IDA JEAN ORLANDO (PELLETIER) 1926-present
CREDENTIALS AND BACKGROUND August 12, 1926 Ida Jean Orlando was born 1947 received a diploma in nursing from New York Medical College, Flower Fifth Avenue Hospital School of Nursing 1951 received a Bachelor of Science in Public Health from St. John s University, Brooklyn 1954 Master of Arts in Mental Health consultation in Columbia University Teachers College - While studying she also worked intermittently and sometimes concurrently as a staff nurse in OB, M/S, ER; as a supervisor in a general hospital, and as an assistant director and a teacher of several courses. - After receiving her masters, she was employed by Yale School of Nursing in New Haven, Connecticut for 8 years. 1958 she became a research associate and principal investigator of a federal project grant entitled Integration of Mental Health Concepts in a Basic Curriculum . She recorded her observations for 3 years and spent the 4th year analyzing the accumulated data. - This year also, she made her first book The Dynamic Nurse-Patient Relationship: Function, Process, and Principles of Professional Nursing Practice , was published 1961. 1961 she married Robert J. Pelletier and left Yale 1962-1972 she became a Clinical Nursing Consultant at McLean Hospital, Belmont, Massachusetts 1967 published the Patient s Predicament and Nursing Function in Psychiatric Opinion 1972 The Discipline and Teaching of Nursing Process : An Evaluative Study 1972-1981 she lectured, served as consultant, conducted about 60 workshops about her theory throughout US and Canada. 1972-1984 served on the board of the Harvard Community Health Plan in Boston, Massachusetts 1979-1985 served as the Hospital Committee of the board 1981 hired as Nurse Educator for Metropolitan State Hospital in Waltham, Massachusetts and held administrative positions from 1984-1987 September 1987 became the Assistant director of Nursing for Education and Research at Metropolitan State Hospital 1992 retired from nursing.
Orlando s Nursing Theory (Deliberative Nursing Process) - Stresses the reciprocal relationship between patient and nurse. - Emphasizes the critical importance of the patient s participation in the nursing process. - Views nursing as a distinct profession and separates from medicine. - Believes that physician s orders are for patients, not for nurses. - Views nurses as determining nursing action rather than being prompted by physician s orders, organizational needs and past personal experiences. - Goal: to develop a theory of effective nursing practice. She described her model as revolving around the following five major interrelated concepts: 1. The function of professional nursing 2. The presenting behavior of the patient 3. The immediate or internal response of the nurse 4. The nursing process discipline 5. Improvement NEED is situationally defined as a requirement of the patient which, if supplied, relieves or diminished his immediate distressor and improves his immediate sense of adequacy or wellbeing. PRESENTING BEHAVIOR - is any observable verbal or non-verbal behavior IMMEDIATE REACTIONS feelings. both the nurse s and patient s individual perceptions, thoughts, and
NURSING PROCESS DISCIPLINE includes the nurse communicating to the patient his or her own immediate reaction, item expressed belongs to the nurse and then asking for validation or correction. Also called deliberative nursing process, nursing process and process discipline on her other books. AUTOMATIC NURSING ACTION patient s immediate need. DELIBERATIVE NURSING ACTION meeting this need. are nursing actions decided upon for reasons other than the
actions decided upon after ascertaining a need and then
MAJOR ASSUMPTIONS 1. Assumptions about Nursing Nursing is a distinct profession separate from other discipline Professional nursing has a distinct function and product (outcome) There is a difference between lay and professional nursing Nursing is aligned to with medicine 2. 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 Patient s behavior is meaningful Patients are able and willing to communicate verbally (and nonverbally when unable to communicate verbally) 3. Assumptions about nurses The nurse s reaction to 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 4. 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 THEORETICAL ASSERTIONS Orlando views the professional function of nursing as finding out and meeting the patient s immediate need for help. Orlando s theory focuses on how to produce improvement in the patient s behavior. According to Orlando, a person becomes a patient requiring nursing care when he or she has needs for help that cannot be met independently because he or she has physical limitations, has negative reaction to an environment, or has experience that prevents the patient from communicating his or her needs.
When the nurse acts, an action process transpires. This action process by the nurse in a nurse-patient contact is called nursing process. The nurse s action may be automatic or deliberative. Automatic nursing actions those having nothing to do with finding out and meeting the patient s need for help. Deliberative nursing actions those designed to identify and meet the patient s immediate needs for help and fulfill the professional nursing function. There are three specific requirements. First, the nurse expresses to the patient any or all of the items contained in his or her reaction to the patient s behavior. Second, the nurses states to the patient that the expressed item belongs to the nurse by use of the personal pronoun (an I message which indicates it is the nurse s perception). Finally, the nurse asks about the item expressed, attempting to verify or correct his or her perceptions, thoughts, or feelings. She viewed the latter type of response as a form of continuous reflection as the nurse tries to understand the meaning to the patient of the behavior she observed and what she needs from her in order to be helped. ANALYSIS AND EVALUATION INTERNAL CRITICISM ADEQUACY: Describes nursing as unique, independent, and disciplined CLARITY: Very easily understood CONSISTENCY: Simplistic nature and consistent throughout LOGICAL DEVELOPMENT: Demonstrates logical development LEVEL OF THEORY DEVELOPMENT: Appropriately considered a middle range theory COMPLEXITY: Simple yet complex DISCRIMINATION: Can be used in all clinical practice, administration, and education REALITY CONVERGENCE: Compatible with expectations for nursing practice PRAGMATIC: Has been used in research studies SCOPE: Low to medium level of abstraction SIGNIFICANCE: Significant contributions to the nursing practice UTILITY: Derived from initial research using a qualitative, observational method CONCLUSION Ida Jean Orlando presents a classic nursing theory. Her theory is simple to understand but requires that the nurse focus on the patient to find out the immediate needs for help. Nurses need to explore patients perception, thoughts, and feelings to find out what help patients need, which is not as easy as it appears.
Orlando s theory is used in various practices, from psychiatric, to public health nursing. It is also used in various hospitals where, there, a psychiatric nurse-physician pair works with people who have bipolar disease. Used also in education, administration, and nursing leadership. Regardless of where the nurses practices, the focus is on the patient. Conceivably, it can be adapted to other nursing situations in which the focus is on identifying and finding out patients immediate needs for help. This nursing process of Orlando is relevant to community and longterm nursing and in other areas where nursing is practiced.