Theoretical Foundations of Practice
March 05, 2012
Nursing Theory Plan of Care
Ida Orlando literally wrote the book on the function of nursing. Her theory of the deliberative nursing process outlines a dynamic nurse-patient relationship in which the nurse uses his or her senses of perception together with deliberate actions to create an individualized care plan for each patient. Results of current research on the application of her theory follow a brief concept analysis and overview. Finally, a case study outlines the application of Orlando's deliberative nursing process. Concept Analysis of Orlando's Theory
Orlando's theory hinges on the major tenets of nursing and the concept of the person as a developmental human being with needs. Individuals possess their own perceptions and personal beliefs that one may or may not observe on the surface. Her definition of health is implied only as a sense of wellbeing that one achieves when needs are met resulting in a sense of comfort. She does not directly define the environment but implies it only within the immediate nurse-patient situation. The true focus of Orlando's theory is nursing. Nursing is responsive to anyone who suffers or anticipates suffering a sense of helplessness. The role of nursing is to discover and meet the client's immediate needs (George, 2011). Ida Orlando bases her deliberative nursing process theory on the interpersonal relationship between the nurse and the patient. This helps to identify the immediate need of the patient and assess the nature of distress. Orlando provides the nurse an interpersonal approach to either simple or complex situations. Within the deliberative nursing process, the nurse continuously observes patient behavior and assesses needs to help with each situation (Sheldon & Ellington, 2008). Nursing communication has an important role in patient behavior such as anxiety, compliance with care, and patient satisfaction. The deliberative nursing process begins with the nurse’s reaction to the patient presentation and patterns of behavior. The four concepts used in her theory are patient behavior, the nurse’s reaction, the nurse’s automatic actions, and the nurse's deliberative actions. Patient behavior includes physiological presentation of symptoms as well as verbal and nonverbal communication. The nurse-patient interaction also involves non-observable reactions used in the nursing process such as perception, thought, and feeling. The nurse uses both patient verbal and nonverbal communication to do the assessment and provide high quality care (Sheldon & Ellington, 2008). Current Research of Utilization in Practice
Alligood and Tomey (2006) cite the findings of current research by Potter, Bockenhauer, and Schmiedling. These studies reveal that applying Orlando’s theory in nursing practice helps achieve positive patient-centered outcomes by improving decision-making and differentiating between nursing and non-nursing tasks. Orlando’s nursing theory provides guidelines to nursing staff regarding how and when to approach a patient. According to these studies, immediate distress reduces when Orlando’s nursing theory is applied (p. 349). According to Sheldon & Ellington (2008), Orlando's theory provides a solid base for communication within the nurse-patient relationship. However, their studies concluded that nurses' cognitive processes are not clearly outlined in her theory. Recent models of social information processing such as the Crick and Dodge model stem directly from Orlando's theory. These models add cognitive processes to Orlando's nursing processes to react to specific clues within the social context of patient behavior (p. 390). Theory-based Plan of Care with Congruence of Concepts
Nursing care with Orlando's theory begins with the nurse's perception of the patient's presentation. The nurse reviews the data, observes patient...