IDA JEAN ORLANDO

A Close Encounter

RAMELDA G. VILLARAZO, RN
MASTERAND
NURSING PROCESS
DISCIPLINE

The Theorist:
IDA JEAN ORLANDO - PELLETIER
 OBJECTIVE
S:
After an hour of interactive discussion, the masterand will
be able to:
• Cite the credentials and background of Ida Jean Orlando
• Relate a Case Scenario pertaining to the theory
• Define the metaparadigm of nursing in Orlando’s theory
• Describe the historical background of the development of Orlando’s
Nursing Process Discipline
• Present the theoretical assumptions in relation to her theory
• Discuss thoroughly the Nursing Process Discipline of Orlando with a
conceptual framework presentation
• Discuss how the community accepted the theory and its application
• Identify strengths and weaknesses of the Nursing Process Discipline
for clinical practice
Nursing theorist in focus…
 A first-generation American of Italian
descent
 Birth date : August 12, 1926
 Birthplace : New York
 Husband : Robert Pelletier
(lived in Boston)
 Death date : November 28, 2007
EDUCATIONAL BACKGROUND:
1947 - Diploma in Nursing, New
York Medical College
1951 - B.S. in Public Health
Nursing, St. John's
University, Brooklyn, New York
1954 - M.A. in mental health
consultation, Columbia
University, New York
NURSING CAREER:
• Staff nurse, varied specialties (OB, MS, ER)
• Supervisor in a General Hospital
• Research Associate & Principal Investigator of a Federal
Project entitled “Integration of Mental Health Concepts in a
Basic Curriculum” at Yale University in New Haven,
Connecticut (1954-1961)
• Clinical Nursing Consultant in Mental Health, McLean
Hospital in Belmont, Massachusetts (1962-1972)
• Served on various committees at Harvard Community
Health Plan in Boston, Massachusetts since 1972
• Nurse Educator for Metropolitan State Hospital in Waltham,
Massachusetts in 1981
• Assistant Director of Nursing for Education and Research
at Metropolitan State Hospital (September1987)
• Retired in 1992
 ATTAINMENTS & HONOR:
Books Published:
 1961 - “The Dynamic Nurse-Patient Relationship:
Function, Process and Principles”
 1967 - “The Patients Predicament and Nursing
Function ” an issue of Psychiatric Opinion
 1972 - “The Discipline and Teaching of Nursing
Process : An Evaluative Study”

• Conducted Training Programs at McLean Hospital

• Managed 60 workshops about her theory in USA and Canada (1972-1981)
• Outstanding Nurse in the Hall of Fame of Massachusetts Nurse’s Association
in 2001
 CASE SCENARIO
Mrs. So: “Nurse, can you give me my morphine!”
Nurse: “Can you tell how painful it is using the 0 ‐10 pain scale, where 0
being not painful and 10 being severely painful?
Mrs.So: “Ummm... I think it’s about 7. Can I have my morphine now?”
Nurse: “Mrs. So, I think something is bothering you besides your pain. Am
I correct?”
Mrs. So (crying): “I can’t help it. I’m so worried about my 3 boys. I’m
not sure how they are or who’s been taking care of them. They’re
still so young to be left alone. My husband is in Yemen right now
and he won’t be back until next month.”
Nurse: “Why don’t we make a phone call to your house so you could
check out on your boys?”
Mrs. So called up his sons. After the phone call.
Mrs. So: “Thank you nurse. I don’t think I still need that morphine. My
boys are fine. Our neighbour, Mrs. Yee, she’s watching over my
boys right now.”
 METAPARADIGM OF NURSING
PERSON
unique and developmental beings
with needs, individuals have their
own subjective perceptions and
feelings that may not be observable
directly

NURSING HEALTH
providing direct assistance to is not well-defined but
individuals in whatever setting assumed as “freedom from
for the purpose of avoiding, mental or physical
relieving, diminishing, or curing discomfort and feelings of
the person’s sense of adequacy and well-being ”
helplessness
ORLANDO

