Ida Jean Orlando:
Mother of the Modern Care Plan
Crystal D Culp
Mercy College of Ohio
Ida Jean Orlando has made major contributions to nursing
theory. In 1961 she penned The Dynamic
Nurse-Patient Relationship. This
book outlined her Nursing Process Discipline theory. This theory changed the
way nurses interacted with their patients. This theory consists of five
concepts. These five concepts are the function of professional nursing, the
presenting behavior, the immediate reaction, nursing process discipline, and
improvement. Orlando defines the function of professional nursing as finding
and meeting the patient’s immediate need. The presenting behavior is what is
readily and easily apparent. This is not always the immediate need but helps to
find it. The immediate reaction is the patient’s response to the nurse. The
nursing process discipline is an exploration into the patient’s needs.
Improvement is the resolution of the patient’s immediate need. Orlando’s model
provides the framework for nursing. The theory has a strong focus on the
interaction between the nurse and patient.
It also relies heavily on the use of the nursing process. Her Deliberative Nursing Process is one we
still use today and has five stages: assessment, diagnosis, planning,
implementation, and evaluation. It is designed to be highly adaptable and
Keywords: nursing theory, nursing
process, Ida Jean Orlando, Deliberative Nursing Process
If you ask
a nurse why they are a nurse you will generally receive a response along the
lines of “I wanted to help people” and “I felt drawn to it”. Many will even tell you they feel compelled
relieve distress in other people. If you
ask a nurse how they go about being a nurse you will frequently get told that
the nurse will assess the situation, make a plan, carry out the plan and then
reassess. Some will even discuss the nursing process that makes our care plans
so adaptable. What most don’t realize is this process is relatively new. It was
first described in 1961 by Ida Jean Orlando and was part of a larger work
called The Dynamic Nurse-patient
Relationship: Function, Process, and Principles. This nursing theory
completely changed the way nurses interacted with their patients.
Orlando devoted her life to nursing, having received a diploma in nursing in
1947 when she was 21 years old. She went on to receive a Bachelor’s degree in
public health nursing from St. John’s University and her Master of Arts degree
in mental health consultation from Columbia University. She worked as a staff
nurse in OB, a staff nurse med-surg, and a staff nurse ER. She was also a supervisor
in a general hospital, a teacher at prestigious universities and an assistant
director. She has worked at places such as Mclean Hospital, Yale University,
and Boston University School of Nursing.
She has served the nursing profession as a practitioner, a consultant, a
researcher, and an educator. She became
internationally known in the psychiatric nursing field.
Orlando’s Deliberative Nursing
Process is still taught to and used by nurses today. It consists of five stages: assessment,
diagnosis, planning, implementation, and evaluation. This process is integral
to developing care plans that are workable and adaptable and it is why these
stages are taught to nurses very early on in their education. Originally there were
only four stages, diagnosis having been added later. This process helps the nurse investigate into
the patient’s immediate need, which may or may not be the presenting behavior.
to Orlando, the function of nursing is to meet the patient’s immediate need for
help. There are times the immediate need for help is the presenting behavior.
However, Orlando maintains that the presenting behavior may not be the
immediate need for help and it up to the nurse to use assessment to discover
the immediate need. She states “First, the nurse must take the initiative in
helping the patient express the specific meaning of his behavior in order to
ascertain his distress. Second, she must help the patient explore the distress
in order to ascertain the help he requires for his need to be met” (Orlando,
1961, p. 26).
next concept is the immediate reaction. This is the patient’s perceptions,
thoughts and feelings that cause how he reacts to the nurse. This then helps
dictate how the nurse reacts. These are automatic responses. Deliberative
actions are thought out actions, based on evidence and the immediate need. The
Deliberative Nursing process helps the nurse have more deliberative actions,
thereby bringing about the improvement of the patient.
changed the way nurses interact with their patients. Her theory proposed that
the participants, the nurse and the patient, were in a reciprocal
relationship. What the nurse does will
affect the patient and what the patient says and does affects the nurse. I
agree entirely with this claim and find it holds true during my nursing
practice. What one person does or says will always affect another person to
some extent or another, even if it is just an alteration in their perception,
thought or feelings.
feel that Orlando’s theory is crucial to nursing, helping us to be adaptive to
ever changing problems, I feel that some of her original definitions and
theories don’t go far enough. For
example, I feel the focus on the immediate need, while definitely the most
pressing matter, is short sighted in the sense that at risk type needs are less
likely to be addressed before they become an emergent problem. This is due in
part to the lack of completion to Orlando’s concept of health. I feel that health
is the entire wellness of the person, not only achieving it but also
maintaining it and the ability to do so. Orlando’s health focus is solely on
the immediate problem. Another area that
I feel this theory is lacking is in environment. Orlando’s environment focuses
mostly on patient-nurse interaction. While it doesn’t specifically mention
family, friends, work, etc., as I feel that it should, this could be assumptive
that the nurse will consider all of this during the assessment phase.
feel that Ida Jean Orlando’s theory has radically changed nursing for the
better. It has allowed our care to be adaptive to the ever changing patient, it
has pointed out the reciprocal nature of the nurse-patient relationship and it
has changed the way nurses interact with their patient. However, I also feel
that it fails to explicitly mention the need to consider the patient as whole,
with all things that affect him. While the immediate need is important, a
patient is more than just the immediate need and the effects of the immediate
surroundings. A patient is a person,
with a million different things that affect and influence him and all of these
must be considered to solve the immediate problem and prevent future ones.
Ida Jean Orlando – Biography and Works. (2017, April 09).
Retrieved from https://nurseslabs.com/ida-jean-orlando/
Ida Jean Orlando – Deliberative Nursing Process Theory.
(2016, December 12). Retrieved from
Ida Jean Orlando – Nursing Theorist. (n.d.). Retrieved
Nursing Process Theory. (n.d.). Retrieved from
Orlando, I. J. (1990). The dynamic nurse-patient relationship: function, process, and
principles. New York, NY: National League for Nursing.
Orlando’s Nursing Process Theory. (n.d.). Retrieved from
Themes, U. (2017, January 10). Orlando’s Nursing Process
Theory in Nursing Practice. Retrieved from