THE NURSING PROCESS THEORY

👉 Project investigator of a National

Institute of Mental Health grant
entitled: Integration of Mental
Health Concepts in a Basic Nursing
Curriculum
👉 published in her 1961 book, The
Dynamic Nurse-Patient
Relationship and revised 1972 book:
The Discipline and Teaching of
Nursing Processes
👉 A board member of Harvard
Community Health Plan
4 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
• - not defined directly but implicitly in the
immediate context for a patient
• - 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.
Orlando’s model of nursing makes the following 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.
 INTRODUCTION TO THEORY

PATIENT BEHAVIOR NURSE REACTION NURSE ACTION

1. The nursing process is set in motion by the
Patient Behavior

All patient behavior:

verbal- a patient’s use of language
non-verbal- includes physiological symptoms,
motor activity, and nonverbal communication
physical forms- vital signs
2. The Patient Behavior stimulates a Nurse Reaction

Nurse- patient relationship takes place

Nurse reactions steps:
1) The nurse perceives behavior through any of the senses
2) The perception leads to automatic thought
3) The thought produces an automatic feeling
4) The nurse shares reactions with the patient to ascertain whether
perceptions are accurate or inaccurate
5) The nurse consciously deliberates about personal reactions and patient
input in order to produce professional deliberative actions based on mindful
assessment rather than automatic reactions
3. Critically considering one or two ways in implementing Nurse
Action

Automatic Reaction (Non-Deliberative)

behaviors that are performed to satisfy a directive other than the
patient’s need for help

Deliberative Reaction
a disciplined professional response´, that all nursing actions are
meant to help the client and should be considered deliberative.
 Orlando’s Nursing Process Discipline
Finding out and meeting the
1. Function of Professional patients immediate needs for help
Nursing -Organizing Principle
🎈To find out the immediate need for help the nurse
2. Presenting Behavior- must first recognize the situation as problematic
Problematic Situation 🎈The presenting behavior of the patient, the stimulus,
causes an automatic internal response in the nurse, and
3. Immediate Reaction - the nurses behavior causes a response in the patient
Internal Response
Person perceives with any one of his five
sense organs an object or objects

4. Nursing Process 🎈Any observation shared and explored with the patient is
Discipline – Investigation 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
5. Improvement - the validity of it in exploration with the patient
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
THE DYNAMIC NURSE-
PATIENT RELATIONSHIP
The action process in a person-to-person contact functioning in secret. The
perceptions, thoughts, and feelings of each individual are not directly available to
the perception of the other individual through the observable action.

The action process in a person-to-person contact functioning by open disclosure.

The perceptions, thoughts, and feelings of each individual are directly available
to the perception of the other individual through the observable action.
The Deliberative Nursing Process has five stages: assessment, diagnosis,
planning, implementation, and evaluation.

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.

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- 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.
 Implementation- In the implementation stage, the nurse begins
using the nursing care plan.
 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 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.
RESEARCH
The diversity of the research using the theory attests to its breadth of
application. It also indicates its utility for application of the findings in:
😉Perioperative Nursing
😉Studying Nurse-Patient
😉Relationships
😉Advanced-Nursing Practice and
😉Administrations
😉Responses to distressed patients
😉Mental Illnesses
😉Positive Patient-Centered Outcomes
EDUCATION

Orlando’s nursing process theory was recommended and

conceptualize BSN curriculum which has an emphasis on the
interaction process and its goal on communication and
psychosocial foundation which may translate into more
effective exploratory skills in the students.
PRACTICE

Orlando’s nursing process discipline reflects the elements of the

therapeutic relationship which includes expression of empathy,
warmth, and genuineness that would increase the therapeutic
effectiveness of nursing having applied throughout various nursing
department.
References:

Ida Jean Orlando - Biography and Works. (2017, April 09).

Retrieved from https://nurseslabs.com/ida-
jean-orlando/
Ida Jean Orlando. (n.d.). Retrieved from
http://nursingtheories.weebly.com/ida-jean-orlando.html
LibGuides: Nurse Theorists & Nursing Theories: Ida Jean Orlando
Pelletier. (n.d.). Retrieved from
https://iuk.libguides.com/c.php?g=130110&p=849615
Nursing Process Theory. (n.d.). Retrieved from http://www.nursing-
theory.org/theories-and
models/orlando-nursing-process-discipline-theory.php
Thank you for listening!