Ida Jean Orlando

 
The Dynamic Nurse-Patient Relationship


 

Theorist Background:

• Ida Jean Orlando - born in 1926.
• wrote about the nursing process.
• Nursing diploma - New York Medical College
• BS in public health nursing - St. John's University, NY,
• MA in mental health nursing - Columbia University, New York.
• Associate Professor at Yale School of Nursing and Director of the Graduate Program in Mental Health Psychiatric Nursing.
• Project investigator of a National Institute of Mental Health grant entitled: Integration of Mental Health Concepts in a Basic Nursing Curriculum.
• published in her 1961 book, The Dynamic Nurse-Patient Relationship and revised 1972 book: The Discipline and Teaching of Nursing Processes
• A board member of Harvard Community Health Plan.

        Orlando’s nursing process discipline is rooted in the interaction between a nurse and a patient at a specific time and place. A sequence of interchanges involving patient behavior and nurse reaction takes place until the patient’s need for help, as he perceives it, is clarified. The nurse then decides on an appropriate action to resolve the need in cooperation with the patient. This action is evaluated after it is carried out. If the patient behavior improves, the action was successful and the process is completed. If there is no change or the behavior gets worse, the process recycles with new efforts to clarify the patient’s behavior or the appropriate nursing action.



         

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 observable action.


The action 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.

 Major Concepts:

Nursing  as unique and independent in its concerns for an individual’s need for help in an immediate situation. The efforts to meet the individual’s need for help are carried out in an interactive situation and in a disciplined manner that requires proper training.

Health  is not specified by Orlando, it is implied. In her initial work, Orlando focused on illness. Later, she indicated that nursing deals with the individual whenever there is a need for help.

 Human  as she emphasizes individuality and the dynamic nature of the nurse-patient relationship. For her, humans in need are the focus of nursing practice

 Environment  not defined directly but implicitly in the immediate context for a patien.

 Subconcepts

 Patient's Behavior

  1.) Verbal
  2.) Non-verbal

Inconsistency between these two types of behavior may be the factor that alerts the nurse that the patient needs help.

 Distress

    The patient’s behavior reflects distress when the patient experiences a need that he cannot resolve, a sense of helplessness occurs. Some categories of patient distress are: “physical limitations,… adverse reactions to the setting and … experiences which prevent the patient from communicating his needs” (Orlando, 1990).

 Nurse Reaction

3 Criteria:

1. What the nurse says to the individual in the contact must match any or all of the items contained in the immediate reaction, and what the nurse does nonverbally must be verbally expressed and the expression must match one or all of the items contained in the immediate reaction.

2. The nurse must clearly communicate to the individual that the item being expressed belongs to herself.

3. The nurse must ask the individual about the item expressed in order to obtain correction or verification from that same individual.

 Nurse’s Action

1.)  Automatic actions are “those decided upon for reasons other than the patient’s immediate need.
2.) Deliberative actions result from the correct identification of patient needs by validation of the nurse’s      
      reaction to patient behavior.
 * The nurse explores the meaning of the action with the patient and its relevance to meeting his need.
 * The nurse validates the action’s effectiveness immediately after completing it.
 * The nurse is free of stimuli unrelated to the patient’s need when she acts.

 Assumptions

When patients cannot cope with their needs without help, they become distressed with feelings of helplessness.

Nursing, in its professional character, does add to the distress of the patient.

Patients are unique and individual in their responses.

Nursing offers mothering and nursing analogous to an adult mothering and nurturing of a child.

Nursing deals with people, environment and health.

Patient need help in communicating needs, they are uncomfortable and ambivalent about dependency needs.

Human beings are able to be secretive or explicit about their needs, perceptions, thoughts and feelings.

The nurse – patient situation is dynamic, actions and reactions are influenced by both nurse and patient.

Human beings attach meanings to situations and actions that are not apparent to others.

Patient’s entry into nursing care is through medicine.

The patient cannot state the nature and meaning of his distress for his need without the nurses help or without her first having established a helpful relationship with him.

Any observation shared and observed with the patient is immediately useful in ascertaining and meeting his need or finding out that he is not in need at that time.

Nurses are concerned with needs that patients cannot meet on their own.

 Analysis

      Compared to other nursing theories which are task oriented, Orlando gave a clear cut approach of a patient oriented nursing theory. It uplifts the integrity of an individualized nursing care. This strengthens the role of the nurse as an independent nurse advocate for the patient. The dynamic concept of the nurse-patient interaction was justified since the participation of the patient in the relationship was sought. The whole process is in constant revision through continuous validation of findings of the nurse’s findings with that of the patient. Because the nurse has to constantly explore her reactions with the patient, it prevents inaccurate diagnosis or ineffective plans. Since the model is applied to an immediate situation, its applicability to a long term care plan is not feasible. The concept of interaction also limits it to individuals capable of conversing, a shared limitation with other nurse-client dynamic theories – unconscious patients are not covered by this theory. Orlando's Deliberative Nursing Process Theory focuses on the interaction between the nurse and patient, perception validation, and the use of the nursing process to produce positive outcomes or patient improvement. Orlando's key focus was to define the function of nursing. (Faust C., 2002)

ELECTRONIC SOURCES: 

http://nursingtheories.weebly.com/ida-jean-orlando.html

http://currentnursing.com/nursing_theory/Orlando_nursing_process.html

1. George B. Julia , Nursing Theories- The base for professional Nursing Practice , 3rd ed. Norwalk, Appleton & Lange.
2. Wills M.Evelyn, McEwen Melanie (2002). Theoretical Basis for Nursing Philadelphia. Lippincott Williams& wilkins.
3. Meleis Ibrahim Afaf (1997) , Theoretical Nursing : Development & Progress 3rd ed. Philadelphia,  Lippincott.
4. Taylor Carol,Lillis Carol (2001)The Art & Science  Of Nursing Care 4th ed. Philadelphia,  Lippincott.
5. Potter A Patricia, Perry G Anne (1992) Fundamentals Of Nursing –Concepts Process & Practice 3rd ed. London Mosby Year Book.
6. Vandemark L.M. Awareness of self & expanding consciousness: using Nursing theories to prepare nurse –therapists Ment Health Nurs. 2006 Jul; 27(6) : 605-15
7. Reed PG, The force of nursing theory guided- practice. Nurs Sci Q. 2006 Jul;19(3):225.
8. Faust C. .Orlando's deliberative nursing process theory: a practice application in an extended care facility. J Gerontol Nurs. 2002 Jul;28(7):14-8