Ida Jean Orlando

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Ida Jean Orlando : 

Ida Jean Orlando Nursing Process Theory By Laura Szymanski, RN, CNOR

Ida Jean’s Beginning : 

Ida Jean Orlando, a first-generation American of Italian descent was born in 1926. She felt that nursing was an opportunity for her to grow beyond her family confines. Ida Jean’s Beginning

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She received her nursing diploma from New York Medical College, her BS in public health nursing from St. John's University, NY, and her MA in mental health nursing from Columbia University, New York.

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Research : 

Orlando was an Associate Professor at Yale School of Nursing where she was Director of the Graduate Program in Mental Health Psychiatric Nursing. While at Yale she was project investigator of a National Institute of Mental Health grant entitled: Integration of Mental Health Concepts in a Basic Nursing Curriculum Research

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Dutifully observing and recording nurse patient interaction in detail. One pile of “good” nursing and one for “bad” nursing.

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What occurred during the “good” nursing between the patient and the nurse? What occurred during the “bad” nursing? “Good” nurses used all their senses in communicating with the patients.

Communication : 

Communication is defined as a process by which we assign and convey meaning in an attempt to create shared understanding. This process requires a vast repertoire of skills in intrapersonal and interpersonal processing, listening, observing, speaking, questioning, analyzing, and evaluating Communication

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The “good” nurses stated what they were seeing in the patients actions as well as hearing what they were saying. They would verify that their interpretation was correct. This allowed the patient to feel validated and understood. Establishing a relationship of trust between the nurse and the patient.

Theory : 

It was from this research that she developed her theory which was published in her 1961 book, The Dynamic Nurse-Patient Relationship. . The nursing process is set in motion by the Patient Behavior. All patient behavior, verbal ( a patient’s use of language ) or non-verbal ( includes physiological symptoms, motor activity, and nonverbal communication) , no matter how insignificant, must be considered an expression of a need for help and needs to be validated . If a patient’s behavior does not effectively assessed by the nurse then a major problem in giving care would rise leading to a nurse-patient relationship failure. Remember : When a patient has a need for help that cannot be resolved without the help of another, helplessness results Theory

Next : 

The Patient behavior stimulates a Nurse Reaction . The beginning of the nurse-patient relationship takes place. It is important to correctly evaluate the behavior of the patient using the nurse reactions steps to achieve positive feedback response from the patient. Next

Breaking it down : 

The steps are as follows:The nurse perceives the patients behavior through any of the senses -> The perception leads to automatic thought -> The thought produces an automatic feeling ->The nurse shares reactions with the patient to verify whether perceptions are accurate or inaccurate -> 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 Breaking it down

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Exploration with the patient helps validate the patient’s behavior Critically considering one or two ways in implementing Nurse Action. When providing care, your actions can either be deliberative or automatic.

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Automatic reactions are nursing behaviors that are performed to satisfy an order or regulations that may have no baring on the patient’s need for help.For example, the nurse who gives a sleeping pill to a patient every evening because it is ordered by the doctor, without first discussing the need for the medication with the patient, is engaging in automatic, non-deliberative behavior. This is because the reason for giving the pill has more to do with following doctors orders (automatically) than with the patient’s immediate expressed need for help.

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Deliberative reaction is a “disciplined professional response” While all of nursing actions could be considered to be in the patients best interest or deliberative. There are times when nurses follow orders without consideration of the patient and their needs. In order for the nurse and the patient to develop a reciprocal relationship, the following criteria should be considered

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Deliberative actions result from the correct identification of patient needs by validation of the nurse's interpretative action to patient behavior. The nurse explores the meaning of the action with the patient and its relevance to meeting his need

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The nurse validates the action was effective immediately after completing it. Remember : for an action to have been truly deliberative, the nurse and the client determine together if it was helpful in meeting the clients need.

