IDA JEAN ORLANDOS

NURSING
PROCESS
DISCIPLINE

The first generation American of Italian descent

was born on August 12, 1926
Diploma graduate, New York Medical College - 1947
B.S. in Public Health Nursing, St. John's University,
Brooklyn - 1951
M.A. in mental health consultation, Columbia
University, New York - 1954
Staff nurse, varied specialties (while pursuing her
education)

Supervisor in a general hospital

Research associate at Yale University

Clinical nurse consultant in mental health, McLean
Hospital, Massachusetts
Various positions at Boston University since 1972

She is married to Robert Pelletier and lives in the

Boston area.

Orlando is known for her ideas about the nursing

process. She published The Dynamic nursepatient relationship: Function, process and
principles, an important contribution to ideas
on nurse-patient communication, in 1961; the
work was reprinted in 1990. This book resulted
from a study she conducted at Yale on
integrating mental health concepts into nursing
and was derived inductively from the field
notes for this study.

She furthered the development of her theory when

at Mc Lean Hospital in Belmont, MA as Director
of Research Project: Two System of Nursing in a
psychiatric Hospital. The result of this research
are contained in her 1972 book titled: The
discipline and teaching of nursing process. She
identifies nursing as "concerned with providing
direct assistance to individuals in whatever setting
they are found for he purpose of avoiding,
relieving, diminishing, or curing the individual's
sense of helplessness" (Orlando, 1972, p.
22). She feels that nurses practice independently
on behalf of their patients.

Orlando's work is a theory of the nursing process

discipline or deliberative nursing process.
The theory was developed in the late 1950s from an
actual situations and observations she recorded
between a nurse and patient. She recognized that they
were either GOOD or BAD patient outcomes. GOOD
outcomes were defined as those that improved the
patients behavior. BAD outcomes defines as the
absence of improvement. From these observation she
formulated the deliberative nursing process.

Orlando states that her search for facts in

observing nursing situation influenced her
most before the development of her theory and
that she derived her theory from the
conceptualization of those facts.
Her overall goal was to develop a theory of
effective nursing practice that would identify
a distinctive role for a professional nurses that
would provide foundation for systematic
study of nursing

Orlandos nursing theory stresses the reciprocal relationship

between patient and nurse. What other says and does affects
both nurse and patient.
She identify and emphasize the elements of nursing process and
the critical importance of the patients participation in the
nursing process.
The theory focuses on how to produce improvement in the
patients behavior. Evidence of relieving the patients distress
is determined by positive changes in the patients observable
behavior

The use of the nursing process discipline is considered a

disciplined professional response. This response is
effective because when one individual in a person-toperson contact expresses and explores his or her own
immediate reaction, the other individual in the contact
is more able to do likewise.
The nursing process discipline guides effectiveness in
all person-to-person contacts of the nursing system,
including the nurse's contacts with patients (nursepatient relationships), other nurse (line and staff
relationships among nursing personnel), and other
professional and nonprofessional people (other staff
relationships).

DEFINITIONS

Nurse Responsibility
Whatever help the patient may require for his
needs to be met (i.e., for his physical and
mental comfort to be assured as far as possible
while he is undergoing some form of medical
treatment or supervision). It is the nurses
responsibility to see that the patients needs
for help are met, either directly by her own
activity or indirectly by calling in the help of
others.

Need
Situationally defined as a requirements of the
patient which, if supplied, relieves or
diminishes his immediate distressor and
improves his immediate sense of adequacy or
well being.

Presenting Behavior of the patients

Any observable verbal or non verbal
behavior.

Improvement
Means to grow better, to turn to profit, to use to
advantage.

Nursing Process Discipline

Includes the nurse communicating to the patient his or
her own immediate reaction, clearly identifying that
the item expressed belong to the nurse and then
asking for validation or correction.

Immediate Reaction
Include both the nurse and the patients individual
perception, thoughts, and feelings.

Purpose of Nursing
Supply the help the patient requires in order for his
needs to be met.
Automatic Nursing Action

Those (nursing actions) decided upon for reaction

other than the patients immediate need.
Deliberative Nursing Action
Those action decided upon after ascertaining a need
and then meeting this need.

There are five major interrelated concepts in

Orlandos Theory
1. Function of the professional nursing
2. Presenting behavior of the patient
3. Immediate or Internal Response of the nurse
4. Nursing process discipline- Investigation
5. Improvement

1.

Function of the professional nursing

Is conceptualized as finding out and meeting the
patients immediate need for help.

2. Presenting behavior of the patient

Patients manifest their immediate needs for help
through their behavior (verbal or non verbal)
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.

3. Immediate or Internal Response of the nurse

Internal response comprises the subjective data in the

immediate experience. It is unique to each person and
represent the starting point of investigation.
Internal response is immediate reaction it includes persons
perception, thought and feeling about another persons
behavior.
Immediate reaction reflects the nurses individuality and
explains that what nurse perceives or think about the
patient reflects the nurse meaning or interpretation of
his or her perception.

4. Nursing process discipline- Investigation

It is a deliberate attempt to understand the meaning
so as to get the facts.
The use of the process discipline requires that a
shared process occur between the nurse and the other
person in order to find out the meaning of the behavior, to
determined what help is needed, and to find out if the
person was helped.
Basic Elements:
a. The behavior of the patient
b. The reaction of the nurse
c. The nursing action, which are designed for the
patients benefits.

5. Improvement
Situation becomes clear; It loses it problematic
character and a new equilibrium is established.
The improvement is observable in the verbal and
the non verbal behavior of the patient. This change
allows the nurse to observe whether the patient
sense of helplessness has been relieved, prevented
or diminished.

A patient behavior, either verbal or nonverbal, that

indicates a need for help.
The nurse recognize the situation as problematic. (Theres
something wrong with the patient)
This behavior results in a reaction from the nurse in which the nurse
perceives a need, applies thought to the need, and produces a feeling
about the need, such as concern or anxiety.

The nurse then confirms her perception, thought, and feeling with the
patient and determined what help is needed, and to find out if the
person was helped.

Situation becomes clear; The improvement is observable in the verbal and

the non verbal behavior of the patient.

Example

1. Patient crying
2. A doctor in operating room
*to be discuss in my reporting

Currently, Orlandos theory was used

successfully in psychiatric and general
hospitals.
a. MidMissouri Mental Health Center
b. a general hospital Antigonish, Nova
Scotia
c. New Hampshire Hospital

A significant amount of research has been based

on Orlandos Theory
It has been designated the experimental
approach in several studies to examine its
effects on a patients distress during admission
and before surgery. And found out that
deliberative nursing actions promote stress
reduction during admission. (Anderson, Mertz,
Leonard)

Schmieding expanded its development,

incorporating criteria in a reflective inquiry
framework for nurse administration.
Schmieding used Orlandos theory to investigate
the action process of nurse administrators to
realistic hypothetical situations presented to
them by their staff. The findings indicated that
the administrators would first thought was
seldom about their staff reaction to the
situation and the majority of the administrators
would tell the nurse what to do rather than
inquire about the situation.

Generality
Orlando discusses and illustrates nurse- patient
contacts in which the patient is conscious, able
to communicate, and in need of help. Although
she did not focus on unconscious patients or
groups is feasible. Non verbal behavior is an
element of her formulations; therefore nurses
would focus on this for determining the
patients need for help and observing for non
verbal behavioral changes after the nursing
action.

THANK YOU!