Nursing Theories

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BACKGROUND
* In the late 1950s, Orlando developed her theory inductively through an empirical study of nursing practice. * For 3 years, she recorded 2000 observations between a nurse and patient interactions. She was only able to categorize the records as "good" or "bad" nursing. * According to records: Good Nursing nurses focus was on the patients immediate verbal and non verbal behavior from the beginning through the end of the contact * Bad Nursing nurses focus was on a prescribed activity or something that had nothing to do with the patients behavior * From these observations, she formulated the Deliberative Nursing Process which was published in 1961. * Her formulations were validated, thus she extended her theory to include the entire nursing practice system which then evolved as Nursing Process Discipline. * Orlando’s theory remains one the of the most effective practice theories available. Many theory scholars utilized her concept as basis for their further studies. * Her work has been translated into six languages and was contained in the international section. * A web page about her theory, developed by Schmieding in 1999, is updated periodically and contains extensive references. ASSUMPTIONS AND ASSERTIONS

* Assumptions about Nurses: The nurse’s reaction to each patient is unique. Nurses should not add to the patients distress * The nurse’s mind is the major tool for helping patients * The nurses use of automatic responses prevents the responsibility of nursing from being fulfilled * Nurses practice is improved through self-reflection

* Assumptions about Patients: Patients needs for help are unique * Patients have an initial ability to communicate their needs for help * When patients cannot meet their own needs they become distressed * The patients’ behavior is meaningful Patients are able and willing to communicate verbally (and non- verbally when unable to communicate verbally) * Assumptions about the nurse-patient situation: The nurse-patient situation is a dynamic whole * The phenomenon of the nurse-patient encounter represents a major source of nursing knowledge * Assumptions about Nursing :Nursing is a distinct profession separate from other disciplines * Professional nursing has a distinct function and product (outcome) * There is a difference between lay and professional nursing * Nursing is aligned with medicine

Metaparadigam
HEALTH is not well-defined but assumed as : freedom from mental or physical discomfort and feelings of adequacy and well-being NURSING providing direct assistance to individuals in whatever setting ENVIRONMENT the purpose of avoiding, relieving, is not clearly defined as dimnishing, or curing the well but assumed as a persons sense of nursing situation when helplessness there is a nurse-patient contact and that both nurse and patientperceive, think, feel, and act in the immediate situation PERSON unique and developmental beings with needs, individuals have their own subjective perceptions and feelings that may not be observable directly

Orlando’s theory makes it hard to include the highly technical and physical care that nurses give in certain settings. Her theory struggles with the authority derived from the function of profession and that of the employing institutions commitment to the public. Nursing process •Subjective Data Assessment •Objective Data •Nursing Diganosis Diagnosis •Validation of Patients Need •Short Term Goals Planning •Long Term Goals •Strategies to Achieve Goals Implementation •Intervention •Patient Outcome Evaluation •Success on Care Plan The patient must be the central character Nursing care needs to be directed at improving outcomes for the patient; not about nursing goals. The nursing process is an essential part of the nursing care plan. Assessment involves taking vital signs, performing a head to toe assessment, listening to the patients comments...
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