Running head: NURSING THEORIST PAPER

Nursing Theorist Paper

Sarah DeLaat
Ferris State University

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Abstract

This theory analysis paper focuses on the work of Ida jean Orlando and her Nursing
Process Theory. It will show how the model can be used in clinical practice and why it is a good
fit for Emergency and Trauma Nursing. Strengths and limitations of the model will also be
identified and explained in how it can be used as a framework for patient assessment.

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Nursing Theorist Paper

Ida Jean Orlando was one of the first nursing theorists to develop a theory based on her
own practice and research. Orlando was a professor of nursing at Yale University in the 1950s,
and developed her theory while doing research on mental health nursing. According to Meleis
(1997), Orlando used field methodology before it became a world view in research (pg. 348).
She continued to observe nursing interactions with clients over the next few years serving as a
nurse educator and consultant. Orlando conducted workshops and lectured for many years. Her
Dynamic Nurse-Patient Relationship Theory (renamed as Nursing Process Theory) remains
influential and practical in todays settings.
Analysis of Model
Dr. Norma Jean Schmieding writes that the Role of the nurse is to find out and meet the
patients immediate need for help (Schmieding, n.d.). Orlando viewed the nurses actions as
being determined by the patients needs, whether that need was verbalized by the patient or not.
The nurses role is to find out what the need is and to take action in order to meet those needs.
Although patients needs may not always be apparent, nurses need to use their own thoughts and
perceptions of the patient in order to discover what that underlying need may be. Nursing deals
with the person, their environment, and health.
Person
Orlando, in her Nursing Process Theory bases some assumptions upon her directly
observed interactions between nurses and clients. One of these being that people are normally
able to meet their own needs, and become distressed when they are unable to do so (Tomey,
2006). The nursing process is set in motion by patient behavior. Behaviors are unique to each
individual with different possible meanings. Nurses perceive this behavior and react deliberately

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according to their assessment after exploring their perceptions with the patient. This process
helps the nurse find out the nature of the distress and what help the patient needs (Schmieding,
n.d.).
Environment
The concept of environment is not specifically defined in her theory; however, Orlando
asserts that nurses assist patients in many different environments or settings. Even if the
environment is designed for therapeutic purposes, it must be considered as a cause for a patients
distress. The nurse-patient contact produces a nursing situation in any environment where it is
present (Tomey, 2006).
Health
Orlando does not define health for her theory, but implicitly assumed feelings of
adequacy and well-being from fulfilled needs contribute to health (Jones & Meleis, 1993, pg.4).
Orlando (1961) also notes that repeated experiences of having been helped undoubtedly
culminate over periods of time in greater degrees of improvement (pg. 90). Health can be said
to be a sense of adequacy or well being, fulfilled needs, and a sense of comfort.
Nursing
Orlando saw nursing behavior as a process. It begins with the introduction of the patient
to the nurse, who then formulates thoughts, perceptions, and makes and educated decision about
the patients needs. The nurse shares these perceptions with the patient, and together they explore
the meaning of the patients behavior. This process helps the nurse find out the nature of the
distress and what help the patient needs (Schmieding, n.d.). Orlando may have facilitated the
development of nurses as logical thinkers (Tomey, 2006).

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Concepts within Orlandos theory that are unique include her focus on research. Orlando
was the first theorist to base her theory on actual nurse-patient interactions. She reviewed the
records of 2000 interactions between nurses and patients in order to base the content of her
theory on the analysis of the data (Schmeiding, 1993). Another unique concept is her focus on
the verbal and non-verbal communication of the patient. Orlandos nursing theory recognizes
that there are sometimes underlying meanings to a patients communication. Searching for those
meanings in a deliberate and inclusive manner are necessary to relieve the distress of the patient.
Orlandos nursing theory is useful to practice in a variety of settings. Her theory keeps the
focus on the patient while effectively communicating. In many settings a nurses ability to hear
the unspoken message alongside the verbalized needs of the patient can be an important
assessment tool. In emergency nursing there are times when the patients are unable to speak for
themselves and a nurse needs to rely on non-verbal and objective assessment tools. Personality
and the ability to interact meaningfully with patients is one of the nurses most important tools.
Orlandos nursing theory guides those interactions through phases starting with raw perceptions
through deliberate actions taken on behalf of the patient. As a framework for patient assessment,
the theory facilitates open communication and discovery of patient needs. This could be
compared to a nurse using their stethoscope to discover heart and lung sounds. The nurse is
discovering information about the patient and their needs.
Use of Orlandos Nursing Process Theory in Education
According to Schmieding, Midwestern State University in Wichita Falls, Texas is using
Orlandos theory for teaching entering nursing students. South Dakota State University in
Brookings, SD has been using a description of communication based on Orlandos theory for
entering nursing students as well as re-enforcing it in their junior year (Schmieding, n.d.).

