Ida Jean Orlando 1w1510

c

A Close Encounter

p After an hour of interactive discussion, the masterand will be able to: ‡ ‡ ‡ ‡ ‡ ‡ ‡ ‡

Cite the credentials and background of Ida Jean Orlando Relate a Case Scenario pertaining to the theory Define the metaparadigm of nursing in Orlando¶s theory Describe the historical background of the development of Orlando¶s Nursing Process Discipline Present the theoretical assumptions in relation to her theory Discuss thoroughly the Nursing Process Discipline of Orlando with a conceptual framework presentation Discuss how the community accepted the theory and its application Identify strengths and weaknesses of the Nursing Process Discipline for clinical practice

Y rrii g t

ri t i f rit

ú A firt-g rati Italia d t ú Birt dat : ú Birt pla : ú H bad : ú Dat dat :

Am ri a

f

÷ ² Diploma in Nursing, New York Medical College ÷ ÷ ² S in Public Health Nursing, St John's University, rooklyn, New York ÷ ² M in mental health consultation, Columbia University, New York

‡ Ôtaff nurse, varied specialties (OB, MÔ, ER) ‡ Ôupervisor in a General Hospital ‡ Research Associate & Principal Investi ator of a Federal Project entitled ³Inte ration of Mental Health Concepts in a Basic Curriculum´ at Yale University in New Haven, Connecticut (÷ -÷ ÷) ‡ Clinical Nursin Consultant in Mental Health, McLean Hospital in Belmont, Massachusetts (÷ -÷ ) ‡ Ôerved on various committees at Harvard Community Health Plan in Boston, Massachusetts since ÷ ‡ Nurse Educator for Metropolitan Ôtate Hospital in Waltham, Massachusetts in ÷ ÷ ‡ Assistant Director of Nursin for Education and Research at Metropolitan Ôtate Hospital (Ôeptember÷ ) ‡ Retired in ÷

÷

ú ÷ ÷ ² ² ú ÷ g ú ÷ ² !

‡ ‡ ‡

Conducted Training Programs at McLean Hospital Managed 60 workshops about her theory in USA and Canada (1972-1981) Outstanding Nurse in the Hall of Fame of Massachusetts Nurse¶s Association in 2001

]]c Mrs. Ôo: P Nurse: P ÷ ÷ Mrs.Ôo: P Nurse: P



Mrs. Ôo à

P ! " # $ % !! !$! & " ' " ! ( Nurse: P! " &)!!" *$ !! Mrs. Ôo: P% " !! " & $ + &'

PERÔON unique and developmental beings with needs, individuals have their own subjective perceptions and feelings that may not be observable directly NURÔING providing direct assistance to individuals in whatever setting for the purpose of avoiding, relieving, diminishing, or curing the person¶s sense of helplessness

HEALTH is not well²defined but assumed as ³freedom from mental or physical discomfort and feelings of adequacy and well²being ´ ORLANDO

ENVIRONMENT is not clearly defined as well but assumed as a nursing situation when there is a nurse²patient and that both nurse and patient perceive, think, feel, and act in the immediate situation

‘evelopment of Theory ‡ ‡ ‡

In the late 1950s, Orlando developed her theory inductively through an empirical study of nursing practice For 3 years, she recorded 2000 observations between a nurse and patient interactions She was only able to categorize the records as "good" or "bad" nursing # $%& ' " " $(& ' "



"

‡ ‡ ‡

‡ ‡ ‡ ‡

From these observations, she formulated the ³Deliberative Nursin Process´ which was published in 1961 Conducted research at McLean Hospital through continuous tape recording of nurses with patients and other health care ased on this research, her formulations were validated, thus she extended her theory to include the entire nursing practice system which then evolved as ³Nursin Process Discipline´ Orlando's theory remains one the of the most effective practice theories available Many theory scholars utilized her concept as basis for their further studies Her work has been translated into six languages and was contained in the international section web page about her theory, developed by Schmieding in 1999, is updated periodically and contains extensive references

Assumptions about Nurses: ‡ ³The nurse¶s reaction to each patient is unique´ ‡ ³Nurses should not add to the patient¶s distress´ ‡ ³The nurse¶s mind is the major tool for helping patients´ ‡ ³The nurse¶s use of automatic responses prevents the responsibility of nursing from being fulfilled´ ‡ ³Nurse¶s practice is improved through self²reflection´

