Ida Jean Orlando 1926-2007

Ida Jean Orlando 1926-2007

Deliberative Nursing Process Theory

(August 12, 1926 – November 28, 2007) was an

internationally known psychiatric health

nurse, theorist and researcher who

developed the “Deliberative Nursing

Process Theory.”

• She was born on August 12, 1926.

• She received her nursing diploma from

New York Medical College at the Lower

Fifth Avenue Hospital School of Nursing.

• Bachelor of Science in Public Health from St. John’s University in

Brooklyn, and Master’s Degree in Mental Health Nursing from

Teachers College, Columbia University.

• associate professor at Yale School of Nursing and Director of the

Graduate Program in Mental Health Psychiatric Nursing.

• She developed the “Deliberative Nursing Process Theory.” or Nursing

Process Theory or Nursing Process discipline. Her theory allows

nurses to create an effective nursing care plan that can be easily

adapted when and if any complications arise.

• She died on November 28, 2007, at the age of 81.

Deliberative Nursing Process

is set in motion

by the behavior of the patient.

According to the theory, all

patient behavior can be a cry for

help, both verbal and non-verbal,

and it is up to the nurse to

interpret the behavior and

determine the needs of the

patient.

Deliberative Nursing Process

“Patients have their own

meanings and interpretations of

situations and therefore nurses

must validate their inferences

and analyses with patients

before drawing conclusions.”

Nursing

Orlando speaks of nursing as unique and independent in its concerns for an individual’s need for help in an immediate situation. The efforts to meet the individual’s need for help are carried out in an interactive situation and in a disciplined manner that requires proper training

Person

rlando uses the concept of human as she emphasizes individuality and the dynamic nature of the nurse-patient relationship. For her, humans in need are the focus of nursing

practice.

Health

In Orlando’s theory, health is replaced by a sense of helplessness as the initiator of a necessity for nursing. She stated that nursing deals with individuals who are in need of help.

Environment

Orlando completely disregarded environment in her theory, only focusing on the immediate need of the client, chiefly the relationship and actions between the nurse and the client (only an individual in her theory; no families or groups were mentioned). The effect that the environment could have on the client was never mentioned in Orlando’s theory.

Professional Nursing Function-Organizing Principle

– The nurse finds the patient’s immediate need for help.

The Pt’s Presenting Behavior /Distress

– Arise when the client

experiences a need that he cannot resolve, a sense of helplessness.

Immediate Reaction

- The internal response. This reflects how the

nurse experiences his or her participation in the nurse-client

relationship.

Deliberative nursing process/Nurse reaction

– Stimulated by the

client’s behavior. This marks the beginning of the nursing process

discipline.

Improvement-Resolution

– This reflects the nursing process

Assessment

In the assessment stage, the nurse completes a holistic

assessment of the patient’s needs.

Diagnosis

The diagnosis stage uses the nurse’s clinical judgment about

health problems.

Planning

The planning stage addresses each of the problems

identified in the diagnosis.

Implementation

The nurse begins using the nursing care plan.

Evaluation

The nurse looks at the progress of the patient

toward the goals set in the nursing care plan.

Changes can be made to the nursing care plan

based on how well (or poorly) the patient is

progressing toward the goals.

5 Stages of the

Deliberative Nursing

Process

Assessment

the nurse completes a holistic

assessment of the patient’s needs.

Diagnosis

uses the nurse’s clinical judgment about

health problems.

Planning

addresses each of the problems

identified in the diagnosis.

Implementation

The nurse begins using the nursing care plan.

Evaluation

The nurse looks at the progress of the patient

toward the goals set in the nursing care plan.

Changes can be made to the nursing care plan

based on how well (or poorly) the patient is

progressing toward the goals.

Practice

Orlando’s nursing process theory is very easy to understand, easy to use,

and focuses on the client. It is clear enough to be used by the beginning

nursing student and comprehensive enough for more advanced

practitioners. It is one of the most effective theories in nursing and

prioritizes the needs of the client rather than protocol. It is the basis of

practice in hospitals. It is used at the client care level, managerial level,

and nursing division level.

Education

Orlando’s process recording has made a significant contribution to

nursing education. Process recording is a tool to facilitate self-evaluation

of whether or not the process discipline was used.

Research

The theory of Orlando has enjoyed considerable acceptance

by the nursing profession in the area of research and has been

applied to a variety of research settings. Evidence of relieving

the client’s distress is seen as positive changes in the client’s

observable behavior. The Deliberative Nursing Process helps

nurses achieve more successful patient outcomes such as fall

reduction.

Clarity

Orlando’s theory is clear. It involves defining concepts minimally at first and then developing

them throughout her books. If Orlando’s theory is incorporated into nursing practice, it will

ensure that the clients are treated individually. This theory also helps in the accurate diagnosis

and keeps the practitioners away from ineffective planning. Orlando’s theory has set a guideline

for the nurse so that they can evaluate outcome of client.

Simplicity

The theory’s simplicity disguises the complexity of its use. Learning to use it requires its

deliberate use, followed by a self-reflective analysis of one’s action process. Practicing to

separate one’s perceptions, thoughts, and feelings allow nurses to analyze their practice to see

whether they have incorporated all or part of their immediate reaction into the action they

have taken with the client. If this is done, the nurse will include the client as a reciprocal partner

in determining both the immediate need for help and the action that will best meet the client’s

need, thus relieving the client’s distress. The theory of Orlando is simple, there are few

concepts and relationships; it is able to make some predictive statements as opposed to just

description and explanation.

Generality

Orlando’s theory focuses on a limited number of situations; it could be

adapted to other nursing situations and other professional fields.

Accessibility

Orlando’s theory benefited research application; two-thirds of her second

book is a report of a research project designed to test the validity of her

nursing formulations.

Importance

Beneficial in achieving valued outcomes; research demonstrated that the

use of a disciplined professional response enables the nurse to ascertain

and meet the client’s needs; the study of what the client says and does in

their practice and the resulting effect is valuable content for nursing

education.