 Biography

■ Orlando was a first generation Irish American born on August 12, 1926. She dedicated
her life studying nursing and graduated in 1947 and received a Bachelor of Science
degree in public health nursing in 1951. In 1954, she completed her Master of Arts in
Mental Health consultation. While studying she also worked intermittently and sometimes
concurrently as a staff nurse in OB, MS, ER; as a supervisor in a general hospital, and as
an assistant director and a teacher of several courses. And in 1961, she was married to
Robert Pelletier and lived in the Boston area.
■ Education
■ As for being a respectable and credible role-model, Orlando was well educated with many
advanced degrees in nursing.
 In 1947, she received a diploma in nursing from the Flower Fifth Avenue Hospital School
of Nursing in New York. In 1951, she received a Bachelor of Science degree in public
health nursing from St. John’s University in Brooklyn, New York. And in 1954, Orlando
received her Master of Arts degree in mental health consultation from Teachers College,
Columbia University.
 Description

■ Orlando’s theory stresses the reciprocal relationship between patient and nurse. It
emphasizes the critical importance of the patient’s participation in the nursing
process. Orlando also considered nursing as 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.
■ She proposed that “patients have their own meanings and interpretations of
situations and therefore nurses must validate their inferences and analyses with
patients before drawing conclusions.”
  Deliberative Nursing Process Theory
The Deliberative Nursing Process has five stages: assessment,
diagnosis, planning, implementation, and evaluation.

■ Assessment
In the assessment stage, the nurse completes a holistic assessment of the patient’s
needs. This is done without taking the reason for the encounter into consideration. The nurse
uses a nursing framework to collect both subjective and objective data about the patient.
■ Diagnosis
The diagnosis stage uses the nurse’s clinical judgment about health problems. The
diagnosis can then be confirmed using links to defining characteristics, related factors, and
risk factors found in the patient’s assessment.
■ Planning
The planning stage addresses each of the problems identified in the diagnosis. Each
problem is given a specific goal or outcome, and each goal or outcome is given nursing
interventions to help achieve the goal. By the end of this stage, the nurse will have a nursing
care plan.
■ Implementation
In the implementation stage, the nurse begins using the nursing care plan.
■ Evaluation
Finally, in the evaluation stage, the nurse looks at the progress of the patient
toward the goals set in the nursing care plan. Changes can be made to the nursing
care plan based on how well (or poorly) the patient is progressing toward the goals.
If any new problems are identified in the evaluation stage, they can be addressed,
and the process starts over again for those specific problems.
 Major Concepts

The nursing metaparadigm consists of four concepts: person, environment, health, and
nursing. Of the four concepts, Orlando only included three in her theory of Nursing Process
Discipline: person, health, and nursing.

■ Human Being
■ Orlando uses the concept of 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.
■ Health
■ In Orlando’s theory, health is replaced by a sense of helplessness as the initiator of a necessity for
nursing. She stated that nursing deals with individuals who are in need of help.
■ 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). The effect that the environment
could have on the patient was never mentioned in Orlando’s theory.
■ Nursing
■ Orlando speaks of 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.
 Subconcepts
■ Patient Behavior
■ This sets the nursing process discipline in motion.

■ All patient behavior, no matter how insignificant, must be considered an expression of need
for help until its meaning to a particular patient in the immediate situation is understood.

■ “The presenting behavior of the patient, regardless of the form in which it appears, may
represent a plea for help” (Orlando, 1990).

■ Patient behavior may be verbal or nonverbal. 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’s Action
■ Orlando (1990) includes “only what she [the nurse] says or does with or for the benefit of the
patient” as professional nursing action. “The nurse initiates a process of exploration to
ascertain how the patient is affected by what she says or does.”
■ The nurse can act in two ways: automatic or deliberative. Only the second manner fulfills her
professional function.
■ Automatic actions are “those decided upon for reasons other than the patient’s immediate
need,” whereas deliberative actions ascertain and meet this need.

■ The following list identifies the criteria for deliberative actions:

■ 1. Deliberative actions result from the correct identification of patient needs by validation of
the nurse’s reaction to patient behavior.
■ 2. The nurse explores the meaning of the action with the patient and its relevance to meeting
his need.
■ 3. The nurse validates the action’s effectiveness immediately after completing it.
■ 4. The nurse is free of stimuli unrelated to the patient’s need when she acts.
 Strengths/Weaknesses

■ Strengths:

■ Use of her theory assures that the patient will be treated as individuals and they will
have an active and constant input into their own care.

■ Assertion of nursing’s independence as a profession and her belief that this

independence must be based on a sound theoretical frame work.

■ Guides the nurse to evaluate her care in terms of objectively observable patient
outcomes.
■ Weaknesses:

■ Lack the operational definitions of society or environment which limits the

development of research hypothesis.

■ The theory focuses on short term care, particularly aware and conscious individuals
and on the virtual absence of reference group or family members.
■ 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.