INTRODUCTION:

Nursing theory is a conceptualization of some aspect of reality that pertains to nursing. Ida Jean Orlando was born in 1926. She was one of the first nursing theorists to write about the nursing process based on her own research (Orlando, I. J. 1972).

DEVELOPMENT OF THEORY:

In the late 1950, Orlando developed her theory inductively through an empirical study of nursing practice. From observations she formulated the “Deliberative nursing process “which was published in 1961.

ASSUMPTION OF THE THEORY:

Distress is the experience of a patient whose need has not been met. Nursing role is to discover and meet the patient’s immediate need for help. Patient’s behaviour may not represent the true need. The nurse validates his/her understanding of the need with the patient. Nursing actions directly or indirectly provide for the patient’s immediate need. An outcome is a change in the behavior of the patient indicating either a relief from distress or an unmet need. Observable verbally and nonverbally.

CONCEPTS:

Five Major Interrelated Concepts:

v Functions of professional nursing

v Presenting behaviour

v Immediate reaction

v Nursing process discipline

v Improvement

Functions of professional nursing organizing principle:

Nursing thought - Does the patient have an immediate need for help or not? Finding out and meeting the patient’s immediate needs for help. The purpose of nursing is to supply the help a patient requires for his needs to be met

Presenting behavior:

To find out the immediate need for help the nurse must first recognize the situation as problematic. The presenting behaviour of the patient, the stimulus causes an automatic internal response in the nurse and the nurse’s behaviour causes a response in the patient. Two types of behavior are as follows Verbal behavior: Encompasses patient’s language. It may take the form of complaints, requests, questions, refusals, demands, comments or statements. Non verbal behaviour: Physiological manifestations such as heart rate, perspirations, urinations and motor activity (walking).Vocal behaviour such as sobbing, laughing, shouting and sighing.

Immediate reaction:

Person perceives with any one of his five sense organs an object. The perceptions stimulate automatic thought. Each thought stimulates an automatic feeling and the person acts.

Nurse’s reaction: Nurse’s reaction comprised of three sequential parts.:

1. First the nurse perceives the behavior through her senses

2. Second the perception leads to automatic thought

3. Finally the thought produces an automatic feeling. Perception, thought and feelings occur automatically and simultaneously.

Nurse’s action: The nurse initiates a process of exploration to ascertain how the patient is affected by what she says or does. The nurse can act in two ways like automatic action and deliberative action Automatic action: Carrying out the physician order or regulations that may have no baring on the patient’s need for help. E.g. Giving sedation

Deliberative action: Deliberative action is a “disciplined professional response” While all of nursing actions could be considered to be in the patients best interest or deliberative.

Deliberative Nursing Action

Fig. 1 The action process in a person-to-person contact functioning in secret. The perceptions, thoughts and feelings of each individual are not directly available to the perception of the other individual through the observation action.

Fig. 2. The cation process in a person-to-person contact functioning by open disclosure. The perceptions, thoughts and feelings of each individual are directly available to the perception of the other individual through the observable action.

Automatic Nursing Action

Nursing process discipline

Any observation shared and explored with the patient is immediately useful in ascertaining and meeting his need. The over-all characteristics of the nursing process and Orlando’s nurse-patient process discipline are similar. Both processes also view the patient as a total person. Both processes are used as a method to provide nursing care and as a mean to evaluate their care. Both require deliberate intellectual processes. She does not use the term holistic but effectively describes a holistic approach.

Improvement :

It means to grow better to turn to profit to use of advantage. In each contact the nurse repeats a process of learning how to help the individual patient.

Metaparadigm:

Human being – Unique, developmental beings with needs, individuals have their own subjective perceptions and feelings that may not be observable directly.

Health – Is not well defined but assumed as freedom from mental or physical discomfort and sense of adequacy or well being.

Environment – Not defined directly but assumed as when there is a nurse patient contact both nurse and patient perceive, think, feel and act in the immediate situation.

Nursing – Providing direct assistance to individuals who suffer, for the purpose of avoiding, relieving, diminishing or curing the person’s sense of helplessness.

Nursing process and orlando process discipline:

The over-all characteristics of the nursing process and Orlando’s nurse-patient process discipline are similar. Both require deliberate intellectual processes and are described in a series of sequential steps.

Assessment phase:

The assessment phase of nursing process corresponds to the sharing of nurse reaction to the patient’s behavior in orlando’s nursing process discipline. Patient behavior initiates the assessment. Direct data are comprised of perception; thought or feeling the nurse has from her own experience of the patient’s behavior. Indirect data are from sources such as records, other health team members.

Nursing diagnosis:

Nursing diagnosis is the product of analysis in the nursing process. Exploration of the nurse’s reaction with the patient in the orlando’s process discipline leads to identification of his need for help.

Planning phase:

Involve writing goals and objectives and deciding upon appropriate nursing actions. This corresponds to the nurse’s action phase of the orlando’s process discipline. Goal is always relief of the patient’s need for help. Objectives relates to the improvement in the patient’s need for help. Both the process requires patient participation in determining the appropriate action.

