Deliberative Nursing Process Model - Case Study Example

Running head: Ida Jean Orlando Ida Jean Orlando (Pelletier Deliberative Nursing Process Model of Institution] Abstract In the 1950s American nursing practice was based on the medical model. During the last four decades, however, nurse scholars began to think seriously about the unique scope and domain of nursing. They began to explore the nature of nursing and the purposes for which nursing exists. They also began developing nursing theory as a foundation for nursing practice and education. This endeavor has presented nurses with the motivation to examine nursing's heritage, its goals and the values upon which nursing is based. This paper is intended to highlight the contribution of one of these nursing scholars, Ida Jean Orlando, who presented his theory with the title of "Deliberative Nursing Process Model". This theory is based on nurse-patient interaction and primarily emphasizes the fulfillment of immediate needs of the patients. Ida Jean Orlando (Pelletier): Deliberative Nursing Process Model I. Ida Jean Orlando: A Brief Biography Ida Jean Orlando is a significant contributor to the development of theoretical nursing knowledge. According to Fitzpatrick and Whall (1989) and Marriner-Tomey (1989), Orlando was born August 12, 1926. In 1947, she received a diploma in nursing from New York Medical College, Flower Fifth Avenue Hospital School of Nursing. She received a B. S. degree in Public Health Nursing from St. Johns University in Brooklyn, New York, in 1951, and an M. A. in Mental health Consultation from Columbia University Teacher's College, in New York in 1954. While pursuing her education Orlando was employed as a staff nurse in obstetrical, medical, surgical and emergency nursing. After receiving her master's degree in 1954, Orlando went to the Yale University School of Nursing in New Haven, Connecticut, for eight years. As an associate professor of mental health and psychiatric nursing at Yale, she was awarded a federal grant and became a research associate and the principal project investigator of a National Institute of Mental Health Institute of the United States Public Health Service's grant entitled "Integration of Mental Health Concepts in a Basic Curriculum". The project sought to identify those factors relevant to the integration of psychiatric-mental health principles into the nursing curriculum. The project consisted of an analysis of 2000 nurse-patient interactions. Her conceptual nursing model evolved from the analysis of this four-year NIMH project and appeared in her first book, The Dynamic Nurse-Patient Relationship: Function, Process and Principles, published in 1961. (Fitzpatrick and Whall, 1989) From 1972 to 1981, Orlando lectured, served as a consultant and conducted numerous workshops across the United States. In 1981, she accepted a position of nurse educator for Metropolitan State Hospital in Waltham, Massachusetts. In 1987, she became the assistant director for nursing education and research at Metropolitan State Hospital. (Morriner-Tomey, 1989) From 1962-72, Orlando served as a clinical nurse consultant at McClean Hospital in Elmont, Massachusetts and reported ten years of research at the hospital in her second book, The Discipline and Teaching of Nursing Process: An Evaluative Study. (George, 1990) As indicated previously, based on her psychiatric-mental health nursing education and practice, Orlando inductively proposed her conceptual nursing model in her first book The Dynamic Nurse-Patient Relationship: Function, Process and Principles, published in 1961. II. Analysis of Theory A. Theory Model-Deliberative Nursing Process This theory model is based upon immediate needs of the patients. Orlando assumes that nursing process initiates with the behavior of the patient. This patient behavior is further explained by her as an indication of the need of assistance from the patient and it may be verbal or non verbal. Such needs indication impacts nurse's response how she recognizes this need, employs her consideration and contemplation to such needs, and generates sensitivity for these patients needs in the form of concern and apprehension. Afterwards she validates her insight and discernment towards the patient. It is noticeable that this account of nursing process is different from successive usage of terms where it does embrace evaluation, planning, assessment, intervention and diagnosis. (Peterson, 1977) B. Focus and scope of the Theory The central focus of Orlando (1961) proposed conceptual nursing model is nurse-client interaction. Orlando identifies that "since