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VERTEX INSTITUTE OF SCIENCE AND TECHNOLOGY

ABBOTTABAD
DEPARTMENT OF NURSING
INTERACTION ORIENTED JEAN ORLANDO “
DELIBERATIVE NURSING PROCESS THEORY”
SUBMITTED BY:HAMZA ISHTIAQ
PROGRAM: GENERIC-BSN-SEMESTER-7
SUBJECT: NURSING THEORIES
DATE: 05-MAY-2020
SUBMITTED TO: MADAM SHAKILA
IDA JEAN ORLANDO’S NURSING PROCESS THEORY
INTRODUCTION
Ida Jean Orlando Pelletier was an internationally known psychiatric health nurse,
theorist and researcher was born on August 12, 1926- in New York who developed
the interaction oriented “Deliberative Nursing Process Theory.” Her theory allows
nurses to create an effective nursing care plan that can also be easily adapted when
and if any complications arise with the patient.
Educational background
In 1947, she received a diploma in nursing from the Flower Fifth Avenue Hospital
School of Nursing in New York. In 1951, she received a Bachelor of Science degree
in public health nursing from St. Johns University in Brooklyn, New York. And in
1954, Orlando received her Master of Arts degree in mental health consultation from
Teachers College, Columbia University.
Career
Ida Jean Orlando work as a practitioner, consultant, researcher, and educator in nursing.
Orlando devoted her life to mental health and psychiatric nursing, working as a clinical nurse
and researcher.in 1954, Orlando went to the Yale University School of Nursing in New
Haven, as an associate professor of mental health and psychiatric nursing for eight
years.From 1962-1972, Orlando served as a clinical nurse consultant at Mclean Hospital in
Belmont, Massachusetts. From 1972 to 1984, she also served on the board of the Harvard
Community Health Plan in Boston, Massachusetts.In 1981, Orlando became an educator at
Boston University School of Nursing and held administrative positions from 1984 to 1987 at
Metropolitan State Hospital in Waltham, Massachusetts. In September 1987, she became the
Assistant director of Nursing for Education and Research in the said institute and finally in
1992, Orlando retired.

Death
Ida Jean Orlando died on November 28, 2007 at the age of 81.
INTERACTION ORIENTED “DELIBERATIVE NURSING PROCESS
THEORY”
Interaction oriented theory
Interaction theorists place the importance of nursing on the establishment and
maintenance of relationships. The impact of nursing on patients and how they interact
with the environment, people and the situations in which they find themselves.
Nurse theorists such as Orlando,King, Paterson, Erikson and Anne Boykin can be
grouped as the interaction theorists.Orlando (1961) asserts that: “The function of
professional nursing is conceptualized as finding out and meeting the patient’s
immediate need for help.”
DELIBERATIVE NURSING PROCESS THEORY
Ida Jean Orlando developed her theory from a study conducted at the Yale University
School of Nursing. 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.” Nursing Process has five stages:
assessment, diagnosis, planning, implementation, and evaluation. Nurses use the
standard nursing process in Orlando’s Nursing Process Discipline Theory to produce
positive outcomes or patient improvement. Orlando’s key focus was the definition of
the function of nursing, the model provides a framework for nursing.
Goal
Ida Jean Orlando’s goal is to develop a theory of effective nursing practice. The
theory explains that the role of the nurse is to find out and meet the patient’s
immediate needs for help. According to the theory, all patient behavior can be a cry
for help. Through these, the nurse’s job is to find out the nature of the patient’s
distress and provide the help he or she needs.

Initiation to develop the theory

Orlando’s model was developed after being dissatisfied with the views that nurses
were motivated to act as a result of orders from physicians, institutional policies, and
other reasons, none of which related to nursing action based on meeting patients
needs.Orlando developed her theory from a study conducted at the Yale University
School of Nursing, integrating mental health concepts into a basic nursing
curriculum. 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 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

