IDA JEAN ORLANDO (PELLETIER)
1926-present
CREDENTIALS AND BACKGROUND
August 12, 1926 – Ida Jean Orlando was born
1947 – received a diploma in nursing from New York Medical College, Flower Fifth Avenue
Hospital School of Nursing
1951 – received a Bachelor of Science in Public Health from St. John’s University, Brooklyn
1954 – Master of Arts in Mental Health consultation in Columbia University Teachers College
- While studying she also worked intermittently and sometimes concurrently as a staff
nurse in OB, M/S, ER; as a supervisor in a general hospital, and as an assistant
director and a teacher of several courses.
- After receiving her masters, she was employed by Yale School of Nursing in New
Haven, Connecticut for 8 years.
1958 – she became a research associate and principal investigator of a federal project grant
entitled “Integration of Mental Health Concepts in a Basic Curriculum”. She recorded her
observations for 3 years and spent the 4th year analyzing the accumulated data.
- This year also, she made her first book “The Dynamic Nurse-Patient Relationship:
Function, Process, and Principles of Professional Nursing Practice”, was published
1961.
1961 – she married Robert J. Pelletier and left Yale
1962-1972 – she became a Clinical Nursing Consultant at McLean Hospital, Belmont,
Massachusetts
1967 – published the “Patient’s Predicament and Nursing Function in Psychiatric Opinion”
1972 – “The Discipline and Teaching of Nursing Process : An Evaluative Study
1972-1981 – she lectured, served as consultant, conducted about 60 workshops about her
theory throughout US and Canada.
1972-1984 – served on the board of the Harvard Community Health Plan in Boston,
Massachusetts
1979-1985 – served as the Hospital Committee of the board
1981 – hired as Nurse Educator for Metropolitan State Hospital in Waltham, Massachusetts
and held administrative positions from 1984-1987
September 1987 – became the Assistant director of Nursing for Education and Research at
Metropolitan State Hospital
1992 – retired from nursing.
Orlando’s Nursing Theory (Deliberative Nursing Process)
- Stresses the reciprocal relationship between patient and nurse.
- Emphasizes the critical importance of the patient’s participation in the nursing
process.
- Views nursing as a distinct profession and separates from medicine.
- Believes that physician’s orders are for patients, not for nurses.
- Views nurses as determining nursing action rather than being prompted by
physician’s orders, organizational needs and past personal experiences.
- Goal: to develop a theory of effective nursing practice.
She described her model as revolving around the following five major interrelated concepts:
1. The function of professional nursing
2. The presenting behavior of the patient
3. The immediate or internal response of the nurse
4. The nursing process discipline
5. Improvement
NEED – is situationally defined as a requirement of the patient which, if supplied, relieves or
diminished his immediate distressor and improves his immediate sense of adequacy or well-
being.
PRESENTING BEHAVIOR - is any observable verbal or non-verbal behavior
IMMEDIATE REACTIONS – both the nurse’s and patient’s individual perceptions, thoughts, and
feelings.
NURSING PROCESS DISCIPLINE – includes the nurse communicating to the patient his or her
own immediate reaction, item expressed belongs to the nurse and then asking for validation or
correction. Also called deliberative nursing process, nursing process and process discipline on
her other books.
AUTOMATIC NURSING ACTION – are nursing actions decided upon for reasons other than the
patient’s immediate need.
DELIBERATIVE NURSING ACTION – actions decided upon after ascertaining a need and then
meeting this need.
MAJOR ASSUMPTIONS
1. Assumptions about Nursing
“Nursing is a distinct profession separate from other discipline”
“Professional nursing has a distinct function and product (outcome)”
“There is a difference between lay and professional nursing”
“Nursing is aligned to with medicine”
2. 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”
“Patient’s behavior is meaningful”
“Patients are able and willing to communicate verbally (and nonverbally when unable to
communicate verbally)”
3. Assumptions about nurses
“The nurse’s reaction to patient is unique”
“Nurses should not add to the patient’s distress”
“The nurse’s mind is the major tool for helping patients”
“The nurse’s use of automatic responses prevents the responsibility of nursing from
being fulfilled”
“Nurse’s practice is improved through self-reflection”
4. 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”
THEORETICAL ASSERTIONS
Orlando views the professional function of nursing as finding out and meeting the
patient’s immediate need for help. Orlando’s theory focuses on how to produce improvement
in the patient’s behavior. According to Orlando, a person becomes a patient requiring nursing
care when he or she has needs for help that cannot be met independently because he or she
has physical limitations, has negative reaction to an environment, or has experience that
prevents the patient from communicating his or her needs.
When the nurse acts, an action process transpires. This action process by the nurse in a
nurse-patient contact is called nursing process. The nurse’s action may be automatic or
deliberative.
Automatic nursing actions – those having nothing to do with finding out and meeting
the patient’s need for help.
Deliberative nursing actions – those designed to identify and meet the patient’s
immediate needs for help and fulfill the professional nursing function. There are three specific
requirements. First, the nurse expresses to the patient any or all of the items contained in his or
her reaction to the patient’s behavior. Second, the nurses states to the patient that the
expressed item belongs to the nurse by use of the personal pronoun (an “I” message which
indicates it is the nurse’s perception). Finally, the nurse asks about the item expressed,
attempting to verify or correct his or her perceptions, thoughts, or feelings. She viewed the
latter type of response as a form of “continuous reflection as the nurse tries to understand the
meaning to the patient of the behavior she observed and what she needs from her in order to
be helped.”
ANALYSIS AND EVALUATION INTERNAL CRITICISM
ADEQUACY: Describes nursing as unique, independent, and disciplined
CLARITY: Very easily understood
CONSISTENCY: Simplistic nature and consistent throughout
LOGICAL DEVELOPMENT: Demonstrates logical development
LEVEL OF THEORY DEVELOPMENT: Appropriately considered a middle range theory
COMPLEXITY: Simple yet complex
DISCRIMINATION: Can be used in all clinical practice, administration, and education
REALITY CONVERGENCE: Compatible with expectations for nursing practice
PRAGMATIC: Has been used in research studies
SCOPE: Low to medium level of abstraction
SIGNIFICANCE: Significant contributions to the nursing practice
UTILITY: Derived from initial research using a qualitative, observational method
CONCLUSION
Ida Jean Orlando presents a classic nursing theory. Her theory is simple to understand but
requires that the nurse focus on the patient to find out the immediate needs for help. Nurses
need to explore patients’ perception, thoughts, and feelings to find out what help patients
need, which is not as easy as it appears.
Orlando’s theory is used in various practices, from psychiatric, to public health nursing. It is also
used in various hospitals where, there, a psychiatric nurse-physician pair works with people
who have bipolar disease. Used also in education, administration, and nursing leadership.
Regardless of where the nurses practices, the focus is on the patient. Conceivably, it can be
adapted to other nursing situations in which the focus is on identifying and finding out patients’
immediate needs for help. This nursing process of Orlando is relevant to community and long-
term nursing and in other areas where nursing is practiced.
