Nursing Theorist Paper - Sarah DeLaat



Nursing Theorist Paper

Sarah DeLaat

Ferris State University

Abstract

This theory analysis paper focuses on the work of Ida jean Orlando and her Nursing Process Theory. It will show how the model can be used in clinical practice and why it is a good fit for Emergency and Trauma Nursing. Strengths and limitations of the model will also be identified and explained in how it can be used as a framework for patient assessment.

Nursing Theorist Paper

Ida Jean Orlando was one of the first nursing theorists to develop a theory based on her own practice and research. Orlando was a professor of nursing at Yale University in the 1950’s, and developed her theory while doing research on mental health nursing. According to Meleis (1997), “Orlando used field methodology before it became a world view in research” (pg. 348). She continued to observe nursing interactions with clients over the next few years serving as a nurse educator and consultant. Orlando conducted workshops and lectured for many years. Her Dynamic Nurse-Patient Relationship Theory (renamed as Nursing Process Theory) remains influential and practical in today’s settings.

Analysis of Model

Dr. Norma Jean Schmieding writes that the “Role of the nurse is to find out and meet the patient’s immediate need for help” (Schmieding, n.d.). Orlando viewed the nurse’s actions as being determined by the patient’s needs, whether that need was verbalized by the patient or not. The nurse’s role is to find out what the need is and to take action in order to meet those needs. Although patient’s needs may not always be apparent, nurses need to use their own thoughts and perceptions of the patient in order to discover what that underlying need may be. Nursing deals with the person, their environment, and health.

Person

Orlando, in her Nursing Process Theory bases some assumptions upon her directly observed interactions between nurses and clients. One of these being that people are normally able to meet their own needs, and become distressed when they are unable to do so (Tomey, 2006). The nursing process is set in motion by patient behavior. Behaviors are unique to each individual with different possible meanings. Nurses perceive this behavior and react deliberately according to their assessment after exploring their perceptions with the patient. “This process helps the nurse find out the nature of the distress and what help the patient needs” (Schmieding, n.d.).

Environment

The concept of environment is not specifically defined in her theory; however, Orlando asserts that nurses assist patients in many different environments or settings. Even if the environment is designed for therapeutic purposes, it must be considered as a cause for a patient’s distress. The nurse-patient contact produces a nursing situation in any environment where it is present (Tomey, 2006).

Health

Orlando does not define health for her theory, but “implicitly assumed feelings of adequacy and well-being from fulfilled needs contribute to health” (Jones & Meleis, 1993, pg.4). Orlando (1961) also notes that “repeated experiences of having been helped undoubtedly culminate over periods of time in greater degrees of improvement” (pg. 90). Health can be said to be a sense of adequacy or well being, fulfilled needs, and a sense of comfort.

Nursing

Orlando saw nursing behavior as a process. It begins with the introduction of the patient to the nurse, who then formulates thoughts, perceptions, and makes and educated decision about the patients’ needs. The nurse shares these perceptions with the patient, and together they explore the meaning of the patient’s behavior. “This process helps the nurse find out the nature of the distress and what help the patient needs” (Schmieding, n.d.). “Orlando may have facilitated the development of nurses as logical thinkers” (Tomey, 2006).

Concepts within Orlando’s theory that are unique include her focus on research. Orlando was the first theorist to base her theory on actual nurse-patient interactions. She reviewed the records of 2000 interactions between nurses and patients in order to base the content of her theory on the analysis of the data (Schmeiding, 1993). Another unique concept is her focus on the verbal and non-verbal communication of the patient. Orlando’s nursing theory recognizes that there are sometimes underlying meanings to a patient’s communication. Searching for those meanings in a deliberate and inclusive manner are necessary to relieve the distress of the patient.

Orlando’s nursing theory is useful to practice in a variety of settings. Her theory keeps the focus on the patient while effectively communicating. In many settings a nurse’s ability to hear the unspoken message alongside the verbalized needs of the patient can be an important assessment tool. In emergency nursing there are times when the patient’s are unable to speak for themselves and a nurse needs to rely on non-verbal and objective assessment tools. Personality and the ability to interact meaningfully with patients is one of the nurse’s most important tools. Orlando’s nursing theory guides those interactions through phases starting with raw perceptions through deliberate actions taken on behalf of the patient. As a framework for patient assessment, the theory facilitates open communication and discovery of patient needs. This could be compared to a nurse using their stethoscope to discover heart and lung sounds. The nurse is discovering information about the patient and their needs.

Use of Orlando’s Nursing Process Theory in Education

According to Schmieding, Midwestern State University in Wichita Falls, Texas is using Orlando’s theory for teaching entering nursing students. South Dakota State University in Brookings, SD has been using a description of communication based on Orlando’s theory for entering nursing students as well as re-enforcing it in their junior year (Schmieding, n.d.). “Orlando deserves credit for writing clear guidelines for the nurse to use in contact with patients” (Tomey, 2006). Orlando’s systematic process for interacting and communicating is clear and concise, and is useful in giving nursing students a framework around which to build their communication skills.

