Nursing Theories: Orlando and Hall Models

NCM 100: TFN

• Course name: NCM 100
• Topic: TFN
• Instructor: Hosanna Angeli D. Corpuz, MAN, RN

Hildegard Peplau's Theory of Interpersonal Relationship

• Peplau was the first published nursing theorist since Florence Nightingale
• Her achievements were recognized worldwide
• She was known as the "Mother of Psychiatric Nursing" and the "Nurse of the Century"
• Her theory emphasizes the nurse-client relationship as fundamental to nursing practice
• It emphasizes the give-and-take of nurse-client relationships
• Peplau created an interpersonal model, emphasizing a partnership between the nurse and client, instead of a passive client receiving treatment and a passive nurse following doctor's orders
• For Peplau, nursing is a "maturing force and an educative instrument" involving interaction between two or more individuals with a common goal that provides incentive for the therapeutic process
• Nurses and patients respect each other as individuals and mutually learn and grow from the interaction

The four components of the theory

• Person: a developing organism that attempts to reduce anxiety caused by needs
• Environment: existing forces outside the person, in the context of culture
• Health: a word symbol that implies a forward movement of personality
• Nursing: a significant therapeutic interpersonal process that cooperatively functions with another process to make health possible for individuals in communities

Therapeutic nurse-client relationship

• A professional and planned relationship between client and nurse focuses on the client's needs, feelings, problems, and ideas
• It involves interaction between two or more individuals with a common goal achieved through a sequential pattern of steps

Sequential phases in the interpersonal relationship

• Orientation
• Identification
• Exploitation
• Resolution

1. Orientation Phase - Initial Phase

• The nurse engages the client in treatment, provides explanations and information, and answers questions
• Problem-defining phase
• Begins when the client meets the nurse as a stranger
• Client seeks assistance, conveys needs, asks questions, and shares preconceptions and expectations of past experiences
• Nurse responds, explains roles to the client, identifies problems, and uses available resources to address them

Factors influencing orientation phase

• Nurse: Values, culture, race, beliefs, past experiences, expectations, preconceived ideas
• Patient: Values, culture, race, beliefs, past experiences, expectations

2. Identification Phase

• The client works interdependently with the nurse, expresses feelings, and begins to feel stronger
• Client starts to trust the nurse and feels comfortable sharing thoughts and feelings
• Nurses support and encourage clients to develop a sense of trust and security

3. Exploitation Phase

• The client makes full use of the services offered
• Use of professional assistance for problem-solving alternatives
• Nurses aid the client in exploiting resources for help, and progress is made towards improved health

4. Resolution Phase

• The client no longer needs professional services and gives up dependent behavior, leading to the termination of the relationship
• The patient's needs have been met through the collaborative effect of the patient and nurse

Roles of the Nurse (in interpersonal relationship)

• Stranger: offering the client the same acceptance and courtesy as any stranger
• Resource person: providing specific answers to questions
• Teacher: helping the client learn formally or informally.
• Leader: offering direction to the client or a group
• Surrogate: serving as a substitute for another person/relatives
• Counselor: promoting health experiences, including the expression of feelings
• Technical Expert: providing physical care and operating equipment

Additional Roles of the Nurse

• Technical expert
• Consultant
• Health teacher
• Tutor
• Socializing agent
• Safety agent
• Manager of environment
• Mediator
• Administrator
• Recorder observer
• Researcher

Anxiety

• Anxiety is defined as the initial response to a psychic threat
• There are four levels of anxiety: mild, moderate, severe, and panic

Four Levels of Anxiety

• Mild: heightened awareness and sharper senses, allowing learning and problem-solving
• Moderate: decreased perceptual field(focus on immediate task); learning and problem-solving with assistance
• Severe: dread and terror, inability to focus; scattered details, physiological symptoms (tachycardia, diaphoresis, chest pain)
• Panic: loss of rational thought; delusions, hallucinations; complete physical immobility or muteness

Ida Jean Orlando's Theory of Deliberative Nursing Process

• An internationally known psychiatric health nurse, theorist, and researcher
• Her theory allows nurses to create an effective nursing care plan that can be easily adapted when complications arise
• Orlando's theory stresses the reciprocal relationship between patient and nurse
• The nurse's function is finding out and meeting the patient's immediate needs for help
• Nursing is seen as an organizing principle, meaning finding out and meeting immediate needs for help

