USE
OF THEORY
Orlando's
theory is evident in nursing education, practice, and
research. Users of the theory in practice and
education are often not aware of their use of Orlando's
theory. Numerous researchers have used the theory
without acknowledgement of it (Schmieding, 1986, p.
13). More people are using Orlando’s theory and their
contributions appear in this link.
Pamela
Green, MS, PhD, RN
Orlando's theory has a continuing influence on nursing
education. However, the faculty using it may be
unaware of its origin because it is not identified as
the theory being used. Through e-mail communication
it was found that the Midwestern State University in
Wichita Falls, Texas, is using Orlando's theory for
teaching entering nursing students. According
to Greene (e-mail communication, June, 2000) she became
aware, when taking a doctoral course about nursing theories,
that it was Orlando theory used by its school.
Joyce
Fjelland, MS, RN
Through networking the author found that for over 10
years South Dakota State University in Brookings, SD
has been using Haggerty’s (1985) description of the
communication based on Orlando’s theory for entering
nursing students as well as re-enforcing it in their
junior year (e-mail communication, (J. Fjelland, June, 2000).
Lois
Haggerty, PhD, ANP, RN
After
working with Schmieding at Boston City Hospital, Lois
Haggerty used Orlando’s theory in her teaching of students
and in conducting a research study of students’ responses
to distressed patients at Boston College in Chestnut
Hill, Massachusetts. Descriptions of her work are found
in the following journal articles.
Haggerty,
L.A. (1985). A theoretical model for developing students’
communication skills. Journal of Nursing Education,
24(7), 296-298.
Haggerty,
L.A. (1987). An analysis of senior nursing students’
immediate responses to distressed patients.. Journal
of Advanced Nursing, 12, 451-461.
Sr.
Lorretta Gillis
In Nova Scotia Sr. Lorretta Gillis developed the following
example how she incorporated Orlando’s theory into a
course syllabus. (Now retired, Sr. Gillis was a former
student of Orlando’s at Yale University School of Nursing)
Department of Nursing
St. Francis Xavier University
Antigonish N.S. B2G 2W5
NURSING 215 Skills in Communication (Laboratory)
Orlando’s Framework
Objectives:
At
the completion of these labs, students will:
1.
Demonstrate
awareness of how her/his thoughts and feelings affect
interactions with others.
2.
Discuss
differences between verbal and nonverbal communication
and give examples of each.
3.
Identify
three personal factors that can impede accurate communication.
4.
Identify
two environmental factors that can impede accurate communication.
5.
Identify
four techniques that enhance communication and discuss
what makes them effective.
6.
Identify
four techniques that hinder communication and discuss
what makes them ineffective.
7.
Compare
and contrast the purpose, focus, communication styles,
and goals for
-A social relationship
-An intimate relationship
-A therapeutic relationship
8.
Demonstrate
beginning skill in communication so as to interact in
a facilitative deliberate manner with all clients, families,
and colleagues.
9.
Demonstrate
in written process recording awareness of own perceptions,
thoughts, and feelings.
10.Demonstrate the ability to find out,
and meet client’s immediate need for help.
Lab
Requirements
10.
Attendance
at all lab sessions
11.
Completion
of four process recordings
Clinical
Education
Based
on completed process recordings
10%
of N215 grade
Required
Readings
Carson
Chapter 20 (200-229)
Barry
Chapter 2 (14-31)
Suggested
Readings
Orlando,
I. J. (1990). The dynamic nurse/patient relationship.
New York: National League for Nursing.
Sieh,
A., & Brentin, L. (1997). The nurse communicates.
Montreal: W. B. Saunders.
Arnold,
E., & Boggs, K. V. (1999). Interpersonal relationships.
Montreal: W. B. Saunders.
| |
The Nurse Communicates |
|
| Chapter
1
3
4
5
6
13 |
Topic
General
Principles in Communication
With
Clients
With
Culturally Diverse People
With
Clients Across the Lifespan
With
Chronically Ill Clients and Their Families
Within
the Home |
Pages
1-20
45-66
69,71-82
84-93
103-131
287-304 |
Nursing 215: Process Recording (Criteria)
Process
recordings are written records of a segment from the
nurse-client session that reflects as closely as possible
the verbal and nonverbal behaviors of both clients and
nurse.
A
finished process recording demonstrates: That the student
is able to:
1.
State
his/her perception clearly
2.
Express
own thought or feeling
3.
Find
out the client’s immediate need for help
4.
Meet
the immediate need for help
5.
Validate
that the immediate need for help is met
PROCESS
RECORDING STUDENT_______________________________________________
DATE_______________________________
Perception
of or about the client |
Thoughts
and/or feelings about perception |
What
nurse said and/or did to, with, or for the client |
|
Describe
client behaviors:
(1)
verbal—what
the client says
(2)
vocal—paraverbals,
i.e., moaning, groaning, tone volume, cadence
(3)
client
activities, i.e., pacing, running, etc.
(4)
physiological
manifestations of behavior, i.e., BP, pulse, patterns
of urination, etc. |
Observation
of the client’s behaviors (the nurse’s perception)
gives rise to the nurse’s reactions. These reactions
are the nurse’s thoughts and feelings.
A
thought is a cognitive process; a feeling is an
affective process.
