Orlando's Nursing Process Theory

By the end of this presentation, you’ll be able to

Discuss the nursing process theory.
 Describe the major concepts nursing
according to Orlando.
 Define the assumptions of Orlando’s theory.
 Discuss the propositions of Orlando’s theory.
Explain Orlando’s theory as a framework for
nursing practice.
Explain The nursing process and Orlando’s
theory.
 Discuss the nursing process theory

• Inculeds:Theory Description ,Critical

Reflection, And theory Evaluation of the
nursing process theory of Ida Jean Orlando.
 INTRODUCTION
• Orlando's theory is a interrelate concepts.
Many various theorist have describe different
classification of this theory. It is a Middle
Range Nursing Theory However all have shown
it is an interactive type of theory.
• We are going to describe this theory analysis
mostly related to Chinn and Kramer’s(2011)
• This theory is a cyclic process as we can
reevaluate and repeat with the new access to
achieve the target goals.
CONTENT ANALYSIS
 HISTORY AND BACKGROUND
About the theorist

• Jean Orlando - born in 1926.

• wrote about the nursing process in1950
• Nursing diploma - New York Medical College
• BSc in public health nursing - St. John's University,
New York.
• MA in mental health nursing - Columbia University,
New York.
 About the theorist con…
• Associate Professor at Yale School of Nursing and Director of
the Graduate Program in Mental Health Psychiatric Nursing.
• Project investigator of a National Institute of Mental Health
grant entitled: Integration of Mental Health Concepts in a
Basic Nursing Curriculum.
• published in her 1961 book, The Dynamic Nurse-Patient
Relationship and revised 1972 book: The Discipline and
Teaching of Nursing Processes
• A board member of Harvard Community Health Plan.
• Orlando her good works ended on November 28, 2007 when
she died
 Formulation of this theory
• Orlando's theory was developed in the late
1950s from2000 observation between nurse
and patient interaction. Despite her efforts,
she was only able to categorize the records as
"good" or "bad" nursing.
• From these observations she formulated the
deliberative nursing process theory.
 THE DOMAINS OF THE THEORY
THE MAIN DOMAIN
-Nurse
-Patient
-Health
-Environment
 SUB DOMAINS CONCEPTS
• Nursing
• Process of care in an immediate experience
• Goal of nursing
• Health
• Environment
• Human being
• Nursing client
• Nursing problem
• Nursing process
• Direct and indirect immediate nursing therapeutic actions
• Automatic functions
 Major concept and definitions
This is a middle range theory and having 5 major concepts

01. Function of professional nursing(organizing principle) -

- Find out and meeting the patients immediate needs for
help.
-The responses of the nurse as responsive to individually
who suffer or anticipate sense of helpless.
-Direct assistance by empirically or interactively .
-Avoiding, Reliving, Diminishing or curing the sufferings
and the helpless.
 Major concept…
02.Presenting behavior -- Problematic situation
• Problem client behavior Automatic internal
response of the nurse- Nursing action

03.Immediate reaction- Internal response

• Perceives through five sense – Thought
stimulations and feelings – Immediate acts for
needs by the automatically thoughts and feelings
 Major concept…
04. Nursing process and discipline– investigations

THE PROCESS STEPS (ADPIE)

A-Assessment
D- Diagnosis
P – Planning
I – Implementing
E - Evaluation
Nursing process
 Nursing process and discipline con…..
• Any observation shared and explored with the patient is
immediately useful in ascertaining and meeting his/her
need or finding out that he/she 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 .
• When the nurse does not explore with the patient her
reaction it seems reasonably certain that clear
communication between them stop.
 Major concept…
05.Improve resolution
I. Evaluation – it was help the nurse to
communicate and fulfill the clients needs.
II. Repeat the procedure of learning – it is a
cyclic process and might be evaluate the out
come
 DEFINITIONS
This theory has defined as follows
 Distress: Experiences of the patient
 Nursing role: Discover and meet the patients
immediate
 Nursing action : Directly and Indirectly
providing patient’s immediate needs.
 Out come : It is a change in the patient’s
behavior shown by the indicators.
MAJOR DIMENTIONS

