Ida Jean Orlando’s Theory of the Deliberative Nursing Process is a powerful middle-range theory that emphasizes the nurse’s role in identifying and responding to a patient’s immediate need for help. It’s rooted in real-world observations and focuses on the dynamic, moment-to-moment interactions between nurse and patient.
Life Story of Ida Jean Orlando
Ida Jean Orlando (1926–2007) was a groundbreaking psychiatric nurse, educator, and theorist who reshaped nursing by emphasizing the nurse-patient relationship and the importance of understanding patient behavior. Her Theory of the Deliberative Nursing Process remains a cornerstone of nursing education and practice.
Early Life & Education
- Born August 12, 1926, in New Jersey, to Italian immigrant parents Nicholas and Antoinette Orlando.
- Grew up during the Great Depression in a large family of six children.
- Earned her nursing diploma from New York Medical College in 1947.
- Completed her BS in Public Health Nursing at St. John’s University (1951).
- Obtained her MA in Mental Health Nursing from Teachers College, Columbia University (1954).
Career & Contributions
- Began as a staff nurse in obstetrics, medical-surgical, and emergency departments.
- Became Associate Professor and Director of Graduate Studies in Mental Health Nursing at Yale University (1954–1961).
- Conducted a landmark study analyzing 2,000+ nurse-patient interactions, which led to her theory.
- Authored The Dynamic Nurse-Patient Relationship (1961) and The Discipline and Teaching of Nursing Process (1972).
- First psychiatric nurse in the U.S. to receive a research grant from the National Institute of Mental Health (NIMH).
Deliberative Nursing Process Theory
Orlando’s theory centers on:
- Patient behavior as a potential cry for help.
- Nurse’s reaction: interpreting and validating the patient’s needs.
- Nursing action: deliberate responses based on validated understanding.
She emphasized that:
“Patients have their own meanings and interpretations of situations, and nurses must validate their inferences before concluding.”
The theory includes five stages:
- Assessment
- Diagnosis
- Planning
- Implementation
- Evaluation
Legacy & Honors
- Conducted over 60 seminars across North America.
- Served on the Harvard Community Health Plan board and consulted internationally.
- Retired in 1992, honored as a Nursing Living Legend by the Massachusetts Registered Nurse Association.
- Passed away on November 28, 2007, at age 81.
Major Concepts
Core Concepts of Orlando’s Theory
| Concept | Description |
|---|---|
| Patient Behavior | Nurses must observe both verbal and nonverbal cues to detect distress or unmet needs. |
| Nurse’s Reaction | The nurse interprets the patient’s behavior and reflects on their own perceptions, feelings, and thoughts. |
| Deliberative Action | The nurse validates their interpretation with the patient before acting—ensuring the response is truly helpful. |
This process is deliberative, not automatic. It requires critical thinking, empathy, and validation to avoid assumptions and ensure that care is tailored to the patient’s actual needs.
Five Stages of the Deliberative Nursing Process
- Assessment – Observe and interpret patient behavior.
- Diagnosis – Identify the patient’s immediate need for help.
- Planning – Collaborate with the patient to determine appropriate actions.
- Implementation – Carry out the agreed-upon care.
- Evaluation – Reflect on the outcome and adjust as needed.
Assumptions
- When patients cannot cope with their needs without help, they become distressed with feelings of helplessness
- Patients are unique and individual in their responses
- Nursing offers mothering and nursing analogous to an adult mothering and nurturing of a child
- Nursing deals with people, environment and health
- Patient need help in communicating needs, they are uncomfortable and ambivalent about dependency needs
- Human beings are able to be secretive or explicit about their needs, perceptions, thoughts and feelings
- The nurse – patient situation is dynamic, actions and reactions are influenced by both nurse and patient
- Human beings attach meanings to situations and actions that are not apparent to others
- Nurses are concerned with needs that patients cannot meet on their own
Application in Orlando’s Theory of the Deliberative Nursing Process
- Clinical Care
- Observe patient behavior for cues of discomfort or unmet needs.
- Validate patient perceptions by asking clarifying questions.
- Provide individualized interventions to relieve distress.
- Example: If a patient grimaces, ask about pain before giving analgesics.
- Emergency or Acute Situations
- Identify immediate needs by quickly assessing patient behavior and symptoms.
- Act deliberately after confirming the patient’s problem to avoid unnecessary interventions.
- Patient-Centered Communication
- Engage in active listening and clarification to understand the real issue.
- Example: A quiet patient may not only be in pain but could be anxious or afraid.
