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Presented by:
A.L.K.Rinsith
A.M.Mohamed
1

By the end of this presentation, you’ll be able to
 Discuss the nursing process theory
 Describe the major concepts of nursing according to
Orlando
 Define the assumptions of Orlando’s theory
 Explain Orlando’s theory as a framework for nursing
practice
 critique of orlando’s theory
 Explain how this theory is to be used in practice and
research
Objectives
2

 Wrote about THE NURSING PROCESS.
 Born in 1926
 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.
 Associate Professor at Yale School of Nursing and
Director of the Graduate Program in Mental Health
Psychiatric Nursing.
 A board member of Harvard Community Health Plan.
Ida Jean Orlando
3

 published in her 1961 book, The Dynamic Nurse-
Patient Relationship and revised 1972 book: The
Discipline and Teaching of Nursing Processes.
 Orlando her good works came to an ended on
November 28, 2007 when she died.
Ida Jean Orlando…
4

 In later half of 1950 she formulated nursing process
theory
 Middle range theory
 Interactive type theory
 Cyclic process
 Developed by conducting an empirical study on the
nursing study and practice.
 Theory is inductive in nature
 because for approximately 3 years, Orlando observed
2000 interactions between the patients and nurses. At the
end of the empirical study, she was able to categorize her
results in two distinct categories
Nursing Process Theory
5

 She categorized as good and bad aspect of nursing
practice
 Good- prime focus on verbal and non verbal behavior of
patient
 Bad- focus on documented and learned activity instead of
observed patient immediate verbal, nonverbal behavior
 Orlando used the conception of nurse- patient interaction
with the prime focus on the nursing practice.
 Interaction is concentrated on a time and space.
6

 This theory is defined as follow;
 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.
Definitions
7

1. Function of professional nursing –(organizing principle)
-finding immediate needs
-Response of nurses
-Direct assistance by empirically or interactively .
- Relieving, curing and Diminishing the sufferings and the
helpless.
2. Presenting behavior – problematic situation
Problem-----Nursing behavior-------Response----Action
3. Immediate reaction - internal response
-Perceive through five sense and immediate act for needs.
Major Concepts
8

4. Nursing process discipline – investigation
 The nurse initiates a process of exploration to
ascertain how the patient is affected by what she
says or does
 The nurse does not assume that any aspect of her
reaction to the patient is correct
 Any observation shared and explored with the
patient is immediately useful in ascertaining and
meeting his need
 Process contain 5 steps;
9

10

5. Improvement - resolution
 Evaluation- fulfill the patient needs through
communication.
 Repeat the procedure-In each contact the nurse
repeats a process of learning how to help the
individual patient.
11

 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 ambivalent about dependency
needs
Assumption
12

 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
Assumption…
13

 Nurse; Orlando speaks of nursing as unique and independent
in its concerns for an individual’s need for help in an
immediate situation
 Person; Individuality and the dynamic nature of the nurse-
patient relationship
 Health; health is replaced by a sense of helplessness as the
initiator of a necessity for nursing.
 nursing deals with individuals who are in need of help.
 Environment; Orlando completely disregarded environment in
her theory
 only focusing on the immediate need of the patient, chiefly the
relationship and actions between the nurse and the patient
Metaparadigm concepts
14

 Clarity -word should be defined carefully
 facilitated with diagrams and examples
 The logical development and type of structure used should be clear
 Assumptions should be stated clearly and be consistent with the
goal of the theory
 There must be shared agreement of the definitions of concepts and
relationships between concepts within a theory
 Simplicity- simple forms of theory, such as middle range, to guide
practice.
 theory should be sufficiently comprehensive, presented at a level
of abstraction to provide guidance
 have as few concepts as possible with simplistic relations to aid
clarity.
 Greatest sense of understanding
Critique
15

 Generality-the scope of application and the purpose within the
theory
 “The broader the scope . . . the greater the significance of the
theory”
 The generality of a theoretical work varies by how abstract or
concrete it is
 Accessibility-Accessibility is linked to the empirical indicators
for testability and ultimate use of a theory to describe aspects of
practice
 Importance-research, theory, and practice are closely related,
nursing theory lends itself to research testing,
 research testing leads to knowledge for practice. Nursing
theory guides research and practice
Critique…
16

 involves defining concepts minimally at first and then
developing them throughout her theory
 Idan Jean orlando’s theory has a clear and linear structure
 The proses itself look at ; Distress of the patient
 Nursing role which is discover the distress and meet
patient needs
 Nursing actions are performed in order to meet the
patient needs
 The outcome which look at the result of nurses action in
order to relieve patient distress.
Clarity
17

 simple; few concepts
 relationships; able to make some predictive statements as
opposed to just description and explanation
 Balance between scientific evidence and personal
interpretation
 Relationship between critical thinking and intuition
 Five steps of nursing process
 Each steps is a detailed phase of the process with its own
set of action
 Each phase provides a frame work for building a nursing
care plane.
Simplicity
18

 This theory force health care professionals to treat patient
as people, not just as identification numbers, and to
improve patient outcomes.
 Very broad scope- cyclic process that cover every stage of
nursing care from assessment to evaluation
 Used by nurses
 Can be applied to individual, families, or society
 No set time frame for any phase of process( ongoing,
continuous process)
 Incorporate element of a patients past, present and future.
Generality
19

 Theory has a concrete concept that are used regularly
in nursing practice
 Concepts include, principle of organization within
nursing, problematic situation encountered in
practice, consequential internal response from the
nurse and determining the appropriate nursing
response
Accessibility
20

 Theory force the medical community to look at
patients as people with individual needs , therefore
forever changing nurse client relationship
 Creation of personalized patient care plane
 Greatly improve patient outcome
 Allows patients to have input in to their own care
 Guide the nurse to evaluate their own care
 Assertion of nursing independence as a profession
Importance
21

 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
Strength
22

 The lack of the operational definitions of society or
environment, only focusing on the immediate need of the
patient, chiefly the relationship and actions between the
nurse and the patient
 Orlando’s work focuses on short term care, particularly
aware and conscious individuals and on the virtual
absence of reference group or family members.
 Orlando completely disregarded environment in her
theory
 only an individual in her theory; no families or groups
were mentioned
 Not mentioned about unconscious patient care
Weakness
23

 Orlando’s theory focuses on how to produce improvement in the
patient’s behavior
 Orlando have facilitated the development of nurses as logical thinkers.
 Orlando's Deliberative Nursing Process Theory focuses on the interaction
between the nurse and patient, perception validation, and the use of the
nursing process to produce positive outcomes or patient improvement
 Orlando's theory remains one the of the most effective practice theories
available.
 The use of her theory keeps the nurse's focus on the patient.
 The strength of the theory is that it is clear, concise, and easy to use.
 While providing the overall framework for nursing, the use of her theory
does not exclude nurses from using other theories while caring for the
patient.
CONCLUSION TO
THEORY
24

 Practice
 Education
 Research
Acceptance by the Nursing
Community
25

 Clearly applicable to nursing practice.
 Basis of practice in hospitals.
 Used at the patient care level, managerial
level, and nursing division level.
5 interrelated concepts:
 The organizing principle or professional nursing function.
 The problematic situation or the patient’s presenting behavior.
 The internal response or immediate reaction
Reflective inquiry or deliberative nursing process.
 Resolution or improvement
Practice
26

 Orlando’s process recording has made a significant
contribution to nursing education.
 Process recording – a tool to facilitate self evaluation
of whether or not the process discipline was used.
Education
27

 considerable acceptance by the nursing profession in
the area of research and has been applied to a variety
of research settings.
Research
28

 This study investigates differences in anxiety level of
patients who receive nursing process of Orlando's theory
prior to endoscopy examination compared to a control
group.
 A Quasi -experimental research design
 Samples were 60 adult patients , assigned to two groups
(30 patients each). Patients in the study group receive
nursing process of Orlando's theory by the researcher
plus the routine hospital intervention, while the control
group only received the routine hospital intervention.
 The Spielberger State-Trait Anxiety Inventory (STAI
scale) is administering to both groups before and after
endoscopy examination
Orlando’s nursing process
application on anxiety levels of
patients undergoing endoscopy
examination
29

 STAI, a self-reporting psychometric test, is used to assess state
anxiety levels.
 The total time required for the intervention ranged from 10 to
15 minutes for each patient
 during the nursing process of Orlando's theory provides;
-patients with information about the nature and sequence of the
examination
- about the endoscopy unit and its structure,
- features and principle of operation
-instructions included a description and discussion of relaxation
techniques, e.g. blinding, imaginative visualization and breathing
techniques that might be useful to the patient in managing anxiety.
30

 Each patient individually completed the
questionnaire before they began the intervention as
well as before beginning the procedure of endoscopy
examination.
 The Spielberger State-Trait Anxiety Inventory (STAI
scale) is administered to both groups before and after
endoscopy examination.
 Total possible anxiety scores range from 20 to 80
(higher scores indicate higher anxiety levels).11-13
The anxiety level is assessed immediately after the
procedure of endoscopy.
31

 Statistically significant difference was evident
between the 2 groups
 Before the intervention, the mean of anxiety level in
the control and study groups were 47±9 and 58 ±11
and after the intervention were: 41±7, 35±7,
respectively.
 Intervention groups have the lower mean of anxiety
level after the intervention
32

 Ida Jean Orlando theory description
 Major concept
 Metaparadigm concepts
 Assumption
 Critique
 Theory application
33
summary

34

 Martha raile alligood(2014). Nursing theorist and their
work(8th ed.).USA; Mosby,Elsevier, p.p-9-11, 340
 Yekefallah, L., Ashktorab, T., Ghorbani, A., & Pazokian,
M. (2017). Orlando ’ s nursing process app lication on
anxiety levels of patients undergoing endoscopy
examination. 4(1), 53–60.
 http://currentnursing.com/nursingtheory/Orlando-
nursing-process.html
 https://nurseslabs.com/ida-jean-orlandos-deliberative-
nursing-process-theory/
 https://prezi.com/7g7wawblfrpq/ida-jean-orlando/
References
35

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critique of Nursing process theory ( ida jean orlando)

