DELIBERATIVE NURSING PROCESS THEORY BY IDA JEAN ORLANDO

Orlando’s nursing theory focuses more on the reciprocal relationship between the nurse
and the patient, wherein the nurse must assess, infer, and observe the patient’s verbal and non-
verbal behavior to determine what the patient needs.

According to the Theory Structure

The structure of her theory would include both major and sub concepts. She has
emphasized the concept of the nurse-patient relationship, the patient’s need for nursing care in the
state of helplessness, the nurse’s reaction and action towards the patient’s behavior, and the
importance of their interaction. It integrates the nursing process discipline which consists of 5 parts
namely: assessment, diagnosis, planning, implementation, and evaluation, wherein it is the tool
used for the nurse’s action and reaction when dealing with the patients need.

Her theory structure is consistent and logical because nurses or care providers can use the
sequences in this theory in order to cater to the needs of the patient. Such sequences are present in
the nurse’s reaction and action towards the patient’s behavior, such as by initially trying to
understand the patient’s cry out for help, followed by the nurse’s immediate reaction and action
by way of interaction and exploration of the patient by also utilizing the nursing process, and the
improvement of the condition or state of the patient and being able to give them the help that they
need. Moreover, she has emphasized that the process of caring isn’t solely based on physician’s
orders, and that nurses have the independence to do the necessary actions they think that is needed
that bases on the individual’s need for help.

Clarity of the Theory

Orlando’s theory is very clear and concise. She was able to define the key concepts and
terms that she has utilized in order for her theory to be more comprehensible and easy to understand.
Although, it is necessary to know the terms used before looking at the diagram/model in order to
immediately understand it at first glance. In addition, her concepts are explained thoroughly and
are all interconnected in a way that it is easy to follow.
Complexity of the Theory

It is simple and easy enough to understand and use. It isn’t a complicated theory because
it focuses on the interaction between the patient and the nurse, and by the way Orlando explains it,
anyone can get the gist of this theory. Due to its simple nature, it is one of the most widely used
nursing theories in the present and is utilized by different care providers.

Generality of the Theory

Orlando’s theory is considered to be a grand theory, and by definition, it is the “broadest

in scope” out of all the nursing theories due to the fact that it presents general concepts and
propositions. The theory isn’t limited in scope because it can be applied to all disciplines of
nursing and can be used in different situations by different care providers.

Strengths and Weaknesses of the Theory

One good thing about this theory is that the patients also have an active participation in the
nursing process and are treated as individuals. Rather than taking care of different patients in the
same way, this theory can make catering to each of their different needs possible. Nurses can also
be independent and incorporate their own knowledge and beliefs in alleviating and giving the
patient’s needs, and allows both of them to explore what works best in order for the well-being of
the patient to be restored.

Some weaknesses that can be identified with this theory is that first of all, the perceptions,
thoughts, and feelings of the nurse can affect their interpretation and assessment of the patient’s
situation, and that their reaction towards the patient’s behavior will depend on the nurse/care
provider. In addition, it lacks operational definitions society or environment which limits the
development of research hypothesis (Wayne, 2014). It also didn’t mention about family members
in the theory.

Applicability of the Theory

This theory is flexible, because it doesn’t necessarily and automatically follow the nursing
care plan. There will be some unexpected situations in which the nursing care plan can’t be
followed, so it is important to be able to deal with the problems that would arise in order to maintain
and revert the patient’s well-being. It makes the necessary adjustments needed depending on the
situation of the patient and caters to their needs. Thus it is applicable to different patients with
different diseases and illnesses.

HUMAN-TO-HUMAN RELATIONSHIP BY JOYCE TRAVELBEE

Travelbee’s theory is one of the interaction theories of nursing which specifies the
interpersonal communication and connection between the care provider and the patient. Her theory
specifically dotes on how the nurse care provider alleviates and helps the patient find meaning to
their illness as well as suffering holistically, and helps the family members cope with it.

According to the Theory Structure

There are a lot of concepts in her theory that must be understood in order to fully grasp the
essence of her theory. She has tackled suffering, meaning and how to help patients find it, hope,
communication, and the therapeutic use of self. She has then related these concepts to the proper
phases that both the nurse and patient should undergo which would eventually lead to rapport such
as the original encounter, emerging identities, empathy, and sympathy.

In her theory, she is able to interrelate these concepts well and is arranged, although not in
logical order. But it is understandable as these concepts are integrated into the phases that she is
pertaining to and that her concepts are essential in the phases in order to establish a great
relationship between the nurse and the patient, which is necessary in order to help the patient find
meaning and give hope. Overall, the relationships between her concepts are all important linkages
that can be followed and understood thoroughly.

