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Ida Jean Orlando

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Ida Jean Orlando

Nursing Process Discipline

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A first-generation American of Italian descent was born in August 12,1926  She received her nursing diploma from New York Medical College, Lower Fifth Avenue Hospital, School of Nursing  Her BS in public health nursing from St. John's University, Brooklyn, NY, and her MA in mental health nursing from Teachers College, Columbia University, New York.  Orlando was an Associate Professor at Yale School of Nursing where she was Director of the Graduate Program in Mental Health Psychiatric Nursing.  While at Yale she was project investigator of a National Institute of Mental Health grant entitled: Integration of Mental Health Concepts in a Basic



It was from this research that Orlando developed her theory which was published in her 1961 book, The Dynamic Nurse-Patient Relationship.  She furthered the development of her theory when at McLean Hospital in Belmont, MA as Director of a Research Project: Two Systems of Nursing in a Psychiatric Hospital.  The results of this research are contained in her 1972 book titled: The Discipline and Teaching of Nursing Processs.  Orlando held various positions in the Boston area, was a board member of Harvard Community Health Plan, and served as both a national and international consultant.

 She

is a frequent lecturer and conducted numerous seminars on nursing process.  She is married to Robert Pelletier and lives in the Boston area.  She passed away on November 28 , 2007.

Concepts:

Function of professional nursing - organizing principle  Presenting behavior - problematic situation  Immediate reaction - internal response  Nursing process discipline – investigation  Improvement - resolution


Orlando’s Conceptual Framework

The nursing process is set in motion by the Patient Behavior.
All patient behavior, verbal ( a patient’s use of language ) or non-verbal ( includes physiological symptoms, motor activity, and nonverbal communication) , no matter how insignificant, must be considered an expression of a need for help and needs to be validated . If a patient’s behavior does not effectively assessed by the nurse then a major problem in giving care would rise leading to a nurse-patient relationship failure. Overtime . the more it is difficult to establish rapport to the patient once behavior is not determined. Communicating effectively is vital to achieve patient’s cooperation in achieving health.

Remember : When a patient has a need for help that cannot be resolved without the help of another, helplessness results

The Patient behavior stimulates a Nurse Reaction .
The beginning of the nurse-patient relationship takes place. It is important to correctly evaluate the behavior of the patient using the nurse reactions steps to achieve positive feedback response from the patient. The nurse perceives behavior through any of the senses > The perception leads to automatic thought -> The thought produces an automatic feeling ->The nurse shares reactions with the patient to ascertain whether perceptions are accurate or inaccurate -> 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.

Two ways in implementing Nurse Action. Automatic reactions stem from nursing behaviors that are performed to satisfy a directive other than the patient’s need for help.

For 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, is engaging in automatic, nondeliberative behavior. This is because the reason for giving 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” It can be argued that all nursing actions are meant to help the client and should be considered deliberative. Correct identification of actions from the nurse’s assessment should be determined to achieve reciprocal help between nurse and patient’s health.

◦ Deliberative actions result from the correct identification of patient needs by validation of the nurses 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.

Nursing Metaparadigm

Health

Environment

Nursing

Person

Human/Person An individual in need. Unique individual behaving verbally or nonverbally. Assumption is that individuals are at times able to meet their own needs and at other times unable to do so Health Assumption is that being without emotional or physical discomfort and having a sense of well-being contribute to a healthy state. She further assumed that freedom from mental or physical discomfort and feelings of adequacy and well being contribute to health. she also noted that repeated experiences of having been helped undoubtedly culminate over periods of time in greater degrees of improvement Environment Orlando assumes it as a nursing situation that occurs when there is a nurse-patient contact and that both nurse and patient perceive, think, feel and act in the immediate situation. any aspect of the environment, even though its designed for therapeutic and helpful purposes, can cause the patient to become distressed.

Nursing A distinct profession "Providing direct assistance to individuals in whatever setting they are found for he purpose of avoiding, relieving, diminishing, or curing the individual's sense of helplessness"

Distinguish the Theory

Conceptual Framework

NEED

PRESENTING BEHAVIOR OF PATIENT

ANA

NURSING PROCESS DESIPLINE

DNA

PATIENTS NEED FOR HELP RESOLVE

Major Assumptions
Assumption 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”.
1.

Assumption about patient: “ Pateint’s needs for help are unique”. “Patient’s have an initial ability to communicate their needs for help”. “ When patients cannot meet their own needs they become distressed”. “ The patient are able and willing to communicate verbally (and non-verbally when unable to communicate verbally)”.
2.

3. Assumption about nurses: “ The nurses reaction to each patient is unique”. “Nurses should not add to the patients distress”. “ The nurses mind is the major tool for helping patients”. “ The nurses use of automatic responses prevents the responsibility of nursing from beginning fulfilled”. “Nurses 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”.

Use in Nursing
 The

use of her theory keeps the nurse's focus on the patient.  Increased effectiveness in meeting patients needs,improved decision making skills among staff nurses ,particularly in determining what constituted nursing versus non nursing functions.  Used successfully in psychiatric and general hospital.  It guides nurses through their interactions with patient.  Ensures that the patient will be treated as individuals and that they will have an active and constant input into their own care.  Helps the nurse deal with her personal reactions and leads her to value her own individuality as thinking person.

 Prevents

inaccurate diagnosis or in effective plans because the nurse has to constantly explore her reaction with the patient  It allows nursing to evolve overtime by avoiding a rigid list of nursing activities.

Nursing Process

Summary
Interpersonal process alleviates distress. Nurses must stay connected to patients andassure that patients get what they need,focused on patient’s verbal and non verbalexpressions of need and nurse’s reactions topatient’s behaviour to alleviate distress. Elements of nursing situation: 1. Patient 2. 2. Nurse reactions 3. 3. Nursing actions

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