User:Beckirn/Ida Jean Orlando (Pelletier)

Widely known as a nursing theorist, Ida Jean Orlando (Pelletier) was the theorist who developed the theory of Deliberative Nursing Process.

Deliberative Nursing Process is one of many middle-range theories of nursing. This theory has been around for a long time, published in 1961 by Ida J. Orlando in her classic book, The dynamic nurse-patient relationship. A literature review of sources was conducted using CINAHL and PSYCHINFO to validate the progress of literature either referring to or utilizing the theory in nursing research, nursing practice, or further nursing theory development. A total of thirty-four references involving this theory were located using the following search terms: deliberative nursing process; Orlando, I.; and Orlando’s theory. Additionally an internet search was conducted which revealed the Ida J. Orlando web site at http://www.uri.edu/nursing/schmieding/orlando/index.html. This source provides additional resources on unpublished works by Orlando. These references were obtained and reviewed for relevance. The purpose of this paper will be to evaluate the theory, its major concepts, their relational connections to each other, and its logical structure. Finally, the paper will also explore the significance of Orlando’s theory to the discipline of nursing and provide an example of its use within nursing practice. Ida J. Orlando (later Pelletier), “uncovered” or “discovered” the theory of Deliberative Nursing Practice through lengthy observations of actual nursing practice in a psychiatric hospital in the late 1950’s. Her research came about at time when nursing was trying desperately to make itself distinct from other disciplines in healthcare, namely that or medicine. She discusses how she developed this theory using induction in her interview with Jacqueline Fawcett (1988). She stated in this videotaped representation that she really was extremely interested in what made for “good” nursing interventions as well as “bad” nursing interventions. She collected data from approximately 2,000 patient records using a process to initially qualify what types of communication within the nurse-patient interaction created positive patient outcomes whether this be a clinical symptom improvement such as pain improved or whether the patient indicated verbally that his status was improved in some way. Following review of these 2,000 records, she asked other nursing reviewers including instructors, nurses with backgrounds in psychology, and social work to review these independently from her conclusion and all came up with the same division between “good” (effective) interactions and “bad” (ineffective) interactions. From this, she then began to qualify what in the interactions had commonalities and from this evolved the theory. The theory defines the following terms: autonomic nursing process, deliberative nursing process, dynamic nurse-patient relationship, immediate need for help, nursing situation, patient distress, patient outcomes/product, and validation. Potter (2009) provides definitions for these key concepts below:

Automatic nursing process: Actions (visible behaviors) the nurse takes based on reasons other than the patient’s immediate needs

Deliberative nursing process: Means by which the professional nurse purposefully explores with the patient the nurse’s perceptions (stimulation of any one of the five senses), thoughts, and/or feelings related to the patient’s immediate need for help

Dynamic nurse-patient relationship: Interactive contact/connection between nurse and patient, when the nurse begins to explore the meaning behind the patient’s verbal and nonverbal behaviors

Immediate need for help: Requirement of the patient in a specific situation. Help for the need relieves of diminishes the patient’s immediate distress of improves the patient’s immediate sense of adequacy or well-being

Nursing situation: Circumstance that involves a patient’s behavior, the nurse’s reaction (perceptions, thoughts, and feelings combined together), and the nurse’s action (activity the nurse completes with or for the patient)

Patient distress: Feeling experienced by a patient when he or she cannot meet certain needs and is not helped in meeting such needs

Patient outcomes/product: Improved verbal and nonverbal patient behaviors that can result from the nurse’s deliberative and effective action(s) with the patient

Validation: Ongoing process of exploring and determining with a patient if the nursing reaction was accurate and if the nursing action was helpful”.

Simply put, a patient has some level of distress that comes from inability to meet a need, therefore has an immediate need for help. The professional nurse hopefully uses deliberative nursing process to enter into an interaction with the patient, if not, then an automatic nursing process is used. When using deliberative nursing process, perceptions, thoughts and feelings related to the need for help are evaluated and the nurse and patient enter into a dynamic relationship. The nurse explores the meanings behind the patient’s verbal and non-verbal behaviors alongside the stated need, while validating with the patient reaction to whether the nursing action was helpful. Patient outcomes are then also evaluated for effectiveness with the patient. The dynamic relationship indicates that the verbal and non-verbal perceptions are jointly evaluated back and forth between nurse and patient until validation of need and validation of effectiveness of action(s) has occurred. Apointe (2009, p. 327) provides the following diagram with references from other sources that outlines the overall conceptual framework nicely.

Orlando (1972) viewed deliberative nursing process as a learned and practiced process and therefore sought to teach students its implications. She viewed the ability to perform deliberative nursing process effectively and to define the function of the professional nurse in this manner as a key attempt to define nursing practice separate and apart from medicine and other healthcare professions. It was during follow-up research with the publishing of her second book, The discipline and teaching of nursing process (an evaluative study), in which she changed the term “deliberative nursing process” to the term “nursing process discipline” to better define the function of the professional nurse.