Clarity of the Theory

Her theory is comprehensible and understandable. The way she has defined the concepts is
straightforward and concise, and consistency is present. The words that she has used were common
ones, and the way she defined these terms were not far off from the layman’s definition of it, so
the terms were on familiar grounds. Although, it would’ve been also alright if she has expounded
and elaborated a little bit more. Moreover, she is able to properly give out the goal of the nurse
practitioner – which is to maintain hope and avoid hopelessness - and the necessary means of
achieving this specific goal. In addition, it would have been better if there was a diagram for her
theory in order to get a visual representation.

Complexity of the Theory

There may be a lot of concepts, but they are simple enough that its interrelation with each
other can still be clearly displayed. Suffering, hope, meaning, the use of self, and the other concepts
present are all linked and integrated in the phases that is present in the theory when the nurse
practitioner meets and forms bonds with the patient with the purpose of establishing rapport to
help the patient in his/her suffering. Thus, this theory simply explained how human-to-human
connection is also an aspect that is essential in the nursing discipline.

Generality of the Theory

The Human-to-Human-Relationship theory can be widely used in the different disciplines

of nursing, because its main concern is the human’s suffering. Both the patients and nurses are all
humans, and so each all undergo through this. Thus, this theory has a wide scope. However, her
theory is more applicable to those who are currently experiencing distress and suffering.

Strengths and Weaknesses of the Theory

This theory not only focuses on the disease aspect of the patient and their supposed cure,
but it also gives nurses and other care providers a chance to contribute and help more than that.
They are able to do so in such a way that they alleviate the patient’s suffering and give them hope
by using themselves in a therapeutic sense, emphasizing the fact that we are all humans, and that
caring is much more than just giving them the medicines that they need as ordered by the doctor,
but it is catering to the humanness and individuality of the patient holistically, giving and helping
them seek meaning.

The downside of this theory though, is that in order for the nurse or care provider to
effectively maximize their therapeutic use of their selves to help the patient, they must first both
undergo each phase in order to establish an effective communication, namely: encounter, identity,
empathy, sympathy, and rapport. In a sense, this is quite difficult to achieve, because both the
patient and nurse have different life orientations and beliefs, so perhaps in a way, it is a matter of
compatibility as well. But this doesn’t serve as a hindrance to attaining the goal of this theory, it
is just a matter of trying to adjust and be well-open to each other. It is somewhat difficult to make
the patient confide in the nurse practitioner if bonds aren’t formed.

Applicability of the Theory

It can be generally applied to all conscious patients who feels pain and suffering, although
it is much more adequate towards those patients with chronic illnesses and diseases, as well as
those who are terminally ill, who needs nursing care providers to give them hope and to help them
find meaning in their suffering. Particularly, people in the Intensive Care Unit and those in
palliative care.
THE HELPING ART OF CLINICAL NURSING BY ERNESTINE WIEDENBACH

This theory mainly identifies the patient's need for help through the observation of
presenting behavior and symptoms, exploration of the meaning of those symptoms, determination
of the cause of discomfort, the determination of the patient's ability to resolve the patient's
discomfort, or determining if the patient has a need of help from the nurse or another health care
professional.

According to the Theory Structure

Wiedenbach’s theory is composed of the following elements which defines clinical nursing.
It is namely: a philosophy, a purpose, a practice and an art. By defining the major concepts such
as the patient, knowledge, judgment, skills, etc. and incorporating and linking these concepts, the
theory becomes more well-defined.

Unlike the other theories, Wiedenbach’s theory doesn’t present a linear progression of the
concepts. There’s still vague interrelation of these concepts because of the fact that they’re too
many relational statements. Although she was able to make a diagram with her prescriptive theory
which includes three factors, specifically the central purpose, prescription, and realities, although
it looks quite simple, it is much more plausible if she was able to expound it more.

Clarity of the Theory

The concepts presented in her theory are clear and intelligible. There is little ambiguity
present since it is common sense that a nurse must have a keen eye in identifying the patient’s
problems by their symptoms and behavior. Her theory encompasses the common knowledge that
individuals have when it comes to nursing care, thus her explanations with the concepts were
comprehended easily.

