Ida Jean Orlando (Pelletier)

Nursing Process Discipline

Ida jean Orlando A first-generation American of Italian descent Birth date : August 12, 1926 Birthplace: New York Husband : Robert Pelletier (lived in Boston) Death date: November 28, 2007 1947 - Diploma in Nursing, New

York Medical College 1951 - B.S. in Public Health Nursing, St. John's

University, Brooklyn, New York

1954 - M.A. in mental health consultation, Columbia

University, New York

•Staff nurse, varied specialties (OB, MS, ER)

•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, Connecticut (1954-1961)

•Clinical Nursing Consultant in Mental Health, McLean Hospital in Belmont, Massachusetts (1962-1972)

•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 (September1987)Retired in 1992

Nursing Career

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 : An Evaluative Study”

Conducted Training Programs at McLean Hospital

Managed 60 workshops about her theory in USA and Canada (1972-1981)

Outstanding Nurse in the Hall of Fame of Massachusetts Nurse’s Association in 2001

ATTAINMENTS & HONOR:

Orlando’s Key Concept

She believes that nursing is unique and independent because it concerns itself with an individual’s need for help, real or potential, in an immediate situation. The process by which nursing revolves this helplessness in interactive and is pursued in disciplined manner that requires training. She believes one’s action should be based on rationale not protocols.

PERSON unique and developmental beings with needs, individuals have their own subjective perceptions and feelings that may not be

observable directly

NURSING providing direct assistance to individuals in whatever setting for the purpose of avoiding, relieving, diminishing, or curing the person’s

sense of helplessness

HEALTH is not well-defined but assumed as “freedom from mental or physical

discomfort and feelings of adequacy and well-being ”

ENVIRONMENT is not clearly defined as well 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

METAPARADIGM OF NURSING

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”• “The nurse’s use of automatic

responses prevents the responsibility of nursing

from being fulfilled” • “Nurse’s practice is improved

through self-reflection”

Assumptions about Patients: • “Patients’ needs 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 behaviour is meaningful”• “Patients are able and willing to communicate verbally (and non-verbally when unable to communicate verbally)”

Assumptions:

Assumptions about the nurse-patient situation:

• “The nurse-patient situation is a dynamic whole”• “The phenomenon of the nurse- patient encounter represents a major source of nursing knowledge”

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”

"I can't move, I can't speak, I need help..."

Introduction to the Theory

Nurse Action

Nurse Reaction

Patient Behavior

A) The nursing process is set in motion by the Patient Behavior

B) The Patient Behavior stimulates a Nurse Reaction

- All patient behavior:

a) verbal ( a patient’s use of language )

b) non-verbal ( includes physiological symptoms, motor activity, and nonverbal communication)

c) physical forms (vital signs)

- Must be considered an expression of a need for help and has to be validated .

- Ineffective assessment by the nurse leads nurse-patient relationship failure.

- Communication process is vital to acquire patient’s cooperation in achieving health.

Remember: When a patient’s need for help is not resolved even with the help of another, will result to sense of helplessness.

- Nurse-patient relationship takes place.

- Correct evaluation of patient’s behavior by using the nurse reactions steps yields positive feedback response from the patient.

The steps are as follows:

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.

 Remember : Exploration with the patient helps validate the patient’s behavior.

 

Automatic Reaction (Non-Deliberative) stem from nursing behaviors that are performed to satisfy a directive other

than the patient’s need for help.

Example: The nurse who gives a sleeping pill to a patient every evening because it is ordered by the physician, without first discussing the need for the medication with the patient.

Rationale : Giving of the pill has more to do with following medical orders (automatically) than with the patient’s immediate expressed need for help.

Deliberative Reaction is a “disciplined professional response”, that all nursing actions are meant to

help the client and should be considered deliberative. The following criteria should be considered. Deliberative actions result from the correct identification of patient needs by validation

of the nurses’s reaction to patient behavior. The nurse explores the meaning of the action with the patient and its relevance to

meeting his need. The nurse validates the action’s effectiveness immediately after compelling it. The nurse is free of stimuli unrelated to the patient’s need (when action is taken).

Remember : For an action to have been truly deliberative, it must undergo reflective evaluation to determine if the action helped the client by addressing the need as determined by the nurse and the client in the immediate situation.

C) Critically considering one or two ways in implementing Nurse Action

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.

