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Ida Orlandos

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Heather Gulian, Lara Kim, Angela Kramer, Beth Smith

‡ How does this patient make you feel? ‡ What do you think they need? ‡ What would you do for them as a nurse?

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Nursing diploma
New York Medical College

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BS- Public Health Nursing
St. John's University, NY

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MA- Mental Health Nursing
Columbia University, NY

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Director of Mental Health Psychiatric Nursing Graduate Program
Yale SON, CT

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NIMH ± Research grant
Integration of Mental Health Concepts in Basic Nursing Curriculum

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Observed patient-nurse interactions
³Good´ ± effective ³Bad´ ± ineffective

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How can you analyze ³good´ and ³bad´ nursing without defining nursing, its function, and its desired outcome? GOAL: ³To develop a µtheory of effective nursing practice¶ that would identify a distinctive role for the professional nurses that would provide a systematic foundation for the study of nursing.´
(Schmieding, 2006, 433)

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1961 ± The Dynamic NursePatient Relationship: Function, Process, and Principles of Professional Nursing Practice 1962 ± Employed as a Clinical Nurse Consultant at McLean Hospital in MA
Grant to develop a nursing training program based on her theory

McLean

ital, nd.

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1972 ± The Discipline and Teaching of Nursing Process: An Evaluative Study

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Distress is the experience of a patient whose need has not been met. Nursing role is to discover and meet the patient¶s immediate need for help.
Patient¶s behavior may not represent the true need. The nurse validates his/her understanding of the need with the patient.

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Nursing actions directly or indirectly provide for the patient¶s immediate need. An outcome is a change in the behavior of the patient indicating either a relief from distress or an unmet need.
Observable verbally and nonverbally.

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Shifted from care based on medical diagnoses to care based on patients¶ immediate needs. MD¶s orders are assigned to patients not to nurses.
If nurses focus on orders (versus immediate patient needs), it keeps the nurse dependent. Immediate needs may include assisting the patient to comply with the doctor¶s orders.

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Patient¶s Behavior ‡ May represent an unmet need

Nurse¶s Reaction ‡ Perception ‡ Thoughts ‡ Feelings

Nurse¶s Explicit Reaction ‡ Validate/correct understanding of the need

Nurse¶s Action ‡ Meet the patient¶s immediate need

Pelletier, 1968.

Pelletier, 1968.

‡ Stresses the reciprocal relationship ‡ Automatic actions are carried between the nurse and patient. out for reasons other than ‡ Nurse seeks verification or correction of meeting the patient¶s immediate his/her thoughts with the patient. needs. ‡ Patients¶ needs and nurses¶ reactions to ‡ Prevents the responsibility of nursing from being performed. each need are unique.

(Potter & Tinker, 2000)

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A patient is frequently asking the nurse to do things for him that he could do for himself. The nurse initially feels frustrated and that the patient doesn¶t want to help himself. However, the nurse also realizes that something else may be going on. The nurse asks, ³I feel like you could be doing many of these things on your own. Is there something else you need?´ The patient replied that when he was upset it was reassuring to have a nurse come into the room.
(Schmieding, 1984)

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Health Promotion & Protection, Disease Prevention & Treatment
Open communication with patient in order to determine their healthcare needs and develop effective diagnoses and care plans
Teenage female requesting birth control (Sylvia Wood)

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Nurse-Patient Relationship
Promotes effective communication between nurse and patient

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Teaching-Coaching
Evaluating patient¶s needs, promoting behavioral changes, evaluating outcomes with the patient

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Professional Role
Allows for autonomy in nursing role Interdisciplinary boundaries: ³If I do that, I won¶t be able to do my job, which is to observe the patient and find out and meet the patient¶s needs for help.´ (Schmieding, 1984, p761) Nursing accountability Understanding supervisee true needs: A nurse¶s request for a weekend off may represent his/her dissatisfaction with another nurse that is scheduled to work that weekend as well. (Schmieding, 1984, p761)

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Managing/Negotiating health care delivery systems
Control costs by focusing care on immediate needs, not unnecessary tasks Patient requests codeine, and the nurse explores the pain sensation. The patient shows the nurse the afflicted area, and the nurse sees the discomfort may be due to the old tape adhesive. After removing the adhesive, the patient states that the area feels much better and that the codeine she had received the night before had been ineffective. (Orlando, 1961)

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Monitoring and ensuring the quality of health care practice
Validating that needs are met and that nursing action provided a positive outcome

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Cultural competence
Keeps the nurse from labeling patients and staff

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Concepts are observable, however these vary from case to case as outcomes are based on both patients and nurses perception of the interaction Research tools are specific to the outcome being measured (i.e. anxiety, pain)
Surveys, questionnaires, and other tools which measure patient outcome, nursing process, nurse empathy, and patient perceived empathy.

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Studies supporting the theory
Pilot study (2000) ± implemented Orlando¶s theory resulting in:
x Positive, patient-centered outcomes x A staff-patient approach model x Decreased patient (immediate) stress

VA study (1987) ± implemented theoretical model with bipolar patients. Results indicate:
x x x x Higher patient retention Reduction of emergency services Decreased hospital stay Increased patient satisfaction

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The relative simplicity of the theory lends itself well to internal consistency. Semantic inconsistency:
Theory Title:
x Deliberative Nursing Process (1961) x Nursing Process Discipline (1972)

Nursing action:
x Good Effective (Deliberative) x Bad Ineffective (Automatic)

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Requires education to implement:
Orlando¶s 1972 book introduces and evaluates a training program.

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Compatible with expectations for nursing practice:
May appear more time consuming initially, but assists the nurse in meeting true needs the first time.

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Very applicable to real-world nursing situations improve patient outcomes
Every face-to-face interaction.

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Favorable outcomes:
Patient needs are met Research shows deliberative nursing process is more likely to produce favorable outcomes then automatic nursing process.

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Feasibility:
Feasible to teach. Unrealistic to expect all nurses to internalize this model.

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Care is patient-focused
Patients are treated as individuals

Patients assume active role in their care The theory can be learned Applicable in various settings
clinical/educational/administrative

Facilitates cultural understanding and respect
Needs are met regardless of cultural or language barriers

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Allows cost and time-saving measures as actions are based on meeting ³immediate needs´ and avoiding unnecessary tasks

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Conceptual model:
Emphasizes the internal reaction of the nurse Needs to expand more on the process of validation

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Metaparadigm, concepts, propositions, and philosophical claims:
Present and clearly stated, but not explicitly identified in a systematic manner Implicit and not completely clear on how they were derived

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No bibliographic references:
Some feel the vast majority of her work was Orlando¶s original thought, not stemming from antecedent knowledge Others feel her theory incorporates the underpinnings of multiple theories including: Peplau¶s Interpersonal Relationships (nursing), Symbolic Interaction (sociology), Dewey¶s Theory of Inquiry (philosophy, psychology), and Behavioral Theory (psychology)

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Clear and Concise
Yes:
x Limited in concepts, propositions, and variables.

No:
x Some concepts are expanded upon in a second book.

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Focus is on short-term care Requires training from a qualified nurse Does not apply to all patients
Pediatrics Unconscious Mentally-ill/impaired

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Does not address the family/caregiver Simplicity of theory masks the intricacy of the nurse-patient dynamic

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Defined nurses¶ role focusing on patients¶ need rather than MD¶s orders Provide nurse¶s with autonomy Enriches nursing¶s unique body of knowledge Strengthens nurse/patient relationship
Positive patient outcomes

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Apply to other fields in order to validate the needs of clients
Psychology: counseling Customer service

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Develop a unique/modifiable tool that applies this theory in various clinical settings to achieve positive outcomes Focus on long-term care needs

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Helene Fuld Health Trust (Producer) (1990). The Nurse Theorists: Portraits of Excellence: Ida J. Orlando Pelletier [Motion picture]. United States: Samuel Merritt College Studio Three. National Organization of Nurse Practitioner Faculties (2006). Domains and core competencies of nurse practitioner practice. Access October 25, 2009 from https://sakai.plu.edu/access/content/group/NURS523_01_20233_FALL2009/Articles/CoreComps.pdf. Orlando, I.J. (1972). The Discipline and Teaching of Nursing Process: An Evaluative Study. NY: G.P. Putnam¶s Sons. Orlando, I. J. (1990). The Dynamic Nurse-Patient Relation: Function, Process, and Principle. NY: National League for Nursing. Potter, M.L. (2009). Deliberative nursing process. In Peterson, S. J. & Bredow, T. S. (Eds.) Middle Range Theories: Application to Nursing Research (2nd ed). (304-325). Philadelphia: Lippincott Williams & Wilkins. Potter, M. & Bockenhauer, B. (2000). Implementing Orlando's nursing theory: A pilot study. Journal of Psychosocial Nursing & Mental Health Services, March, 38(3), 14-21. Potter, M. & Tinker, S. (2000). Put power in nurses' hands: Orlando's nursing theory supports nurses simply. Nursing Management, July, 40-41. Schmieding, N. J. (1984). Putting Orlando¶s theory into practice. Journal of Advanced Nursing, 84(6), 759-761. Schmieding, N. J. (1987). Analysing managerial responses in face-to-face contacts. Journal of Advanced Nursing, 12, 357-365. Schmieding, N. J. (1989). An integrative nursing theoretical framework. Journal of Advanced Nursing, 15, 463-467. Schmieding, N. J. (2006). Nursing process theory. In Tomey, A.M. & Alligood, M. R. (Eds.), Nursing Theorists and their Work. (431-451). St. Louis: Mosby Elsevier.

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