IMPLEMENTATION:

Involve the final selection and carrying out of the planned actions. Part of the nurse’s action phase of Orlando’s process of discipline. Both processes mandate that the action be appropriate for the patient’s as a unique individual. Orlando’s process discipline is concerned only with the effectiveness of the action in resolving the immediate need for help.

EVALUATION:

Evaluation in both processes is based on objective criteria. It is inherent in Orlando’s action phase of process discipline. For an action to be deliberative the nurse must evaluate its effectiveness.

Application of orlando’s theory in nursing process:

Case Scenario:

Mrs. J is agitated sitting, awaiting surgery for her carpal tunnel. She is clutching the blankets, eyes wide and lips pressed firmly together. The nurse comes to the bedside; she asks if there is anything that she can do to make Mrs. J feel more comfortable. Mrs. J responds “Nothing, I’m fine!” Now does the nurse leave her alone after she receives her answer? (Ann Marriner Tomey, Martha Raile Alligood)

Patient behavior:

What the nurse has heard (verbal) as well as seen (non verbal) would mean that the nurse attempt to meet Mrs. J’s need. What are her needs?

Mrs. J’s Needs: Acknowledgment of feeling out of control. Acknowledgment of the fear of unknown. Education on what is going to happen in each step of the way. Participation in her care.

Nurse’s reaction:

“I understand how frightening it can be to be the patient in the bed. Letting others do things to you. I want you to know that it’s ok to be afraid, but I’m going to be with you the whole time. Is that how you are feeling?”

Mrs. J’s response “May be a little.”

“I’d like to tell you about what we’re going to do from here, is that alright with you?”. Nurse’s response

Nurse’s action:

Allow Mrs. J to join in a dialogue about the surgery, sequence of events, what to expect. Mrs. J is invited to participate in her care. Validation is given to her feelings as well as input on her ongoing anxiety or any pain that she may be experiencing. With each step or intervention her participation is actively pursued and surgery proceeds with her participation.

Improvement (Resolution):

Mrs. J is now sitting up relaxed feeling satisfied that she has overcome an anxiety that she had been experiencing for days. When asked “How was your experience?” She responds, “Great! A lot easier than I ever thought it would be. I’ll be back in six weeks to have my other hand done.”

Assessment:

Direct data: Perception of the nurse includes the anxiety exhibited by Mrs. J awaiting surgery for her carpal tunnel.

Nursing Diagnosis (Patient Problem):

Acknowledgment of anxiety by Mrs. J

Planning (Goals/ Objectives):

Nurse starts to participate in the care of Mrs. J. The nurse gives validation to Mrs. J‘s feeling of anxiety or any pain that she may be experiencing.

Implementation (Selection/Carrying Planned Action):

The nurse explains each step of intervention about the surgery for carpal tunnel to Mrs. J. Stays with the client and offer reassurance of safety and security. Encourage the client to explore underlying feelings. Teach the relaxation technique. Administer tranquilizing medication.

Evaluation:

Mrs. J is relaxed; feeling satisfied that she has overcome an anxiety. The nurse evaluates the effectiveness of nursing action as evidenced by relief from anxiety.

Theory critique:

Lack of operational definitions for concepts – limits development of research hypothesis. Theory is more congruent in guiding nurse – patient interactions for assessing needs and in providing nursing therapeutics deemed necessary to patient care. Focus on short term care, particularly aware and conscious individuals and on the virtual absence of reference group or family members.

CONCLUSION:

The nurse develops a unique/modifiable tool that applies this theory in various clinical settings to achieve positive outcomes.

REFERENCE:

1. Orlando, I. J, (1972) “The discipline and teaching of nursing process: An evaluative study” New York: G. P. Putnam.

2. Ann Marriner Tomey, Martha Raile Alligood Nursing Theorists and Their Work Communication: State of Washington, Office of Supervisor.

3. George B. Julia Nursing Theories- The base for professional Nursing Practice, 3rd ed. Norwalk, Appleton & Lange.

4. Wills M. Evelyn, McEwen Melanie, (2002) “Theoretical Basis for Nursing” Philadelphia. Lippincott Williams& wilkins.

5. Meleis Ibrahim Afaf, (1997) “Theoretical Nursing: Development & Progress” 3rd ed. Philadelphia, Lippincott.

6. Taylor Carol,Lillis Carol, (2001) “The Art & Science of Nursing Care” 4th ed. Philadelphia, Lippincott.

7. Potter A Patricia, Perry G Anne, (1992) “Fundamentals Of Nursing –Concepts Process & Practice” 3rd ed. London Mosby Year Book.

Received on 13.01.2015 Modified on 13.02.2015

Asian J. Nur. Edu. and Research 5(2): April-June 2015; Page212-216

DOI: 10.5958/2349-2996.2015.00042.7