Orlando's theory of deliberative nursing process

Chapter 16

Nursing Process

Chapter 16

Nursing Process Theory:

Ida Jean Orlando (Pelletier)(Pelletier)

Overview of Orlando’s Nursing Overview of Orlando’s Nursing Process Theory

• Stresses reciprocal relationship between patient and nurse; what the nurse and patient say and do during their interaction affects both of them and nurse; what the nurse and patient say and do during their interaction affects both of them

• Imperative that nurses share their perceptions • Imperative that nurses share their perceptions with patients to determine if their perception is congruent with the patient’s perception of need

• Focuses on producing improvement in the patient’s behavior

Major Concepts of Nursing According to OrlandoAccording to Orlando

• Person: defines person in terms of patient or • Person: defines person in terms of patient or person with unmet needs

• Environment: assumes that a nursing situation • Environment: assumes that a nursing situation occurs when there is a nurse-patient contact

• Health: assumes feelings of adequacy and well-• Health: assumes feelings of adequacy and well- being from fulfilled needs contribute to health

• Nursing: profession functions autonomously; • Nursing: profession functions autonomously; function to meet patient’s need for help

Assumptions of Orlando’s Nursing Process Theory About NursingProcess Theory About Nursing

Nursing is a distinct profession, separate from • Nursing is a distinct profession, separate from other disciplines

• Professional nursing has a distinct function and product (outcome)and product (outcome)

• There is a difference between lay and professional nursingprofessional nursing

• Nursing is aligned with medicine

Assumptions of Orlando’s Nursing Process Theory About PatientsProcess Theory About Patients

• Each patient’s needs for help are unique• Each patient’s needs for help are unique • Patients have an initial ability to communicate Patients have an initial ability to communicate

their needs for help • When patients cannot meet their own needs • When patients cannot meet their own needs

they become distressed • The patient’s behavior is meaningful• The patient’s behavior is meaningful • Patients are able and willing to communicate

verballyverbally

Assumptions of Orlando’s Nursing Process Theory About NursesProcess Theory About Nurses

• Nurse’s reaction to each patient is unique• Nurse’s reaction to each patient is unique • Nurses should not add to the patient’s distress • Nurse’s mind is the major tool for helping

patientspatients • Nurse’s use of automatic responses prevents the

responsibility of nursing from being fulfilledresponsibility of nursing from being fulfilled • Nurse’s practice is improved through self-

reflectionreflection

Assumptions of Orlando’s Nursing Process Assumptions of Orlando’s Nursing Process Theory About Nurse-Patient SituationTheory About Nurse-Patient Situation

• The nurse–patient situation is a dynamic • The nurse–patient situation is a dynamic whole

• The phenomenon of the nurse–patient • The phenomenon of the nurse–patient encounter represents a major source of nursing knowledgenursing knowledge

Propositions of Orlando’s Nursing Process TheoryProcess Theory

• There is a relationship between the patient’s • There is a relationship between the patient’s presenting behavior and the presence of patient distresspatient distress

• There is a relationship between nurse’s use of There is a relationship between nurse’s use of Orlando’s distinct nursing function and the nurse’s ability to recognize the need for inquiry (deliberative nursing process) into the nurse’s ability to recognize the need for inquiry (deliberative nursing process) into the meaning of the patient’s presenting behavior

Propositions of Orlando’s Nursing Process TheoryProcess Theory

• The more competent the nurse is in labeling his or her perceptions, thoughts, and feelings, his or her perceptions, thoughts, and feelings, the more apt the nurse is to find out the nature of the patient’s distressnature of the patient’s distress

• If the nurse explores his or her immediate reaction with the patient, the patient’s reaction with the patient, the patient’s distress is lessened

Propositions of Orlando’s Nursing Process TheoryProcess Theory

The nurse’s use of the deliberative nursing • The nurse’s use of the deliberative nursing process will be less costly than the nurse’s use of automatic personal responses of automatic personal responses

• Patients’ experiencing repeated improvement • Patients’ experiencing repeated improvement as result of deliberative nursing will have positive cumulative effectspositive cumulative effects

Brief Critique of Orlando’s Nursing Process TheoryProcess Theory

• Developed inductively • Developed inductively • Logical and applicable to nursing practiceLogical and applicable to nursing practice • Considered simple because it includes few

concepts and relationships concepts and relationships • Internally consistent and meets the criteria for

testability for a middle-range theory testability for a middle-range theory • Effective practice theory that is especially

helpful to new nurses as they begin practicehelpful to new nurses as they begin practice

Orlando’s Theory as Framework for Nursing Orlando’s Theory as Framework for Nursing Practice: Five Interrelated Concepts

• The organizing principle or professional nursing function nursing function

• The problematic situation or the patient’s presenting behaviorpresenting behavior

• The internal response or immediate reaction • Reflective inquiry or deliberative nursing • Reflective inquiry or deliberative nursing

process • Resolution or improvement• Resolution or improvement

Orlando’s Theory as Framework for Nursing PracticeNursing Practice

Assessment: nurse helps person express specific • Assessment: nurse helps person express specific meaning of behaviors in effort to determine source of distress; next, the nurse should source of distress; next, the nurse should explore the distress to assess the help required. The process used to share and validate the The process used to share and validate the nurse’s direct and indirect observations is known as the deliberative nursing process.as the deliberative nursing process.

• Planning: participation from nurse and patient• Planning: participation from nurse and patient

Orlando’s Theory as Framework for Nursing PracticeNursing Practice

• Implementation: • Implementation: – Direct help occurs when the patient is unable to meet

need and the activity is confined to the nurse–patientneed and the activity is confined to the nurse–patient – Indirect help occurs when activity to meet patient’s

need extends to arranging services need extends to arranging services

• Evaluation: focus not on nurse’s activity; rather, if nurse’s action helped patient communicate need nurse’s action helped patient communicate need for health and if need was met