NURSING DISTRES
RESPONSE NURSING S
IMEDIATE
ACTIONS

OUT COME NURSING

AND PATIENT’S PROCESS
INDICATION STEP BY STEP
Concept relationship with the Structure
• The theory is describe the step by step process
to achieve the goal as a frame work for
nursing practice there are 5 interrelated
concepts .
• The structure of five step by step process to
applying nursing intervention individually and
is the only theory for direct nurse – patient
intervention
 RELATIONSHIP…
It is a theoretical frame work having two aspects
(THE DIANAMIC NURSE – PATIENT RELATIONSHIP)
01. Action process – person to person -
Perception
Thoughts
Feelings
02.Action process – Person to person
In at functions
 MAJOR ASSUMPTIONS
• When a patient cannot cope with their needs
without help they become distressed with
feelings at helpless.
• Patients are unique and individual in their
response.
• Nursing officers mothering and nurturing of
their patients as a child.
• Nursing deals with people, health, and the
environment.
 ASSUMPTIONS CON…
Basic acceptance truth
• Patient need help in communicating needs, they are
uncomfortable and ambivalent about dependency needs
• Human beings are able to be secretive or explicit about their
needs, perceptions, thoughts and feelings
• The nurse – patient situation is dynamic, actions and
reactions are influenced by both nurse and patient
• Human beings attach meanings to situations and actions that
are not apparent to others
• Nurses are concerned with needs that patients cannot meet
on their own.
 ASSUMPTIONS CON …
Current indications for this truth
• using in the daily care activities
• By using get good efficient out come
• can be increase and refine the research
knowledge
• Make advance in education curriculum.
• It couldn't delimit at all.
 CLARITY OF THIS THEORY
It having a congruent triangle process and
interactive.
NEEDS

NURSING
PROCESS OUTPU
CONTAIN 5
STEPS TS
 CLARITY…
• Semantic clarity – can be extend and improve according to
the changing context and growing advances of the life span
and he technologies.
• Semantic consistency – It is truly acceptable.
• Structural clarity – fixed basic concepts and having a
systematic frame work constantly.
• Structural consistency – theory shows only of the patient
needs individually, but now a days we are seems the health
care as the human as a whole and doing the integral
nursing so the consistency should be change according to
the context at the present and growing the needs from the
individual to the global level.
 SIMPLICITY,GENERABILITY AND THE
ACCESSSIBLE OF THIS THEORY
SIMPLICITY
• Having the countable number of concepts which are
understandable and the continuously practicable.
• So this theory can be called simple

GENERALABILITY
• This is very general because up to now we are practicing
these concepts as possible as in all nursing interventions
and in all roles of nursing such in the management,
education and research also .
• In the evidence base practice also has infiltrated these
concepts.
 Cont…
How accessible
• Now we are going to demonstrate in a simple way
that how much accessible this theory in our nursing
practice by using the main steps of this theory in
nursing process.
• Assessment – how?
• Diagnosis – how?
• Planning – how?
• Implementation– how?
• Evaluation – how?
 CONGRUENT THE THEORY GOAL AND THE
PRACTICAL GOAL
Theory goal :
• Identification of the nature of the patient with distress and
• Immediate needs providing

The practical goal :

• Identifying the immediate and the potential need of the person as a
whole .
• Giving the primordial, primary prevention, secondary prevention, Tertiary
prevention and the rehabilitation level health care.
• Prevent the disease, promote the health, and the restore the health
from the unique individual to the global level.
• So there is a vast different between the goals of comparing the practice
but there is no so different between the theory goal comparing .
• We are doing the holistic approach.
 SUFFICIENT TO BE USED AS A BASIS IN PRATICAL
APPLICATION IN THE DAY TO DAY NURSING PRACTISE

• Earlier using this basic process concept directly with

the empirical evidence data
• Now a days also we using this concept as a basically
and extend our ways of approach according to the
growing scientific technology world and needs of
health care of the human beings.
• So this theory is a applicable and sufficient to be
used with more evidence based practice and more
updated knowledge and it can be depict as a
congruent theory with the new generations.
 STRENTHS AND WEAKNESSESS
STRENGTHS
• It has a concrete concepts using with the individuals and
treated actively and constantly input into their own care
• Prevents inaccurate diagnosis , ineffective plans because
the nurse has constantly explore her reactions with a
patient.
• Assertion of nursing’s independence as a profession and
her belief that this independence based on a sound
theoretical framework.
• Guide the nurse to evaluate her care in terms of
objectively observable patient outcomes.
 Cont…..
WEAKNESS
• Using the empirical evidence, thoughts, and feelings
only for assess the patient needs with the distress.
There is no any clear evidence for using any
instruments.
• Individual nurses perceive the patient needs in different
manner and outcome may differ.
• This study fails to focus on the ICU patients that are
unable to verbalize their discomforts.
• Orlando’s work focuses on short term care, particularly
aware and conscious individuals and on the virtual
absence of reference group or family members .
 Research evidence to support theory
• A cross sectional study on nursing process implementation and associated
factors among nurses working in selected hospitals of Central and
Northwest zones, Tigray Region, Ethiopia
According to this study
- Seventy (35%) of participants have implemented nursing process. Different
factors showed significant association.
- Nurses who worked in a stressful atmosphere of the workplace were 99% less
likely to implement the nursing process than nurses who worked at a very
good atmosphere.
- The nurses with an educational level of BSc. Degree were 6.972 times more
likely to implement the nursing process than those who were diploma
qualified.
- Nurses with no consistent material supply to use the nursing process were
95.1% less likely to implement the nursing process than nurses with
consistent material supply.
.
Research evidence to support theory con….