Complexity of the Theory

Her theory is somewhat complex in a way that the concepts present have sub concepts and the
interrelation of these concepts are confusing in a way that it is too many. There are a lot of
relational components and it would have been more comprehensible, especially to beginning nurse
practitioners if she has only expounded and elaborated it more, as well as explaining the linkage
between these concepts to her theory as a whole.
Generality of the Theory

This theory has a broad scope because of the fact that it is applicable to majority of the
patients who are mostly in need for help and thus can be used in all disciplines of nursing with a
few exceptions. Since this is more on the patient’s need for help and their own acknowledgment
of their need, patients that are unconscious, infants, and are emotionally and psychologically
challenged and incompetent are excluded from this.

Strengths and Weaknesses of the Theory

This theory also requires the patient’s participation and acknowledgment of their need for
help. It also makes use of the nurse’s knowledge and competence as a whole when catering to the
patient in need such as being able to make decisions and can act with independence depending on
the nurse’s assessment with the condition of the patient.

Although some weaknesses of this theory would include the patient acknowledging his/her
need for help, but preventing to ask for reasons that they may feel uncomfortable in doing so. That
is why it is essential for the nurse and patient to establish a bond or connection in order for the
patient to not hesitate when asking for help, and to be able to openly voice out his/her needs to the
nurse practitioner.

Applicability of the Theory

This theory is applicable specifically to patients who are conscious and can identify their
need for help. Individuals who fail to acknowledge their need for help and lacks the motivation to
ask for what they need are not encompassed in this theory.
INTERPERSONAL RELATIONS THEORY BY HILDEGARD PEPLAU

Peplau's Interpersonal Relations theory focuses on the interpersonal processes and

therapeutic relationship between the nurse and the client (McQuiston, & Webb, 1995). Peplaus's
theory operates on two major assumptions which states, "the kind of nurse each person becomes
makes a substantial difference in what each client will learn as she or he is nursed throughout her
or his experience with illness" (Peplau, 1952) and "fostering personality development in the
direction of maturity is a function of nursing and nursing education; it requires the use of principles
and methods that permit and guide the process of grappling with everyday interpersonal problems
or difficulties," (Peplau, 1952).

According to the Theory Structure

The theory is basically about how therapeutic interactions between the nurse and client can
help achieve the necessary goal for the patient’s well-being and to satisfy their needs, in the sense
that the patient goes from being a dependent individual to an independent one that doesn’t need
nursing care. Moreover, during these interactions, both the nurse and patient can grow and learn
from each other. Other main concepts tackled in this theory included the four metaparadigms of
nursing mainly: client, health, society and environment, and nursing. She has identified the four
phases of interpersonal relationship that they must undergo which includes: orientation,
identification, exploitation, and resolution.

Overall, the ideas where organized in a manner that is easy to understand. The concepts
and definitions are consistent in the theory and they fit together to make the one comprehensible
idea of the theory. It is organized in a manner that it could be followed in a series of steps following
a series of pattern, in which these steps are the four phases that encompasses the different concepts
tackled in the theory.

Clarity of the Theory

Her theory is very easy to understand, with explaining her concepts in a simple fashion,
and showing the correlation of each of the concepts with each other without any complications.
She was also able to blatantly point out the obvious role of the nurse which is to interact with the
patient therapeutically in order to identify the problems, and to make the necessary nursing
interventions needed.
Complexity of the Theory

The concepts in the theory is simple in such a way that it describes the progression of the
phases that both the nurse and patient will have to undergo in order to be able to solve the patient’s
problem and give the individual what he/she needs. When all of the concepts are combined, it leads
to a more fruitful understanding of the goal and the necessary nursing interventions that is needed.

Generality of the Theory

It is broad in scope, and it can be specifically used in situations and areas wherein
interaction between the nurse and patient is possible. This can usually happen in the hospital setting
wherein there is room for adequate interaction and for building trust and enhancing communication.
Also, this theory is only for the patients who are able to express their need.

Strengths and Weaknesses of the Theory

This theory focuses on the therapeutic interactions between the nurse and the patient. What
sets it apart from other interactive theories is that nurses assume many roles that would contribute
to the restoration of the well-being of the patient. The patient is dependent on the nurse to give
them their needs but in the end, they need to make an effort to be well and be independent
themselves. This is the strength in this theory in a way that the patient is given the chance to deal
with their own problem as well and have the participation in decreasing their sense of hopelessness.
It also provides a systematic role for nurses and is used based on the needs of the individual, not
only focusing on treating his/her ailment, but is concerned for their wellness as well.

One factor that may be a hindrance in establishing a good nurse-patient relationship would
be the life orientation of both parties such as beliefs, values, race, gender, experiences, expectations,
and etc.In addition, this theory would be more realistic in a way if there is a 1:1 ratio because it is
quite difficult if the patient meets different nurses that holds different orientations during their
hospital stay. It would only cause the patient to be more stressed and perhaps may affect his/her
well-being.

