Ida Jean Orlando:Mother of the Modern Care PlanCrystal D CulpMercy College of Ohio AbstractIda Jean Orlando has made major contributions to nursingtheory. In 1961 she penned The DynamicNurse-Patient Relationship. Thisbook outlined her Nursing Process Discipline theory. This theory changed theway nurses interacted with their patients.
This theory consists of fiveconcepts. These five concepts are the function of professional nursing, thepresenting behavior, the immediate reaction, nursing process discipline, andimprovement. Orlando defines the function of professional nursing as findingand meeting the patient’s immediate need. The presenting behavior is what isreadily and easily apparent. This is not always the immediate need but helps tofind it. The immediate reaction is the patient’s response to the nurse. Thenursing process discipline is an exploration into the patient’s needs.Improvement is the resolution of the patient’s immediate need.
Orlando’s modelprovides the framework for nursing. The theory has a strong focus on theinteraction between the nurse and patient. It also relies heavily on the use of the nursing process. Her Deliberative Nursing Process is one westill use today and has five stages: assessment, diagnosis, planning,implementation, and evaluation. It is designed to be highly adaptable andflexible. Keywords: nursing theory, nursingprocess, Ida Jean Orlando, Deliberative Nursing Process If you aska nurse why they are a nurse you will generally receive a response along thelines of “I wanted to help people” and “I felt drawn to it”. Many will even tell you they feel compelledrelieve distress in other people.
If youask a nurse how they go about being a nurse you will frequently get told thatthe nurse will assess the situation, make a plan, carry out the plan and thenreassess. Some will even discuss the nursing process that makes our care plansso adaptable. What most don’t realize is this process is relatively new. It wasfirst described in 1961 by Ida Jean Orlando and was part of a larger workcalled The Dynamic Nurse-patientRelationship: Function, Process, and Principles. This nursing theorycompletely changed the way nurses interacted with their patients. Ida JeanOrlando devoted her life to nursing, having received a diploma in nursing in1947 when she was 21 years old. She went on to receive a Bachelor’s degree inpublic health nursing from St.
John’s University and her Master of Arts degreein mental health consultation from Columbia University. She worked as a staffnurse in OB, a staff nurse med-surg, and a staff nurse ER. She was also a supervisorin a general hospital, a teacher at prestigious universities and an assistantdirector. 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, aresearcher, and an educator. She becameinternationally known in the psychiatric nursing field. Orlando’s Deliberative NursingProcess is still taught to and used by nurses today. It consists of five stages: assessment,diagnosis, planning, implementation, and evaluation.
This process is integralto developing care plans that are workable and adaptable and it is why thesestages are taught to nurses very early on in their education. Originally there wereonly four stages, diagnosis having been added later. This process helps the nurse investigate intothe patient’s immediate need, which may or may not be the presenting behavior. Accordingto Orlando, the function of nursing is to meet the patient’s immediate need forhelp. There are times the immediate need for help is the presenting behavior.
However, Orlando maintains that the presenting behavior may not be theimmediate need for help and it up to the nurse to use assessment to discoverthe immediate need. She states “First, the nurse must take the initiative inhelping the patient express the specific meaning of his behavior in order toascertain his distress. Second, she must help the patient explore the distressin order to ascertain the help he requires for his need to be met” (Orlando,1961, p. 26). Orlandonext concept is the immediate reaction.
This is the patient’s perceptions,thoughts and feelings that cause how he reacts to the nurse. This then helpsdictate how the nurse reacts. These are automatic responses.
Deliberativeactions are thought out actions, based on evidence and the immediate need. TheDeliberative Nursing process helps the nurse have more deliberative actions,thereby bringing about the improvement of the patient. Orlandochanged the way nurses interact with their patients. Her theory proposed thatthe participants, the nurse and the patient, were in a reciprocalrelationship.
What the nurse does willaffect the patient and what the patient says and does affects the nurse. Iagree entirely with this claim and find it holds true during my nursingpractice. What one person does or says will always affect another person tosome extent or another, even if it is just an alteration in their perception,thought or feelings. While Ifeel that Orlando’s theory is crucial to nursing, helping us to be adaptive toever changing problems, I feel that some of her original definitions andtheories don’t go far enough. Forexample, I feel the focus on the immediate need, while definitely the mostpressing matter, is short sighted in the sense that at risk type needs are lesslikely to be addressed before they become an emergent problem. This is due inpart to the lack of completion to Orlando’s concept of health. I feel that healthis the entire wellness of the person, not only achieving it but alsomaintaining it and the ability to do so. Orlando’s health focus is solely onthe immediate problem.
Another area thatI feel this theory is lacking is in environment. Orlando’s environment focusesmostly on patient-nurse interaction. While it doesn’t specifically mentionfamily, friends, work, etc., as I feel that it should, this could be assumptivethat the nurse will consider all of this during the assessment phase. Overall, Ifeel that Ida Jean Orlando’s theory has radically changed nursing for thebetter.
It has allowed our care to be adaptive to the ever changing patient, ithas pointed out the reciprocal nature of the nurse-patient relationship and ithas changed the way nurses interact with their patient. However, I also feelthat 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, apatient is more than just the immediate need and the effects of the immediatesurroundings. A patient is a person,with a million different things that affect and influence him and all of thesemust be considered to solve the immediate problem and prevent future ones. ReferencesIda 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 fromhttps://nurseslabs.com/ida-jean-orlandos-deliberative-nursing-process-theory/Ida Jean Orlando – Nursing Theorist. (n.d.). Retrievedfrom http://www.
nursing-theory.org/nursing-theorists/Ida-Jean-Orlando.phpNursing Process Theory. (n.d.). Retrieved fromhttp://www.
nursing-theory.org/theories-and-models/orlando-nursing-process-discipline-theory.phpOrlando, I. J.
(1990). The dynamic nurse-patient relationship: function, process, andprinciples. New York, NY: National League for Nursing.Orlando’s Nursing Process Theory. (n.
d.). Retrieved fromhttp://currentnursing.com/nursing_theory/orlando_nursing_process.htmlThemes, U.
(2017, January 10). Orlando’s Nursing ProcessTheory in Nursing Practice. Retrieved fromhttps://nursekey.com/orlandos-nursing-process-theory-in-nursing-practice/#bib31