PREPARED BY

MARIVIC L. MISOLA
 One important thing that nurses do is
converse with the patients and let them know
what the plan of care for the day is going to
be. However, regardless of how well thought
out a nursing care plan is for a patient,
unexpected problems to the patients
recovery may arise at any time. With these,
the job of the nurse is to know how to deal
with those problems so the patient can
continue to get back and reclaim his or her
well-being.
Ida Jean Orlando developed
her Deliberative Nursing Process that allows
nurses to formulate an effective nursing care
plan that can also be easily adapted when
and if any complexity come up with the
patient.
 IdaJean Orlando-Pelletier (August 12,
1926 November 28, 2007) was an
internationally known psychiatric health
nurse, theorist and researcher who
developed the Deliberative Nursing
Process Theory. Her theory allows nurses
to create an effective nursing care
planthat can also be easily adapted
when and if any complications arise with
the patient.
 Nursing Diploma in New York Medical
College
BS in Public Health Nursing at St. Johns
University , NY
Associate Professor at Yale School of
Nursing and Director of the Graduate
Program in Mental Heath Psychiatric
Nursing.
Project investigator of a National Institute
of Mental Heath grant entitled;
Integration of Mental Heath Concepts in
a Basic Nursing Curriculum.
 Published in her 1961 book, The Dynamic
Nurse- Patient Relationship and revised 1972
book; The Discipline and Teaching of Nursing
Process.
A Board Member of Harvard Community
Health Plan.
Orlando retired from nursing in 1992. After
becoming well-educated, researching over
2,000 nurse-patient interactions, and coming
up with a theory that changed nursing, she
was recognized as a Nursing Living Legend
by the Massachusetts Registered Nurse
Association.
 Orlandodied on November 28, 2007 at
the age of 81.
PHILOSOPHICAL UNDERPINNINGS
Orlando developed her theory from a
study conducted at the Yale University
School of Nursing, integrating mental
health concepts into a basic nursing
curriculum. She proposed that patients
have their own meanings and
interpretations of situations and therefore
nurses must validate their inferences and
analyses with patients before drawing
conclusions.
 The theory was published in The Dynamic
Nurse-Patient Relationship: Function, Process,
and Principles (NLN Classics in Nursing Theory)
in 1961. Her book purposed a contribution to
concern about the nurse-patient relationship,
the nurses professional role and identity, and
the knowledge development distinct to
nursing.
Orlandos nursing theory stresses the
reciprocal relationship between patient and
nurse. What the nurse and the patient say
and do affects them both. She views the
professional function of nursing as finding out
and meeting the patients immediate need
for help.
MAJOR ASSUMPTIONS/ CONCEPTS
When patients are unable to cope with their needs on
their own, they become distressed by feelings of
helplessness.
In its professional character, nursing adds to the distress
of the patient.
Patients are unique and individual in how they respond.
Nursing offers mothering and nursing analogous to an
adult who mothers and nurtures a child.
The practice of nursing deals with people, environment,
and health.
Patients need help communicating their needs; they
are uncomfortable and ambivalent about their
dependency needs.
People are able to be secretive or explicit about their
needs, perceptions, thoughts, and feelings.
*cont. major assumptions
The nurse-patient situation is dynamic; actions and
reactions are influenced by both the nurse and
the patient.
People attach meanings to situations and actions
that arent apparent to others.
Patients enter into nursing care through medicine.
The patient is unable to state the nature and
meaning of his or her distress without the help of
the nurse, or without him or her first having
established a helpful relationship with the patient.
Any observation shared and observed with the
patient is immediately helpful in ascertaining and
meeting his or her need, or finding out that he or
she is not in need at that time.
Nurses are concerned with the needs the patient
is unable to meet on his or her own.
MAJOR CONCEPTS
The nursing metaparadigm consists of four
concepts: person, environment, health,
and nursing. Of the four concepts,
Orlando only included three in her theory
of Nursing Process Discipline: person,
health, and nursing.
Human Being
Orlando uses the concept of human as
she emphasizes individuality and the
dynamic nature of the nurse-patient
relationship. For her, humans in need are
the focus of nursing practice.
Health
In Orlandos theory, health is replaced by
a sense of helplessness as the initiator of a
necessity for nursing. She stated that
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 (only an
individual in her theory; no families or groups were
mentioned). The effect that the environment
could have on the patient was never mentioned
in Orlandos theory.
Nursing
Orlando speaks of nursing as unique and
independent in its concerns for an individuals
need for help in an immediate situation. The efforts
to meet the individuals need for help are carried
out in an interactive situation and in a disciplined
manner that requires proper training
Subconcepts
Orlando described her model as revolving
around the following five major
interrelated concepts: function of
professional nursing, presenting behavior,
immediate reaction, nursing process
discipline, and improvement.
Function of Professional Nursing
The function of professional nursing is the
organizing principle. This means finding out
and meeting the patients immediate needs
for help. It is focused on the process of care in
an immediate experience, and is concerned
with providing direct assistance to a patient in
whatever setting they are found in for the
purpose of avoiding, relieving, diminishing, or
curing the sense of helplessness in the patient.
That is, if the patient has an immediate need
for help, and the nurse discovers and meets
that need, the purpose of nursing has been
achieved
Presenting Behavior
Presenting behavior is the patients
problematic situation. Through the
presenting behavior, the nurse finds the
patients immediate need for help.
Immediate Reaction
The immediate reaction is the internal
response. The patient perceives objects
with his or her five senses. These
perceptions stimulate automatic thought,
and each thought stimulates an
automatic feeling, causing the patient to
act.
Deliberative Nursing Actions are actions
decided upon after ascertaining a need and
then meeting this need
The following list identifies the criteria for
deliberative actions:
Deliberative actions result from the correct
identification of patient needs by validation
of the nurses reaction to patient behavior.
The nurse explores the meaning of the action
with the patient and its relevance to meeting
his need.
The nurse validates the actions effectiveness
immediately after completing it.
The nurse is free of stimuli unrelated to the
patients need when she acts.
The action process in a person-to-person contact
functioning in secret. The perceptions, thoughts, and
feelings of each individual are not directly available to the
perception of the other individual through the observable
action.
The action process in a person-to-person contact
functioning by open disclosure. The perceptions, thoughts,
and feelings of each individual are directly available to the
perception of the other individual through the observable
action.
5 Stages of the Deliberative Nursing Process
Assessment
In the assessment stage, the nurse completes
a holistic assessment of the patients needs.
This is done without taking the reason for the
encounter into consideration. The nurse uses a
nursing framework to collect both subjective
and objective data about the patient.
Diagnosis
The diagnosis stage uses the nurses clinical
judgment about health problems. The
diagnosis can then be confirmed using links to
defining characteristics, related factors, and
risk factors found in the patients assessment.
Planning
The planning stage addresses each of the
problems identified in the diagnosis. Each problem
is given a specific goal or outcome, and each
goal or outcome is given nursing interventions to
help achieve the goal. By the end of this stage,
the nurse will have a nursing care plan.
Implementation
In the implementation stage, the nurse begins
using the nursing care plan.
Evaluation
Finally, in the evaluation stage, the nurse looks at
the progress of the patient toward the goals set in
the nursing care plan. Changes can be made to
the nursing care plan based on how well (or
poorly) the patient is progressing toward the goals.
ASSESSMENT NSG.DIAGNOSI PANNING INTERVENTION RATIONAE EVAUATION
S

