Ida Jean Orlando Nursing Process theory 1962 (USA)

(By National Cancer Institute [Public domain], via Wikimedia Commons)

Ida Jean Orlando Nursing Process theory 1962 (USA)

Ida Jean Orlando Pelletier (1926-2007) had worked as practitioner, educator,researcher and consultant in nursing. Throughout her career, she was active in various organizations including the Massachusetts Nurse’s Association and the Harvard Community Health Plan. She described the nursing process based on the interaction between patient and nurse. She has written a book “The dynamic nurse patient relationship” explains the factors which enhanced the integration of mental health of the people in the basic nursing curriculum and published in 1961 at the age of 36 years.

She defined the nursing is responsible to individuals who suffer or anticipate a sense of helplessness, it is focused on the process of care in an immediate experience, it is concerned with providing direct assistance to individuals in whatever setting and they are found for the purpose of avoiding, relieving, diminishing or curing the individual sense of helplessness. According to her theory, nurse patient relationship includes patient behavior, nurse’s reaction and professional function.

Patient behavior
The nursing process discipline is set in motion by patient behavior. It represents a plea for help. It may be verbal or non verbal. Verbal behavior consists of patient’s language in the form of complaints, requests, demands etc. Non verbal behavior includes physiological manifestations such as heart rate, perspiration, avoiding eye contact etc. If the nurse were not able to help the patient, helplessness would be developed. It reflects the distress, physical limitations and adverse reactions to the setting and experience which the patient from communicating his needs.

Nurse’s reaction
The patient behavior stimulates a nurse’s reaction, which paves the way for beginning of nursing process discipline. The reaction is comprised of three parts. First, the nurse perceives the behavior through any of her senses. Second, the perception leads to automatic thought. Finally, the thought produces an automatic feeling. For example, the nurse sees a patient in restless, thinks that she is in pain and confirms with the patient that she has correctly identified the need for help and to identify the nursing action appropriately to resolve it.

Nurse’s action 
Once the nurse has validated her reaction of the patient’s behavior through exploration with him, she can complete nursing process discipline with the nurse’s action. The nurse can act in two ways: automatic and deliberative. Automatic actions are ‘those decided upon for reactions other than the patient’s immediate needs. For example, the nurse gives the sedative to patient to sleep because the physician ordered it. But deliberate actions result from the correct identification of patient’s needs by validation of the nurse’s reaction to patient behavior. It fulfills her professional function

Professional function
Nurses often work with other professions and supposed to coordinate the patient care with them. Naturally, at times conflicts will arise between the actions appropriate to the nurse’s profession and those required by the job. Non professional actions of nurse leads to inadequate patient care. A well defined function of the profession can help to prevent and resolve the conflict.

Comparison of the Orlando’s process discipline and nursing process

It consists of seven phases. These are assessment, diagnosis, outcomes, plan of action, implementation and evaluation.

Assessment of the nursing process corresponds to the sharing of the nurse’s reaction to the patient behavior. The collection of data includes only information relevant to identifying patient’s need for help.

The product of the nursing process analysis is nursing diagnosis. The statement of the nursing process includes formally written problem related to etiological factors and signs and symptoms.

The outcome and plan of action phase involves writing outcomes, goals and objectives and deciding on appropriate nursing action.

The implementation phase involves the final selection of actions and carries out it. The evaluation phase asks whether the outcomes achieved or not.

This theory has much to offer to nursing. It guides nurses through their interactions with patients and ensure that they will be treated as individuals and focuses on patient’s needs rather than the demands of professional setting. Orlando should be considered as a nursing theorist who made significant contribution to the advanced nursing practice. She helped nurses to focus on patient needs rather than institutional demands. Here, nurse is viewed as a ‘care giver’ for the patient, not a ‘hand maiden’ for the physician. 