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Orlando deserves credit for writing clear guidelines for the nurse to use in contact with patients
(Tomey, 2006). Orlandos systematic process for interacting and communicating is clear and
concise, and is useful in giving nursing students a framework around which to build their
communication skills.
Strengths and Limitations of Orlandos Nursing Process Theory
The strengths of Orlandos nursing theory are its simplicity, clarity, and application to
practice. The needs of the patient, whether expressed or observed, lead to thoughts and
perceptions from the nurse, which lead to deliberate actions. The focus is on communication and
meeting needs of the patient.
According to Dr. Julia George, RN PhD., its focus on short term care, particularly aware
and conscious individuals and on the virtual absence of reference group or family members
(George, 2009) is a limitation to Orlandos Nursing Process Theory. The style of her writing is
also critiqued. Schmeiding writes Although her writing is clear and concise, some repetition
might facilitate easier comprehension (Tomey, 2006).
Orlandos theory is a good fit for many nurses because of the emphasis on
communication. In emergency nursing, there is limited time to interact with patients. The
emphasis is on moving patients through the department quickly and efficiently after they are
stabilized. Accurate communication and the ability to comprehend non-verbal cues from a
patient are essential to a good outcome. These points are a central tenet of Orlandos theory.
Deliberate, as opposed to automatic or off the cuff nursing actions are the most time saving
and beneficial for the patient in this setting.
Another component of Orlandos theory is that the patients actual need may be different
than their expressed need. The proper response from the nurse would be to meet their actual

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need. This theory recognizes that patients do not always have insight into their underlying needs,
and this can cause distress. When the nurse cannot differentiate between the verbalized need and
the actual need, more distress is caused for the patient. That is why this theory is so important for
nurses to comprehend in their clinical setting.

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References

George, J. B. (2009, March 16). Orlandos Nursing Process Theory. Current Nursing- A portal
for nursing professionals. Retrieved from
http://currentnursing.com/nursing_theory/Orlando_nursing_process.htm
Jones, P., & Meleis, A. I. (1993). Health is Empowerment. Advanced Nursing Science, 15(3), 114.
Orlando, I. J. (1961). The dynamic nurse-patient relationship: Function, process and principles
of professional nursing practice. New York, NY: G.P. Putnams Sons.
Schmieding, N. J. (n.d.). University of Rhode Island. Retrieved from
URI.edu:http://www.uri.edu/nursing/schmieidng/orlando/.
Tomey, A. M. (2006). Nursing Theorists and Their Work (6th ed.). St. Louis, MO: Mosby
Elsevier.

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Grading Rubric for Theory Paper

1. Introduction of theory/model
a. Introduction clear and well focused
b. History and significance of model
2. Analysis of Model
a. Explain the model in terms of: Person, Environment, Health,
and Nursing.
b. Explain other concepts that are unique to the model.
c. Demonstrate how the model can be used in clinical practice.
d. Explain how the model can be used as a Framework for
patient assessment.
e. Explain the model within the context of nursing education.
f. Identify strengths and limitations of the model.
g. Analyze the model overall, demonstrating new insights
about the model.
3. Evidence of Academic Writing
a. Development of a clear, logical, well-supported paper;
demonstrating original thought and content.
b. Evidence of research with a minimum of 2 research articles
in addition to the course required texts. Correct acknowledgement
of sources using APA style referencing. Attaches APA checklist
c. Overall presentation; grammar, spelling, punctuation, clean
and legible.
d. Stays within page limit which includes: one cover page, one
reference page, body of paper is to have a maximum of 5 pages
and a minimum of 3 full pages.
Total Possible Points
Total Points Earned