ENVIRONMENT
is not clearly defined as well but
assumed as a nursing situation when
there is a nurse-patient contact and
that both nurse and patient perceive,
think, feel, and act in the immediate
situation
 Development of Theory
• In the late 1950s, Orlando developed her theory inductively through an empirical study of
nursing practice.
• For 3 years, she recorded 2000 observations between a nurse and patient interactions.
• She was only able to categorize the records as "good" or "bad" nursing.
According to records:
*Good Nursing – nurse’s focus was on the patient’s immediate verbal and nonverbal behavior from the
beginning through the end of the contact
*Bad Nursing – nurse’s focus was on a prescribed activity or something that had nothing to do with the
patient’s behavior
• From these observations, she formulated the “Deliberative Nursing Process” which was
published in 1961.
• Conducted research at McLean Hospital through continuous tape recording of nurses with
patients and other health care members
• Based on this research, her formulations were validated, thus she extended her theory to
include the entire nursing practice system which then evolved as “Nursing Process
Discipline”
• Orlando's theory remains one the of the most effective practice theories available.
• Many theory scholars utilized her concept as basis for their further studies.
• Her work has been translated into six languages and was contained in the international section.
• A web page about her theory, developed by Schmieding in 1999, is updated periodically and
contains extensive references.
 ASSUMPTIONS:
Assumptions about Nurses:
• “The nurse’s reaction to each patient
is unique”
• “Nurses should not add to the
patient’s distress”
• “The nurse’s mind is the major tool
for helping patients”
• “The nurse’s use of automatic
responses prevents the responsibility
of nursing from being fulfilled”
• “Nurse’s practice is improved
through self-reflection”
Assumptions about Patients:
• “Patients’ needs for help are unique”
• “Patients have an initial ability to
communicate their needs for help”
• “When patients cannot meet their own
needs they become distressed”
• “The patient’s behaviour is meaningful”
• “Patients are able and willing to
communicate verbally (and non-
verbally when unable to communicate
verbally)”
ASSUMPTIONS:

Assumptions about the nurse- Assumptions about Nursing:

patient situation: • “Nursing is a distinct profession
• “The nurse-patient situation is a separate from other disciplines”
dynamic whole” • “Professional nursing has a distinct
• “The phenomenon of the nurse- function and product (outcome)”
patient encounter • “There is a difference between lay
represents a major source of and professional nursing”
nursing knowledge”
• “Nursing is aligned with medicine”
 Introduction to the Theory
"I can't move, I can't speak, I need help..."
A) The nursing process is set in motion by the Patient Behavior
- All patient behavior:
a) verbal ( a patient’s use of language )
b) non-verbal ( includes physiological symptoms, motor activity, and nonverbal
communication)
c) physical forms (vital signs)
- Must be considered an expression of a need for help and has to be validated .
- Ineffective assessment by the nurse leads nurse-patient relationship failure.
- Communication process is vital to acquire patient’s cooperation in achieving health.
Remember: When a patient’s need for help is not resolved even with the help of another, will result to
sense of helplessness.

B) The Patient Behavior stimulates a Nurse Reaction

- Nurse-patient relationship takes place.
- Correct evaluation of patient’s behavior by using the nurse reactions steps yields positive feedback
response from the patient.
The steps are as follows:
1) The nurse perceives behavior through any of the senses
2) The perception leads to automatic thought
3) The thought produces an automatic feeling
4) The nurse shares reactions with the patient to ascertain whether perceptions are accurate or inaccurate
5) The nurse consciously deliberates about personal reactions and patient input in order to produce
professional deliberative actions based on mindful assessment rather than automatic reactions.
 Remember : Exploration with the patient helps validate the patient’s behavior.
 
C) Critically considering one or two ways in implementing Nurse Action

Automatic Reaction (Non-Deliberative)

 stem from nursing behaviors that are performed to satisfy a directive other than the
patient’s need for help.
Example: The nurse who gives a sleeping pill to a patient every evening because it is
ordered by the physician, without first discussing the need for the medication with the
patient.
Rationale : Giving of the pill has more to do with following medical orders (automatically)
than with the patient’s immediate expressed need for help.
Deliberative Reaction
 is a “disciplined professional response”, that all nursing actions are meant to help
the client and should be considered deliberative.
 The following criteria should be considered.
 Deliberative actions result from the correct identification of patient needs by validation of
the nurses’s reaction to patient behavior.
 The nurse explores the meaning of the action with the patient and its relevance to
meeting his need.
 The nurse validates the action’s effectiveness immediately after compelling it.
 The nurse is free of stimuli unrelated to the patient’s need (when action is taken).

