Application of nursing theory in clinical practice

Ida Jean Orlando 1926- Theory of the Nursing Process Discipline

The Deliberative Nursing Process Theory was developed by Ida Jean Orlando and consists of the five stages of assessment, diagnosis, planning, implementation, and evaluation. The domain main concepts are: nursing, the process of care in an immediate experience, the goal of nursing, health, sense of environment, human being, nursing client, nursing problem, nursing process, nurse, nursing therapeutics, indirect function, nursing therapeutics, and automatic activities (thoughts, feelings, actions). Orlando believed that the goal of nursing was to respond to individuals who were experiencing a sense of helplessness. She believed the nursing process of care occurred to address immediate patient needs. Orlando described the nursing process as consisting of the interaction of the behavior of the patient and the reaction of the nurse. An assumption of Orlando's theory is that the nurse cannot know that his or her approach is correct or helpful until the patient confirms this is the case (Raingruber, 2017).

Another assumption is that nursing can add to the distress of the patient. Describe a time that one of your nursing interventions added to the distress of a patient. In addition, Orlando assumed nursing offers mothering care in the way a mother cares for a child. Discuss why you agree and/or disagree with that assumption. Orlando also assumed a patient cannot state the nature of his or her distress without the help of a nurse. Orlando also assumed a patient cannot state the nature of his or her distress without the help of a nurse. Finally, Orlando assumed that patients enter into nursing care through medicine. Orlando's theory is only applicable to patients capable of interacting with a nurse, not to an unconscious patient or to one who cannot communicate (Raingruber, 2017).

Orlando's theory stresses the reciprocal relationship between patient and nurse. It emphasizes the critical importance of the patient's participation in the nursing process. Orlando also considered nursing as a distinct profession and separated it from medicine where nurses as determining nursing action rather than being prompted by physician's orders, organizational needs and past personal experiences. She believed that the physician's orders are for patients and not for nurses. She proposed that patients should have their own meanings and interpretations of situations and therefore nurses must validate their inferences and analyses with patients before drawing conclusions (Wayne, 2016).

Compassion unites people in difficult times and is a foundation to building human relationships which can promote both physical and mental health. In the some countries such as United States and United Kingdom, the importance of compassion in care is highlighted in a number of recent healthcare documents arguing that nurses should provide compassionate care to patients. However, there is increasing concern worldwide that despite the growing capabilities and sophistication of healthcare systems, there is a failure at a fundamental level with care and compassion (Bramley, & Matiti, 2014).

There is a need to address and evaluate how compassion can become an integral part of nursing care within teams and there should be an increased focus on a culture of compassion at all levels in nurse education, training and recruitment. Designing and implementing education strategies to meet the challenge of ensuring that nursing care is delivered with compassion is a priority. However, practice development and implementing the evidence base can be a difficult task, particularly when there is a lack of such evidence and/or increasing recognition being given to different sources of evidence (Bramley, & Matiti, 2014).

Orlando's theoretical work was based on analysis of thousands of nurse-patient interactions to describe major attributes of the relationship. Based on this work, her later book provided direction for understanding and using the nursing process. This has been known as the first theory of nursing process and has been widely used in nursing education and practice in the United States and across the globe. Orlando considered her overall work to be a theoretical framework for the practice of professional nursing, emphasizing the essentially of the nurse-patient relationship. Orlando's theoretical work reveals and bears witness to the essence of nursing as a practice discipline. Orlando's work has been used as a foundation for master's theses. Reinforcing Orlando's theory as a practice and conceptual framework continues to be relevant and applicable to nursing situations in today's healthcare environment (Smith & Parker, 2015).

The New Hampshire Hospital, a University-affiliated psychiatric facility, adopted Orlando's framework for nursing practice. Two nursing interventions stemmed directly from the adoption of Orlando's ideas. The researchers developed a structured group curriculum for nurse-led psychoeducational groups in an inpatient setting. Both nurses and patients demonstrated improved comfort, active involvement and learning from combining Orlando's dynamic nurse-patient relationship and a psychoeducational curriculum with training in group leadership (Smith & Parker, 2015).

The nurse-client relationship is the foundation of nursing practice across all populations and cultures and in all practice settings. High quality family Communication is the backbone of the art and science of nursing, it has a significant impact on patient well-being as well as the quality and outcome of nursing care, and is related to patients' family overall satisfaction with their care. The maintenance of high nurse- patient's family communication also depends on the nurse and patients' family. There are challenges in nurse- patients' family communication evidence from four sources. These are personal observation, narratives from client and their families, media reports, and official health reports. It is therapeutic and focuses on the needs of the client. It is based on trust, respect and professional intimacy, and it requires the appropriate use of authority (Loghmani, Borhani & Abbaszadeh, 2014).

