Nursing Practice Concept Analysis - Essay Example

Analysis of a Concept Ida Jean Orlando 1926 Analysis of a Concept Ida Jean Orlando determined that there were three steps in the nursing process. Those steps included determining what the patients need was, determining what to do about the need, and meeting the patients need. These steps after much observation of patients, nurses and medical records became a major concept in her theory, The Dynamic Nurse-Patient Relationship which she coined in 1972. Her theory is seen somewhat differently by different researchers and theororists. Some of these are described in this paper. This theory stresses the relationship between the nurse and the patient and how the process she uses meets the need of the patient. She felt that action by the nurse was always automatic or deliberate and that automatic actions did not include perceptions, thoughts, and feelings. Today's nursing process is essentially based on Orlando's theories and this paper reviews three case studies and how this concept works in those studies. Analysis of a concept Ida Jean Orlando developed her theory in the 1950's. She used a category of "good" nursing and " bad" nursing. The basis for her observations was the patient's record, coupled with observation of other nurses, and the patients. Thus she formulated her theory. Her theory is that the nurse has the role of discovering and meeting the patient's immediate needs. The most basic concept to her theory is that," the nursing process describes the nurses reactions to patients behavior as generating a perception, thought and feeling in the nurse and then action by the nurse" (Sheldon & Ellington, 2008, pg 1). This paper will discuss this concept of this theory and use it in context of today's nursing arena. Ida Jean Orlando is probably not as well known as many theorists. Her theory was really meant to define the function of nursing. It was published the first time in 1961 in her book, The Dynamic Nurse-Patient Relationship. She later continued her concepts in her second book, The Discipline and Teaching of the Nursing Process. She discovered during this process and during her process working as a nurse that the role of the nurse is to find out and meet the patients immediate need for help (Simmons, 2003). She felt the patients behavior often represented a plea for help but that plea may not be what it seems to be, therefore the nurse also needed to be able to assess that behavior. The nurses perception and thoughts would help her accomplish that. The major dimensions of the theory are function of professional nursing (organizing principle, presenting behavior (problematic situation), immediate reaction (internal response), nursing process discipline (investigation) and improvement or resolution (current nursing.com, 2009). Orlando felt that here work was a search for facts about what the purpose of nursing was (Faust, 2002). In 1961, she wrote, "the purpose of nursing is to supply the help a patient requires in order for his needs to be met "(Orlando, 1961, pg 8). This is a more straight forward way of saying what the chosen concept says. Orlando's concept of care includes three pieces. Those are, the behavior of the patient, the reaction of the nurse, and the nursing action used to benefit the need of the patient. Practically, the concept is definitely used in the nursing process of care throughout healthcare. The functions of professional nursing work essentially this way. Nursing must find and meet the patients immediate need for help. This is part of the nursing need to remain responsive to individuals who are suffering in some way or in the need to anticipate a feeling of helplessness from patients. It remains focused on the process of caring for those that need a nurses help now as in an acute setting. However, at the same time, the focus allows for determining the need for assistance to those that are in other settings so nurses are able to determine and relieve, diminish, or cure the helpless feeling that patients have under many circumstances (Arora, 2003). The nurse must observe the behavior of her patient to determine what his needs are or assumptions. The nurse must then communicate those reactions to the patient to find out if her assumptions are correct, which then validates what her assumptions were. The nurse then takes action based on that validated assumption and this should be what is needed to meet the patients need (Faust, 2002). When a patient is in distress, it is because of unmet needs. The nurse observes that distress, makes an observation about it, and validates her perceptions. When patients behavior occurs, then is when it needs to be assessed. Assessment is the key because the behavior may mean one thing right now and a completely different thing next time that behavior occurs. Any behavior may mean that the patient is asking for help (Faust, 2002) and is asking for help. Because of the assessment and foundational parts of Orlando's theories, her theory has been used for the foundation of the nursing program at Mclean Hospital in Belmont Massachusetts and for the Yale University Graduate Program in mental Health and Psychiatric. Sheldon & Ellinton (2008) describe Orlando's theory using three concepts which are patient's behavior, the nurse reaction, and the nurse activity. The patient sends a cue (behavior) and the nurse responds to that behavior solving the patients problem. This involves nurse patient reciprocity which makes the relationship both dynamic and collaborative. The nursing process as defined by many is aimed at identifying, diagnosing, and treating actual or potential human responses to health and illness. Though this is a fairly recent theory (Potter, Boxerman, & Wolf et. al., 2004), it follows the concept of Orlando's theory. A model case can be determined by reviewing a case that meets the theoretical model. In Orlando's theory lies the concept that the patients behavior, if assessed well, will tell the story of what the patient needs. Theoretically we can apply this to the patient who arrives in the emergency room complaining of severe abdominal pain (Belcek, 2007). While assessing the patients vital signs, she notes that the patient seems very wary of the man (husband) in the room. She does not comment much about her condition and he seems to hover. This nurse might ask whether this patients behavior tells her that the abdominal pain is truly the patients problem or is she crying out for help in another way The same concept might be applied in terms of a related case. This same patient truly does have abdominal pain but there is also something else going on in the room. The patient seems to have a great deal of fear related to the other figure. This is certainly something that the nurse needs to keep in mind but she must help the patient with the immediate problem first, that of the abdominal pain. That would mean a physical assessment. Once the patient is comfortable, she may want to attempt to deal with the other issue (Clayton, Mishel, & Belyea, 2006). In the illegitimate case, the patients power