Applicability of the Theory

It is applicable to conscious patients which have a “felt need” and can actively participate
meaning those who are in palliative care, the unconscious, infants, and the incompetent in the
psychological aspect is not suitable for this theory. It requires the mutual participation of two
parties.

HUMANISTIC NURSING THEORY BY PATERSON & ZDERAD

Their theory is mainly about how the nurse’s concern isn’t merely about his well-being,
but his more-being. This means that “health is conceptualized as somewhat more than the freedom
from disease.”, rather it is being able to nurture and being able to relate to one another.

According to the Theory Structure

Their theory mainly focuses on the “call and response” concept, wherein the patient makes
a call for help, and the nurse responds to this call and helps the patient with his health need. When
this happens, dialogue between the two is present. Although this isn’t simply interacting. There
must be a call for intersubjectivity and relation with each other, while taking into consideration
their respective gestalts or to be precise, all aspects of their being and existence. It is basically
encapsulating all that the human person is, and using it to interact with others and not just as a
presentation of a sum of attributes. Each person is perceived to be existing “all at once”. Nurses
interweave their own individuality, creating their own life experiences which unfolds during their
responses with (being with and doing with) for persons to become all that they can be in
particular lived situations. These former concepts were clearly connected to these latter concepts
which includes: nursing, community, and phenomenologic nursology - in which they have
dissected into 5 stages. These are the following: preparation of the nurse knower for coming to
know, nurse knowing the other intuitively, nurse knowing the other scientifically, nurse
complimentarily synthesizing known others, and succession within the nurse from the many to the
paradoxical one.

These concepts are all linked. The diagrams and models by the use of visuals shown in the
theory has just strengthened the correlation of all of these concepts. They were organized in such
a manner that the basic concepts were explained thoroughly first before interrelating it with each
other.

Clarity of the Theory

 The terms and concepts are borrowed from the discipline of philosophy, which, by nature,
is abstract. By putting it within the context of nursing, it is confusing and too vague especially
from the way it is describing the theory. An example of these would be the terms “more-being”,
“being and becoming”, “intersubjective experience”, “existential phenomenology”, “existing all-
at-once”, and etc.

Beginning nurse practitioners may perhaps have a hard time in deeply understanding this
theory thus it is suggested that the way of explanation could have been more straightforward, clear
and concise by not expounding it in a complicated philosophical context.

Complexity of the Theory

What makes the theory confusing is due to the way of explaining the concepts in a
“philosophical manner”, but overall, the theory is still quite simple because it has presented the
concepts and their interrelation with one another and by the use of the models.

Generality of the Theory

The theory has a broad scope, since it can be applied to any nursing situation in which the
nursing dialogue between the nurse and patient can happen.

Strengths and Weaknesses of the Theory

Strengths. This theory gives importance to the whole being of the individual. Moreover,
it is emphasizing on the subjective aspect where it gives importance to the holistic healing and
well-being of the patient and their loved ones. By means of interaction in the nurse-patient
relationship, one can derive meaning in their respective lives by sharing experiences and relating
to one another.

Weaknesses. There are a lot of factors that must be considered when using this theory. The
nurse must take into consideration the environment of his/her work, as well as the working hours
and his/her emotional and psychological state which could render focus on the patient. The nurse
is also a unique individual as well and therefore has feelings and emotions. There is a possibility
that they would rather not want to relate to the patient’s present experience for certain reasons such
as exhaustion and mental drainage, so the nurses state must also be noted. When this happens, the
purpose of this theory may not be met.
Applicability of the Theory

This is applicable to anyone who needs help from the nurses, specifically those who are in
palliative nursing, hospice nursing, end-of-life care, NICU/ICU, oncology nursing, and
community health nursing, since in their crucial state of health, meaning in their existence would
help them achieve the state of “being more”. Moreover, there is not enough basis for this theory to
be applied in the research setting due to its subjectivity thus empirical testing is difficult to do.
NURSING AS CARING THEORY BY BOYKIN AND SCHOENHOFER

In the Nursing as Caring theory, the challenge is to come to know the other as caring person
and to nurture that person in ways that are specific to the situation rather than to discover what is
missing or needed.

According to the Theory Structure

It is within our human nature to care or be caring. Nurses specifically adopt this human
nature in their line of work and utilize this for the holistic healing of their patients as well as the
enhancement of personhood.