The nurse-client relationship is conducted within boundaries that separate professional and therapeutic behavior from non-professional and non-therapeutic behavior. A client's dignity, autonomy and privacy are kept safe within the nurse-client relationship. Within the nurse-client relationship, the client is often vulnerable because the nurse has more power than the client. The nurse has influence, access to information, and specialized knowledge and skills. Nurses have the competencies to develop a therapeutic relationship and set appropriate boundaries with their clients. Nurses who put their personal needs ahead of their clients' needs misuse their power (Loghmani, Borhani & Abbaszadeh, 2014).

The nurse who violates a boundary can harm both the nurse-client relationship and the client. A nurse may violate a boundary in terms of behavior related to favoritism, physical contact, friendship, socializing, gifts, dating, intimacy, disclosure, chastising and coercion. Some boundaries are clear cut. Others are not so clear and require the nurse to use professional judgment. This is true particularly in small communities3 where nurses may have both a personal and a professional role. Employers that provide education, supervision and support related to boundary issues will help staff recognize and resolve problems in the early stages (College of Registered Nurses of British Colombia, 2012).

Communication between health officials -- in this case nurses -- and patient is a process that begins with the first contact of the two and lasts as long as the therapeutic relationship. The nurse, who wants to create the right relationship with the patient, must win him/her from the first moment. This will happen if the conversation is held in appropriate conditions. Even though it seems obvious, it should be noted that courtesy and kindness on part of the nurse is required. The patient should feel comfortable with the nurse, but the latter should protect his/her prestige and not give rise to misunderstandings. A key element is the need for a peaceful environment with no external distractions, which will ensure appropriate confidentiality of the dialogue. Frequently we see the phenomenon of serious discussions taking place in the middle of the corridor of the outpatient department or the nursing department, clinic, or in some office of the hospital, in which third parties unrelated to the care of the individual patient are coming in and out. In such an environment the patients are ashamed to express themselves freely (Kourkouta & Papathanasiou 2014).

Unfortunately, the concept of privacy is pretty much unknown to the Greek hospital system. Skilled nursing operations for the patients are made in chambers without screens or in hallways, in front of others. Patients and visitors of hospitals move without restriction in all the areas of the nursing and clinical departments. However, it is up to us to teach our colleagues and especially the new nurses and their patients setting the right example, in order for things to slowly change for the better (Kourkouta & Papathanasiou 2014).

Even more than the comfort of space, communication with the patient requires ample time. Each patient has his own way and pace to reveal his problem, but it takes some time to get to know the nurses and feel the confidence necessary to face them. The patient should have the feeling that the time-whether it is five minutes or an hour-is entirely his. The patient who has the undivided attention of the nurse reveals his problem sooner, with the satisfaction that the nurse has listened and observed him. After the nurse has listened to the ill, he/she should also talk to him. The language he uses for this purpose is very important. Often the patient is bombarded with big words with little or no significance for him. Once again the nurse may be directed to the ill in an incomprehensible way. Patients that are ashamed of their ignorance or are hesitant, avoid seeking an explanation, and as a result the consultation is inadequate and does not lead to the right outcome for the patient. The language of communication should therefore be at the level of the listener, who is not able to assess our scientific knowledge, but has to understand what we are telling him (Kourkouta & Papathanasiou 2014).

Another important requirement for proper and successful communication between nurses and patients is frankness and honesty. The discussion with the patient should leave no suspicions, doubts and misunderstandings. For example, if the patient suspects that while chatting with him we are making gestures to an escort, he/she will suspect that we are not telling him the whole truth. Where there is a need for a separate and private discussion with someone from the patient's environment, we should be very careful of the place, manner and time of this communication, which should be independent of the discussion with the patient (Kourkouta & Papathanasiou 2014).

Communication as already stated is bidirectional, but the nurse or other health professional is responsibility for its proper conduct. The patient comes into the dialogue under stress and the emotional events he/she is facing. Moreover, depending on the psychosynthesis it can be more or less calm. Reactions such as anger, disbelief, moaning, aggression and denial of reality are known defence mechanisms, which are recruited to help him adjust to the new situation he is facing. The angry patient usually does not have any previous personal differences with health professionals, although they are the direct recipients of his anger. The latter should understand and accept these mechanisms which serve the underlying anxiety of the patient and to respond with information, awareness and readiness to provide all possible assistance (Kourkouta & Papathanasiou 2014).