A Close Encounter: Orlando's Dynamic Nurse-Patient Relationship

"I can't move, I can't speak, I need help..."

An origami design is used to express OrlandoPelletiers Nursing Theory. The three large folds represents the three steps or processes of patient behavior, nurse reaction, and nurse action. Subsequent smaller folds would include the assumptions associated with the theory. The finished object might resemble a silhouette of two people connected to one another, alluding to the ongoing nurse and client interaction required for deliberative care to effectively take place.

Understanding Ida Jean Orlando-Pelletiers

Dynamic NursePatient Relationship Know the THEORIST

Associate Professor at Yale School of Nursing where she was Director of the Graduate Program in Mental Health Psychiatric Nursing. While at Yale she was project investigator of a National Institute of Mental Health grant entitled: Integration of Mental Health Concepts in a Basic Nursing Curriculum. It was from this research that Orlando developed her theory which was published in her 1961 book, The Dynamic Nurse-Patient Relationship. She furthered the development of her theory when at McLean Hospital in Belmont, MA as Director of a Research Project: Two Systems of Nursing in a Psychiatric Hospital. The results of this research are contained in her 1972 book titled: The Discipline and Teaching of Nursing Processs. Orlando held various positions in the Boston area, was a board member of Harvard Community Health Plan, and served as both a national and international consultant. She is a frequent lecturer and conducted numerous seminars on nursing process. She is married to RobertPelletier and lives in the Boston area. She passed away on November 28 , 2007.

Ida Jean Orlando, a first-generation American of

Italian descent was born in 1926. She received her nursing diploma from New York Medical College, Lower Fifth Avenue Hospital, School of Nursing, her BS in public health nursing from St. John's University, Brooklyn, NY, and her MA in mental health nursing from Teachers College, Columbia University, New York. Orlando was an

Distinguish the THEORY

Case Scenario
Nurse, can you give me my morphine, cried out Mrs. So. Can you tell how painful it is using the 0 10 pain scale, where 0 being not painful and 10 being severely painful?replied the nurse. Ummm... I think its about 7. Can I have my morphine now? Mrs. So, I think something is bothering you besides your pain. Am I correct? Mrs. So cried and said, I cant help it. Im so worried about my 3 boys. Im not sure how they are or whos been taking care of them. Theyre still so young to be left alone. My husband is in Yemen right now and he wont be back until next month. Why dont we make a phone call to your house so you could check out on your boys? Mrs. So phoned his sons. Thank you nurse. I dont think I still need that morphine. My boys are fine. Our neighbour, Mrs. Yee, shes watching over my boys right now.

The focus of Orlandos paradigm hubs the context of a dynamic nurse-patient phenomenon constructively realized through highlighting the key concepts such as : Patient Behavior, Nurse Reaction , Nurse Action. 1. The nursing process is set in motion by the Patient Behavior. All patient behavior, verbal ( a patients use of language ) or non-verbal ( includes physiological symptoms, motor activity, and nonverbal communication) , no matter how insignificant, must be considered an expression of a need for help and needs to be validated . If a patients behavior does not effectively assessed by the nurse then a major problem in giving care would rise leading to a nurse-patient relationship failure. Overtime . the more it is difficult to establish rapport to the patient once behavior is not determined. Communicating effectively is vital to achieve patients cooperation in achieving health. Remember : When a patient has a need for help that cannot be resolved without the help of another, helplessness results 2. The Patient behavior stimulates a Nurse Reaction . In this part, the beginning of the nurse-patient relationship takes place. It is important to correctly evaluate the behavior of the patient using the nurse reactions steps to achieve positive feedback response from the patient. The steps are as follows: The nurse perceives behavior through any of the senses -> The perception leads to automatic thought -> The thought produces an automatic feeling ->The nurse shares reactions with the patient to ascertain whether perceptions are accurate or inaccurate -> The nurse consciously deliberates about personal reactions and patient input in order to produce professional deliberative actions based on mindful assessment rather than automatic reactions. Remember : Exploration with the patient helps validate the patients behaviour. 3. Critically considering one or two ways in implementing Nurse Action. When providing care, nursing action can be done either automatic or deliberative.

automatic, non-deliberative behaviour. This is because the reason for giving the pill has more to do with following medical orders (automatically) than with the patients immediate expressed need for help. Deliberative reaction is a disciplined professional response It can be argued that all nursing actions are meant to help the client and should be considered deliberative. However, correct identification of actions from the nurses assessment should be determined to achieve reciprocal help between nurse and patients health. The following criterias should be considered. >Deliberative actions result from the correct identification of patient needs by validation of the nurses reaction to patient behaviour. >The nurse explores the meaning of the action with the patient and its relevance to meeting his need. >The nurse validates the actions effectiveness immediately after compelling it. >The nurse is free of stimuli unrelated to the patients need (when action is taken).

Automatic reactions stem from nursing behaviours that are performed to satisfy a directive other than the patients need for help. For example, the nurse who gives a sleeping pill to a patient every evening because it is ordered by the physician, without first discussing the need for the medication with the patient, is engaging in

Remember : for an action to have been truly deliberative, it must undergo reflective evaluation to determine if the action helped the client by addressing the need as determined by the nurse and the client in the immediate situation

METAPARADIGM CONCEPTS Human/Person An individual in need. Unique individual behaving verbally or nonverbally. Assumption is
that individuals are at times able to meet their own needs and at other times unable to do so. Health Assumption is that being without emotional or physical discomfort and having a sense of well-being contribute to a healthy state. She further assumed that freedom from mental or physical discomfort and feelings of adequacy and well being contribute to health. she also noted that repeated experiences of having been helped undoubtedly culminate over periods of time in greater degrees of improvement Environment Orlando assumes it as a nursing situation that occurs when there is a nurse-patient contact and that both nurse and patient perceive, think, feel and act in the immediate situation. any aspect of the environment, even though its designed for therapeutic and helpful purposes, can cause the patient to become distressed. She stressed out that when a nurse observes a patient behaviour, it should be perceived as a signal of distress. Nursing A distinct profession "Providing direct assistance to individuals in whatever setting they are found for he purpose of avoiding, relieving, diminishing, or curing the individual's sense of helplessness" (Orlando, 1972, p. 22). Professional nursing is conceptualized as finding out and meeting the clients immediate need for help.

Nazareno. Kirzty Marie B.