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Ida Jean Orlando

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Ida Jean Orlando

Ida Jean Orlando
· The role of the nurse is out find out and

meet the patient’s immediate need for
help.
· The patient’s presenting behavior may
be plea for help, however, the help
needed may not be what it appears to be.
· Nurses needed to use their perception,
thoughts about the perception or the
feeling engendered from their thoughts to
explore with patients the meaning of their
behavior.

History and Background
· Ida Jean Orlando, a first-generation
American of Italian descent was born in
1926.
· She received her nursing diploma from
New York Medical College, her BS in
public health nursing from St. John’s
University NY, and her MA IN MENTAL
HEALTH NURSING FROM 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.

 Yale she was project investigator of a National
Institute of Mental Health grant entitled: Integration
of Mental Health Concepts in a Basic Nursing
Curriculum.
 She 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 system of Nursing in a
Psychiatric Hospital.
 The results of the research are contained in her 1972
book titled the Discipline and Teaching of Nursing
Processes.
 Orlando held various position in the Boston area, was
a board member of Harvard Community Health Plan,
and served as both a national and international
consultant.

 A frequent lecture and conducted numerous
seminar on nursing process.
 Orlando’s theory was developed in the late
1950’s from observations she recorded
between a nurse and patients.
 Despite her efforts, she was only able to
categories the records as “good” or “bad”
nursing.
 It hen dawned on her that both the
formulations for “good” and ‘bad” nursing
contained in the records. From these
observations she formulated the deliberative
nursing process.
 

Person { Human
Being}
 A developmental being with
needs.
 Nursing clients are patients
who under medical care and
who cannot deal with their
needs or who cannot carry
out medical treatment alone.

Health
 A sense of adequacy or well 
being.
 Fulfilled needs.
 Sense of comport

Environme
nt
 Not Defined
 Sense of comport.
 Fulfilled needs

Nursing
 Is a dynamic nurse patient relationship.
 Is a responsive to individuals who suffer or
anticipate a sense of helplessness.
 The goal of nursing is increased sense of well
being, increase in ability, adequacy in better
care of self and improvement in patient’s
behavior.
 Nursing are composed of direct function,
disciplined and professional activities and
automatic activities.

a. Direct Function – Process of helping the patient
express the specific meaning of his behavior in order
to ascertain his distress and helps the patient to
explore the distress in order to ascertain the help
requires so that his distress may be relieved.
b. Indirect function – Calling for help of others,
whatever help the patient may require for his need
to be met.
c. Disciplined and Professional activities – Automatic
activities plus matching of verbal and non-verbal
responses, validation of perceptions, matching of
thoughts and feelings with action.
d. Automatic activities – Perception by five senses ,
automatic thoughts automatic feeling and automatic
action.
 

CHARACTERISTICS OF
THE THEORY
Orlando's theory interrelate concepts.
Orlando's theory has a logical nature.

Orlando's theory is simple and applicable in the daily
practice.
Orlando's theory contribute to the professional
knowledge.
Orlando's theory is applicable in clinical practice.

The major dimensions of Orlando’s 
Nursing Process Theory
Professional nursing function- organizing 
principle.
The patient’s presenting behavior  
-Problematic situations.
Immediate reaction - internal response.
Deliberative nursing process - reflective 
inquiry.
Improvement - resolution.

1.Professional Nursing
Function –
Finding out and meeting the patient’s immediate needs for
help{Orlando, 1972}

Organizing
Principle
The nurses unique function is finding out and meeting the
patients immediate needs for help.

The nurse’s unique function is “Finding out and meeting th
patients immediate needs for
Nursing is responsive to individuals who suffer or anticipa
a sense of helplessness, it is focused on the process of care
an immediate experience, it is concerned with providing
direct assistance to individuals in whatever setting they are
found for the purpose.

 The patient’s sense of helplessness, stress, or need
originates from physical Limitations, adverse reaction
to the setting, and experiences that prevent a patient
from communicating his or her needs.
 “ Need is situationally defined as a requirement of the
patient which, if supplied, relieves or diminishes his
immediate distress or improving his immediate sense of
adequacy or well-being”
 Nurse’s responsibility to meet the patient’s immediate
needs for help either by supplying it directly or by
calling in the services of others.
 The central core of the nurse’s practice is to understand
what is happening between the patient and the nurse
that provides framework for the help the nurse gives
the patient.
 Nursing Thought “ Does the patient have an immediate
need for help or not.
 If the patient is in need and the need is fulfilled , the
nursing function has been fulfilled.

 If the patient is need the nurse’s focus of
inquiry is always on the patient’s immediate
experience.
 The product of meeting the patient’s
immediate need for help is improvement
helplessness.
"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

The Patient’s Presenting
Behavior – Problematic
Situation
 To find out the immediate need for help the nurse 
2.

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.
 

