IDA JEAN ORLANDO'S DELIBERATIVE NURSING PROCESS

UNIT 3 HAND OUT: Grand Nursing Theories Based on Interactive Process

• Focus: Emphasizes relationships in nursing, patient impacts, and their interactions with the environment, people, and situations.

• Organization: Melanie McEwen categorizes nursing theories into grand theories based on:

  • Human needs

  • Interactive Process

  • Unitary process

  • Middle-range theories

• Philosophical Basis: Theories depict humans as holistic beings interacting and adapting to their situations, highlighting continual interactions with their environments.

Deliberative Nursing Process Theory by Ida Jean Orlando

Background

• Ida Jean Orlando: Renowned psychiatric health nurse and theorist. Developed the Deliberative Nursing Process Theory to create effective care plans adaptable to evolving patient needs.

• Nursing Process: A systematic method for assessing healthcare needs, whether the individual is healthy or ill.

Theory Development

• Developed from research at Yale University School of Nursing, integrating mental health concepts into nursing practice.

• Reciprocal Relationship: Highlights the interaction between nurse and patient and the impact of their actions and expressions on each other.

• Focus on Helplessness: Nursing aims to address individuals' immediate needs for help in feelings of helplessness.

Key Terms

• Distress: Indicator of unmet needs in patients; nursing role involves discovering and addressing these needs.

• Patient Behavior: This may not always represent true needs; validation with the patient is crucial.

• Nursing Actions: Provide for immediate needs, leading to observable behavioral changes indicating improved outcomes.

Major Dimensions of Orlando's Theory

• Validation of Patient Interpretation: Understanding patients' meanings behind situations is essential; nurses must confirm their conclusions with patients.

• Finding Immediate Needs: Nurses must discern the real help needed beyond just the presenting behavior.

• Perception and Response: Nurses should explore emotions and thoughts linked to patient behavior to assess distress.

Nursing's Metaparadigm in Orlando's Theory

1. Human Being: Individuality is key; the focus is on those in need.

2. Health: Defined by a sense of helplessness guiding nursing interventions.

3. Environment: Primarily focused on immediate nurse-patient interactions, neglecting wider environmental factors.

4. Nursing: Recognized as independent, addressing immediate individual needs through interactive methods.

Five Major Interrelated Concepts

1. Function of Professional Nursing: Organizing principle; focus on immediate needs.

2. Presenting Behavior: Identifying the problematic situation that indicates patient needs.

3. Immediate Reaction: Internal responses to patient behavior guide the nursing process.

4. Nursing Process Discipline: Investigative approach to ascertain patient needs through observation and interaction.

5. Improvement: Evaluation of whether nursing actions effectively facilitated communication of needs.

Stages of the Deliberative Nursing Process

1. Assessment: Comprehensive evaluation without preconceived notions; gathers subjective and objective data.

   • Example: Subjective: Patient reports coughing; Objective: Observations of lung condition.

2. Diagnosis: Applying clinical judgment to identify health problems based on assessment data.

   • Example: Ineffective airway clearance identified through assessment.

3. Planning: Develop specific outcomes and nursing interventions for identified problems.

   • Example: Setting goals for clear airways through targeted interventions.

4. Implementation: Executing the nursing care plan and interventions.

   • Example: Carrying out the nursing actions outlined in the plan.

5. Evaluation: Assessing patient progress towards set goals, allowing for plan adjustments if necessary.

   • Example: Determining if breath sounds improved.