Assumptions about Patients: ‡ ³Patients¶ needs for help are unique´ ‡ ³Patients have an initial ability to communicate their needs for help´ ‡ ³When patients cannot meet their own needs they become distressed´ ‡ ³The patient¶s behaviour is meaningful´ ‡ ³Patients are able and willing to communicate verbally (and non² verbally when unable to communicate verbally)´

Assumptions about the nursepatient situation: ‡ ³The nurse²patient situation is a dynamic whole´ ‡ ³The phenomenon of the nurse² patient encounter represents a major source of nursing knowledge´

Assumptions about Nursin : ‡ ³Nursing is a distinct profession separate from other disciplines´ ‡ ³Professional nursing has a distinct function and product (outcome)´ ‡ ³There is a difference between lay and professional nursing´ ‡ ³Nursing is aligned with medicine´

cntroduction to the Theory 6 , , "!6

Patient ehavior Nurse Reaction Nurse ction

A) The nursin process is set in motion by the Patient Behavior ² ll patient behavior: a) verbal ( a patient¶s use of language ) b) non²verbal ( includes physiological symptoms, motor activity, and nonverbal communication) c) physical forms (vital signs) ² Must be considered an expression of a "$! and has to be validated ² Ineffective assessment by the nurse leads nurse²patient relationship failure ² Communication process is vital to acquire patient¶s cooperation in achieving health : When a patient¶s need for help is not resolved even with the help of another, will result to sense of helplessness

B) The Patient Behavior stimulates a Nurse Reaction ² Nurse²patient relationship takes place ² Correct evaluation of patient¶s behavior by using the nurse reactions steps yields positive response from the patient The steps are as follows: 1) The nurse perceives behavior through any of the senses 2) The perception leads to automatic thought 3) The thought produces an automatic feeling 4) The nurse shares reactions with the patient to ascertain whether perceptions are accurate or inaccurate 5) The nurse consciously deliberates about personal reactions and patient input in order to produce professional deliberative actions based on mindful assessment rather than automatic reactions : Exploration with the patient helps validate the patient¶s behavior

C) Critically considerin one or two ways in implementin Nurse Action Automatic Reaction (Non-Deliberative) ú stem from nursing behaviors that are performed to satisfy a directive other than the patient¶s need for help | #) * #% + , " Deliberative Reaction ú is a ³disciplined professional response´, that all nursing actions are meant to help the client and should be considered deliberative ú The following criteria should be considered Deliberative actions result from the correct identification of patient needs by validation of the nurses¶s reaction to patient behavior The nurse explores the meaning of the action with the patient and its relevance to meeting his need The nurse validates the action¶s effectiveness immediately after compelling it The nurse is free of stimuli unrelated to the patient¶s need (when action is taken) : For an action to have been truly deliberative, it must undergo reflective evaluation to determine if the action helped the client by addressing the need as determined by the nurse and the client in the immediate situation

Orlando¶s Nursin Process Discipline x x x x

The role of the nurse is to find out and meet the patient's immediate need for help The patient's presenting behavior may be a plea for help, however, the help needed may not be what it appears to be Therefore, nurses need to use their perception, thoughts about the perception, or the feeling engendered from their thoughts to explore with patients the meaning of their behavior This process helps nurse find out the nature of the distress and what help the patient needs

MAJOR DIMENÔIONÔ OF THE THEORY Function of Professional Nursin - Or anizin Principle Presentin Behavior - Problematic Ôituation Immediate Reaction - Internal Response

Nursin Process Discipline ± Investi ation Improvement - Resolution

 p  p p p FUNCTIONÔ OF PROFEÔÔIONAL NURÔING - ORGANIZING PRINCIPLE ‡ Finding out and meeting the patients immediate needs for help ‡ Nursing«is responsive to individuals who suffer or anticipate a sense of helplessness, it is focused on the process of care in an immediate experience, it is concerned with providing direct assistance to individuals in whatever setting they are found for the purpose of avoiding, relieving, diminishing or curing the individuals sense of helplessness ‡ The purpose of nursing is to supply the help a patient requires for his needs to be met ‡ Nursing thought ² Does the patient have an immediate need for help or not? ‡ If the patient has an immediate need for help and the nurse finds out and meets that need ,the function of professional nursing is achieved PREÔENTING BEHAVIOR ± PROBLEMATIC ÔITUATION ‡ To find out the immediate need for help the nurse must first recognize the situation as problematic ‡ The presenting behavior of the patient, regardless of the form in which it appears, may represent a plea for help ‡ The presenting behavior of the patient, the stimulus, causes an automatic internal response in the nurse, and the nurses behavior causes a response in the patient