3.
Immediate
reaction 
- internal
response


The problematic situation, in the form of patient’s
presenting behavior triggers an automatic immediate
reaction in the nurse that is both cognitive and affective.

Example: Requests, comments ,questions ,crying, pallor,
difficulty of breathing Assumptions.




The nurse’s immediate reaction is unique for each
situation, What the nurse thinks or feels reflects his or her
individuality.
The extent of nurse’s accuracy, the perceptions that
evoked the thoughts are communications from the
patient.




4.Deliberative Nursing
Process
- Reflective
The nurse’s behavior
affects the patient and
the nurse is affected by the patient’s behavior.
ToInquiry
be successful the nurse’s focus must be on

the patient rather than on an assumption that
he/she knows what the patients problems are
and on arbitrary decision what action to take.
 The use of Orlando’s {1961} deliberative
process requires that there are
communication process between the patients
and nurse









By determining of this
The meaning of patients behavior
The help required by the patient
Whether the patient was helped by the nurse’s action.
The nurse will find more efficient to find out what the patient’s
immediate need for help is by first exploring and understanding
the patient’s.
Feeling come from the thought about the perception. The nurse
must state the perception that evoked the thought from which
the feeling was derived.

Example:





Nurse: I’m concerned that you keep asking for the bedpan, But I
don’t think you really need it. I am right or not.
Patient: Yes, But I’m afraid I might have chest pain again and
then I wouldn’t be able to call for the nurse.
If Nurses do not resolve their feelings with patients, these same
feelings occur each time they are in contact with the patient.
A nurse’s past experiences are not sufficient as the basis for
understanding the patient’s immediate behavior.

5. Improvement – re
 It is not the nurse’s activity that is
evaluated but rather its result. When the
patient’s immediate need for help have
been determined and met, there is
improvement.
 It is not the nurse’s activity that is
evaluation but rather it’s the result.
 When a situation becomes clear, it loses
its problematic character and a new
equilibrium is established.
 In each contact the nurse repeats a
process of learning how to help the
individual patient.

Assumptions
      The theory assumes that a patient who cannot cope
with their medical needs without assistance will become
distressed and begin feeling helpless. At the base level,
nursing can contribute to this distress. However, Orlando
theorized that the nurse/patient relationship is one that
is decided by both parties. The patient cannot
appropriately convey their needs or fears without first
establishing a close relationship with the nurse. As such,
nurses exist to offer patients a motherly and nurturing
presence to relieve distress.

The action process in a person-to person 
contact functioning in secret. 
    The perceptions, thoughts and feelings 
of each individual are not directly 
available to the perception of the other 

         - The action process in a person-to person contact 
functioning by open disclosure.      
The perceptions, thoughts, and feelings of each individual are 
directly available to the perception of the other individual 
through the observation action

Assessing

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

 
1.Guiding principle 
Finding out and meeting the patient’s 
immediate need for help

 
The nurse’s  focus is on the patient. 
The nurses mind is free of distracting 
thoughts.

2. Problematic situation and immediate   The nurse recognizes that a patient 
reaction
problem may exist before the next 
step in the process.
The nurse identifies his or her immediate 
perception, thoughts and feelings.
 
3. Inquiry-problem determination

 The nurse use terms the patient can 
understand and explores immediate 
reactions with the patient to discover 
physical/non-physical problems. As 
the problem is identified, the nurse 
asks the patient to confirm.
        The nurse explores the 
disagreement   to determine basis.

4. Identifying specific plans for 
each problem

 With the patient, the nurse determination
actions needed and develops plans for each 
problem.
The nurse explores whether the patient’s 
agree with or refutes the plan. The nurse 
explores and resolves the basis of 
disagreement. The patient verbally and or 
non verbally agrees. If not, the nurse 
continues the inquiry for the basis.

5. Implement

 If the patient is unable , the nurse 
implements the plan and asks the 
patient whether the action I 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.
 

   6.Improvement 
 
 
 

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

Nursing
Process Theory

The Nursing Process was based on a theory 
developed by nurse Ida Jean Orlando, This theory 
delves into the purpose of nurses and their 
requirements in the medical field. Orlando's theory 
was developed in the late 1950s from observations 
she recorded between a nurse and patient. Despite 
her efforts, she was only able to categorize the 
records as "good" or "bad" nursing. It then 
dawned on her that both the formulations for 
"good" and "bad" nursing were contained in the 
records. From these observations she formulated the 
deliberative nursing process. 

“A  Deliberate nursing process has 
elements of Continuous reflection as the 
nurse tries to understand the meaning 
to the patient of the behavior she 
observes and what he needs from her in 
order to helped.
Responses comprising this process are 
stimulated by the nurse’s unfolding 
awareness of the particulars of the 
individual situation.”




 
 

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 the nurse find out 
the nature of the distress and what help the 
patient needs. Orlando's theory remains one the 
of the most effective practice theories available.

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