Theorist’s Background
Ida Jean Orlando was an outstanding theorists, and significant contributor to the nursing profession. She was born on August 12, 1926 in New Jersey and was the fourth of six children. She was a first generation American with Italian heritage. Her father was a mechanic and her mother a homemaker. She grew up in the depression era, and wanted to study nursing to better her life. Her mother was reluctant to allow this, but eventually gave in. Orlando obtained her nursing diploma in 1947, and in 1951 she earned her bachelor of science in public health. Three years later in 1954 she achieved her masters of arts in mental health. During her career she worked as an Associate Professor of Nursing, Director of the Graduate Program in Mental Health Psychiatric Nursing, Clinical Nursing Consultant, director of research projects, and Assistant Director of Nursing for Education and Research. She worked at a variety of hospitals and nursing schools in New England where she also worked as a national and international consultant and speaker for nursing. In 1961 she married the love of her life Robert Pelletier. In 1992, Orlando retired and received the Nursing Living Legend award by the Massachusetts Registered Nurse Association. She passed away on November 28, 2007 at 81 years of age.
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Although she was in administration and nursing in Obstetrics, medical surgical, and emergency nursing, she was also an educator. Orlando devoted her life to mental health and psychiatric nursing, working as a clinical nurse and researcher (American Psychiatric Nurses Association, 2016). Ida Jean Orlando received a Bachelor of Science degree in public health nursing from St. John’s University in Brooklyn, New York. And in 1954, Orlando received her Master of Arts degree in mental health consultation from Teachers College, Columbia University. She left Yale University that same year she married in 1962, and began working as a clinical nursing consultant at McLean Hospital in Belmont, Massachusetts. She became the first psychiatric nurse in the United States to receive a research grant from the National Institute of Mental Health (NIMH). The project was called Two Systems of Nursing in a Psychiatric Hospital. Through this grant, she was able to perform a comprehensive study of the deliberative nursing process. Furthermore, she used the results to teach the instructors, supervisors and nursing staff to use this process to understand the needs of patients. This was the initial forethought into research where a nursing process was studied with a scientific approach (American Psychiatric Nurses Association, 2016). Meleis (2010) note that Ida Jean Orlando was the first to use field methodology in research before it was a primary focus by all in research. Because of Orlando and her studies nurses were given evidence based reasoning to use their experience and intuition to meet the needs of the patient and family.
Orlando developed her theory from a study conducted at the Yale University School of Nursing. In her research Orlando was the principal investigator at the Yale School of Nursing Project. Her goal was to identify and relate the nurse-patient relationship, describe the nurse’s professional role and identity and ascertain knowledge development distinct to nursing. Orlando and her studies nurses were given evidence based reasoning to use their experience and intuition to meet the needs of the patient and family. Over three years she personally observed over two thousand nurse-patient interactions, diligently taking noted and classifying interactions as either “good” or “bad” nursing (Macapaz, 2011). This simple form of identification helped her realize how the patient felt in their own views about what was happening to the patient.
Theory Description
Ida Jean Orlando created a middle-range nursing theory called The Deliberative Nursing Process. Orlando’s theory foundation is that the role of the nurse is to establish and meet the patient’s immediate needs. She believed all patient behavior could be a cry for help and the patient may be unable to express or determine what it is they really need (Gonzalo, 2019). The theory allows nurses to create a nursing care plan that can be easily adapted when and if any complications arise with the patient. She proposed that patients have their own meanings and interpretations of situations and therefore nurses must validate their inferences and analyses with patients before drawing conclusions. Orlando also believes that the nurse patient relationship is a key factor in ensuring the patient is involved and a part of their nursing care plan to achieve optimal healthcare outcomes.
Theory Concepts
Her theory was first published in 1961 in The Dynamic Nurse-Patient Relationship: Function, Process and Principles. The book purposed emphasis on the nurse-patient relationship, the nurse’s professional role, the nurse’s identity and the knowledge development that is distinct to nursing (Gonzalo, 2019). In the book, she stresses the relationship between a nurse and his/her patient. Her theory has five stages; assessment, diagnosis, planning, implementation, and evaluation. The function of the nurse is the main concept in all of the stages and her theory provides the framework for nursing.
Theory Diagram
Orlando’s beliefs are that a nursing care plan that involves the patient’s participation is crucial in achieving optimal health. She believed every patient should have input in their care. In the assessment stage it is the nurse’s job to evaluate the patient’s behavior and determine what their needs are. At this point the nurse recognizes nursing diagnoses that are unique to the individual patient’s needs. The nurse uses a holistic approach when assessing the patient’s needs and behaviors. Then, in the planning phase the nurse and the patient are involved in creating a plan of care including short and long term goals. These goals need to be clear, concise and attainable for the patient. The implantation stage is where the nurse and patient’s plan goes into motion. It’s the nurse’s responsibility to monitor the patient and ensure they are implanting the plan as discussed. Documentation in the patient’s chart is also a necessary step in the process so that when the evaluation stage begins there is a history to go by. The nursing process is an ongoing process. Evaluation involves analyzing the success and/or failure of the current goals and interventions. Evaluation also includes examining the need for changes to plans. At this point, the health care team will compare the patient from step one all the way to step 5 to determine if the goals have been achieved or not (Petiprin, 2016).
