IDA JEAN ORLANDO

THEORYPRESENTED BY

MS LISA CHADHAF.Y. MSC NURSING

BVCON, PUNE

About the Theorist

•Ida Jean Orlando - born in 1926.•wrote about the nursing process.•Nursing diploma - New York Medical College•BSC in public health nursing - St. John's University, NY,•MA in mental health nursing - Columbia University, New York.•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.

INTRODUCTION TO INTRODUCTION TO THEORYTHEORY

O The role of the nurse is to find out and meet The role of the nurse is to find out and meet the patient's immediate need for help. the patient's immediate need for help.

O The patient's presenting behavior may be a The patient's presenting behavior may be a appeal for help; however, the help needed appeal for help; however, the help needed may not be what it appears to be. may not be what it appears to be.

O Therefore, nurses need to use their Therefore, nurses need to use their perception, thoughts about the perception, perception, thoughts about the perception, or the feeling engendered from their or the feeling engendered from their thoughts to explore with patients the thoughts to explore with patients the meaning of their behaviormeaning of their behavior. .

O This process helps nurse find out the nature This process helps nurse find out the nature of the distress and what help the patient of the distress and what help the patient needs. needs.

Terms•Distress is the experience of a patient whose need has not been met.•Nursing role is to discover and meet the patient’s immediate need for help.

•Patient’s behavior may not represent the true need.•The nurse validates his/her understanding of the need with the patient.

•Nursing actions directly or indirectly provide for the patient’s immediate need.

•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

ASSUMPTIONS

When patients cannot cope with their needs without help,

they become distressed with feelings of helplessness.

•Patients are unique and individual in their responses.

•Nursing deals with people, environment and health

•Patient need help in communicating needs, they are

uncomfortable and undecided 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

•Nurses are concerned with needs that patients cannot

meet on their own

CHARACTERISTICS OF THE THEORY

•Orlando's theory interrelate concepts•Orlando's theory has a logical nature•Orlando's theory is simple and applicable in the daily practice.•Orlando's theory contribute to the professional knowledge.•Orlando's theory is applicable in clinical practice

STRENGTHS

•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•Prevents inaccurate diagnosis or ineffective plans because

the nurse has to constantly explore her reactions with the

patient•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 outcome

Assessment Assessment O Identifying patients need for Identifying patients need for

help.help.

O It includes:It includes:Perception of clientPerception of clientThoughts and feelings about Thoughts and feelings about

perceptionperception

Perception of client Perception of client O VerbalVerbal- what client says- what client saysO Non verbal Non verbal - moaning, groaning, tone - moaning, groaning, tone

,volume.,volume. Client Client

activities ,pacing, runningactivities ,pacing, runningO Physiological manifestations: Physiological manifestations: BP, BP,

pulse, patterns of urinationpulse, patterns of urination

Thoughts and feelings about Thoughts and feelings about perceptionperception

O Observation of clients behavior (nurse’s Observation of clients behavior (nurse’s perception ) gives rise to nurse’s thoughts perception ) gives rise to nurse’s thoughts and feelings.and feelings.

O A thought is a cognitive process and feeling is A thought is a cognitive process and feeling is an affective process.an affective process.

O Thoughts about a client’s behavior are merely Thoughts about a client’s behavior are merely assumptions which should not guide nursing assumptions which should not guide nursing actions unless validated by the client.actions unless validated by the client.

Nursing DiagnosisNursing DiagnosisOProduct of analysisProduct of analysisOLeads to identification of need Leads to identification of need

for helpfor help..

Planning phase Planning phase OWriting goals and objectives and Writing goals and objectives and

deciding about appropriate deciding about appropriate actionaction..

Nursing actionNursing actionTwo types of nursing actions:Two types of nursing actions:O Deliberative: The nurse initiates Deliberative: The nurse initiates

believing that she will help ascertain believing that she will help ascertain or meet client’s immediate need for or meet client’s immediate need for help.help.

O Automatic: Actions which are not Automatic: Actions which are not focused on the clients need but other focused on the clients need but other need such as nurse’s or physicians.need such as nurse’s or physicians.

ImplementationImplementationOFinal selection and carrying Final selection and carrying

out planned actionout planned action..

EvaluationEvaluationONurse need to evaluate the Nurse need to evaluate the

process to know that the action process to know that the action taken by her is appropriate for taken by her is appropriate for the patient or not.the patient or not.

Application of theoryApplication of theoryOMrs Reshma Anil Barisode, a 26 Mrs Reshma Anil Barisode, a 26

year old nullipara came to year old nullipara came to infertility OPD with history of 6 infertility OPD with history of 6 years of non consanguineous years of non consanguineous marriage and no history of marriage and no history of contraceptives for the contraceptives for the treatment of primary infertility.treatment of primary infertility.

Objectives of nursing Objectives of nursing managementmanagement

OUsing Orlando’s nursing theory, the Using Orlando’s nursing theory, the following objectives were planned following objectives were planned for care:for care:

To assess patient condition by use To assess patient condition by use of theoryof theory

State perception of clientState perception of clientFind client’s immediate need for Find client’s immediate need for

helphelpValidate immediate need for help.Validate immediate need for help.

Reactions:Reactions:

O Verbal: can I able to concieve? My Verbal: can I able to concieve? My family members keep on blaming me …family members keep on blaming me …huge family pressurehuge family pressure

O Non verbal: anxious, worried depressedNon verbal: anxious, worried depressedO No eye to eye contact while answering, No eye to eye contact while answering,

only nodding of headonly nodding of head

Need for helpNeed for help

OAnxiety r/t chances of Anxiety r/t chances of conceptionconception

OKnowledge deficit regarding Knowledge deficit regarding assisted reproductive assisted reproductive techniques and treatment of techniques and treatment of infertilityinfertility..

Nurse actionNurse actionO Identify positive coping behavior and Identify positive coping behavior and

reinforce them.reinforce them.O Give positive reinforcement.Give positive reinforcement.O Reassure the patient.Reassure the patient.O Clarify the doubts of patient.Clarify the doubts of patient.O Provide explanation in simple Provide explanation in simple

understanding terms to patient.understanding terms to patient.O Involve both couple for counselingInvolve both couple for counselingO Arrange special meeting with patients Arrange special meeting with patients

who had positive results from who had positive results from infertility treatmentinfertility treatment

OProvide psychological support to Provide psychological support to the patient.the patient.

OGive realistic opinion.Give realistic opinion.OEncourage patient to take her Encourage patient to take her

decision independently.decision independently.

Evaluation

O Evaluate the patient level of anxiety and stress after clarifying the doubts.

O Re evaluate the patient in next visit

LimitationsO Highly interactive nursing theory

makes it hard to include highly technical and physical care that nurses give in certain situation.

O Long term care and planning are not applicable.

Conclusion O Orlando’s nursing theory stresses the

reciprocal relationship between patient and nurse and finding out and meeting the patient’s immediate need for help.

O Orlando may have facilitated the development of nurses as logical thinkers.

O 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

BibliographyGeorge, J.B. (2011). Nursing theories: The base for professional nursing practice (6th ed.). Philadelphia: Pearson. Potter, P.A., & Perry, A.G. (2012). Fundamentals of nursing (8th ed.). St. Louis, MO: Mosby Elsevier. Schmieding, N. (1990). An integrative nursing theoretical framework. Journal of Advanced. Nursing, 15(4), 463-46