Ida Jean Orlando (Pelletier)

T h e D y n a m i c N u r s e - P a t i e n t R e l a t i o n s h i p

About the Theorist •a f i r s t - g e n e r a t i o n A m e r i c a n o f I t a l i a n d e s c e n t w a s b o r n i n 1 9 2 6 .

•N u r s i n g d i p l o m a - N e w Y o r k M e d i c a l C o l l e g e

•B S i n p u b l i c h e a l t h n u r s i n g - S t . J o h n ' s U n i v e r s i t y , N Y

•M A i n m e n t a l h e a l t h n u r s i n g - C o l u m b i a U n i v e r s i t y , N e w Y o r k .

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•A s s o c i a t e P r o f e s s o r a t Y a l e S c h o o l o f N u r s i n g a n d D i r e c t o r o f t h e G r a d u a t e P r o g r a m i n M e n t a l H e a l t h P s y c h i a t r i c N u r s i n g .

•P r o j e c t i n v e s t i g a t o r o f a N a t i o n a l I n s t i t u t e o f M e n t a l H e a l t h g r a n t e n t i t l e d : I n t e g r a t i o n o f M e n t a l H e a l t h C o n c e p t s i n a B a s i c N u r s i n g C u r r i c u l u m .

•p u b l i s h e d i n h e r 1 9 6 1 b o o k , “ T h e D y n a m i c N u r s e - P a t i e n t Re l a t i o n s h i p ” a n d r e v i s e d 1 9 7 2 b o o k : “ T h e D i s c i p l i n e a n d T e a c h i n g o f N u r s i n g P r o c e s s e s ”

•A b o a r d m e m b e r o f H a r v a r d C o m m u n i t y H e a l t h P l a n . I D A J E A N O R L A N D O ( P E L L I E T E R )

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Introduction to the theory

• Nursing is unique and independent

because it concerns itself with an

individual’s need for help, real or

potential, in an immediate situation.

• The process by which nursing resolves this

helplessness is interactive and is pursued

in a disciplined manner that requires

training.

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ORLANDO’S KEY CONCEPTS

Case Scenario

“Nurse, can you give me my morphine,” cried out Mrs. So.

“Can you tell how painful it is using the 0 ‐10 pain scale, where 0 being not painful and 10 being severely painful?”replied the nurse.

“Ummm... I think it’s about 7. Can I have my morphine now?”

“Mrs. So, I think something is bothering you besides your pain. Am I correct?”

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Mrs. So cried and said,

“I can’t help it. I’m so worried about my 3 boys. I’m not sure how they are or who’s been taking care of them. They’re still so young to be left alone.

My husband is in Yemen right now and he won’t be back until next month.”

“Why don’t we make a phone call to your house so you could check out on your boys?”

Mrs. So phoned his sons.

“Thank you nurse. I don’t think I still need that morphine. My boys are fine. Our neighbour, Mrs. Yee, she’s watching over my boys right now.”

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NURSING PROCESS DISCIPLINE

Orlando describes her model as revolving around the 5 major interrelated concepts/dimensions. (Schmieding, 1986)

1. Function of professional nursing (Organizing principle)

Nurses must be constantly aware that their “activity is professional only when it deliberately achieves the purpose of helping the patient” (Orlando, 1961)

If the patient has an immediate need for help and the nurse finds out and meets that need ,the function of professional nursing is achieved

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2. Presenting Behavior of the Patient – (Problematic Situation)

Orlando stresses that: “the presenting behavior of the patient, regardless of the form in which it appears, may represent a plea for help.”

When a patient experiences a need that he cannot resolve, a sense of helplessness occurs. The patient’s behavior reflects this distress.

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3. Immediate or Internal Response of the Nurse

- (Internal Response)

Patient behavior stimulates a nurse reaction, which marks the beginning of the nursing process discipline.

The perceptions stimulate automatic thought

Each thought stimulates an automatic feeling

Then the person acts

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4. The Nursing Process Discipline – (Investigation)

“The nurse does not assume that any aspect of of her reaction to the patient is correct, helpful or appropriate until she checks the validity of it in exploration with the patient” (Orlando, 1961)

Orlando (1972), also provides 3 criteria to ensure that the nurse’s exploration of her reaction with the patient is successful:

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1) What the nurse says to the individual in contact must match any or all the items contained in the immediate reaction, and what the nurse does nonverbally must be verbally expressed and the expression must match items contained in the immediate reaction.

2) The nurse must clearly communicate to the individual that the item being expressed belongs to herself.

3) The nurse must ask the individual about the item expressed in order to obtain correction or verification from that same individual

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Once the nurse has validated or corrected her reaction to the patient’s behavior, she can complete the nursing process discipline with the nurse’s action.

The nurse can act in two ways: automatic or deliberative

Criteria for deliberate actions a. Result from correct identification of patient’s needs

by validation of the nurse’s reaction to patient behavior

b. The nurse explores the meaning of the action with the patient and relevance to meeting his need

c. The nurse validates the action’s effectiveness immediately after completing it.

d. The nurse is free of stimuli unrelated to the patient’s need when she acts.

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5. Improvement – (Resolution)

It is not the nurses activity that is evaluated but rather its result : whether the activity serves to help the patient communicate her or his need for help and how it is met

In each contact the nurse repeats a process of learning how to help the individual patient.

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ORLANDO’S THEORY AND METAPARADIGM

Orlando includes material specific to three (3)

of the four major concepts:

1. Human

2. Health

3. Nursing

The fourth concept, society, is not included in

her theory.

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