Nursing Theorist Group Presentations By: Tara Braun, Nathan Buchinger, Leah Mueller, Elisabeth Vander Zwaagas Ida J. rlando

Ida J. Orlando’s Nursing Process Theory Theory of the Deliberative Nursing Process “How nurses process their observations of patient behavior and also about how they react to patients on the basis of inferences from patients’ behavior, including what they say” (Chitty & Black, 2011, p. 315).

What is Nursing Theory? “Refers to a group of related concepts, definitions, and statements that describe a certain view of nursing phenomena from which to describe, explain, or predict outcomes” (Chitty & Black, 2011, p. 303)

What is a Nursing Conceptual Model? “Provide comprehensive, holistic, perspectives of nursing by describing the relationships of specific concepts” (Chitty & Black, 2011, p. 310) Are more formalized than a philosophy but more abstract than a theory (Chitty & Black, 2011, p.310)

Ida Jean Orlando - Pelletier (1926 – 2007) Achievements Received her Nursing Diploma at New York Medical College in 1947 Earned her BS in Public Health at St. John’s University in 1951 Received her MA in Mental Health at Columbia University in 1954 (Tyra, 2008)

As the National Institute of Mental Health (NIMH) principle investigator worked on a grant in which she worked to identify factors relevant to the integration of psychiatric mental health principles into a nursing curriculum Published her results in: The Dynamic Nurse-Patient Relationship: Function, Process, And Principles in 1961 First nurse in the United States to obtain an applied research grant from NIMH. Allowed her to conduct the first ever scientific nursing study of the teaching and use of the nursing process. Published her results in: The Discipline and Teaching of Nursing Process: An Evaluation Study in 1972 (Tyra, 2008)

Motivation Length 1:31 (Ida Jean Orlando)

Based on the nurse-patient relationship focusing on communication (Sheldon & Ellington, 2008) “The role of the Nurse is to find out and meet the patient’s immediate need for help” (Nursing Theory: Orlando Nursing Process) “The patient’s presenting behavior may be a plea for help, however, the help needed may not be what it appears to be” (Nursing Theory: Orlando Nursing Process) Primary goal of Orlando’s theory is the “identification of the nature of the patient’s distress and is or her immediate needs for help” (D. Venes, 2010)

Nurses are expected “to use their perception, thoughts about the perception, or the feeling engendered from their thoughts to explore with the patients the meaning of their behavior” (Nursing Theory: Orlando Nursing Process) “This process helps nurses find out the nature of the distress and what help the patient’s needs” (Nursing Theory: Orlando Nursing Process) Orlando felt the purpose of her theory was to allow nurses “to get to the bottom line more quickly when observing, listening to, and confirming with patients…saves time and energy for both the patient and the nurse” (Chitty & Black, 2011, p. 316)

Nursing Process Theory Stated perception, thought, or feeling Patient asked a question about same perception, thought, or feeling Good Nursing (Ida Jean Orlando)

Three basic aspects of Orlando’s Nursing Theory Patient Behavior - verbal and nonverbal communication relating to the nurse what the patient immediately needs The Nurse’s Reaction – An active thought process by the nurse in which he/she observes the behavior, interprets them, and formulates a plan to meet the patient’s needs. The nurse also communicates with the patient to validate whether the patient’s behavior was correctly perceived by the nurse before deciding on an appropriate intervention. The Nurse’s Activity – An interactive process with the patient whereby the nurse performs actions for and with the patient to meet the patient’s observed needs. (Sheldon & Ellington, 2008)

How did Ida J. Orlando develop her theory – In her own words. Length 1:44 (Ida Jean Orlando)

Benefits (Tyra, 2008) Patient’s needs being met more effectively Improved critical thinking Enhanced nurse – physician relationship Improved Nursing Identity (Tyra, 2008)

Deliberate action, as opposed to automatic action, involves critical thinking as well as constant interaction with the patient. Orlando heavily emphasizes a strong and dynamic nurse-patient relationship (Chitty & Black, 2011)

Relationship Between Orlando’s Theory and the 4 Global Concepts Human Beings Environment Health Nursing

Human Beings Patients are human beings who cannot meet their specific, immediate health needs without intervention by the nurse (Alligood & Tomey, 2006). Patients are interactive, dynamic, and constantly make inferences about their needs. Nurses are to observe inferences made by them in order to provide deliberate nursing care that will “relieve distress or discomfort” (Chitty & Black, 2011, p. 315). Patient’s are relational beings who, through both verbal and nonverbal communications, work with the nurse to meet their immediate needs (Chitty & Black, 2011)

Environment Because inferences are taken from the patient as to what the nurse can do immediately to meet his/her needs, the nurse also takes into account how the environment may need to be adjusted to help meet patient outcomes. Since patients exist within the environment they are currently in, and “all patient behavior is meaningful and may reflect distress,” the nurse must actively take action based on his/her observations and meet the patient’s needs (Schmieding, 1993). This may include adjusting the patient environment. “This distress is related to the inability to meet one's own needs because of injury or disease, the inability to recognize or accurately communicate one's own needs, or the reaction to the confusing, new, painful, or exhausting care environment” (emphasis added, Orlando, 1987, as paraphrased by Potter & Bockenhauer, 2000, para. 6).

