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Megan Griffin

Leah Langenberg
Miranda Thomas
Elizabeth Hagen

Summary
Ida Jean Orlando is well educated with many advanced degrees in nursing, making her a
respectable and credible role-model. She has had a diverse career, working as a practitioner,
consultant, researcher, and educator in nursing. Orlando devoted her life to mental health and
psychiatric nursing, working as a clinical nurse and researcher. With her clinical expertise,
Orlando developed the theory of nursing process discipline. The theory emphasizes the
interaction between a nurse and a patient, particularly the steps that take place to clarify a
patients immediate need for help. Orlandos theory consists of three steps that include patient
behavior, the nurses reaction, and the nurses action. These steps follow along with the phases
of the nursing process and can be applied to three of the four concepts of the meta-paradigm.
Education and Nursing Specialty
Ida Jean Orlando was educated in many areas of nursing. In 1947, Orlando received a
diploma in nursing from Flower Fifth Avenue Hospital School of Nursing in New York. In 1951,
from St. Johns University in Brooklyn, New York she received a Bachelor of Science degree in
public health nursing. From Columbia University, in 1954, Orlando received her Master of Arts
degree in mental health consultation (George, 2011).
As a beginning nurse, Ida Jean Orlando worked as a staff nurse in medicine, obstetrics,
surgery, and the emergency department but later her nursing specialty became mental health and
psychiatric nursing. After working as a staff nurse, Orlando became Assistant Director of
Nursing and performed managerial duties. After receiving her Master of Arts, she worked as a
research associate and principal investigator at Yale University. Here she studied incorporating
Megan Griffin
Leah Langenberg
Miranda Thomas
Elizabeth Hagen

mental health concepts into nursing curriculum. After working as a researcher, she wrote a book
on her findings from Yale, entitled The Dynamic Nurse-Patient Relationship: Function, Process,
and Principles. Her book was published in 1961. A year later, she began working at McLean
Hospitala psychiatric hospital in Belmont, Massachusettsas a clinical nurse consultant. Here
she also continued her research studies, and in 1972 she published her second book The
Discipline and Teaching of Nursing Process. Later on in her nursing career, Ida Jean Orlando
became an educator at Boston University School of Nursing and at Metropolitan State Hospital
in Waltham, Massachusetts. She was also a project consultant for the Mental Health Project for
Associate Degree Faculties created by the New England Board of Higher Education. Finally in
1992, Orlando retired and received the Nursing Living Legend award by the Massachusetts
Registered Nurse Association (George, 2011).
Orlandos Nursing Theory
The use of an integrative nursing theoretical framework for clinical and administrative
professional practice can benefit nursing in many ways. Nursing theory can help guide clinical
and administrative decisions, provide a foundation for nursing philosophy, and promote
improved communication with both patients and with other healthcare professionals
(Schmieding, 1990). Nursing theory provides a standard for nursing education, as well as, a
means for defining nursing and non-nursing functions. Lastly, nursing theory promotes
professionalism and alliance among the nursing profession (Schmieding, 1990).
Ida Jean Orlando is a nurse that has influenced nursing theory. Orlando served as
director of the graduate program in mental health and psychiatric nursing at Yale (George, 2011).
Her original work was published in 1961 and reprinted in 1990 with the title The Dynamic
Megan Griffin
Leah Langenberg
Miranda Thomas
Elizabeth Hagen

Nurse-Patient Relationship: Function, Process and Principles (George, 2011). Orlandos
nursing theory, the nursing process discipline, is focused on the interaction between a nurse and
a patient, specifically the steps that take place to clarify a patients immediate need for help
(George, 2011). The nurse, in collaboration with the patient, decides on the action to resolve the
patients need. The action is evaluated to determine if the desired outcome was achieved, if no
change occurred, or if the desired outcome was not achieved. This nursing process emphasizes
the need for a nurse to continuously reflect on patient behavior by observing patient responses,
outcomes, and patient behavior (George, 2011).
Orlandos nursing process begins with the patients verbal or nonverbal behavior as
communication of a need for help (George, 2011). Patient behavior is followed with a reaction
from the nurse. The nurse reaction begins the nursing process. First, the nurse uses all of his or
her senses to perceive the patients behavior. Secondly, the nurse takes the perceived patient
behaviors to an automatic thought. Finally, the nurse takes the thought to a feeling. The nurse
then shares with the patient his or her reaction to the behavior to confirm the perceived need for
help (George, 2011). After validating his or her reaction to the patients behavior, the nurse can
take action. A deliberative action is preferred, since it results from the nursing process of
observing patient behavior, affirming the patient need, and validating the effectiveness of the
action.
Orlandos theory has practical application in nursing practice. A nurse aware of
Orlandos nursing theory is reminded to treat the patient as an individual who plays an active
role in his or her own care. The practice of Orlandos nursing theory can decrease inaccuracy in
care plans as well as in diagnosis because the nurse is continuously observing, responding, and
Megan Griffin
Leah Langenberg
Miranda Thomas
Elizabeth Hagen

