Orlando's Deliberative Nursing Process Theory PDF

OCULARES, RONALD JAMES C. ESTRADA, JHON CARL D. TORRES, PRECIOUS AN V. LARA, BEATRIZ C. THEORY OF IDA JEAN ORLANDO  In 1947, she received a nursing diploma from the Flower Fifth Avenue Hospital School of Nursing in New York. In 1951, she received a Bachelor of Science degree in public health nu...

OCULARES, RONALD JAMES C. ESTRADA, JHON CARL D. TORRES, PRECIOUS AN V. LARA, BEATRIZ C. THEORY OF IDA JEAN ORLANDO  In 1947, she received a nursing diploma 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. In 1954, Orlando received her Master of Arts degree in mental health consultation from Teachers College, Columbia University. Orlando’s Deliberative Nursing Process Theory "Patients have their own meanings and interpretations of situations and therefore nurses must validate their inferences and analyses with patients before drawing conclusions." INTRODUCTION TO THEORY 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 appeal 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. FIVE MOJOR INTERRELATED CONCEPTS 1. The function of professional nursing 2. The presenting behavior of the patient 3. The immediate or internal response of the nurse 4. The nursing process discipline 5. Improvement 1. The Function of Professional Nursing - The function of professional nursing is the organizing principle. This means finding out and meeting the patient’s immediate needs for help. According to Orlando, nursing is responsive to individuals who suffer or who anticipate a sense of helplessness. 2. The Presenting Behavior of the Patient - Presenting behavior is the patient’s problematic situation. Through the presenting behavior, the nurse finds the patient’s immediate need for help. Regardless of how the presenting behavior appears, it may represent a cry for help from the patient. Distress - The patient’s behavior reflects distress when the patient experiences a need that he cannot resolve, a sense of helplessness occurs 3. The Immediate or Internal Response of the Nurse - The immediate reaction is the internal response. The patient perceives objects with his or her five senses. These perceptions stimulate automatic thought, and each thought stimulates an automatic feeling, causing the patient to act. These three items are the patient’s immediate response. The immediate response reflects how the nurse experiences his or her participation in the nurse-patient relationship. Nurse Reaction - The patient’s behavior stimulated a nurse’s reaction, which marks the nursing process discipline’s beginning. Nurse’s Action -When the nurse acts, an action process transpires. This action process by the nurse in a nurse-patient contact is called the nursing process. The nurse’s action may be automatic or deliberative. Automatic Nursing Actions are nursing actions decided upon for reasons other than the patient’s immediate need. Deliberative Nursing Actions are actions decided upon after ascertaining a need and then meeting this need. 4. The Nursing Process Discipline - The nursing process discipline is the investigation into the patient’s needs. Any observation shared and explored with the patient is immediately useful in ascertaining and meeting his or her need or finding out they have no needs at that time. The nurse initiates this exploration to determine how the patient is affected by what they say and do. - The nurse decides on appropriate action to resolve the need in cooperation with the patient. This action is evaluated after it is carried out. If the patient’s behavior improves, the action was successful, and the process is completed. If there is no change or the behavior gets worse, the process recycles with new efforts to The action process in a person-to-person contact functioning in secret. The perceptions, thoughts, and feelings of each individual are not directly available to the other individual’s perception through the observable action. The action process in a person-to-person contact functioning by open disclosure. The perceptions, thoughts, and feelings of each individual are directly available to the other individual’s perception through the observable action  An outcome is a change in the behavior of the patient indicating either a relief from distress or an unmet need. Observable verbally and nonverbally 5. Improvement - Improvement is the resolution to the patient’s situation. In the resolution, the nurse’s actions are not evaluated. Instead, the result of his or her actions is evaluated to determine whether their actions served to help the patient communicate his or her need for help and how it was met. - In each contact, the nurse repeats learning how he or she can help the patient. The nurse’s own individuality and that of the patient require going through this each time the nurse is called upon to render service to those who need him or her. Assumptions of the Deliberative Nursing Process Theory 1. When patients cannot cope with their needs on their own, they become distressed by feelings of helplessness. 2. In its professional character, nursing adds to the distress of the patient. 3. Patients are unique and individual in how they respond. 4. Nursing offers mothering and nursing analogous to an adult who mothers and nurtures a child. 5. The practice of nursing deals with people, the environment, and health. 6. Patients need help communicating their needs; they are uncomfortable and ambivalent about their dependency needs. Assumptions of the Deliberative Nursing Process Theory 7. People can be secretive or explicit about their needs, perceptions, thoughts, and feelings. 8. The nurse-patient situation is dynamic; actions and reactions are influenced by both the nurse and the patient. 9. People attach meanings to situations and actions that aren’t apparent to others. 10. Patients enter into nursing care through medicine. 11. The patient cannot state the nature and meaning of his or her distress without the nurse’s help or him or her first having established a helpful relationship with the patient. 12. Any observation shared and observed with the patient is immediately helpful in ascertaining and meeting his or her need or finding out that he or she is not in need at that time. 13. Nurses are concerned with the needs the patient is unable to meet on his or her own 5 Stages of the Deliberative Nursing Process 1. 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. 2. 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. 3. 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. 4. Implementation – In the implementation stage, the nurse begins using the nursing care plan. 5. Evaluation – The evaluation stage, the nurse looks at the patient’s progress 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. Metaparadigm Nursing - Orlando speaks of nursing as unique and independent in its concerns for an individual’s need for help in an immediate situation. Person - Orlando uses the concept of human as she emphasizes individuality and the dynamic nature of the nurse-patient relationship. Health - In Orlando’s theory, health is replaced by a sense of helplessness as the initiator of a necessity for nursing. Environment - Orlando completely disregarded the environment in her theory, only focusing on the patient’s immediate need, 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.