  • 2.  By the end of this presentation, you’ll be able to  Discuss the nursing process theory  Describe the major concepts of nursing according to Orlando  Define the assumptions of Orlando’s theory  Explain Orlando’s theory as a framework for nursing practice  critique of orlando’s theory  Explain how this theory is to be used in practice and research Objectives 2
  • 3.   Wrote about THE NURSING PROCESS.  Born in 1926  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.  Associate Professor at Yale School of Nursing and Director of the Graduate Program in Mental Health Psychiatric Nursing.  A board member of Harvard Community Health Plan. Ida Jean Orlando 3
  • 4.   published in her 1961 book, The Dynamic Nurse- Patient Relationship and revised 1972 book: The Discipline and Teaching of Nursing Processes.  Orlando her good works came to an ended on November 28, 2007 when she died. Ida Jean Orlando… 4
  • 5.   In later half of 1950 she formulated nursing process theory  Middle range theory  Interactive type theory  Cyclic process  Developed by conducting an empirical study on the nursing study and practice.  Theory is inductive in nature  because for approximately 3 years, Orlando observed 2000 interactions between the patients and nurses. At the end of the empirical study, she was able to categorize her results in two distinct categories Nursing Process Theory 5
  • 6.   She categorized as good and bad aspect of nursing practice  Good- prime focus on verbal and non verbal behavior of patient  Bad- focus on documented and learned activity instead of observed patient immediate verbal, nonverbal behavior  Orlando used the conception of nurse- patient interaction with the prime focus on the nursing practice.  Interaction is concentrated on a time and space. 6
  • 7.   This theory is defined as follow;  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. Definitions 7
  • 8.  1. Function of professional nursing –(organizing principle) -finding immediate needs -Response of nurses -Direct assistance by empirically or interactively . - Relieving, curing and Diminishing the sufferings and the helpless. 2. Presenting behavior – problematic situation Problem-----Nursing behavior-------Response----Action 3. Immediate reaction - internal response -Perceive through five sense and immediate act for needs. Major Concepts 8
  • 9.  4. Nursing process discipline – investigation  The nurse initiates a process of exploration to ascertain how the patient is affected by what she says or does  The nurse does not assume that any aspect of her reaction to the patient is correct  Any observation shared and explored with the patient is immediately useful in ascertaining and meeting his need  Process contain 5 steps; 9
  • 11.  5. Improvement - resolution  Evaluation- fulfill the patient needs through communication.  Repeat the procedure-In each contact the nurse repeats a process of learning how to help the individual patient. 11
  • 12.   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 ambivalent about dependency needs Assumption 12
  • 13.   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 Assumption… 13
  • 14.   Nurse; Orlando speaks of nursing as unique and independent in its concerns for an individual’s need for help in an immediate situation  Person; Individuality and the dynamic nature of the nurse- patient relationship  Health; health is replaced by a sense of helplessness as the initiator of a necessity for nursing.  nursing deals with individuals who are in need of help.  Environment; Orlando completely disregarded environment in her theory  only focusing on the immediate need of the patient, chiefly the relationship and actions between the nurse and the patient Metaparadigm concepts 14
  • 15.   Clarity -word should be defined carefully  facilitated with diagrams and examples  The logical development and type of structure used should be clear  Assumptions should be stated clearly and be consistent with the goal of the theory  There must be shared agreement of the definitions of concepts and relationships between concepts within a theory  Simplicity- simple forms of theory, such as middle range, to guide practice.  theory should be sufficiently comprehensive, presented at a level of abstraction to provide guidance  have as few concepts as possible with simplistic relations to aid clarity.  Greatest sense of understanding Critique 15
  • 16.   Generality-the scope of application and the purpose within the theory  “The broader the scope . . . the greater the significance of the theory”  The generality of a theoretical work varies by how abstract or concrete it is  Accessibility-Accessibility is linked to the empirical indicators for testability and ultimate use of a theory to describe aspects of practice  Importance-research, theory, and practice are closely related, nursing theory lends itself to research testing,  research testing leads to knowledge for practice. Nursing theory guides research and practice Critique… 16
  • 17.   involves defining concepts minimally at first and then developing them throughout her theory  Idan Jean orlando’s theory has a clear and linear structure  The proses itself look at ; Distress of the patient  Nursing role which is discover the distress and meet patient needs  Nursing actions are performed in order to meet the patient needs  The outcome which look at the result of nurses action in order to relieve patient distress. Clarity 17
  • 18.   simple; few concepts  relationships; able to make some predictive statements as opposed to just description and explanation  Balance between scientific evidence and personal interpretation  Relationship between critical thinking and intuition  Five steps of nursing process  Each steps is a detailed phase of the process with its own set of action  Each phase provides a frame work for building a nursing care plane. Simplicity 18