TERMS
1. Distress
Distress is the experience of a patient whose need has not been met.
2. Nursing role
The role of a nursing is to discover and met the patient immediate need for help.
3. Nursing action
The nursing action directly or indirectly provide for patients immediate need.
4. Outcome
Outcome is change in the behavior of patient indicating in the relieve distress or
unmet need.
ASSUMPTIONS
Ida Jean Orlando’s model of nursing makes the following assumptions which focus
on nursing profession ,nurses,patients, the nature of nurse-patient interaction.
1. When patients are unable to cope with their needs on their own, they become
distressed by feelings of helplessness.
2. In its professional character, nursing adds to the distress of the patient.
3. Patients are unique and individual in how they respond.
4. Nursing offers mothering and nursing analogous to an adult who mothers and
nurtures a child.
5. The practice of nursing deals with people, environment, and health.
6. Patients need help communicating their needs; they are uncomfortable and
ambivalent about their dependency needs.
7. People are able to be secretive or explicit about their needs, perceptions,
thoughts, and feelings.
8. The nurse-patient situation is dynamic; actions and reactions are influenced by
both the nurse and the patient.
9. People attach meanings to situations and actions that aren’t apparent to others.
10. Patients enter into nursing care through medicine.
11. The patient is unable to state the nature and meaning of his or her distress
without the help of the nurse, or without him or her first having established a
helpful relationship with the patient.
12. Any observation shared and observed with the patient is immediately helpful in
ascertaining and meeting his or her need, or finding out that he or she is not in
need at that time.
13. Nurses are concerned with the needs the patient is unable to meet on his or her
own.
Meta-paradigm
The nursing meta-paradigm consists of four concepts: person, environment, health,
and nursing. Of the four, Orlando included three in her theory of Nursing Process:
person, health, and nursing.
Human Being (Person)
Orlando 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.
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.
Environment
Environment is not clearly defined as well in Orlando’s nursing theory 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.
CONCEPT
There are five major concepts of this theory which are as follow;
1. Professional nursing function
2. The patients presenting behavior
3. Immediate reaction
4. Deliberative nursing process
5. Improvement
1. Professional nursing function
According to Orlando the nursing function as ’’finding out and meeting the patient’s
immediate need for help’’.
If the patient is in need and the need for help is met by the nurse, the professional
function has been fulfilled.
2. The patients presenting behavior
In the problematic situation the presenting behavior of the patient, regardless of the
form in which it appears, may represent a request for help’’
Patient’s behavior can be manifested in the following forms:
Verbal: such as asking a question or making a statement to the nurse.
Vocal: such as coughing, moaning, crying, wheezing, shouting.
Non-verbal: such as Tears in the eyes, skin color, reddened face, clenched fist, or
physiological manifestations like BP,Pulse .
3. Immediate reaction
Person perceives with any one of his five sense organs an object than the patient
behavior stimulated a nurse reaction, which marks the beginning of the nursing
process discipline.
4. Deliberative nursing process
After investigation deliberative nursing process formulations reflect the nurse- patient
situation as a dynamic whole; the patient’s behavior affects the nurse and the nurse’s
behavior (action) affects the patient.The use of a deliberative nursing action requires
a shared communication process between the nurse and the patient in order to
determine:
 The meaning of the patients behavior
 The help required by the patient ,and
 Whether the patient was helped by the nurse’s action
5. Improvement
This refers to improvement in the patient’s behavior According to Orlando, If the
nurses activity meets the patient’s immediate needs for help, the patient’s behavior
improves.If behavior of the patient doesn’t change, the nursing function has not been
met.
5 Stages of the Deliberative Nursing Process
The Deliberative Nursing Process has five stages: assessment, diagnosis, planning,
implementation, and evaluation.

Assessment
In the assessment stage, the nurse completes a holistic assessment of the patient’s
needs. This is done without taking the reason for the encounter into consideration.
The nurse uses a nursing framework to collect both subjective and objective data
about the patient.
Diagnosis
The diagnosis stage uses the nurse’s clinical judgment about health problems. The
diagnosis can then be confirmed using links to defining characteristics, related
factors, and risk factors found in the patient’s assessment.
Planning
The planning stage addresses each of the problems identified in the diagnosis. Each
problem is given a specific goal or outcome, and each goal or outcome is given
nursing interventions to help achieve the goal. By the end of this stage, the nurse will
have a nursing care plan.
Implementation
In the implementation stage, the nurse begins using the nursing care plan.
Evaluation
In the evaluation stage, 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. If any new problems
are identified in the evaluation stage, they can be addressed, and the process starts
over again for those specific problems.
Example
We have a patient with surgery also with ongoing anxiety or any pain that she may be
experiencing, following steps will be there in our nursing assessment, diagnose,
planning, implementation and evaluation.
Assessment
Subjective Data: Pain, fear
Objective Data:BP(140/90), HR (105) and T(38 oC)
Nursing Diagnosis (Patient Problem)
1. Acute pain related to the diseases process as evidenced by patient verbalization.
2. Anxiety related to surgical procedure as evidenced by patient verbalization .
3. Hyperthermia related to the inflammatory process of bowel as manifested by
body temperature is 38oC .
Planning
Our goal is to relieve pain, to reduce anxiety and normalize body temperature. Our
expected out come will be that after 1 hour pain will be relieved ,anxiety will be
reduced and body temperature will be normal after 30 minutes.
Implementation :
1. Give Diclofenac 50 mg IM.
2. Give advice ,explains each step of intervention about the surgery, Stay with the
client and offer reassurance of safety and security.
3. Apply cold compress and give paracetamol 1000 mg per oral.
Evaluation
1. Pain is relieved as evidenced by patients verbal response
2. Anxiety reduced as evidenced by patients verbal response
3. normal body temperature as evidenced by her body temperature is 37 oC.
STRENGTHS
The guarantee that patients will be treated as individuals is very much applied in
Orlando’s theory of Deliberative Nursing Process. Each patient will have an active
and constant input into their own care.
Assertion of nursing’s independence as a profession and her belief that this
independence must be based on a sound theoretical framework.
The model also guides the nurse to evaluate her care in terms of objectively
observable patient outcomes.
Weaknesses
The lack of the operational definitions of society or environment was evident which
limits the development of research hypothesis.Orlando’s work focuses on short term
care, particularly aware and conscious individuals and on the virtual absence of
reference group or family members.
Conclusion
Orlando’s nursing theory stresses the reciprocal relationship between patient and
nurse. What the nurse and the patient say and do affects 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
produce improvement in the patient’s behavior. Evidence of relieving the patient’s
distress is seen as positive changes in the patient’s observable behavior. Orlando may
have facilitated the development of nurses as logical thinkers.Orlando’s theory
remains a most effective practice theory that is especially helpful to new nurses as
they begin their practice.

References
1. George, J.B. (2011). Nursing theories: The base for professional nursing practice
(6th ed.). Philadelphia: Pearson.com/nursing_theory/Orlando_nursing_process.
2. Orlando, I. J. (1972). The discipline and teaching of nursing process. In George,
J. (Ed.). Nursing theories: the base for professional nursing practice. Norwalk,
Connecticut: Appleton & Lange.
3. 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.