is called nursing process.

There are two kinds of nursing action:1. deliberative nursing action2. automatic nursing action

Three specific requirements in deliberative nursing action

1. The nurse expresses to the patient any o all of the items contained in her or his reaction to the patients behavior.

2. The nurse states to the patient that the expressed item belongs to the nurse by use of the personal pronoun.

3. The nurse asks about the time expressed, attempting to verify or correct his or her perceptions, thoughts, or feelings

The value of nursing process discipline is its accuracy in determining whether the patient experiences distress and, if so, finding out what is required to relieve the distress.

LOGICAL FORMOrlando’s theory was developed inductively. She collected records of her observations of nurse-patient situations during a 3-year period. After attempts to categorize data, she recognized that they were either good or bad patient outcomes.

Acceptance by the Nursing Community

It was accepted early in it’s development. Her theory shows the most effective nursing involves a continuous analysis and interpretation of the patient’s needs. The theory is also readily applicable to nursing practice because applying it would increase the therapeutic effectiveness of nursing and improved-decision making skills of nurses.

EDUCATION:The theory helps the nursing education to develop and integrate in order to produce better nurses.

RESEARCH:The theory is used in many nursing research and helped nursing research evolve and develop.