evaluating the patient, and also his or her own reactions as the nurse provider (George, 2011).
Orlandos nursing theory has produced positive outcomes in patient behavior (George, 2011).
However, practice of Orlandos theory is reported to be time intensive if not used consistently as
part of nursing practice (George, 2011).
There are limitations to the application of Orlandos nursing theory. Orlandos theory is
focused specifically on nurse interaction with an individual patient. It does not take into account
the view of the patient as part of a family or a community (George, 2011). It is often essential
that a nurse evaluate the patient/family unit in actions related to a patients care. Another
limitation of Orlandos nursing process discipline is that it cannot be used in long-term planning
for the patient, since the theory is applicable to nursing practice in response to a patients
immediate need for help (George, 2011).
Application of the Meta-paradigm in Orlandos Nursing Theory
The nursing meta-paradigm consists of four concepts: person, environment, health, and nursing
(Potter & Perry, 2012). Of the four concepts, Ida Jean Orlando only included three in her theory
of Nursing Process Discipline: person, health, and nursing (George, 2011).
Person is the individual, group, family, or community receiving nursing care (Potter &
Perry, 2012). Each "person" has unique and complex needs, so it is important that each person,
whether it be an individual or an entire community, receive individualized, patient-centered care
(Potter & Perry, 2012). Orlandos theory discussed the concept of human rather than person
(George, 2011). Humans that are in need are the focus of nursing practice according to Orlando,
Megan Griffin
Leah Langenberg
Miranda Thomas
Elizabeth Hagen

and in her view it is imperative that all nurse-patient relationships are individualized and always
active (George, 2011).
The environment/situation is collectively all of the conditions that have the ability to
affect patients and the setting in which they are receiving their health care (Potter & Perry,
2012). These conditions may have a positive or negative effect on the patient (Potter & Perry,
2012). 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). The effect that
the environment could have on the patient was never mentioned in Orlandos theory (George,
2011).
Health has a different meaning for each patient, clinical setting, and health care career
and is always changing (Potter & Perry, 2012). In Orlandos theory, health is replaced by a sense
of helplessness as the initiator of a necessity for nursing (George, 2011). She stated that nursing
deals with individuals who are in need of help (George, 2011).
Nursing encompasses a broad scope of responsibilities, but is specifically defined as
diagnosis and treatment of human responses to actual or potential health problems (Potter
& Perry, 2012, pg. 41). Orlando, however, found nursing to be exclusive in its concern for each
individual humans need for help in the immediate situation (George, 2011). She also expressed
an urgency in her theory that nursing should be carried out in a disciplined fashion with a focus
on interacting with the patient, which requires thorough training to carry out properly (George,
2011).
Megan Griffin
Leah Langenberg
Miranda Thomas
Elizabeth Hagen

Implication of Theory
The Dynamic Nurse Patient Relationship: Function, Process, and Principles can be
compared with and utilized in the nursing process. There are several characteristics that are
similar between this theory and the nursing process. Both are intellectual processes and an
important characteristic of both processes is that they are used to provide care to patients and to
evaluate the care provided to that patient. Another similarity between the two processes is the
phases of the both. These phases are either the same, with different names, or they lead up to the
phase of another. In the nursing process, there are five phases: assessment, diagnosis, outcome
and planning, implementation, and evaluation. In the discipline theory, there are three phases:
the patient behavior, the nurses reaction, and the nurses action (George, 2011).
The patient behavior from Orlandos theory is what initiates the assessment of the
nursing process, which also corresponds with the nurses reaction due to past experiences with
the patient and other patients. Also, the assessment of both processes consists of data collection.
The next part of both processes is the nursing diagnosis. In the nursing process, the diagnosis is
the analysis of the assessment and the data collected. In Orlandos theory, exploration of the
nursing reaction is done to identify the patients needs. The difference between the two
processes is the formality of them. The nursing process wants a more formal action, while the
theory is more informal and deals with one problem at a time (George, 2011).
The next step is the outcomes and planning. In the nursing process, goals and objectives
are written out so that an appropriate nursing action can be decided on. Orlandos theory relates
to this as this step is the nurses action for immediate help. Patient participation is needed for
both processes action to be determined. Implementation according to both needs to be patient
Megan Griffin
Leah Langenberg
Miranda Thomas
Elizabeth Hagen

centered and individualized. The nursing process expects that the nurse will consider all possible
outcomes, while the discipline process is just concerned with the effectiveness of the actions.
The last step, evaluation, is based on objective criteria and is whether the outcomes and goals
were met by the patient (George, 2011).
There are a few important differences between the two processes. The nursing is a lot
more formal and has more detailed and in depth steps than Orlandos theory. Also, in the
nursing process nurses need to use their knowledge to get to the end, while Orlando wants nurses
to follow the steps that are laid out for the theory. Another difference is the nursing process is a
long term plan, whereas the discipline process is a short term plan (George, 2011).
References
George, J.B. (2011). Nursing theories: The base for professional nursing practice (6
th
ed.).
Philadelphia: Pearson.
Potter, P.A., & Perry, A.G. (2012). Fundamentals of nursing (8
th
ed.). St. Louis, MO: Mosby
Elsevier.
Schmieding, N. (1990). An integrative nursing theoretical framework. Journal of Advanced.
Nursing, 15(4), 463-467. doi:10.1111/j.1365-2648.1990.tb01840.x