- Promotes Critical Thinking
- Encourages nurses to analyze before acting, reducing errors from assumptions or routine actions.
Case Scenario 1: Postoperative Patient in Pain
Scenario:
Mr. A, 55 years old, is 6 hours post-abdominal surgery. He is restless, grimacing, and holding his abdomen but does not verbally complain.
Application of Orlando’s Theory
- Patient Behavior: Non-verbal cue (grimacing, restlessness, guarding abdomen)
- Nurse’s Perception: Possible pain or discomfort
- Validation: Nurse asks, “Are you in pain or feeling uncomfortable?”
- Deliberative Nursing Action: Administers prescribed analgesic after confirmation and teaches relaxation techniques.
- Evaluation: Pain score decreases; patient rests calmly.
Possible Nursing Diagnoses
- Acute pain related to surgical incision.
- Anxiety related to postoperative discomfort and unfamiliar environment.
Interventions
- Assess pain level using a pain scale.
- Validate non-verbal cues with the patient.
- Administer analgesics as prescribed and evaluate response.
- Encourage deep breathing and relaxation techniques.
Case Scenario 2: Elderly Patient with Anxiety and Refusal of Medication
Scenario:
Mrs. B, 70 years old, admitted for hypertension management, refuses to take her medications, and appears worried and withdrawn.
Application of Orlando’s Theory
- Patient Behavior: Verbal (refusal) + non-verbal (withdrawn, worried)
- Nurse’s Perception: Patient may be afraid of side effects or lacks understanding of treatment.
- Validation: Nurse asks, “Can you tell me why you don’t want to take the medicine?”
- Deliberative Nursing Action: Explains medication purpose, addresses fears, and reassures safety.
- Evaluation: Patient verbalizes understanding and agrees to take the medication.
Possible Nursing Diagnoses
- Anxiety related to hospitalization and fear of medication effects.
- Ineffective health management related to lack of knowledge about treatment.
Interventions
- Establish rapport and encourage expression of feelings.
- Validate concerns by active listening and asking clarifying questions.
- Provide patient education about the purpose and benefits of medication.
- Reassure and offer emotional support to reduce anxiety.
REFERENCES
- Orlando, I. J. (1962). Function, process and principles of professional nursing practice. In Integration of mental health concepts with the human relations professions (pp. 87–106). New York, NY: Bank Street College of Education.
- Orlando, I. J. (1972). The discipline and teaching of nursing process. New York, NY: G .P. Putnam’s Sons.
- Faust C. Orlando’s deliberative nursing process theory: a practice application in an extended care facility. J Gerontol Nurs. 2002 Jul;28(7):14-8. doi: 10.3928/0098-9134-20020701-05. https://pubmed.ncbi.nlm.nih.gov/12168713/
- Orlando, I.J. & Dugan, A.B. (1989). Independent and dependent paths: The fundamental issue for the nursing profession. Nursing and Health Care, 10, 76–80.
- George B. Julia , Nursing Theories- The base for professional Nursing Practice , 3rd ed. Norwalk, Appleton & Lange.
- Wills M.Evelyn, McEwen Melanie (2002). Theoretical Basis for Nursing Philadelphia. Lippincott Williams& wilkins.
- Meleis Ibrahim Afaf (1997) , Theoretical Nursing : Development & Progress 3rd ed. Philadelphia, Lippincott.
- Taylor Carol,Lillis Carol (2001)The Art & Science Of Nursing Care 4th ed. Philadelphia, Lippincott.
- Potter A Patricia, Perry G Anne (1992) Fundamentals Of Nursing –Concepts Process & Practice 3rd ed. London Mosby Year Book.
- Vandemark L.M. Awareness of self & expanding consciousness: using Nursing theories to prepare nurse –therapists Ment Health Nurs. 2006 Jul; 27(6) : 605-15
- Reed PG, The force of nursing theory guided- practice. Nurs Sci Q. 2006 Jul;19(3):225.
- Faust C. .Orlando’s deliberative nursing process theory: a practice application in an extended care facility. J Gerontol Nurs. 2002 Jul;28(7):14-8
- Pelletier, I. O. (1963). Behind the theory of nursing practice. [Interview with Ida Orlando Pelletier by the staff of the American Journal of Nursing.] American Journal of Nursing, 63(8), 54.
- Pelletier, I. O. (1967). The patient’s predicament and nursing function. Psychiatric Opinion, 4(1), 25–30.
Stories are the threads that bind us; through them, we understand each other, grow, and heal.
JOHN NOORD
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