Ida Jean Orlando: Nursing Theorist Alicia Troup, RN Tianna Ferris, RN

Introduction to Ida Jean Orlando and the Deliberative Nursing Process Ida Jean Orlando, RN, Nursing Theorist Born in New York, 1926 Died November 2007 Education: New York Medical College, St. John’s University, NY and Columbia University Focus: The dynamic nurse-patient relationship Major Publication: (1961) The Dynamic Nurse- Patient Relationship: Function, Process, and Principles Orlando was an early nursing theorist who asked the question: “How can I best figure out what my patient needs through my interaction with him or her” (Black, 2014, p.276) Ida Jean Orlando was born in New York in 1926. She was well educated having received her nursing diploma in 1947 from New York Medical College, A Bachelor of Science in public health from St. John’s University in Brooklyn in1951 and a Masters in Mental Health Consultation in 1954 from Columbia University. She had a variety of nursing jobs throughout her career but her passion was mental health. She received a grant from the National Institute of Mental Health to conduct a study on identifying what factors of mental health should be used in Nursing education curriculum. It was during this study that she formulated the Deliberative Nursing Process that she wrote about in her book “ The Dynamic Nurse- Patient Relationship: Function, Process, and Principles. She proposed that how nurses process their observations of patient behavior and how they react to a patient is based on inferences taken from the actions of the patient along with what a patient states. This power point will outline Orlando’s Deliberative Nursing Process and how it relates to EBP, the four nursing Metaparadigms and how it can be incorporated into local, regional and global healthcare..

Evidence Based Practice Patient’s must be active in their health care . Nurses need to educate patients on all possible options and then support the decision they choose. Patients are diverse and needs may vary dependent upon their own set of moral values and perceptions. Observed outcomes “When used in practice, Orlando’s theory guides interactions to predictable outcomes, which are different from outcomes that occur when the theory is not used.” (Black, 2014) Evidence based practice: Orlando’s deliberative nursing process is logical in nature and can be applied to various nursing practices. Her theory assures that a patient’s individual needs are met and that patient’s remain active in their own care by increasing patient participation and self reflection of need with constant nurse- patient interaction. Providing education on all viable options involving a patient’s diagnosis and health is important and can help decrease ineffective plans of care. This theory guides the nurse to evaluate her care in terms of observable patient outcome

Nursing Metaparadigms Person: People with unmet needs are the focus of nursing practice. Each person and situation is individual and changes the dynamic of the nurse-patient relationship. Environment: Orlando did not specifically discuss environment but all situations with nurse-patient contact, including those that are therapeutic, can cause distress or helplessness. According to Orlando, persons become patients when they have needs that cannot be met individually because of physical restrictions, negative reactions to the environment or inability to communicate their needs. Each person and situation is individual and changes the dynamic of the nurse-patient relationship. Orlando alludes to environment in her theory, focusing on the immediate need of the patient, chiefly the relationship and actions between the nurse and the patient. She cautions that any part of environment, even if intended to be therapeutic, can cause distress to the patient.

Metaparadigms continued Health: Feelings of competence, fulfillment, and lack of physical and mental discomfort contribute to health. Nursing: A distinct profession that functions independently to provide assistance in meeting the patient’s needs. (Masters, K., 2015, pp.193-194) Health is replaced by a sense of helplessness as reason for seeking care. Feelings of competence, fulfillment and lack of physical and mental discomfort define health. Orlando believes that being emotionally and physically satisfies enhances health. Nursing is unique and independent in providing assistance for an individual’s need to relieve or avoid feelings of helplessness in an immediate situation. The nursing process is composed of 3 elements; the behavior of the patient, the reaction of the nurse, and the nurse’s action, which are aimed for the patient’s overall happiness and health.

Improving Contemporary Health Care Environment Nurses serve diverse populations with varying cultural beliefs and needs. Deliberative Nursing Process – 5 stages: assessment, diagnosis, planning, implementation, and evaluation The goal of this model is for a nurse to act deliberately rather than automatically Turn attention to the Nurse/Patient relationship in order to improve health care at the local, regional and global level. Local: Walk- in health clinics, urgent cares, doctor offices, and other community based healthcare programs. Regional: Large medical care facilities, State programs for healthcare, Diversity training mandating Global: Diversity awareness, immunization, looking at the population as a whole Orlando’s nursing theory focuses on the nurse-patient relationship and the importance of nurse reaction to a situation. Nurse’s interact with diverse populations who have varying cultural beliefs and needs. It is the nurses job to be aware of these differences and how they may affect a situation. Orlando's Deliberative Nursing Process is set in action by the behavior of the patient. According to the theory, all patient behavior can be a cry for help, both verbal and non-verbal, and it is up to the nurse to interpret the behavior and determine the needs of the patient. The Deliberative Nursing Process has five stages: assessment, diagnosis, planning, implementation, and evaluation. This way, a nurse will have a meaning behind the action which means the patient gets care geared specially toward their needs at that time. This nursing process is also one that can easily be adapted to a variety of diverse patients with different problems, and can be stopped at anytime, depending on the patient’s progress or health. This makes Orlando’s theory universal for the nursing field. The Nurse- Patient relationship is Orlando’s main focus. It is the nurse’s interaction with the patient that helps resolve any feelings of helplessness or distress that the person may encounter. At a local level, improving the nurse- patient interaction can increase feelings of fulfillment and lead to better outcomes. This includes all community based healthcare organizations such as walk-in clinics, urgent cares, and doctor offices. Regional facilities like major hospitals and state run organizations should have mandatory diversity training in order to improve interaction between staff and patients. Globally there must be a push for better nurse- patient interaction and diversity awareness over all. It is important to treat the individual but focus on the whole population.

References Black, B.P. (2014). Professional nursing: Concepts and challenges. St. Louis, MO: Saunders. Nursing Theories. (2013). Orlando's Nursing Process Theory. Retrieved from http://currentnursing.com/nursing_theory/Orlando _nursing_process.html Nursing theory. (2015). Retrieved from http://www.nursing-theory.org/nursing- theorists/Ida-Jean-Orlando.php

References Masters, K. (2015). Nursing process theory: Ida Jean Orlando (Pelletier). Nursing theories: a framework for professional practice. (2nd ed.). (pp. 191-200). Burlington, MA: Jones & Bartlett Publishers. Petiprin, A. (2015). Nursing process theory. Retrieved from http://www.nursing-theory.org/theories-and-models/orlando-nursing- process-discipline-theory.php