SUBECTIVE ELEVATED At the end of Independent nursing Reduce After 4

Giniginaw BODY 4 hours nursing action elevated hours of
ako ,as TEMPERATURE intervention = change to light body temp. nursing
verbalized pt. body temp clothing intervention
by pt. should be in a =initiate tepid sponge pt. is
normal range bath afebrile
Obective =advised to increase
OFI
Febrile T 38.8
Flushed skin Pharmacological
Warm to = administration of
touch anti pyretic
medication as
ordered by AP
Testability
The Deliberative Nursing Process helps
nurses achieve more successful patient
outcomes such as fall reduction.
Orlandos theory remains a most effective
practice theory that is especially helpful
to new nurses as they begin their practice
VALUE IN EXTENDING NURSING SERVICE
Strengths
The guarantee that patients will be treated as
individuals is very much applied in Orlandos
theory of Deliberative Nursing Process. Each
patient will have an active and constant
input into their own care.
Assertion of nursings independence as a
profession and her belief that this
independence must be based on a sound
theoretical framework.
The model also guides the nurse to evaluate
her care in terms of objectively observable
patient outcomes.
Weaknesses
The lack of the operational definitions of
society or environment was evident which
limits the development of research
hypothesis.
Orlandos work focuses on short term
care, particularly aware and conscious
individuals and on the virtual absence of
reference group or family members.