Boykin and Schoenhofer’s theory centers more around the caring that happens between the
nurse and the individual. It focuses more on the nursing situation rather than the concepts because
they believed that each situation is personal and unique and it provides a different perspective in
looking at the phenomenon of the relationship. It doesn’t focus much on the problem-solving
aspect of health. The relationship of the concepts that they have presented are consistent and is
coherent. Especially with the way they elaborated the concepts of the different perceptions such
as perceptions of person as caring, in which they have given some assumptions and conception of
nursing as discipline and profession. But the theory lacks the necessary structure that may make
novice nurses reluctant to use this theory because it does not outline the steps or phases on what
to do and how to do it. It is merely simply concepts that can be integrated with other theories that
has a concrete structure.

Clarity of the Theory

The concepts are concise and easily understandable. All the concepts are defined, with each
having an appropriate amount of explanation and is utilized in a consistent and congruent way,
such as the concepts of personhood, caring, etc. It further clarifies and gives individuals a deeper
understanding of caring in the context of nursing and what it entails.

Complexity of the Theory

The theory isn’t complex and it is simple. It basically discusses how much caring for a
person holistically is important in the nursing profession by much detailed way. Nurses must
portray and give care to patients who need their service and must engage in rapport in order for
both of them to build and grow in care.

Generality of the Theory

Boykin and Schoenhofer’s theory is broad in scope and thus it is applicable to any nursing
situation/ In fact, this theory isn’t that specific to nursing – all people may utilize this theory
because caring is not only for those in the medical profession, but it is for all humans because the
act of caring is innate in each individual.

Strengths and Weaknesses of the Theory

Strengths. It gave emphasis to the central value of nursing, which is to care. Both nurses and
patients have the chance to express their way of caring but before doing so they must know and
acknowledge that the other party is a caring person as well. It would help in the recuperation of
the patient as the individual would feel that he/she is being truly cared for. Moreover, it can be
used with other theories.

Weaknesses. The personality and character of the nurse would still affect the care and attention
that is being given to the patient, as well as their work schedule, which would eventually “routinize”
the care that is being given. In order for this theory to be utilized effectively, nurses must
demonstrate care at every moment and valuing each individual and relationship. In addition,
patients may harbor an emotional attachment to the nurse which may cause complications.

Applicability of the Theory

This theory can be applied to all and that there are no limits. Moreover, this theory can also
be tested qualitatively due to its subjectiveness. This can be applied to any nursing situation if the
nurse integrates her caring perspective in her nursing approach.
REFERENCES:

Orlando

http://nursingtheories.weebly.com/ida-jean-orlando.html
https://www.slideshare.net/JosephineAnnNecor/ida-jean-orlandos-nursing-process-theory
http://www.nursing-theory.org/theories-and-models/orlando-nursing-process-discipline-
theory.php
http://www.nursing-theory.org/nursing-theorists/Ida-Jean-Orlando.php

Travelbee

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5866131/
http://currentnursing.com/nursing_theory/Joyce_Travelbee.html
http://www.nursing-theory.org/theories-and-models/travelbee-human-to-human-model-of-nursing.php

Wiedenbach

http://currentnursing.com/nursing_theory/Ernestine_Wiedenbach.html
http://www.nursing-theory.org/theories-and-models/wiedenbach-the-helping-art-of-clinical-
nursing.php
https://www.slideshare.net/JosephineAnnNecor/02-ernestine-wiedenbachs-the-helping-art-of-
clinical-nursing

Peplau

http://www.nursing-theory.org/theories-and-models/peplau-theory-of-interpersonal-relations.php
http://currentnursing.com/nursing_theory/interpersonal_theory.html
http://nursingtheories.weebly.com/hildegard-e-peplau.html

Paterson and Zderad

https://humanisticnursing.weebly.com/the-theory.html
https://www.slideshare.net/vaisakhgopakumar/humanistic-nursing-theory-ppt
https://prezi.com/weigiu-mebji/paterson-and-zderad-humanistic-nursing-theory/

Boykin and Schoenhofer

http://nursingiscaringtheory.blogspot.com/
https://www.gutenberg.org/files/42988/42988-h/42988-h.htm
https://www.slideshare.net/karolesessums/nursing-as-caring-revised-2013
 Theoretical Foundation of Nursing

Ateneo de Davao University

A CRITIQUE PAPER ON THE THEORIES OF ORLANDO, TRAVELBEE,

WIEDENBACH, PATERSON & ZDERAD, AND BOYKIN & SCHOENHOFER

Submitted by:

Oona Nicole L. Diorico

Submitted to: