Ida Jean Orlando

Ida Jean Orlando

The role of the nurse is out find out and

meet the patients immediate need for

help.
The patients presenting behavior may
be plea for help, however, the help
needed may not be what it appears to be.
Nurses needed to use their perception,
thoughts about the perception or the
feeling engendered from their thoughts to
explore with patients the meaning of their
behavior.

History and Background

Ida Jean Orlando, a first-generation
American of Italian descent was born in
1926.
She received her nursing diploma from
New York Medical College, her BS in
public health nursing from St. Johns
University NY, and her MA IN MENTAL
HEALTH NURSING FROM Columbia
University, New York
Orlando was an Associate Professor at
Yale School of Nursing where she was
Director of the Graduate Program in
Mental Health Psychiatric Nursing.

 Yale she was project investigator of a National

Institute of Mental Health grant entitled: Integration
of Mental Health Concepts in a Basic Nursing
Curriculum.
She Developed her theory which was published in her
1961 book : The Dynamic Nurse-Patient
Relationship
She Furthered the development of her theory when at
Mclean Hospital in Belmont, MA as Director of a
Research Project: Two system of Nursing in a
Psychiatric Hospital.
The results of the research are contained in her 1972
book titled the Discipline and Teaching of Nursing
Processes.
Orlando held various position in the Boston area, was
a board member of Harvard Community Health Plan,
and served as both a national and international
consultant.

 A frequent lecture and conducted numerous

seminar on nursing process.
Orlandos theory was developed in the late
1950s from observations she recorded
between a nurse and patients.
Despite her efforts, she was only able to
categories the records as good or bad
nursing.
It hen dawned on her that both the
formulations for good and bad nursing
contained in the records. From these
observations she formulated the deliberative
nursing process.

Person { Human
Being}
A developmental being with
needs.
Nursing clients are patients
who under medical care and
who cannot deal with their
needs or who cannot carry
out medical treatment alone.

Health
Asenseofadequacyorwell
being.
Fulfilledneeds.
Senseofcomport

Environme
nt
Not Defined
Sense of comport.
Fulfilled needs

Nursing
Is a dynamic nurse patient relationship.
Is a responsive to individuals who suffer or
anticipate a sense of helplessness.
The goal of nursing is increased sense of well
being, increase in ability, adequacy in better
care of self and improvement in patients
behavior.
Nursing are composed of direct function,
disciplined and professional activities and
automatic activities.

a. Direct Function Process of helping the patient

express the specific meaning of his behavior in order
to ascertain his distress and helps the patient to
explore the distress in order to ascertain the help
requires so that his distress may be relieved.
b. Indirect function Calling for help of others,
whatever help the patient may require for his need
to be met.
c. Disciplined and Professional activities Automatic
activities plus matching of verbal and non-verbal
responses, validation of perceptions, matching of
thoughts and feelings with action.
d. Automatic activities Perception by five senses ,
automatic thoughts automatic feeling and automatic
action.

CHARACTERISTICS OF
THE THEORY
Orlando's theory interrelate concepts.
Orlando's theory has a logical nature.

Orlando's theory is simple and applicable in the daily

practice.
Orlando's theory contribute to the professional
knowledge.
Orlando's theory is applicable in clinical practice.

ThemajordimensionsofOrlandos
NursingProcessTheory
Professionalnursingfunction-organizing
principle.
Thepatientspresentingbehavior
-Problematicsituations.
Immediatereaction-internalresponse.
Deliberativenursingprocess-reflective
inquiry.
Improvement-resolution.

1.Professional Nursing
Function
Finding out and meeting the patients immediate needs for
help{Orlando, 1972}

Organizing
Principle
The nurses unique function is finding out and meeting the
patients immediate needs for help.

The nurses unique function is Finding out and meeting th

patients immediate needs for
Nursing is responsive to individuals who suffer or anticipa
a sense of helplessness, it is focused on the process of care
an immediate experience, it is concerned with providing
direct assistance to individuals in whatever setting they are
found for the purpose.

 The patients sense of helplessness, stress, or need

originates from physical Limitations, adverse reaction
to the setting, and experiences that prevent a patient
from communicating his or her needs.
Need is situationally defined as a requirement of the
patient which, if supplied, relieves or diminishes his
immediate distress or improving his immediate sense of
adequacy or well-being
Nurses responsibility to meet the patients immediate
needs for help either by supplying it directly or by
calling in the services of others.
The central core of the nurses practice is to understand
what is happening between the patient and the nurse
that provides framework for the help the nurse gives
the patient.
Nursing Thought Does the patient have an immediate
need for help or not.
If the patient is in need and the need is fulfilled , the
nursing function has been fulfilled.

 If the patient is need the nurses focus of

inquiry is always on the patients immediate
experience.
The product of meeting the patients
immediate need for help is improvement
helplessness.
"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." - Orlando

The Patients Presenting

Behavior Problematic
Situation
Tofindouttheimmediateneedforhelpthenurse
2.

mustfirstrecognizethesituationasproblematic.
Thepresentingbehaviorofthepatient,regardlessof
theforminwhichitappears,mayrepresentaplea
forhelp.
Thepresentingbehaviorofthepatient,thestimulus,
causesanautomaticinternalresponseinthenurse,
andthenursesbehaviorcausesaresponseinthe
patient.

3.
Immediate
reaction
- internal
response

The problematic situation, in the form of patients

presenting behavior triggers an automatic immediate
reaction in the nurse that is both cognitive and affective.

Example: Requests, comments ,questions ,crying, pallor,

difficulty of breathing Assumptions.

The nurses immediate reaction is unique for each

situation, What the nurse thinks or feels reflects his or her
individuality.
The extent of nurses accuracy, the perceptions that
evoked the thoughts are communications from the
patient.

4.Deliberative Nursing
Process
- Reflective
The nurses behavior
affects the patient and
the nurse is affected by the patients behavior.
ToInquiry
be successful the nurses focus must be on

the patient rather than on an assumption that

he/she knows what the patients problems are
and on arbitrary decision what action to take.
The use of Orlandos {1961} deliberative
process requires that there are
communication process between the patients
and nurse

By determining of this
The meaning of patients behavior
The help required by the patient
Whether the patient was helped by the nurses action.
The nurse will find more efficient to find out what the patients
immediate need for help is by first exploring and understanding
the patients.
Feeling come from the thought about the perception. The nurse
must state the perception that evoked the thought from which
the feeling was derived.

Example:

Nurse: Im concerned that you keep asking for the bedpan, But I
dont think you really need it. I am right or not.
Patient: Yes, But Im afraid I might have chest pain again and
then I wouldnt be able to call for the nurse.
If Nurses do not resolve their feelings with patients, these same
feelings occur each time they are in contact with the patient.
A nurses past experiences are not sufficient as the basis for
understanding the patients immediate behavior.

5. Improvement re
It is not the nurses activity that is
evaluated but rather its result. When the
patients immediate need for help have
been determined and met, there is
improvement.
It is not the nurses activity that is
evaluation but rather its the result.
When a situation becomes clear, it loses
its problematic character and a new
equilibrium is established.
In each contact the nurse repeats a
process of learning how to help the
individual patient.

Assumptions
The theory assumes that a patient who cannot cope
with their medical needs without assistance will become
distressed and begin feeling helpless. At the base level,
nursing can contribute to this distress. However, Orlando
theorized that the nurse/patient relationship is one that
is decided by both parties. The patient cannot
appropriately convey their needs or fears without first
establishing a close relationship with the nurse. As such,
nurses exist to offer patients a motherly and nurturing
presence to relieve distress.

Theactionprocessinaperson-toperson
contactfunctioninginsecret.
Theperceptions,thoughtsandfeelings
ofeachindividualarenotdirectly
availabletotheperceptionoftheother

-Theactionprocessinaperson-topersoncontact
functioningbyopendisclosure.
Theperceptions,thoughts,andfeelingsofeachindividualare
directlyavailabletotheperceptionoftheotherindividual
throughtheobservationaction

Assessing

a Patient by
using Orlandos Theory
to Guide the Nurses
Process


1.Guidingprinciple
Findingoutandmeetingthepatients
immediateneedforhelp

Thenursesfocusisonthepatient.
Thenursesmindisfreeofdistracting
thoughts.

2.Problematicsituationandimmediate Thenurserecognizesthatapatient
reaction
problemmayexistbeforethenext
stepintheprocess.
Thenurseidentifieshisorherimmediate
perception,thoughtsandfeelings.

3.Inquiry-problemdetermination

Thenurseusetermsthepatientcan
understandandexploresimmediate
reactionswiththepatienttodiscover
physical/non-physicalproblems.As
theproblemisidentified,thenurse
asksthepatienttoconfirm.
Thenurseexploresthe
disagreementtodeterminebasis.

4.Identifyingspecificplansfor
eachproblem

Withthepatient,thenursedetermination
actionsneededanddevelopsplansforeach
problem.
Thenurseexploreswhetherthepatients
agreewithorrefutestheplan.Thenurse
exploresandresolvesthebasisof
disagreement.Thepatientverballyandor
nonverballyagrees.Ifnot,thenurse
continuestheinquiryforthebasis.

5.Implement

Ifthepatientisunable,thenurse
implementstheplanandasksthe
patientwhethertheactionIhelpful.If
itisnot,thenurseexploresthebasis.
Thenursehelpsthepatientifheor
sheisunabletodoitaloneand
exploreswhetherthepatientwas
helped.Thenurseinquiresabout
Hisorherresults.

6.Improvement

Thenurseasksthepatient
whethertheactionhelpedand
observesthepatientsverbal
andnon-verbalbehavior.Ifhe
orshehasimproved,theneed
forhelpwasmet.Ifnot,the
nursecontinuestousethe
contentofimmediatereaction
toexplorewiththepatient
untilapositivechangeis
evident.

Nursing
Process Theory

TheNursingProcesswasbasedonatheory
developedbynurseIdaJeanOrlando,Thistheory
delvesintothepurposeofnursesandtheir
requirementsinthemedicalfield.Orlando'stheory
wasdevelopedinthelate1950sfromobservations
sherecordedbetweenanurseandpatient.Despite
herefforts,shewasonlyabletocategorizethe
recordsas"good"or"bad"nursing.Itthen
dawnedonherthatboththeformulationsfor
"good"and"bad"nursingwerecontainedinthe
records.Fromtheseobservationssheformulatedthe
deliberativenursingprocess.

ADeliberatenursingprocesshas
elementsofContinuousreflectionasthe
nursetriestounderstandthemeaning
tothepatientofthebehaviorshe
observesandwhatheneedsfromherin
ordertohelped.
Responsescomprisingthisprocessare
stimulatedbythenursesunfolding
awarenessoftheparticularsofthe
individualsituation.

Theroleofthenurseistofindoutandmeetthe
patient'simmediateneedforhelp.Thepatient's
presentingbehaviormaybeapleaforhelp,
however,thehelpneededmaynotbewhatit
appearstobe.Therefore,nursesneedtouse
theirperception,thoughtsabouttheperception,
orthefeelingengenderedfromtheirthoughtsto
explorewithpatientsthemeaningoftheir
behavior.Thisprocesshelpsthenursefindout
thenatureofthedistressandwhathelpthe
patientneeds.Orlando'stheoryremainsonethe
ofthemosteffectivepracticetheoriesavailable.