MAJOR DIMENSIONS OF THE THEORY

Function of Professional Nursing - Organizing Principle

Presenting Behavior - Problematic Situation

Immediate Reaction - Internal Response

Nursing Process Discipline – Investigation

Improvement - Resolution

Orlando’s Nursing Process Discipline

FUNCTIONS OF PROFESSIONAL NURSING - ORGANIZING PRINCIPLE

• Finding out and meeting the patients immediate needs for help

• 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

• The purpose of nursing is to supply the help a patient requires for his needs to be met

• Nursing thought - Does the patient have an immediate need for help or not?

• If the patient has an immediate need for help and the nurse finds out and meets that need ,the function of professional nursing is achieved

PRESENTING BEHAVIOR – PROBLEMATIC SITUATION

• 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 help

• 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

Major Dimensions of the Theory

IMMEDIATE REACTION –INTERNAL RESPONSE

• 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 • Reflects how the nurse experiences her or his participation in the nurse patient situation

NURSING PROCESS DISCIPLINE - INVESTIGATION• 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 • Automatic reactions are not effective because the nurses action is decided upon for

reasons other than the meaning of the patients behavior or the patients immediate need for help

• When the nurse does not explore with the patient her reaction it seems reasonably certain that clear communication between them stops

IMPROVEMENT - 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 In each contact the nurse repeats a process of learning how to help the individual patient. Her own individuality and that of the patient requires that she go through this each time

she is called upon to render service to those who need her

Distinguish the Theory Analyze the Theory

Conceptual Framework

PRACTICEOrlando’s nursing process discipline reflects the elements of the therapeutic relationships which include expression of empathy, warmth, and genuineness that would increase the therapeutic effectiveness of nursing having applied throughout various nursing departments: Operating Rooms, Mental Health Units, Administrations and Public Health departmentsUse in Clinical Practice: Nursing care plan, Case studies, Progressive patient care settings Nursing process: A-D-P-I-E

ACCEPTANCE by the Nursing Community

EDUCATION

Orlando’s nursing process theory was recommended for teaching BSN students and conceptualize BSN curriculums which has an emphasis on the interaction process and its goal on communication and psychosocial foundations which may translate into more effective exploratory skills in the students.

ACCEPTANCE by the Nursing Community:

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

Acceptance by the Nursing Community

Nursing can pursue Orlando's work for

retesting and further developing her work

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

Make evaluation a less time consuming and more deliberate function, the results of which would be

documented in patients charts

Guides the nurse to evaluate her care in terms of objectively observable patient

outcomes

Limitations

Highly interactive nature Orlando's

theory makes it hard to include the highly

technical and physical care that

nurses give in certain settings

Her theory struggles with the authority derived from the

function of profession and that of the employing

institution’s commitment to the

public

Strengths

2. Problematic situation and immediate reaction(s)

The nurse’s focus is on the patient and free of distracting thoughts

-The nurse recognizes cues that a patient problem may exist before the next step in the process.-The nurse identifies his or her immediate perception, thoughts, feelings (Immediate reaction)

-The nurse uses terms the patient can understand and explores immediate reactions with the patient to discover physical/nonphysical problems. As the problem is identified, the nurse asks the patient to confirm or refute its accuracy.-The nurse explores the disagreement to determine its basis

-With the patient, the nurse determines action(s) needed and develops plans for each problem.-The nurse explores whether the patient agrees with or refutes the plan. The nurse explores and resolves the basis of disagreement. The patient verbally or nonverbally agrees. If not, the nurse continues the inquiry for the basis.

4. Identifying specific plans for each problem

-If the patient is unable, the nurse implements the plan and asks the patient whether the action is helpful. If it is not, the nurse explores the basis . -The nurse helps the patient if he or she is unable to do it alone and explores whether the patient was helped. The nurse inquires about his or her results.

The nurse asks the patient whether the action helped and observes the patient’s verbal and nonverbal behavior. If he or she has improved, the need for help was mer. If not, the nurse continues to use the content of immediate reaction to explore with the patient until a positive change is evident.

5. Implement

6. Improvement

3. Inquiry-Problem Determination

1. Guiding Principle

Finding out and meeting the patient’s immediate need for help

Assessing a Patient by using Orlando’s Theory to guide the Nurse’s Process