Ida Jean Orlando-Pelletier August 12, 1926 – Nursing Process
Nursing Process “The dynamic nurse-patient relationship: Function, process and principles” Based on the interaction between the patient and the nurse
Health• Orlando did not define health but assumed that freedom from mental or physical discomfort and feelings of adequacy and well-being contribute to health.
Professional Nursing• Finding out and meeting the client’s immediate need for help.
Verbal behavior Nonverbal behavior- encompasses all the -includespatients use of language physiological responses, motor activity, vocal activity
Verbal & Non-verbal Behavior Inconsistency between these two types of behavior should alert the nurse that the client needs help. All patient behavior, no matter how insignificant, must be considered an expression of need for help until its meaning is understood. Improvement in patients behavior indicating resolution of the need is the desired result.
Environment Person• Environment: Not fully defined• Person: A unique individual behaving verbally and non-verbally.
Central ThemeHow nurses learnto do nursing(stages of clinicalcompetence)
Stage 1: Novice• No experience of the situations in which one is expected to perform• Is taught rules to help one perform • Rules are context-free and independent of specific cases tend to be applied universally (limited & inflexible)• “Just tell me what I need to do and Ill do it.”
Stage 2: Advanced Beginner• Can demonstrate marginally acceptable performance• Has experience with enough real situations (sometimes with the help of a mentor) recurring meaningful situational components• Based on experience, begins to formulate principles to guide action
Stage 3: Competent• Has been on the job in the same or similar situations two or three years• Does not have enough experience to recognize a situation in terms of an overall picture or in terms of which aspects are most important
Stage 3: Competent• Begins to see one’s actions in terms of long-range goals or plans of which one is consciously aware competence• Considerable conscious, abstract, analytic contemplation of the problem plan perspective plan efficiency and organization
Stage 3: Competent• Lacks speed and flexibility but with a feeling of mastery and the ability to cope with and manage the many contingencies of clinical nursing
Stage 4: Proficient• Perceives the meaning of a situation in terms of long- term goals (holistic understanding)• Based on experience: what events to expect in a given situation need to modify plans in response to events improved decision making
Stage 4: Proficient• Can recognize when the expected normal picture does not materialize• Performance guided by maxims that provide direction as to what must be taken into account & that reflect nuances of the situation improved decision making
Stage 5: The Expert• With an enormous background of experience• Has an intuitive grasp of each situation zeroes in on the problem without wasteful consideration of a large range of unfruitful, alternative diagnoses and solutions
Stage 5: The Expert• No longer relies on maxims to connect understanding of the situation to an appropriate action• Operates from a deep understanding of the total situation• Performance fluid and flexible and highly proficient
Stage 5: The Expert• Uses analytic tools for situations with which the nurse has had no previous experience & when the expert gets a wrong grasp of the situation and then finds that events and behaviors are not occurring as expected
Person• A self-interpreting being. They do not come into the world predefined but gets defined in the course of living a life.
Environment• Benner used the term situation rather than environment. Situation conveys a social environment with social definition and meaningfulness.
Health• Based on the lived experience of being healthy or ill.
Nursing• A caring relationship, an enabling condition of connection and concern
Ernestine Wiedenbach 1900 -1999The Prescriptive Theory of Nursing
Central Theme• Quality of health that the nurse desires to sustain in her patient and specifies what she recognizes to be her responsibility in caring.
Central Theme• Nurse = philosophy• Patient = autonomy & individuality• Nurse + patient prescription or plan for care
Prescription• A directive to activity which specifies the nature of action and the thinking process. – Voluntary action • Mutually understood and agreed upon • Recipient-directed • Practitioner directed
5 Realities• Agent – practicing nurse who is committed and competent in nursing• Recipient – patient who has the ability to cope with problems• Goal – desired outcome; what the nurse wishes to achieve• Means – activities and devices used to attain goal• Framework – the context in which nursing is practiced and constitutes currently existing limits