1. Presented by: Mary Duncan Karin Mogren-Kuzma Brianna Hall Ida Orlando’s Nursing Theory

2. Orlando’s Background Born in New York in 1926 (Chitty & Black, 2011, p. 315- 316). Initially graduated from a diploma nursing program (Chitty & Black, 2011, p. 315- 316). 1951 received her BS in public health nursing (Chitty & Black, 2011, p. 315- 316). 1954 graduated with a MA in mental health nursing from Columbia University (Chitty & Black, 2011, p. 315- 316). Professor at Yale School of Nursing as well as Director of the Graduate Program in Mental Health Psychiatric Nursing (2012, Orlando’s Nursing Process Theory). 1961 published her book, The Dynamic Nurse-Patient Relationship (Chitty & Black, 2011, p. 315- 316). 1972 published The Discipline and Teaching of Nursing Process (2012, Orlando’s Nursing Process Theory). Harvard Community Health Plan board member (2012, Orlando’s Nursing Process Theory).

3. Historical Background Nursing practice involved assisting physicians to provide medical care when Ida Jean Orlando’s theory was evolving. Orlando recognized that for nursing to be its own profession, it needed its own distinctions and goals. She believed that because the profession lacked defined objectives and nurses functioned as paraprofessionals to medicine, nurses were left without a clear concept of patient outcomes should be. In the late 1950’s, Orlando was the principal investigator of the Yale School of Nursing Project. The outcome from a research project on mental health concepts was Orlando’s book, published in 1961, The Dynamic Nurse-Patient Relationship.

4. Historical Background cont. The focus of the book was on the nurse-patient relationship, the nurse’s professional role and identity, and knowledge development distinct to nursing. Orlando was one of the early thinkers in nursing who proposed that patients have their own interpretations of situations, and therefore nurses must validate their analysis with patients before drawing a conclusion. In the years to come, Orlando refined her theory by assessing its relevance, testing the validity, and training and evaluating nurses. In Orlando’s second book, The Discipline and Teaching of Nursing Process, Orlando had extended her formulations into a definition of the entire nursing practice, known as the nursing process. The nursing process is the central framework of practicing nurses today.

5. Theory Evaluation It has been said that “one of the most important tests of a theory is its applicability in practice” (Barnum, 1989, p. 19). Orlando’s theory is profound yet simple enough to comprehend and apply to practice. Identifying the nature of the patient’s distress, their immediate need for help, the nurse’s reaction, and the nurse’s activity is an interpersonal process based on a reciprocal relationship between nurse and patient, known as the nursing process. The nursing process is widely used in modern nursing, and its concept is concrete enough to function as a framework to nurse’s actions regardless of the unit, or setting the nurse might work in.

6. Theory Evaluation cont. Orlando’s theory have been tested and used in variety of situations and settings. The theory’s range of utility, the beneficial impacts on patient outcomes, and patient nurse relationship has been demonstrated from extended care facilities to operating rooms. By using Orlando’s approach, the nurse is able to identify patient’s needs and consequently provide timely and therapeutic nursing interventions.

7. Web Links http://nursing-theory.org/nursing-theorists/Ida-Jean- Orlando.php http://currentnursing.com/nursing_theory/Orlando_nursing_ process.html

8. References Barnum, B. S. (1989). Nursing theory: analysis, application, evaluation (3rd ed.). Glenview, IL: Little, Brown. Chitty, K. K., & Black, B. P. (2011). Professional Nursing Concepts and Challenges (6th ed.). Maryland Heights, MS: Saunders. Noakes, S. R. (1990). The dynamic nurse-patient relationship. RN, 53(11), 96. Retrieved from: Academic OneFile Schmieding, N. J. (1995). Ida Jean Orlando a nursing process theory. In C. M. McQuiston & A. A. Webb (Eds.), Foundations of nursing theory contributions of 12 key theorists (pp. 563-613). Thousand Oaks, CA: Sage.

9. Case Study Orlando’s theory is based upon a shared communication process between nurse and patient in order to identify with the patient what the meaning of the patient’s behavior is, so needs can be met and distress can be relieved. From the case study scenario, describe how Orlando’s deliberative process is used by identifying the meaning of the patient’s behavior, the nurse’s reaction to the behavior, and the nurse’s action to relieve distress. A 39- year old diabetic patient who was 4 months pregnant was admitted with vomiting. She spoke only when spoken to and remained in the bed even though she could be up. She said she had vomited, but the nurses had not observed it. During reports, nurses speculated, “I don’t think she really is vomiting” and “I don’t think she really wants this baby.”

10. Case Study cont. These remarks were passed from shift to shift and eventually these speculations were passed in as fact even though no one had confirmed them with the patient. One nurse was shocked to learn that the patient did not want her baby. Although apprehensive, the nurse decided to express her feeling to the patient. She stated, “I’m shocked because I hear that you don’t want this baby. Is that true?” Immediately the patient’s eyes began to well over with tears and she sobbed, “That’s not true. I want the baby, it’s just that I’m afraid I’ll die in labor. Fifteen years ago when my other child was born I wasn’t diabetic.” The nurse was stunned by the patient’s remark and asked, “Does your doctor or anyone know of this?” The patient replied, “No, I thought if I told people they would think I was a hysterical woman.” The patient then agreed to discuss this with both her doctor and her family. Nurses on the unit, when hearing about this, became sympathetic toward the patient (Schmieding, 1995).