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She furthered the development of her theory when at McLean Hospital in Belmont, MA as Director of a Research Project: Two Systems of Nursing in a Psychiatric Hospital. The results of this research are contained in her 1972 book titled: The Discipline and Teaching of Nursing Processes

Books and articles by Orlando : 

Orlando, I. J. (1961). The dynamic nurse-patient relationship: Function, process and principles. New York: G. P. Putman's Sons. [Reprinted 1990, New York: National League for Nursing.] Orlando, I. J. (1972). The discipline and teaching of nursing process: An evaluative study. New York: G. P. Putman's Sons. Schmieding, N. J. (1983). The analysis of Orlando's nursing theory based on Kuhn's theory of science. In P. Chinn (Ed.), Advances Books and articles by Orlando

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in nursing theory development (pp.63-87). Rockville, MD: Aspen. Schmieding, N. J. (1984). Putting Orlando's theory into practice. American Journal of Nursing, 84(6), 759-761. Orlando, I. J. (1987). Nursing in the 21st century: Alternate paths. Journal of Advanced Nursing, 12(4), 405-412. ey theorists (pp. 561-620). Thousand Oaks, CA: Sage.

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Schmieding, N. (1987). Problematic situations in nursing: Analysis of Orlando's theory based on Dewey's theory of inquiry. Journal of Advanced Nursing, 12(4), 431-440. Schmieding, N. (1988). Action process of nurse administrators to problematic situations based on Orlando's theory. Journal of Advanced Nursing, 13(1), 99-107. Orlando, I. J., & Dugan, A. (1989). Independent and dependent paths: The fundamental issue for the nursing profession. Nursing & Health Care, 2(2), 77-80.

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Schmieding, N. J. (1993). Empowerment through context, structure, and process. Journal of Professional Nursing, 9(4), 239-245. Schmieding, N. J. (1995). Ida Jean Orlando: A nursing process theory. In C. M. McQuiston & A. A. Webb (Eds.), Foundations of nursing theory: Contributions of 12 k

Case Study : 

Mrs. J is agitated sitting in the gurney awaiting surgery for her carpal tunnel. She is clutching the blankets, eyes wide and lips pressed firmly together. The nurse comes to the bedside, she asks if there is anything that she can do to make Mrs. J feel more comfortable. Mrs. J responds “ Nothing, I’m fine!” Now does the nurse leave her alone after she receive her answer? Case Study

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Deliberative thought about what the nurse has heard as well as seen would mean that the nurse attempt to meet Mrs. J’s need. What are her needs?

Mrs. J’s Needs : 

Acknowledgment of feeling out of control. Acknowledgment of fear of the unknown. Education on what is going to happen each step of the way. Participation in her care. Mrs. J’s Needs

Nurse’s response : 

“ I understand how frightening it can be to be the patient in the bed. Letting others do things to you. I want you to know that it’s ok to be afraid, but I’m going to be with you the whole time. Is that how you are feeling?” Mrs. J’s response “ Maybe a little.” “I’d like to tell you about what we’re going to do from here, is that alright with you?” . Nurse’s response

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Allow Mrs. J to join in a dialog about the surgery, sequence of events, what to expect. Mrs. J is invited to participate in her care. Validation is given to her feelings as well as input on her ongoing anxiety or any pain that she may be experiencing. With each step or intervention her participation is actively pursued and surgery proceeds with her participation.

Recovery room : 

Mrs. J is now sitting up in the gurney, relaxed feeling satisfied that she has overcome an anxiety that she had been experiencing for days. When asked “ How was your experience?” She responds, “Great! A lot easier then I ever thought it would be. I’ll be back in six weeks to have my other hand done.” Recovery room

Analysis : 

The nurse recognized Mrs. J’s anxiety from her visual input, not on what Mrs. J was saying. By verbalizing what she was seeing and verifying that impression with Mrs. J. she took the first step to establish report. By inviting Mrs. J’s participation she allowed Mrs. J a human connection in a sterile and frightening environment. By continuing to engage Mrs. J with education on Analysis

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what was happening and going to happen she allowed Mrs. J a feeling of control thereby decreasing her anxiety. Mrs. J leaves feeling good about herself and the experience that she had. She will be more likely to pursue further healthy behaviors such as having her other carpal tunnel procedure done with less overall anxiety.

Questions? : 

How do you connect, and verify your connection with your patients? In what other ways can you help your patients meet their unspoken or unacknowledged needs? Questions?

Bibliography : 

Nursing Theorists and Their Work Ann Marriner Tomey, Martha Raile Alligood Communication: State of Washington, Office of Supervisor Nursing Process Theory: Bibliography

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