IMMEDIATE REACTION ±INTERNAL REÔPONÔE ‡ Person perceives with any one of his five sense organs an object or objects ‡ The perceptions stimulate automatic thought ‡ Each thought stimulates an automatic feeling ‡ Then the person acts ‡ The first three items taken together are defined as the person¶s immediate reaction ‡ Reflects how the nurse experiences her or his participation in the nurse patient situation NURÔING PROCEÔÔ DIÔCIPLINE - INVEÔTIGATION ‡ ny observation shared and explored with the patient is immediately useful in ascertaining and meeting his need or finding out that he is not in need at that time ‡ The nurse does not assume that any aspect of her reaction to the patient is correct, helpful or appropriate until she checks the validity of it in exploration with the patient ‡ The nurse initiates a process of exploration to ascertain how the patient is affected by what she says or does ‡ utomatic reactions are not effective because the nurses action is decided upon for reasons other than the meaning of the patients behavior or the patients immediate need for help ‡ When the nurse does not explore with the patient her reaction it seems reasonably certain that clear communication between them stops IMPROVEMENT - REÔOLUTION ‡ It is not the nurses activity that is evaluated but rather its result : whether the activity serves to help the patient communicate her or his need for help and how it is met ‡ In each the nurse repeats a process of learning how to help the individual patient ‡ Her own individuality and that of the patient requires that she go through this each time she is called upon to render service to those who need her

CONCEPTUAL FRAMEWORK Distin uish the Theory

Analyze the Theory

ACCEPTANCE by the Nursing Community: ? ? a ‡ › ‡ › ?

‡ ›

‡?



‡



‡› ›

ACCEPTANCE by the Nursing Community: |

p

ACCEPTANCE by the Nursing Community: PRACTICE Orlando¶s nursing process discipline reflects the elements of the therapeutic relationships which include expression of empathy, warmth, and genuineness that would increase the therapeutic effectiveness of nursing having applied throughout various nursing departments: p * - . / - Use in Clinical Practice: Nursing care plan, Case studies, Progressive patient care settings Nursin process: A-D-P-I-E

ANALYScS / CRcTc UE:





› ? ? ô ? !

" || || | p ! !

Limitations

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

Nursing can pursue Orlando's work for retesting and further developing her work

Prevents inaccurate diagnosis or ineffective plans because the nurse has to constantly explore her reactions with the patient

Make evaluation a less time consuming and more deliberate function, the results of which would be documented in patients charts

ssertion 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 of objectively observable patient outcomes

Highly interactive nature Orlando's theory makes it hard to include the highly technical and physical care that nurses give in certain settings

Her theory struggles with the authority derived from the function of profession and that of the employing institution¶s commitment to the public

]]c Mr. Ôo: P Nurse: P ÷ ÷ Mr .Ôo: P Nurse: P



Mrs. Ôo à

P ! " # $ % !! !$! & " ' " ! ( Nurse: P! " Mrs. Ôo called up his sons. After the phone call. Mrs. Ôo: P% " !! " & $ + &'

Assessin a Patient by usin Orlando¶s Theory to uide the Nurse¶s Process ÷. Guidin Principle Findin out and meetin the patient¶s immediate need for help . Problematic situation and immediate reaction(s) 3. Inquiry-Problem Determination . Identifyin specific plans for each problem

. Implement

. Improvement

The nurse¶s focus is on the patient and free of distracting thoughts ²The nurse reco nizes cues that a patient problem may exist before the next step in the process. ²The nurse identifies his or her immediate perception, thou hts, feelin s (Immediate reaction) ²The nurse uses the patient can understand and explores immediate reactions with the patient to discover physical/nonphysical problems s the problem is identified, the nurse asks the patient to confirm or refute its accuracy ²The nurse explores the disagreement to determine its basis ²With the patient, the nurse determines action(s) needed and develops plans for each problem ²The nurse explores whether the patient agrees with or refutes the plan The nurse explores and resolves the basis of disagreement The patient verbally or nonverbally agrees If not, the nurse continues the inquiry for the basis ²If the patient is unable, the nurse implements the plan and asks the patient whether the action is helpful If it is not, the nurse explores the basis ²The nurse helps the patient if he or she is unable to do it alone and explores whether the patient was helped The nurse inquires about his or her results The nurse asks the patient whether the action helped and observes the patient¶s verbal and nonverbal behavior If he or she has improved, the need for help was mer If not, the nurse continues to use the content of immediate reaction to explore with the patient until a positive change is evident

a a

! " # $ •





a a a a

!



a " a

a a

# !

a a # a !