Remember : For an action to have been truly deliberative, it must undergo reflective evaluation to
determine if the action helped the client by addressing the need as determined by the nurse
and the client in the immediate situation.
 Orlando’s Nursing Process Discipline
 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 nurse find out the nature of the distress and what help the patient needs.

MAJOR DIMENSIONS OF THE THEORY

Function of Nursing
Presenting Immediate
Professional Process
Behavior - Reaction -
Nursing - Discipline –
Problematic Internal
Organizing Investigatio
Situation Response
Principle n
 MAJOR DIMENSIONS OF THE
FUNCTIONS OF PROFESSIONALTHEORY
NURSING - ORGANIZING PRINCIPLE
• Finding out and meeting the patients immediate needs for help
• 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
• The purpose of nursing is to supply the help a patient requires for his needs to be met
• Nursing thought - Does the patient have an immediate need for help or not?
• If the patient has an immediate need for help and the nurse finds out and meets that
need ,the function of professional nursing is achieved

PRESENTING BEHAVIOR – PROBLEMATIC SITUATION

• To find out the immediate need for help the nurse 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
IMMEDIATE REACTION –INTERNAL RESPONSE
• Person perceives with any one of his five sense organs an object or objects
• The perceptions stimulate automatic thought
• Each thought stimulates an automatic feeling
• Then the person acts
• The first three items taken together are defined as the person’s immediate reaction
• Reflects how the nurse experiences her or his participation in the nurse patient situation
NURSING PROCESS DISCIPLINE - INVESTIGATION
• Any observation shared and explored with the patient is immediately useful in ascertaining and
meeting his need or finding out that he is not in need at that time
• The nurse does not assume that any aspect of her reaction to the patient is correct, helpful or
appropriate until she checks the validity of it in exploration with the patient
• The nurse initiates a process of exploration to ascertain how the patient is affected by what she
says or does
• Automatic reactions are not effective because the nurses action is decided upon for reasons
other than the meaning of the patients behavior or the patients immediate need for help
• When the nurse does not explore with the patient her reaction it seems reasonably certain that
clear communication between them stops
IMPROVEMENT - RESOLUTION
• It is not the nurses activity that is evaluated but rather its result : whether the activity serves to
help the patient communicate her or his need for help and how it is met
• In each contact the nurse repeats a process of learning how to help the individual patient.
• Her own individuality and that of the patient requires that she go through this each time she is
called upon to render service to those who need her
 CONCEPTUAL FRAMEWORK

Distinguish the Theory Analyze the Theory

ACCEPTANCE by the Nursing Community:

RESEARCH

The diversity of the research using the

theory attests to its breadth of
application. It also indicates its utility
for application of the findings in:
• Perioperative Nursing
•Studying Nurse-Patient Relationships
•Advanced-Nursing Practice and
Administrations
•Responses to distressed patients
•Mental Illnesses
•Positive Patient-Centered Outcomes
ACCEPTANCE by the Nursing Community:

EDUCATION

Orlando’s nursing process theory was

recommended for teaching BSN students
and conceptualize BSN curriculums which
has an emphasis on the interaction
process and its goal on communication
and psychosocial foundations which may
translate into more effective exploratory
skills in the students.
ACCEPTANCE by the Nursing Community:

PRACTICE
Orlando’s nursing process discipline reflects the
elements of the therapeutic relationships which include
expression of empathy, warmth, and genuineness that
would increase the therapeutic effectiveness of nursing
having applied throughout various nursing departments:
Operating Rooms, Mental Health Units, Administrations
and Public Health departments
Use in Clinical Practice: Nursing care plan, Case
studies, Progressive patient care settings
Nursing process: A-D-P-I-E
ANALYSIS / CRITIQUE:
CLARITY
• Presents concepts clearly and consistently uses the same words for her major
components and processes.The writing style involves defining concepts
minimally at first and then developing them throughout the book.

SIMPLICITY
• Theory is considered simple yet elegant and has benefited research
applications. It was also used as an example of grand nursing theory and
described as a practice theory.

GENERALITY
• Conceivably, the theory could be adapted to other nursing situation and other
professional fields whose focus is on identifying and finding out patient’s
immediate need for help.