• Orlando’s Nursing Process Theory the Effects

of an Ambulatory Collaborative Practice
Model on Process and Outcome of Care for
Bipolar Disorder by Shea, N., McBride, L., &
Bauer, C., Gavin, M. (1997). Journal of the
American Psychiatric Nurses Association, 3,
Retrieved April 11, 2009.
Research evidence to support theory con..

After applying Orlando’s Nursing Process

Theory to patient care, the following results
were discovered:
• Increased patient satisfaction
• Decreased hospital length of stay
• Less emergency services required
• Higher patient retention
• Increased intensity of medication treatment
• Decreased use of costly mental health services
Research evidence to support theory con..
Application of Nursing Process and Its Affecting Factors among Nurses Working
in Mekelle Zone Hospitals, Northern Ethiopia (Received 4 September 2013;
Accepted 18 November 2013; Published 6 February 2014)
• The majority (90%) of the study participants were poorly knowledgeable
about the nursing process.

• Almost all of study participants had positive attitude towards the nursing
process. This seems that nurses’ attitude towards the nursing process is not a
factor affecting the application of nursing process.

• From the sociodemographic characteristics, only educational status has direct

statistically significant relationship with the knowledge of nurses on nursing
process.

• Participants reported that factors such as shortage of resources, lack of

knowledge, high patient nurse ratio/work load, and lack of training and
motivating factors such as salary affected the application of the nursing
process
 Conclusion
• Orlando’s nursing theory stresses the reciprocal relationship between
patient and nurse. What the nurse and the patient say and do affects
them both.
• Orlando views the professional function of nursing as finding out and
meeting the patient’s immediate need for help.
• She was one of the first nursing leaders to identify and emphasize the
elements of the nursing process and the critical importance of the
patient’s participation in the nursing process.
• Orlando’s theory focuses on how to produce improvement in the
patient’s behavior. Evidence of relieving the patient’s distress is seen as
positive changes in the patient’s observable behavior. Orlando may have
facilitated the development of nurses as logical thinkers.
• The Deliberative Nursing Process helps nurses achieve more successful
patient outcomes such as fall reduction. Orlando’s theory remains a most
effective practice theory that is especially helpful to new nurses as they
begin their practice.
 Summary
Get clear picture of nursing process theory.
 Understand the major concepts nursing
according to Orlando.
Can define the assumptions of Orlando’s
theory.
 Understand of Orlando’s theory as a
framework for nursing practice.
Simply explain The nursing process and
Orlando’s theory.
 References
1. Fisseha Hagos,1 Fessehaye Alemseged,2 Fikadu Balcha,2 Semar Berhe3 and Alemseged Aregay3 A
cross sectional study on nursing process implementation and associated factors among nurses
working in selected hospitals of Central and Northwest zones, Tigray Region, Ethiopia BMC
Nursing volume 16, Article number: 54 (2017)

2. Zeray Barai, Fiseha Girmay, Kalayou Kidanu, and Hadgu Gerensea Application of Nursing
Process and Its Affecting Factors among Nurses Working in Mekelle Zone Hospitals, Northern
Ethiopia (Received 4 September 2013; Accepted 18 November 2013; Published 6 February
2014)

3.Potter, M.L., & Bockenhauer, B.J. (2000). Implementing Orlando's Nursing Theory: a pilot study.
Journal of Psychosocial Nursing and Mental Health Services. 38(3), 14-21.
4. Shea, N., McBride, L., & Bauer, C., Gavin, M. (1997). The Effects of an Ambulatory Collaborative
Practice Model on Process and Outcome of Care for Bipolar Disorder. Journal of the American
Psychiatric Nurses Association, 3, Retrieved April 11, 2009, from
http://jap.sagepub.com/cgi/content/abstract/3/2/49

5.http://currentnursing.com/nursing-theory/Orlando-nursing-process.html
Take home Message
Thank you for listening