IDA JEAN ORLANDO

“The Nursing Process Theory”

BRIEF HISTORY
■ Born in 1926 from American parents of Italian descent.
■ She received her Nursing Diploma in New York Medical College.
■ She also had a diploma in BS Public Health Nursing at St. John’s University, New York
■ She also had a MA in Mental Health Nursing from Columbia University, New York
■ She was an Associate Professor at Yale School of Nursing where she was also Director of
Graduate Program in Mental Health Psychiatric Nursing.
■ She was a project investigator at Yale of a National Institute of Mental Health grant entitled:
Integration of Mental Health Concepts in a Basic Nursing Curriculum. From this research, she
developed her theory which was published in 1961 book: “The Dynamic Nurse-Patient
Relationship”.
■ She further developed her theory at McLean Hospital in Belmont, MA. This led to the
publishing of her other book: The Discipline and Teaching of Nursing Processes.
■ She died in the year 2007 and was recognized as a “Nursing Living Legend” by the
Massachussettes Registered Nurses Association.
THE NURSING PROCESS
THEORY
■ There are no theoretical sources for this theory according to
Orlando.
■ She used empirical evidence to construct this theory.
Assumptions:
■ When patients are unable to cope with their needs on their own, they become
distressed by feelings of helplessness.
■ In its professional character, nursing adds to the distress of the patient.
■ Patients are unique and individual in how they respond.
■ Nursing offers mothering and nursing analogous to an adult who mothers and
nurtures a child.
■ The practice of nursing deals with people, environment, and health.
■ Patients need help communicating their needs; they are uncomfortable and
ambivalent about their dependency needs.
■ People 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
the nurse and the patient.
■ People attach meanings to situations and actions that aren’t apparent to others.
■ Patients enter into nursing care through medicine.
■ The patient is unable to state the nature and meaning of his or her distress
without the help of the nurse, or without him or her first having established a
helpful relationship with the patient.
■ Any observation shared and observed with the patient is immediately helpful in
ascertaining and meeting his or her need, or finding out that he or she is not in
need at that time.
■ Nurses are concerned with the needs the patient is unable to meet on his or her
own.
The Major Dimensions of Orlando’s
Nursing Process Theory
1. Professional Nursing function – organizing principle
2. The patient’s presenting behavior – problematic situation
3. Immediate reaction – internal response
4. Nursing process discipline – investigation
5. Improvement - Resolution
 1. Professional nursing function
■ This means finding out and meeting the patient’s immediate needs for help.
■ According to Orlando, nursing is responsive to individuals who suffer, or who
anticipate a sense of helplessness. It is focused on the process of care in an
immediate experience, and is concerned with providing direct assistance to a
patient in whatever setting they are found in for the purpose of avoiding,
relieving, diminishing, or curing the sense of helplessness in the patient.
■ The Nursing Process Theory labels the purpose of nursing to supply the help a
patient needs for his or her needs to be met.
2. The patient’s presenting behavior
■ Distress – When the patient experiences a need that he cannot resolve, a
sense of helplessness occurs.
■ Presenting behavior is the patient’s problematic situation.
■ To do this, the nurse must first recognize the situation as problematic.
Regardless of how the presenting behavior appears, it may represent a cry for
help from the patient.
■ This is the stimulus that causes an interaction between the nurse and the patient.
3. Immediate Reaction
■ The immediate reaction is the internal response.
■ Nurse Reaction - The patient behavior stimulated a nurse reaction, which
marks the beginning of the nursing process discipline.
■ Nurse’s Action
– When the nurse acts, an action process transpires. This action process by
the nurse in a nurse-patient contact is called nursing process. The nurse’s
action may be automatic or deliberative.
■ Automatic Nursing Actions are nursing actions decided upon for reasons
other than the patient’s immediate need.
■ Deliberative Nursing Actions are actions decided upon after ascertaining a
need and then meeting this need
 4. Nursing Process Discipline
■ The nursing process discipline is the investigation into the patient’s needs.
■ Any observation shared and explored with the patient is immediately useful in
ascertaining and meeting his or her need, or finding out he or she has no needs at
that time.
■ The nurse cannot assume that any aspect of his or her reaction to the patient is
correct, helpful, or appropriate until he or she checks the validity of it by exploring it
with the patient. The nurse initiates this exploration to determine how the patient is
affected by what he or she says and does.
■ Automatic reactions are ineffective because the nurse’s action is determined for
reasons other than the meaning of the patient’s behavior or the patient’s immediate
need for help.
■ When the nurse doesn’t explore the patient’s reaction with him or her, it is
reasonably certain that effective communication between nurse and patient stops.
5. Improvement
■ Improvement is the resolution to the patient’s situation.
■ In the resolution, the nurse’s actions are not evaluated.
■ Instead, the result of his or her actions are evaluated to determine whether his
or her actions served to help the patient communicate his or her need for help
and how it was met.
VIEW OF THE THEORY TO
PERSON, HEALTH,
NURSING AND
ENVIRONMENT
Person
■ Developmental being with needs, own perception and feelings that may not be
observed directly from a nurse’s perception.

Health
■ The fulfilled need of a patient, not in the state of distress.

Nursing
■ A distinct profession and separated it from medicine where nurses as determining
nursing action rather than being prompted by physician’s orders, organizational
needs and past personal experiences. She believed that the physician’s orders are
for patients and not for nurses.
Environment
■ Orlando completely disregarded environment in her theory, only focusing on the
immediate need of the patient, chiefly the relationship and actions between the
nurse and the patient (only an individual in her theory; no families or groups
were mentioned).
 RELEVANCE/IMPORTANCE
TO EDUCATION, RESEARCH
AND NURSING PRACTICE
Education
■ It teaches a way of assessing a patient through his/her
behavior and using the observations a nurse make while
interacting with the patient.
Practice
■ This theory keeps the focus on the patient and not
on other things.
■ This theory also puts focus on the mental health of a
patient.
Research
■ The theory can be a framework for nursing
researches regarding the mental health of a patient.