  • 19.   This theory force health care professionals to treat patient as people, not just as identification numbers, and to improve patient outcomes.  Very broad scope- cyclic process that cover every stage of nursing care from assessment to evaluation  Used by nurses  Can be applied to individual, families, or society  No set time frame for any phase of process( ongoing, continuous process)  Incorporate element of a patients past, present and future. Generality 19
  • 20.   Theory has a concrete concept that are used regularly in nursing practice  Concepts include, principle of organization within nursing, problematic situation encountered in practice, consequential internal response from the nurse and determining the appropriate nursing response Accessibility 20
  • 21.   Theory force the medical community to look at patients as people with individual needs , therefore forever changing nurse client relationship  Creation of personalized patient care plane  Greatly improve patient outcome  Allows patients to have input in to their own care  Guide the nurse to evaluate their own care  Assertion of nursing independence as a profession Importance 21
  • 22.   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 Strength 22
  • 23.   The lack of the operational definitions of society or environment, only focusing on the immediate need of the patient, chiefly the relationship and actions between the nurse and the patient  Orlando’s work focuses on short term care, particularly aware and conscious individuals and on the virtual absence of reference group or family members.  Orlando completely disregarded environment in her theory  only an individual in her theory; no families or groups were mentioned  Not mentioned about unconscious patient care Weakness 23
  • 24.   Orlando’s theory focuses on how to produce improvement in the patient’s behavior  Orlando have facilitated the development of nurses as logical thinkers.  Orlando's Deliberative Nursing Process Theory focuses on the interaction between the nurse and patient, perception validation, and the use of the nursing process to produce positive outcomes or patient improvement  Orlando's theory remains one the of the most effective practice theories available.  The use of her theory keeps the nurse's focus on the patient.  The strength of the theory is that it is clear, concise, and easy to use.  While providing the overall framework for nursing, the use of her theory does not exclude nurses from using other theories while caring for the patient. CONCLUSION TO THEORY 24
  • 25.   Practice  Education  Research Acceptance by the Nursing Community 25
  • 26.   Clearly applicable to nursing practice.  Basis of practice in hospitals.  Used at the patient care level, managerial level, and nursing division level. 5 interrelated concepts:  The organizing principle or professional nursing function.  The problematic situation or the patient’s presenting behavior.  The internal response or immediate reaction Reflective inquiry or deliberative nursing process.  Resolution or improvement Practice 26
  • 27.   Orlando’s process recording has made a significant contribution to nursing education.  Process recording – a tool to facilitate self evaluation of whether or not the process discipline was used. Education 27
  • 28.   considerable acceptance by the nursing profession in the area of research and has been applied to a variety of research settings. Research 28
  • 29.   This study investigates differences in anxiety level of patients who receive nursing process of Orlando's theory prior to endoscopy examination compared to a control group.  A Quasi -experimental research design  Samples were 60 adult patients , assigned to two groups (30 patients each). Patients in the study group receive nursing process of Orlando's theory by the researcher plus the routine hospital intervention, while the control group only received the routine hospital intervention.  The Spielberger State-Trait Anxiety Inventory (STAI scale) is administering to both groups before and after endoscopy examination Orlando’s nursing process application on anxiety levels of patients undergoing endoscopy examination 29
  • 30.   STAI, a self-reporting psychometric test, is used to assess state anxiety levels.  The total time required for the intervention ranged from 10 to 15 minutes for each patient  during the nursing process of Orlando's theory provides; -patients with information about the nature and sequence of the examination - about the endoscopy unit and its structure, - features and principle of operation -instructions included a description and discussion of relaxation techniques, e.g. blinding, imaginative visualization and breathing techniques that might be useful to the patient in managing anxiety. 30
  • 31.   Each patient individually completed the questionnaire before they began the intervention as well as before beginning the procedure of endoscopy examination.  The Spielberger State-Trait Anxiety Inventory (STAI scale) is administered to both groups before and after endoscopy examination.  Total possible anxiety scores range from 20 to 80 (higher scores indicate higher anxiety levels).11-13 The anxiety level is assessed immediately after the procedure of endoscopy. 31
  • 32.   Statistically significant difference was evident between the 2 groups  Before the intervention, the mean of anxiety level in the control and study groups were 47±9 and 58 ±11 and after the intervention were: 41±7, 35±7, respectively.  Intervention groups have the lower mean of anxiety level after the intervention 32
  • 33.   Ida Jean Orlando theory description  Major concept  Metaparadigm concepts  Assumption  Critique  Theory application 33 summary
  • 35.   Martha raile alligood(2014). Nursing theorist and their work(8th ed.).USA; Mosby,Elsevier, p.p-9-11, 340  Yekefallah, L., Ashktorab, T., Ghorbani, A., & Pazokian, M. (2017). Orlando ’ s nursing process app lication on anxiety levels of patients undergoing endoscopy examination. 4(1), 53–60.  http://currentnursing.com/nursingtheory/Orlando- nursing-process.html  https://nurseslabs.com/ida-jean-orlandos-deliberative- nursing-process-theory/  https://prezi.com/7g7wawblfrpq/ida-jean-orlando/ References 35