is taken away. If Orlando's theory of nursing process is actually being used, this should not happen. In fact, the opposite should happen. Orlando believed that nursing should always solve the patients needs as they are projected by the patient. Nursing should never disempower the patient by not allowing the patient to tell the nurse in some way what the problem is. An example would be the patient who climbs out of bed at night. We would be illegitimately be applying Orlando's theory if we assumed that the patient was confused and kept them in the be (Florin, 2005). That may not be the problem at all. Nursing is able to apply Orland's concepts in many venues. This paper will discuss several examples of that use. In this particular case, the problem developed on a post ICU unit. The nursing staff felt they did not have a solution so they ask the supervisor to help with the solution. There were two patient's on the unit that were causing problems for the nurses and other patients at night. They rang their bells constantly and it was difficult to get anything done for the other patients. This also caused excessive noise on a unit where patients badly needed their rest. Worst of all one of them was falling a lot and the nurses were concerned for her safety. One of the patients had end stage COPD and the other had a fractured hip and was post ventilator care. The lady (we will call Grace) consistently removed her oxygen and sometimes got out of bed when she should not. This would cause her to desaturate and become very confused. She often fell and she sometimes got into the wrong bed which distressed her room mate. She seemed very confused at night but in the day time told her family that no one was there to take care of her at night and she was quite lucid so the family remained upset. She called out to her husband constantly. The other lady (Jean) cried all night. She rang her call bell constantly as soon as the staff left her room. She constantly ask for pain medication and cried whether or not she was medicated. Using Orlando's theory, one has to decide that in both cases, this is distress caused from unmet needs. If the patient does not have the ability to communicate which is the case with both of these patients, it is the nurses responsibility to figure it out through her perception. It must be remembered that the presenting behavior of the patient is a plea for help no matter what the behavior looks like. The nurse must figure out how to help the patient express what they need to tell. It turns out that the patient with the COPD was afraid that she might die alone and was trying to get out to the hall where there were other people. When she pulled her oxygen off, she became confused but in the day time, when she had her oxygen on, she was lucid. This was discovered through discussion with the patient and a light was left on in her room so she could see that there were people around. She did die but she no longer got out of her bed and took off her oxygen and she never felt alone nor did she remove her oxygen and climb out of bed. In the case of the patient with the hip fracture, she was afraid that her family was not going to take her home. This fear came back to her over and over again in the night when it was quiet. She tried to make the fear go away with pain medication. She felt her family was going to sell her house and she would never see her family or her things again. The nurses listened to her story and had her pain medication changed to something less likely to increase her fears and allow her to rest at night. She was more often able to sleep. They then held family conferences so she could see what the families goals were and that she would go home when she was well enough to go. She no longer cried throughout the night and the rest helped her get better faster. In discussing these two cases the four nursing pieces have been met. There were persons in distress, the environment was the nursing unit at night, the full nursing process as described by Orlando took place, and the patients' needs were met. In assuming that the patients needs were one thing, the nurses were missing what the true problems were. Once those were discovered and something was done about them, the patients behavior changed. The third case is one of fear. The patient was a 48 year old woman admitted to the hospital post total right mastectomy with positive cancer diagnosis. The physician came to tell her today that it was a stage II cancer and all lymph nodes were negative. He then told her that she would need to do six months of chemotherapy and another five years of Tamoxifen. The nurse who was in the room with the patient felt like this was very good news. It appeared that the patient would survive. The patient on the other hand began to cry hysterically. The nurse ask her if she were in pain and she said yes so the nurse medicated her and she fell asleep. However, in the middle of the night, the patient awoke and began to cry again, this time in long jerking sobs. The night nurse went in, sat on the side of the bed and just held her hand. After awhile the patient stopped crying and told the story of the fact that she was a nurse herself and had worked many years and seen many patients die from breast cancer. She had never known a patient who had to have chemotherapy to survive and she had three teen age children at home. The next morning, the night nurse gave report to the day shift and ask for a visit from a breast cancer survivor for this patient this morning. The visit happened. The patient was no longer so fearful that she would not survive as she saw that the other patients cancer was much worse than hers and she was already a ten year survivor. Applying Orlando's theory to this case tells us that the night nurse did the right thing. She did not know what was wrong but holding the patients hand seemed to meet the patients needs at the moment. Then once that need was met, the patient was able to tell her the story that she needed to hear to solve the overall problem, which she did. The nurse identified the need, communicated with the patient and discovered what needed to be done to meet the need and then met it. This is exactly what Orlando would have expected to happen. In conclusion, Ida Jean Orlando had a vision of what nursing really was and how that process should be carried out. She knew that nursing as well as the process of nursing needed to be identified and she spent many years observing nurses, patients, and medical records before defining her theory. Once she did that however, her theory became the foundation for solving patient need as well as the structure that many other theories are built on. You can see from the case studies presented that her theory can easily be applied in many different situations. References Arora, N.K. (2003). Interacting with cancer patients: the significance of physicians' communication behavior. Social Science and Medicine. 57. 791-806. Belcik, K., (2007). Information literacy: a prerequisite to evidence based nursing. 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