Assumptions
- When patients feel they are unable to cope they start having feelings of helplessness.
- Professional nursing character can add stress to the patient.
- Every patient responds differently.
- The profession of nursing deals with people, environment, and health.
- Patients need help communicating what their needs are.
- Patients are able to hide their needs, thoughts, and feelings.
- The nurse and the patient influence the actions and reactions.
- Patients attach meanings to situations.
- Patients enter into nursing care through medicine.
- The patient isn’t able to communicate the nature and meaning of their distress without the nurse’s help.
- Nurses are concerned with the patient’s needs that the patient is unable to meet alone without help. (Petiprin, 2016).
Metaparadigm
The nursing metaparadigm has four key components; person, environment, health and nursing. Orlando’s theory only incorporates three of the metaparadigms. The three she focuses on are person, health and nursing. Orlando specifies that a human in need is our patient and that is what nursing is. As far as health goes, she focuses more on the patient’s helplessness. The things the patient may need that they don’t even know they are lacking. 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 needs are carried out in an interactive situation and in a disciplined manner that requires proper schooling and training. This is also one of downfalls of her theory is that the nurse addresses immediate needs, but long term needs are equally important. Looking ahead past the current situation is something this theory is lacking. Personally, I think the reason she only mentions those three are because environment is included with the person/patient. When assessing the patient’s needs, if there is an issue with the environment it will be included in the nursing care plan (Thompson, 2017).
Evaluation
The goal of the nursing theory is to help the patient. In nursing school, the basic foundation of nursing is the nursing process and nurse to patient relationship. Orlando established the framework for students to be a better nurse for the patient. Her theory places emphasis on the patient as an unique individual. In my opinion, she views each patient as a rubrics cube, and it is the nurse’s responsibility to figure out how to align it correctly. It is our job to focus on the steps required to help our patients reach their healthcare goals. I unknowingly use Orlando’s deliberative nursing process every day in my nursing career. Assessment and planning are two key factors I use daily with each patient at my surgery center. Every day I encounter a patient that has needs that is my job to figure out how to get their needs met effectively. Each surgery that is scheduled through our clinic requires the nursing process to be used. Transportation, medications, pre-admission instructions and surgery education are details that I and the patient work together on. I had a patient this week that needed a colonoscopy, but she also needed an endometrial ablation performed by another physician at our facility. These two doctors do not operate on the same day. However, what is best for the patient is for these two procedures to be performed on the same day so that the patient only has to be sedated once. After discussing the issue with the patient, I spoke with my doctor and he agreed that we could start clinic thirty minutes later on the day the other surgeon has OR time so she can have it all done on the same day.
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Weaknesses and Strengths
The weaknesses of this theory are it is modeled to take care of the patient’s immediate needs. Long term issues aren’t taken into consideration. The concept of interaction also limits it to individuals capable of having a conversation, a shared limitation with many other nurse-client dynamic theories; unconscious patients are not included by this theory. The theory does ensure that patients will be treated as individuals are very much applied in Orlando’s theory of Deliberative Nursing Process. Every patient will have an active, constant, and valuable input into their own plan of care.
Conclusion
Orlando’s nursing theory stresses the importance of the relationship between the nurse and patient. What the patient and nurse says and does has an effect on them both. Orlando views the professional function of nursing as finding out and meeting the patient’s immediate need for help. She was one of the first nursing leaders to identify and emphasize the elements of the nursing process and the critical importance of the patient’s participation in the nursing process. Orlando’s theory focuses on how to provide improvement in the patient’s behavior. Evidence of alleviating the patient’s distress is seen as positive changes in the patient’s demonstrated behavior. Orlando has helped facilitate the development of nurses as logical thinkers. The Deliberative Nursing Process helps nurses achieve more successful patient outcomes. Orlando’s theory remains a most effective practice theory that is especially helpful to new nurses as they begin their practice.
References
- Gonzalo, A., (2019). Nurse labs. Ida Jean Orlando’s deliberative nursing process theory. Retrieved from https://nurseslabs.com/ida-jean-orlandos-deliberative-nursing-process-theory/
- Orlando, I. J. (1990). The dynamic nurse-patient relationship: Function, process and principles. In George, J. (Ed.). Nursing theories: the base for professional nursing practice. Norwalk, Connecticut: Appleton & Lange.
- Petiprin, A., (2016). Nursing theory. Ida Jean Orlando- Nursing theorists. Retrieved from https://nursing-theory.org/nursing-theorists/Ida-Jean-Orlando.php
- Thompson, C.J., (2017). Nursing education expert. What is the nursing metaparadigm? Retrieved from https://nursingeducationexpert.com/metaparadigm/
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