the nurse and patient are both people, they interact, and a process goes on between them" (p. 8). she further states, "learning how to understand what is happening between herself and the patient is the central core of the nurse's practice and comprises the basic framework for the help she gives to patients" (p. 4) C. The Main Content of the Theory Orlando's (1961) book is divided into four chapters. Chapter one focuses on the task of the professional nurse and provides a foundational understanding Orlando's Conceptualization of nursing; Chapter two clarifies the client of nursing; The third chapter, the longest one, discusses Orlando's deliberative nursing process; The final chapter examines problems encountered in nursing situations and presents client case studies to illustrate how Orlando's model can be applied directly with clients in nursing practice. D. Concepts Orlando intends to differentiate between involuntary and planned actions that take place during nurse-patient interaction; She has not investigated sentiments, notions and perceptions as involuntary actions; She believes that planned actions result into way outs and deterrence of troubles E. . Metaparadigm Concepts Orlando presents four metaparadigm concepts as follows: i. Person Conceptualizing person as a behaving human organism who has needs, Orlando asserts that nurses should be concerned only with those individuals who are unable to meet their needs. Focusing on person, she defines the client of nursing as "a person who become distressed, when without help, he cannot meet his needs" (p. 11). The distress experienced by the client may result from physical limitations, adverse reaction to the setting or experiences that prevent clients from communicating their needs. Implying that nursing is dependent on medicine, Orlando states, the doctor places the patient under the care f the nurse for either or both of the following reasons: The patient cannot deal with what he needs, or He cannot carry out the prescribed treatment or diagnostic plan alone. ii. Nursing Orlando (1961) perceives the second metaparadigm concept, nursing, as a dynamic, deliberative, situational unique process, in which the nurse ascertains the client's needs and initiates a process to meet these needs. She differentiates nursing in the general sense from professional nursing. Nursing in the general sense occurs when any individual carries, in whole or part, the burden of responsibility for what the person cannot yet or can no longer do alone. In contrast, the professional nurse, aligned with the practice of medicine, offers whatever help the patient may require to meet his needs while he is undergoing some form of medical treatment or supervision. (p. 5) iii. Health Orlando does not define explicitly the metaparadigm concept of health. One must assume that her definition of health is conceived as fulfilled needs or a sense of comfort and well being. She believes that relaxation from psychological or corporeal embarrassment and sentiments of satisfactoriness play a role to health. (Marriner-Tomey. 2006) iv. Environment Likewise, although Orlando frequently mentions the concept of environment as an important element in the deliberative nursing process, she does not define the concept. The best attempt to define environment seem to be Orlando's discussion of the hospital setting in which nursing occurs (p. 17) and situational conflict (p. 71). It appears that Orlando proposes that a nursing situation occurs when there is a nurse-client contact and both the nurse and client perceive, think and act in the immediate situation. References Fitzpatrick, J. and Whall, A. (1989) Conceptual Models of Nursing: analysis and Application, 2nd edition, Norwalk, Conn.: Appleton and Lange. George, J. (Ed.). (1990) Nursing theories: The Base for Professional Nursing Practice, 3rd Edition, Norwalk, Conn.: Appleton and Lange. Joel, L. A. and Kelly, L. Y. (2003) Kelly's Dimensions of Professional Nursing, McGraw-Hill Professional, p.204 Marriner-Tomey, A. (1989) Nursing Theorists and their Work, 2nd Edition, St. Louis: C. V. Mosby Co. Marriner-Tomey, A. (2006) Nursing Theorists and their Work, 6th Edition, Elsevier Health Sciences, p. 435-6 Orlando, I. J. (1972) The Discipline and teaching of Nursing Process: An Evaluative Study, New York: G. P. Putnam's Sons. Orlando, I. J. (1961) The Dynamic Nurse-Patient relationship: Function, process, and Principles, New York: G. P. Putnam's Sons. Peterson, C. (1977). "Questions Frequently Asked about the Development of a Conceptual Framework", Journal of Nursing Education, 16(4), 22-32. Read More