Faye Glenn Abdellah 21 Nursing Problems Theory 1960 (USA)

Faye Glenn Abdellah 21 Nursing Problems Theory 1960 (USA) 

Faye Abdellah was one of the first nursing theorists. She earned her bachelor’s degree, master’s and doctorate of nursing from Colombia University. She has been awarded many academic honors from civilian and military sources. Abdellah’s patient centered approach to nursing was developed inductively from her clinical practice at the age of 41 years and is considered as human needs theory. It is also relevant to community setting also. She considered the object of nursing as ‘patient’ rather than client or consumer. She developed the concept of nursing diagnosis in nursing care plan.

Abdellah and colleagues (1960) developed a list of 21 nursing problems.

To maintain good hygiene and physical comfort

To promote optimal activity, exercise, rest and sleep

To promote safety through prevention of accidents, injury, or other trauma and through the prevention of the spread of infection

To maintain good body mechanics and prevent and correct deformities

To facilitate the maintenance of supply of oxygen

To facilitate the maintenance of nutrition

To facilitate the maintenance of elimination

To facilitate the maintenance of fluid and electrolyte balance

To recognize the physiologic responses of the body to disease conditions

To facilitate the maintenance of regulatory mechanics and functions

To facilitate the maintenance of sensory function

To identify and accept positive and negative expressions, feelings and reactions

To identify and accept the interrelatedness of emotions and organic illness

To facilitate the maintenance of effective verbal and nonverbal communication

To promote the development of interpersonal relationships

To facilitate progress toward achievement of personal spiritual goals

To create and maintain a therapeutic environment

To facilitate awareness of self as an individual with varying physical, emotional and developmental needs

To accept the optimum possible goals in the light of physical and emotional limitations

To use community resources as an aid in resolving problems arising from illness

To understand the role of social problems as influencing factors in the cause of illness

They also identified a list of 10 steps and skills in nursing to be used in developing nursing care plan.

Know the patient

Differentiate the significant data

Make generalizations from the data

Identify the therapeutic plan

Test the generalizations with the patient and make additional generalizations

Validate the patient’s conclusions regarding the problem

Frequent evaluation and follow up

Explore the patient and family reaction to therapeutic plan

Identify the nurse’s reaction to patient and family

Develop a comprehensive nursing care plan based on the needs

This patient centered approach is very useful in nursing practice and education. She categorized nursing problems based on the individual needs and developed a typology of nursing care and skills. It is widely considered as major contributions to nursing into Nightingale’s ideal of becoming a profession.

­­­­­­­Virginia Henderson 14 basic need theory 1955 (USA)

(By Mennonite Church USA Archives [No restrictions], via Wikimedia Commons )

Virginia Henderson 14 basic need theory 1955 (USA) 

Virginia Henderson was born in Missouri and graduated in nursing from Colombia University. She was a well known nursing educator and author. She developed a concept of nursing from her educational and practical experiences at the age of 55 years. She stated nursing as a “Nursing is primarily assisting the individual (sick or well) in the performance of those activities contributing to health or its recovery (or peaceful death) that he would perform unaided if he had the necessary strength, will or knowledge. It is likewise the unique contribution of nursing to help the individual to be independent of such assistance as soon as possible” (Harmer and Henderson, 1955).

The major assumption of the theory that the nurse care for patients until they can care for themselves. She defined the patient who needs nursing care with supportive environment. The concept of this theory involved the nurse attending 14 activities to assist the individual towards independence.

Breathe normally

Eat and drink adequately

Eliminate body wastes

Move and maintain desirable postures

Sleep and rest

Select suitable clothes

Maintain body temperature with in normal range by adjusting clothing and modifying environment

Keep the body cleaned and well groomed and protect the integument

Avoid dangers in the environment

Communicate with the others in expressing emotions, needs or fears

Worship according to one’s faith

Work in such a way that there is a sense of accomplishment

Play and participate in various forms of recreation

Learn, discover or satisfy the curiosity that leads to normal development and health and use the available health facilities.

To conclude, Henderson’s work is parsimonious in its presentation, but complex in its scope. The 14 statements cover the whole of the practice of nursing and her vision about the nurse’s role on patient care contributed to that complexity.