Health Through the deliberative nursing process, a patient’s immediate health needs are met. A patient will then experience feelings of adequacy and wholeness. Meeting patient outcomes is the goal of Orlando’s process theory in general Nursing (Alligood & Tomey, 2006) Nurses work autonomously, use critical thinking, establish a working patient relationship, and effectively communicate with patients determine proper interventions. Nurses exist to “meet patients’ immediate needs and to improve their situation” (Chitty & Black, 2011, p. 315).

Evaluation of Global Concepts Orlando’s theory does address these concepts as shown on the previous slides. However, the primary foci of her theory is on the patient and nursing. Although environment is included, it is assumed that the nurse will make changes if that is what is required to meet patients’ needs. Health is also addressed, though less emphasized, and it is assumed that meeting immediate needs will contribute to patients’ long-term health achievement.

How can this model be used? Concrete theory based on needs of the patient Specific to nurse patient relationship Used in OR or OB setting Nurse must monitor patient needs during and after surgery Nurse must be able to adapt care based on patient needs Postoperatively the patient will have different needs than preoperatively The laboring patient will have different needs than during delivery and then postpartum (Citation?)

Similarities between Orlando & Peplau’s Theories Highly regarded and still used and taught today Centered on patient care Focus is on the Nurse –Patient Relationship Patient behavior is an essential tool in patient care (Chitty & Black, 2011, p. 314-315; Bunkers, 2012)

Situations where Orlando’s theory has been used in… Must assess patient needs Including comfort both physically and emotionally Closure for the family and patient, facing fears, and closing resolved issues End of Life Issues Solve the immediate problem, meet immediate needs while planning for future needs Listen to both verbal and nonverbal communication Emergency Situations Each patient is an individual with individual needs and values Don’t assume how a patient will react to different situations Level of need will change as disease process progresses Long-term Care (Citation ?)

Examples of other fields where Orlando’s theory may be useful… Need to always listen to the customer to satisfy their needs Follow their verbal and nonverbal cues to determine their satisfaction Customer Service Can be used in any client interaction to determine the steps to moving forward Similar to the principles of Lean Manufacturing Business Review the assignments done by the students to assess their understanding of the material Assess the flow of discussion as new material is presented to determine if clarification is necessary Teaching

Case Study A patient just recovering from surgery is complaining of pain. He has already had the maximum dose of his pain medications and is continually using his call light to make demands on the nursing staff. He has made several complaints that his pain is not being taken care of and other patients are receiving better care. How can you deal with this patient using Orlando’s theory? What are some questions you should ask this patient?

Case Study Answers How can you deal with this patient using Orlando’s theory? Ask the patient what his concerns are and listen to both verbal and nonverbal answers. Attempt to discuss with the patient different methods of pain relief. Discuss with the patient why he feels others are receiving better care. Assess the patient’s needs and take care of the needs promptly What are some questions you should ask this patient? What is your pain level? Where is your pain? What are we doing for the other patients differently than we are doing for you? What are your main concerns about your health?

References Abdoli, S., & Safavi, S.S. (2010). Nursing Student’s Immediate Responses to Distressed Clients Based on Orlando’s Theory. Iranian Journal of Nursing and Midwifery Research, 15(4), 178-184. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/21589792 Alligood, M.R., & Tomey, A.M. (2006). Nursing Theorists and Their Work. St Louis, MO: Mosby. Bunkers, S.S. (2012). Presence: The Eye of the Needle. Nursing Science Quarterly, 25(1), 1-14. Retrieved from doi: 10.1177/0894318411429074 Chitty, K.K., & Black, B.P. (2011). Professional Nursing: Concepts and Challenges (6th ed.) Maryland Heights, MO: Saunders. Ida Jean Orlando. (n.d.). Retrieved February 22, 2012 from You Tube: http://www.youtube.com/results?search_query=ida+jean+orlando

Nursing Theories. (2012). A Companion to Nursing Theories and Models Nursing Theories. (2012). A Companion to Nursing Theories and Models. [Data file]. http://currentnursing.com/nursing_theory/Watson.html Potter, M.L. & Bockenhauer, B.J. (2000). Implementing Orlando’s Nursing Theory: A Pilot Study. Journal of Psychosocial Nursing and Mental Health Services, 38(3), 14-21. Sheldon, L.K. & Ellington, L. (2008). Application of a Model of Social Information Processing to Nursing Theory: How Nurses Respond to Patients. Journal of Advanced Nursing,64(4), 388-398. Schmieding, N.J. (1993). Ida Jean Orlando: A Nursing Process Theory (Notes on Nursing Theories), (Vol. 12). Newbury Park, CS: Sage Publications. Tyra, P.A. (2008). In Memoriam: Ida Jean Orlando Pelletier. Journal of the American Psychiatric Nurses Association, 14(3), 231-231. Retrieved from doi: 10.1177/1078390308321092 Venes, D. (Ed.). (2010). Tabor’s Cyclopedic Medical Dictionary 21st ed. Philadelphia, Pennsylvania. F. A. Davis Company.