Orlando's Nursing Process
- Ida Jean Orlando - born in 1926.
- wrote about the nursing process.
- Nursing diploma - New York Medical College
- BS in public health nursing - St. John's University,
- MA in mental health nursing - Columbia University, New
- Associate Professor at Yale School of Nursing and
Director of the Graduate Program in Mental Health
- 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.
- 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.
- Distress is the experience of a
patient whose need has not been met.
- Nursing role is 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 is a change in the behavior
of the patient indicating either a relief from distress or
an unmet need.
- Observable verbally and nonverbally.
- Function of professional nursing -
- Presenting behavior - problematic
- Immediate reaction - internal response
- Nursing process discipline –
- Improvement - resolution
- Finding out and meeting the patients immediate needs
"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
- 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
- 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
- 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
- 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
- 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.
- When patients cannot cope with their needs without
help, they become distressed with feelings of
- Patients are unique and individual in their responses
- Nursing offers mothering and nursing analogous to an
adult mothering and nurturing of a child
- Nursing deals with people, environment and health
- Patient need help in communicating needs, they are
uncomfortable and ambivalent about dependency needs
- Human beings are able to be secretive or explicit
about their needs, perceptions, thoughts and feelings
- The nurse – patient situation is dynamic, actions and
reactions are influenced by both nurse and patient
- Human beings attach meanings to situations and
actions that are not apparent to others
- Nurses are concerned with needs that patients cannot
meet on their own
- Nursing – is responsive to
individuals who suffer or anticipate a sense of
- Process of care in an immediate experience…..
for avoiding, relieving, diminishing or curing the
individuals sense of helplessness. Finding out meeting
the patients immediate need for help
- Goal of nursing – increased sense
of well being, increase in ability, adequacy in better
care of self and improvement in patients behavior
- Health – sense of adequacy or well
being . Fulfilled needs. Sense of comfort
- Environment – not defined
directly but implicitly in the immediate context for a
- Human being – developmental beings
with needs, individuals have their own subjective
perceptions and feelings that may not be observable
- Nursing client – patients who are
under medical care and who cannot deal with their needs
or who cannot carry out medical treatment alone
- Nursing problem – distress due to
unmet needs due to physical limitations, adverse
reactions to the setting or experiences which prevent
the patient from communicating his needs
- Nursing process – the interaction
of 1)the behavior of the patient, 2) the reaction of the
nurse and 3)the nursing actions which are assigned for
the patients benefit
- Nurse – patient relations –
central in theory and not differentiated from nursing
therapeutics or nursing process
- Nursing therapeutics – Direct
function : initiates a process of helping the patient
express the specific meaning of his behavior in order to
ascertain his distress and helps the patient explore the
distress in order to ascertain the help he requires so
that his distress may be relieved.
- Indirect function – calling for
help of others , whatever help the patient may require
for his need to be met
- Nursing therapeutics - Disciplined
and professional activities – automatic activities plus
matching of verbal and nonverbal responses, validation
of perceptions, matching of thoughts and feelings with
- Automatic activities – perception
by five senses, automatic thoughts, automatic feeling,
- Orlando's theory interrelate concepts
- Orlando's theory has a logical nature
- Orlando's theory is simple and applicable in the
- Orlando's theory contribute to the professional
- Orlando's theory is applicable in clinical practice
- Use of her theory assures that patient will be
treated as individuals and that they will have active
and constant input into their own care
- Prevents inaccurate diagnosis or ineffective plans
because the nurse has to constantly explore her
reactions with the patient
- Assertion of nursing’s independence as a profession
and her belief that this independence must be based on a
sound theoretical frame work
- Guides the nurse to evaluate her care in terms of
objectively observable patient outcome
- Orlando's Deliberative Nursing Process Theory focuses
on the interaction between the nurse and 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. (Faust C., 2002)
- Orlando's theory remains one the of the most effective
practice theories available.
- The use of her theory keeps the nurse's focus on the
- 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.
- George B. Julia , Nursing Theories- The base for
professional Nursing Practice , 3rd ed. Norwalk,
Appleton & Lange.
- Wills M.Evelyn, McEwen Melanie (2002). Theoretical
Basis for Nursing Philadelphia. Lippincott Williams&
- Meleis Ibrahim Afaf (1997) , Theoretical Nursing :
Development & Progress 3rd ed. Philadelphia,
- Taylor Carol,Lillis Carol (2001)The Art &
Science Of Nursing Care 4th ed.
- Potter A Patricia, Perry G Anne (1992) Fundamentals Of
Nursing –Concepts Process & Practice 3rd ed. London
Mosby Year Book.
- Vandemark L.M. Awareness of self & expanding
consciousness: using Nursing theories to prepare nurse
–therapists Ment Health Nurs. 2006 Jul; 27(6) : 605-15
- Reed PG, The force of nursing theory guided- practice.
Nurs Sci Q. 2006 Jul;19(3):225.
- Faust C. .Orlando's deliberative nursing process
theory: a practice application in an extended care
facility. J Gerontol Nurs. 2002 Jul;28(7):14-8
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