Five Stages of Deliberative Nursing Process Theory

• Assessment
• Diagnosis
• Planning
• Implementation
• Evaluation

Lydia Hall's Core, Care, Cure

• Nursing is defined as participation in care, core and cure aspects of patient care.
• CARE is the sole function of nurses; CORE and CURE are shared with other healthcare team members
• The theory emphasizes the whole patient, focusing on all three components working together
• The patient comprises the core, care, and cure aspects
• Nurses play a vital role in all three aspects of nursing: core, care, and cure

Abdellah's Typology of 21 Nursing Problems

• Based on Henderson's 14 basic human needs and nursing research
• Nursing is an art and science that molds attitudes and competencies
• Guiding care in hospital and community health settings

Four categories of Patient's Needs

• Basic
• Sustenance care
• Remedial care
• Restorative care

Basic Needs

• Hygiene and comfort
• Optimal activity (exercise, rest, sleep)
• Safety (accident, injury prevention, infection control)
• Good body mechanics
• Deformity prevention or correction

Sustenance Care Needs

• Oxygen supply maintenance
• Nutrition maintenance
• Elimination
• Fluid and electrolyte balance
• Body response to disease
• Regulatory mechanisms maintenance
• Sensory function

Remedial Care Needs

• Accepting positive and negative expressions
• Interrelatedness of emotions and illness
• Effective communication
• Interpersonal relationships
• Personal spiritual goals
• Therapeutic environment
• Self awareness

Restorative Care Needs

• Optimal goals with limitations
• Community resources
• Role of social problems

Ten steps to identify the patient's problem

• Learn to know the patient
• Sort out relevant data
• Make generalizations about similar nursing problems
• identify therapeutic plan
• Test generalizations with the patient and generate additional ones
• Validate patient conclusions
• Observe/evaluate the patient over a period of time for attitudes and behavior
• Explore patient and family reactions
• Identify nurse feelings about the patient's problem
• Discuss and develop comprehensive care plan

The 11 nursing skills

• Observation of the health status
• Skills of communication
• Application of knowledge
• Teaching patients and families
• Planning and organization of work
• Use of resource materials
• Use of personnel resources
• Problem-solving
• Direction of work of others
• Therapeutic use of the self
• Nursing procedure

Conclusion

• Abdellah's typology of 21 nursing problems is a conceptual model that focuses on patient needs and nurses' role in problem identification through a problem-analysis approach.
• Patients have physical, emotional, and sociological needs.
• People are the reason why nursing exists.

Abraham Maslow's Hierarchy of Needs

• A motivational theory in psychology comprising a five-tier model of hierarchical human needs
• Physiological
• Security and safety
• Love and Belongingness
• Self-esteem
• Self-actualization

Physiological Needs

• Food
• Water
• Breathing/air
• Sleep
• Shelter

Security and Safety Needs

• Financial security
• Health and wellness
• Safety against accidents and injury

Love and Belongingness

• Friendships
• Romantic attachments
• Family relationships
• Social groups
• Community groups
• Churches and religious organizations

Self-Esteem

• Appreciation and respect
• Need to accomplish things and have efforts recognized
• Feeling valued by others
• Feeling a contribution to the world

Self-Actualization Needs

• Self-aware, concerned with personal growth, less concerned with other’s opinions, fulfills potential.
• Reaching full potential, living meaningfully, and feeling living their best lives

Appendix: Patient Examples

• Physiological, safety, love and belonging, esteem, and self-actualization needs of a homeless person (Mina)
• Expanded Hierarchy of Needs
• Cognitive, aesthetic, and transcendence needs
• Erik Erikson's Stages of Psychosocial Development
• Stages of Psychosocial Development

This quiz explores key concepts from Orlando's Deliberative Nursing Process and Lydia Hall's Care Circle model. Test your understanding of nurse-patient relationships, nursing actions, and care theories. Perfect for nursing students seeking to deepen their knowledge of nursing theory.