The document discusses several theories related to nursing processes: 1. Orlando's nursing process theory focuses on the dynamic nurse-patient relationship and how nurses can meet patients' immediate needs through understanding their verbal and nonverbal behaviors. 2. Benner's stages of clinical competence describes how nurses develop from novice to expert through experiences in various clinical situations. 3. Wiedenbach's prescriptive theory of nursing defines the nurse's role and responsibility in caring for patients by developing a prescription or care plan based on the patient's autonomy and individuality. 4. Fitzpatrick's nursing classification theory centered around developing a standardized system for classifying nursing diagnoses, interventions, and outcomes.

1. Process Theories

2. Ida Jean Orlando-Pelletier
August 12, 1926 –
Nursing
Process

3. Nursing Process
 “The dynamic nurse-patient
relationship: Function, process and
principles”
 Based on the interaction between the
patient and the nurse

5. 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.

6. Professional Nursing
• Finding out and
meeting the
client’s
immediate need
for help.

7. Verbal behavior Nonverbal behavior
- encompasses all the -includes
patient's use of language physiological
responses, motor
activity, vocal
activity

8. 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 patient's behavior indicating
resolution of the need is the desired result.

9. Environment
Person
• Environment: Not fully defined
• Person: A unique individual behaving
verbally and non-verbally.

10. Patricia Benner
Stages of Clinical
Competence

11. Central Theme
How nurses learn
to do nursing
(stages of clinical
competence)

12. 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 I'll do it.”

13. 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

14. 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

15. 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

16. 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

17. 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

18. 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

19. 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

20. 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

21. 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

22. Person
• A self-interpreting
being. They do not
come into the world
predefined but gets
defined in the course of
living a life.

23. Environment
• Benner used the term situation rather than
environment. Situation conveys a social
environment with social definition and
meaningfulness.

24. Health
• Based on the lived experience of being
healthy or ill.

25. Nursing
• A caring relationship, an enabling condition
of connection and concern

26. Ernestine Wiedenbach
1900 -1999
The Prescriptive Theory
of Nursing

27. 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.

28. Central Theme
• Nurse = philosophy
• Patient = autonomy &
individuality
• Nurse + patient 
prescription or plan
for care

29. 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

30. 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

31. Joyce Fitzpatrick
Nursing
Classification
Main theme: Classification of
nursing diagnoses, interventions
& outcomes

32. Central Theme
Classification of nursing
diagnoses, interventions & *
outcomes
* North American Nursing
Diagnosis Association