Possible
points
5
5
10
10
10
10
10
10
10

5
5
5
5
100

Points
Earned

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CHECK
DATE,
TIME, &
INITIAL

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PROOFREAD FOR: APA ISSUES

1. Page Numbers: Did you number your pages using the automatic functions of your Word
program? [p. 230 and example on p. 40)]
2. Running head: Does the Running head: have a small h? Is it on every page? Is it less
than 50 spaces total? Is the title of the Running head in all caps? Is it 1 from the top of your
title page? (Should be a few words from the title of your paper). [p. 229 and example on p.
40]
3. Abstract: Make sure your abstract begins on a new page. Is there a label of Abstract and
it is centered at the top of the page? Is it a single paragraph? Is the paragraph flush with the
margin without an indentation? Is your abstract a summary of your entire paper? Remember
it is not an introduction to your paper. Someone should be able to read the abstract and know
what to find in your paper. [p. 25 and example on p. 41]
4. Introduction: Did you repeat the title of your paper on your first page of content? Do not
use Introduction as a heading following the title. The first paragraph clearly implies the
introduction and no heading is needed. [p. 27 and example on p. 42]
5. Margins: Did you leave 1 on all sides? [p. 229]
6. Double-spacing: Did you double-space throughout? No triple or extra spaces between
sections or paragraphs except in special circumstances. This includes the reference page. [p.
229 and example on p. 40-59]
7. Line Length and Alignment: Did you use the flush-left style, and leave the right margin
uneven, or ragged? [p. 229]
8. Paragraphs and Indentation: Did you indent the first line of every paragraph? See P.
229 for exceptions.
9. Spacing After Punctuation Marks: Did you space once at the end of separate parts of a
reference and initials in a persons name? Do not space after periods in abbreviations. Space
twice after punctuation marks at the end of a sentence. [p. 87-88]
10. Typeface: Did you use Times Roman 12-point font? [p. 228]
9. Abbreviation: Did you explain each abbreviation the first time you used it? [p. 106-111]
11. Plagiarism: Cite all sources! If you say something that is not your original idea, it must
be cited. You may be citing many timesthis is what you are supposed to be doing! [p. 170]
12. Direct Quote: A direct quote is exact words taken from another. An example with
citation would look like this:
The variables that impact the etiology and the human response to various disease states
will be explored (Bell-Scriber, 2007, p. 1).
Please note where the quotation marks are placed, where the final period is placed, no first
name of author, and inclusion of page number, etc. Do all direct quotes look like this? [p.
170-172]
13. Quotes Over 40 Words: Did you make block quotes out of any direct quotes that are 40
words or longer? [p. 170-172]
14. Paraphrase: A paraphrase citation would look like this:
Patients respond to illnesses in various ways depending on a number of factors that will be
explored (Bell-Scriber, 2007). Do all paraphrased citations look like this? [p. 171 and
multiple examples in text on p. 40-59]
15. Headings: Did you check your headings for proper levels? [p. 62-63].
16. General Guidelines for References:

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A. Did you start the References on a new page? [p. 37]

B. Did you cut and paste references on your reference page? If so, check to make
sure they are in correct APA format. Often they are not and must be adapted. Make
sure all fonts are the same.
C. Is your reference list double spaced with hanging indents? [p. 37]
PROOFREAD FOR GRAMMAR, SPELLING, PUNCTUATION, & STRUCTURE
13. Did you follow the assignment rubric? Did you make headings that address each major
section? (Required to point out where you addressed each section.)
14. Watch for run-on or long, cumbersome sentences. Read it out loud without pausing
unless punctuation is present. If you become breathless or it doesnt make sense, you need
to rephrase or break the sentence into 2 or more smaller sentences. Did you do this?
15. Wordiness: check for the words that, and the. If not necessary, did you omit?
16. Conversational tone: Dont write as if you are talking to someone in a casual way. For
example, Well so I couldnt believe nurses did such things! or I was in total shock over
that. Did you stay in a formal/professional tone?
17. Avoid contractions. i.e. dont, cant, wont, etc. Did you spell these out?
18. Did you check to make sure there are no hyphens and broken words in the right margin?
19. Do not use etc. or "i.e." in formal writing unless in parenthesis. Did you check for
improper use of etc. & i.e.?
20. Stay in subject agreement. When referring to 1 nurse, dont refer to the nurse as they
or them. Also, in referring to a human, dont refer to the person as that, but rather
who. For example: The nurse that gave the injection. Should be The nurse who gave
the injection Did you check for subject agreement? Likewise, dont refer to us, we,
our, within the paperthis is not about you and me. Be clear in identifying. For example
dont say Our profession uses empirical data to support . . Instead say The nursing
profession uses empirical data..
21. Did you check your sentences to make sure you did not end them with a preposition?
For example, I witnessed activities that I was not happy with. Instead, I witnessed
activities with which I was not happy.
22. Did you run a Spellcheck? Did you proofread in addition to running the Spellcheck?
23. Did you have other people read your paper? Did they find any areas confusing?
24. Did you include a summary or conclusion heading and section to wrap up your paper?
25. Do not use we us our you I etc. in a formal paper! Did you remove these
words?
26. Does your paper have sentence fragments? Do you have complete sentences?
27. Did you check apostrophes for correct possessive use. Dont use apostrophes unless it is
showing possession and then be sure it is in the correct location. The exception is with the
word it. Its = it is. Its is possessive.
Signing below indicates you have proofread your paper for the errors in the checklist:
Sarah DeLaat
________________________________________________________DATE:__04/03/2010____________
__
A peer needs to proofread your paper checking for errors in the listed areas and sign below:
Sarah Keena
________________________________________________________DATE:04/04/2010______________
Revised Fall 2009

(signature may be typewritten)

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