Strengths and Limitations of Orlando’s Nursing Process Theory

The strengths of Orlando’s nursing theory are its simplicity, clarity, and application to practice. The needs of the patient, whether expressed or observed, lead to thoughts and perceptions from the nurse, which lead to deliberate actions. The focus is on communication and meeting needs of the patient.

According to Dr. Julia George, RN PhD., “its focus on short term care, particularly aware and conscious individuals and on the virtual absence of reference group or family members” (George, 2009) is a limitation to Orlando’s Nursing Process Theory. The style of her writing is also critiqued. Schmeiding writes “Although her writing is clear and concise, some repetition might facilitate easier comprehension” (Tomey, 2006).

Orlando’s theory is a good fit for many nurses because of the emphasis on communication. In emergency nursing, there is limited time to interact with patients. The emphasis is on moving patients through the department quickly and efficiently after they are stabilized. Accurate communication and the ability to comprehend non-verbal cues from a patient are essential to a good outcome. These points are a central tenet of Orlando’s theory. Deliberate, as opposed to automatic or “off the cuff” nursing actions are the most time saving and beneficial for the patient in this setting.

Another component of Orlando’s theory is that the patient’s actual need may be different than their expressed need. The proper response from the nurse would be to meet their actual need. This theory recognizes that patients do not always have insight into their underlying needs, and this can cause distress. When the nurse cannot differentiate between the verbalized need and the actual need, more distress is caused for the patient. That is why this theory is so important for nurses to comprehend in their clinical setting.

References

George, J. B. (2009, March 16). Orlando’s Nursing Process Theory. Current Nursing- A portal for nursing professionals. Retrieved from

Jones, P., & Meleis, A. I. (1993). Health is Empowerment. Advanced Nursing Science, 15(3), 1-14.

Orlando, I. J. (1961). The dynamic nurse-patient relationship: Function, process and principles of professional nursing practice. New York, NY: G.P. Putnam’s Sons.

Schmieding, N. J. (n.d.). University of Rhode Island. Retrieved from URI.edu:.

Tomey, A. M. (2006). Nursing Theorists and Their Work (6th ed.). St. Louis, MO: Mosby Elsevier.

|Grading Rubric for Theory Paper |Possible points |Points Earned |

|1. Introduction of theory/model | | |

| a. Introduction clear and well focused |5 | |

| b. History and significance of model |5 | |

| | | |

|2. Analysis of Model | | |

| a. Explain the model in terms of: Person, Environment, Health, and Nursing. |10 | |

| b. Explain other concepts that are unique to the model. |10 | |

| c. Demonstrate how the model can be used in clinical practice. |10 | |

| d. Explain how the model can be used as a Framework for patient assessment. |10 | |

| e. Explain the model within the context of nursing education. |10 | |

| f. Identify strengths and limitations of the model. |10 | |

| g. Analyze the model overall, demonstrating new insights about the model. |10 | |

|3. Evidence of Academic Writing | | |

| a. Development of a clear, logical, well-supported paper; demonstrating original thought and|5 | |

|content. | | |

| b. Evidence of research with a minimum of 2 research articles in addition to the course |5 | |

|required texts. Correct acknowledgement of sources using APA style referencing. Attaches APA | | |

|checklist | | |

| c. Overall presentation; grammar, spelling, punctuation, clean and legible. |5 | |

| d. Stays within page limit which includes: one cover page, one reference page, body of paper|5 | |

|is to have a maximum of 5 pages and a minimum of 3 full pages. | | |

|Total Possible Points |100 | |

|Total Points Earned | | |

|CHECK | |

|DATE, TIME, & |PROOFREAD FOR: APA ISSUES |

|INITIAL | |

| |1. Page Numbers: Did you number your pages using the automatic functions of your Word program? [p. 230 and example on p. |

| |40)] |

| |2. Running head: Does the Running head: have a small “h”? Is it on every page? Is it less than 50 spaces total? Is the title|

| |of the Running head in all caps? Is it 1” from the top of your title page? (Should be a few words from the title of your |

| |paper). [p. 229 and example on p. 40] |

| |3. Abstract: Make sure your abstract begins on a new page. Is there a label of Abstract and it is centered at the top of |

| |the page? Is it a single paragraph? Is the paragraph flush with the margin without an indentation? Is your abstract a |

| |summary of your entire paper? Remember it is not an introduction to your paper. Someone should be able to read the abstract |

| |and know what to find in your paper. [p. 25 and example on p. 41] |

| |4. Introduction: Did you repeat the title of your paper on your first page of content? Do not use ‘Introduction’ as a |

| |heading following the title. The first paragraph clearly implies the introduction and no heading is needed. [p. 27 and |

| |example on p. 42] |

| |5. Margins: Did you leave 1” on all sides? [p. 229] |

| |6. Double-spacing: Did you double-space throughout? No triple or extra spaces between sections or paragraphs except in |

