The Dynamic Nurse-Patient Relationship
, published in 1961 and written by Ida Jean
Orlando, described Orlando's Nursing Process Discipline Theory. The major dimensions of the model explain that
the role of the nurse is to find out and meet the patient's immediate needs for help.
The patient's presenting behavior might be a cry for help. However, the help the patient
needs may not be what it appears to be. Because of this, nurses have to use their own
perception, thoughts about perception, or the feeling engendered from their thoughts
to explore the meaning of the patient's behavior. This process helps nurses find out
the nature of the patient's distress and provide the help he or she needs.
The concepts of the theory are: function of professional nursing, presenting behavior,
immediate reaction, nursing process discipline, and improvement.
The function of professional nursing is the organizing principle. This means finding out
and meeting the patient's immediate needs for help. According to Orlando, nursing is
responsive to individuals who suffer, or who anticipate a sense of helplessness. It is
focused on the process of care in an immediate experience, and is concerned with providing
direct assistance to a patient in whatever setting they are found in for the purpose of
avoiding, relieving, diminishing, or curing the sense of helplessness in the patient.
The Nursing Process Discipline Theory labels the purpose of nursing to supply the help
a patient needs for his or her needs to be met. That is, if the patient has an immediate
need for help, and the nurse discovers and meets that need, the purpose of nursing has
Presenting behavior is the patient's problematic situation. Through the presenting behavior,
the nurse finds the patient's immediate need for help. To do this, the nurse must first
recognize the situation as problematic. Regardless of how the presenting behavior appears,
it may represent a cry for help from the patient. The presenting behavior of the patient,
which is considered the stimulus, causes an automatic internal response in the nurse, which
in turn causes a response in the patient.
The immediate reaction is the internal response. The patient perceives objects with his
or her five senses. These perceptions stimulate automatic thought, and each thought
stimulates an automatic feeling, causing the patient to act. These three items are the
patient's immediate response. The immediate response reflects how the nurse experiences
his or her participation in the nurse-patient relationship.
The nursing process discipline is the investigation into the patient's needs. Any
observation shared and explored with the patient is immediately useful in ascertaining
and meeting his or her need, or finding out he or she has no needs at that time. The nurse
cannot assume that any aspect of his or her reaction to the patient is correct, helpful,
or appropriate until he or she checks the validity of it by exploring it with the patient.
The nurse initiates this exploration to determine how the patient is affected by what he
or she says and does. Automatic reactions are ineffective because the nurse's action is
determined for reasons other than the meaning of the patient's behavior or the patient's
immediate need for help. When the nurse doesn't explore the patient's reaction with him
or her, it is reasonably certain that effective communication between nurse and patient
Improvement is the resolution to the patient's situation. In the resolution, the nurse's
actions are not evaluated. Instead, the result of his or her actions are evaluated to
determine whether his or her actions served to help the patient communicate his or her
need for help and how it was met. In each contact, the nurse repeats a process of learning
how he or she can help the patient. The nurse's own individuality, as well as that of the
patient, requires going through this each time the nurse is called upon to render service
to those who need him or her.
Orlando's model of nursing makes the following assumptions:
When patients are unable to cope with their needs on their own, they become
distressed by feelings of helplessness.
In its professional character, nursing adds to the distress of the patient.
Patients are unique and individual in how they respond.
Nursing offers mothering and nursing analogous to an adult who mothers and nurtures a child.
The practice of nursing deals with people, environment, and health.
Patients need help communicating their needs; they are uncomfortable and ambivalent about their dependency needs.
People 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 the nurse and the patient.
People attach meanings to situations and actions that aren't apparent to others.
Patients enter into nursing care through medicine.
The patient is unable to state the nature and meaning of his or her distress
without the help of the nurse, or without him or her first having established a
helpful relationship with the patient.
Any observation shared and observed with the patient is immediately helpful
in ascertaining and meeting his or her need, or finding out that he or she is
not in need at that time.
Nurses are concerned with the needs the patient is unable to meet on his or her own.
The nurse uses the standard nursing process in Orlando's Nursing Process Discipline Theory,
which follows: assessment, diagnosis, planning, implementation, and evaluation. The theory
focuses on the interaction between the nurse and patient, perception validation, and the
use of the nursing process to produce positive outcomes or patient improvement. Orlando's
key focus was the definition of the function of nursing. The model provides a framework
for nursing, but the use of her theory does not exclude nurses from using other nursing theories
while caring for patients.