EMPIRICAL PRECISION
• Orlando used a qualitative method to obtain data from which she developed

her theory. She also utilized field methodology before it became a world view
in research.
DERIVABLE CONSEQUENCES
• The nursing process discipline allows the nurses to view the patient from a
medical disease orientation. The use of Orlando’s theory benefits the patient,
enhances the nurse’s professional identity, and helps to advance the nursing
profession.
 STRENGTHS
Use of her theory assures
that patient will be treated as
individuals and that they will
have active and constant
input into their own care .
Prevents inaccurate
diagnosis or ineffective plans
because the nurse has to
constantly explore her
reactions with the patient
Assertion of nursing’s
independence as a
profession and her belief
that this independence must
be based on a sound
theoretical frame work
Limitations
Highly interactive nature
Nursing can pursue Orlando's theory makes it
Orlando's work for hard to include the highly
retesting and further technical and physical care
developing her work that nurses give in certain
settings
Make evaluation a less
time consuming and more
deliberate function, the
Her theory struggles with the
results of which would be
authority derived from the
documented in patients
function of profession and
charts
that of the employing
institution’s commitment to
the public
Guides the nurse to
evaluate her care in terms
of objectively observable
patient outcomes
 CASE SCENARIO
Mr. So: “Nurse, can you give me my morphine!”
Nurse: “Can you tell how painful it is using the 0 ‐10 pain scale, where 0
being not painful and 10 being severely painful?
Mr .So: “Ummm... I think it’s about 7. Can I have my morphine now?”
Nurse: “Mrs. So, I think something is bothering you besides your pain. Am
I correct?”
Mrs. So (crying): “I can’t help it. I’m so worried about my 3 boys. I’m
not sure how they are or who’s been taking care of them.
They’re still so young to be left alone. My husband is in Yemen
right now and he won’t be back until next month.”
Nurse: “Why don’t we make a phone call to your house so you could
check out on your boys?”
Mrs. So called up his sons. After the phone call.
Mrs. So: “Thank you nurse. I don’t think I still need that morphine.
My boys are fine. Our neighbour, Mrs. Yee, she’s watching over
my boys right now.”
Assessing a Patient by using Orlando’s Theory to guide
the Nurse’s Process
The nurse’s focus is on the patient and free of distracting thoughts
1. Guiding Principle
Finding out and -The nurse recognizes cues that a patient problem may exist
meeting the before the next step in the process.
-The nurse identifies his or her immediate perception,
patient’s
thoughts, feelings (Immediate reaction)
immediate need
for help -The nurse uses terms the patient can understand and explores
immediate reactions with the patient to discover physical/nonphysical
problems. As the problem is identified, the nurse asks the patient to
2. Problematic confirm or refute its accuracy.
situation and -The nurse explores the disagreement to determine its basis
immediate reaction(s)
-With the patient, the nurse determines action(s) needed and develops
plans for each problem.
3. Inquiry-Problem -The nurse explores whether the patient agrees with or refutes the
Determination plan. The nurse explores and resolves the basis of disagreement. The
patient verbally or nonverbally agrees. If not, the nurse continues the
inquiry for the basis.
4. Identifying specific
plans for each problem -If the patient is unable, the nurse implements the plan and asks the
patient whether the action is 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
5. Implement or her results.

The nurse asks the patient whether the action helped and observes
the patient’s verbal and nonverbal behavior. If he or she has improved,
the need for help was mer. If not, the nurse continues to use the
6. Improvement content of immediate reaction to explore with the patient until a
positive change is evident.
THANK YOU
and
GOOD NIGHT!
 The nurse’s focus is on the patient and free of distracting thoughts
1. Guiding Principle
Finding out and -The nurse recognizes cues that a patient problem may exist before
meeting the the next step in the process.
-The nurse identifies his or her immediate perception, thoughts,
patient’s
feelings (Immediate reaction)
immediate need
for help -The nurse uses terms the patient can understand and explores
immediate reactions with the patient to discover physical/nonphysical
problems. As the problem is identified, the nurse asks the patient to
2. Problematic confirm or refute its accuracy.
situation and -The nurse explores the disagreement to determine its basis
immediate
reaction(s) -With the patient, the nurse determines action(s) needed and develops
plans for each problem.
-The nurse explores whether the patient agrees with or refutes the
3. Inquiry-Problem plan. The nurse explores and resolves the basis of disagreement. The
Determination patient verbally or nonverbally agrees. If not, the nurse continues the
inquiry for the basis.

4. Identifying specific -If the patient is unable, the nurse implements the plan and asks the
plans for each patient whether the action is helpful. If it is not, the nurse explores
problem 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
5. Implement or her results.

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