| |special circumstances. This includes the reference page. [p. 229 and example on p. 40-59] |

| |7. Line Length and Alignment: Did you use the flush-left style, and leave the right margin uneven, or ragged? [p. 229] |

| |8. Paragraphs and Indentation: Did you indent the first line of every paragraph? See P. 229 for exceptions. |

| |9. Spacing After Punctuation Marks: Did you space once at the end of separate parts of a reference and initials in a |

| |person’s name? Do not space after periods in abbreviations. Space twice after punctuation marks at the end of a sentence. |

| |[p. 87-88] |

| |10. Typeface: Did you use Times Roman 12-point font? [p. 228] |

| |9. Abbreviation: Did you explain each abbreviation the first time you used it? [p. 106-111] |

| |11. Plagiarism: Cite all sources! If you say something that is not your original idea, it must be cited. You may be citing |

| |many times…this is what you are supposed to be doing! [p. 170] |

| |12. Direct Quote: A direct quote is exact words taken from another. An example with citation would look like this: |

| |“The variables that impact the etiology and the human response to various disease states will be explored” (Bell-Scriber, |

| |2007, p. 1). |

| |Please note where the quotation marks are placed, where the final period is placed, no first name of author, and inclusion |

| |of page number, etc. Do all direct quotes look like this? [p. 170-172] |

| |13. Quotes Over 40 Words: Did you make block quotes out of any direct quotes that are 40 words or longer? [p. 170-172] |

| |14. Paraphrase: A paraphrase citation would look like this: |

| |Patients respond to illnesses in various ways depending on a number of factors that will be explored (Bell-Scriber, 2007). |

| |Do all paraphrased citations look like this? [p. 171 and multiple examples in text on p. 40-59] |

| |15. Headings: Did you check your headings for proper levels? [p. 62-63]. |

| |16. General Guidelines for References: |

| |A. Did you start the References on a new page? [p. 37] |

| |B. Did you cut and paste references on your reference page? If so, check to make sure they are in correct APA format. Often |

| |they are not and must be adapted. Make sure all fonts are the same. |

| |C. Is your reference list double spaced with hanging indents? [p. 37] |

| | |

| |PROOFREAD FOR GRAMMAR, SPELLING, PUNCTUATION, & STRUCTURE |

| |13. Did you follow the assignment rubric? Did you make headings that address each major section? (Required to point out |

| |where you addressed each section.) |

| |14. Watch for run-on or long, cumbersome sentences. Read it out loud without pausing unless punctuation is present. If you |

| |become breathless or it doesn’t make sense, you need to rephrase or break the sentence into 2 or more smaller sentences. Did|

| |you do this? |

| |15. Wordiness: check for the words “that”, and “the”. If not necessary, did you omit? |

| |16. Conversational tone: Don’t write as if you are talking to someone in a casual way. For example, “Well so I couldn’t |

| |believe nurses did such things!” or “I was in total shock over that.” Did you stay in a formal/professional tone? |

| |17. Avoid contractions. i.e. don’t, can’t, won’t, etc. Did you spell these out? |

| |18. Did you check to make sure there are no hyphens and broken words in the right margin? |

| |19. Do not use “etc.” or "i.e." in formal writing unless in parenthesis. Did you check for improper use of etc. & i.e.? |

| |20. Stay in subject agreement. When referring to 1 nurse, don’t refer to the nurse as “they” or “them”. Also, in referring |

| |to a human, don’t refer to the person as “that”, but rather “who”. For example: The nurse that gave the injection….” Should |

| |be “The nurse who gave the injection…” Did you check for subject agreement? Likewise, don’t refer to “us”, “we”, “our”, |

| |within the paper…this is not about you and me. Be clear in identifying. For example don’t say “Our profession uses empirical|

| |data to support ….” . Instead say “The nursing profession uses empirical data….. |

| |21. Did you check your sentences to make sure you did not end them with a preposition? For example, “I witnessed activities |

| |that I was not happy with.” Instead, “I witnessed activities with which I was not happy.” |

| |22. Did you run a Spellcheck? Did you proofread in addition to running the Spellcheck? |

| |23. Did you have other people read your paper? Did they find any areas confusing? |

| |24. Did you include a summary or conclusion heading and section to wrap up your paper? |

| |25. Do not use “we” “us” “our” “you” “I” etc. in a formal paper! Did you remove these words? |

| |26. Does your paper have sentence fragments? Do you have complete sentences? |

| |27. Did you check apostrophes for correct possessive use. Don’t use apostrophes unless it is showing possession and then be|

| |sure it is in the correct location. The exception is with the word it. It’s = it is. Its is possessive. |

Signing below indicates you have proofread your paper for the errors in the checklist:

Sarah DeLaat

________________________________________________________DATE:__04/03/2010______________

A peer needs to proofread your paper checking for errors in the listed areas and sign below:

Sarah Keena

________________________________________________________DATE:04/04/2010______________

Revised Fall 2009 (signature may be typewritten)

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