Thoughts
about the client’s behaviors are merely assumptions
which should not guide nursing actions unless
validated with the client. |
This
column is for the nursing actions. There are two
types:
(1)
Deliberative—The nurse initiates believing that she/he
will help to ascertain or meet the client’s immediate
need for help;
(2)
Automatic—Actions which are not focused on the
client’s needs but on other needs such as the
nurse’s or physician’s. |
Orlando's
theory, for both practice and administration, has in
the past been used by the Mid Missouri Mental Health
Center in Columbia, Missouri and in a new psychiatric
unit located within a general hospital in Antigonish,
Nova Scotia.
Norma
Jean Schmieding, EdD, RN
Schmieding
successfully used Orlando's theory in two major hospitals
for both practice and administration (Lincoln General
Hospital, Lincoln, NE and Boston City Hospital, Boston,
MA). Schmieding (1990) reports the advantages of adopting
Orlando’s theory throughout a nursing department. Implementation
of Orlando’s theory produced substantial benefits. Its
use increased effectiveness in meeting patient needs;
improved decision-making skills among staff nurses,
including determining what constituted nursing versus
non-nursing functions; negotiated more effectively in
resolving conflict among staff nurses and between staff
and physicians; and influenced a more positive nursing
identity and unity among staff. Schmieding (1987, 431-440) discussed
“how specific types of actions facilitate or thwart
problem identification” and, used Orlando’s theory to
analyze managerial responses in face-to-face contacts.
In a recent publication Schmieding (1999) provided a
reflective inquiry framework administrators could use
in their administrative practice.
Schmieding,
N.J. (1984). Putting Orlando's theory into practice.
American Journal of Nursing, 84(6), 759-761.
Schmieding,
N. J. (1987). Face-to-face contacts: Exploring their
meaning. Nursing Management, 18(11), 82-86.
Schmieding,
N. J. (1987). Problematic situations in nursing: Analysis
of Orlando's theory based on Dewey's theory of inquiry.
Journal of Advanced Nursing, 12(4), 431-440.
Schmieding,
N. J. (1989). Time spent on MDs work is astronomical
[Letter to the editor] Nursing Management 20, (5), 18-19.
Schmieding,
N. J. (1990). An integrative nursing theoretical framework.
Journal of Advanced Nursing, 15(4), 463-467.
Schmieding,
N. J. (1999). Reflective inquiry framework for nurse
administrators. Journal of Advanced Nursing, 30(3),
631-639.
New
Hampshire Hospital Nursing Department
Barbara
Jo Bockenhauer, MS, RNC, Mimi Dye, MSN, RNC,
Mertie
Potter, ND, ARNP, CS
Currently, the New Hampshire Hospital Nursing Department
in Concord, NH is using Orlando’s deliberative nursing
process theory for nursing administration, nursing practice,
and nursing research. A former student of Orlando's
at Yale, Mimi Dye, is a consultant to the New Hampshire
Hospital Orlando Project (personal communication, July,
2000). Ms. Dye educates people throughout
the hospital about the theory. An in-house publication,
authored by Barbara Jo Bockenhauer, contains a column
named "Theoretically Speaking" that is devoted
to fostering the use of Orlando's theory.
Potter,
a psychiatric nursing professor and a consultant/ARPH
for NHH, is also involved in advancing the use of Orlando’s
theory through various methods. She supervises Group
Leadership Education for nurses for a 12 weeks (26 contact
hours) experience
focusing
on developing their competency for group leadership skills.
In addition they have readings and written assignments.
During the group sessions, nurses focuses on addressing
patients’ immediate distress by validating their understanding
of what the patient’s distress is and meeting the patient’s
specific needs for help. Potter notes that their check-ins
and check-outs are extremely helpful in addressing patient’s
distress and immediate needs. Levels are initially
addressed during check-ins. Check-outs at the end of
the session help patients assume some responsibility
in helping to meet their needs for the day.
Potter
also is involved in development of a new group
format that includes an agenda for each session focused
on various topics determined by previous patient group
members. For each session there is pre-and post-test
taken by patients about the proposed topic for the day’s
session.
In
summer of 2002, under the direction of Professor Sylvia
Durette at Saint Anselm College, Potter assisted in a nursing camp for 8th graders.
Included in the camp was an introduction to communication
and psychiatric-mental health nursing. Potter incorporated
Orlando’s deliberative nursing within her presentation
to the campers.
Potter
also supervises a nurse and a psychologist in a formalized
patient group psychological/educational learning format.
This group has an agenda for each session focused on
differences of patients’ learning needs. For each session
there is pre-and post-test taken by patients. Evaluation
is anonymous. In addition Potter is supervising a psychologist
in gaining supervisory leadership skills of groups.
The principles of Orlando’s theory are incorporated
in this training process. As an aside the psychologist
is considering becoming a nurse and is interested in
learning more about Orlando’s theory
Potter along with Ann Dawson, MA, RNC, and Roberta Vitale-Nolen, MBA, MS, CS,
RN currently are involved in researching Safety Agreements.
These Safety Agreements incorporate Orlando’s deliberative
process theory into the agreement. Currently there is
a plan to obtain Institutional Research Board approval.
They want to determine if (a) a relationship exists between the use of
Safety Agreements and the rate of self-harm incidents
at NHH and (b) whether implementation of Safety Agreements
increases nurses’ level of comfort in assessing patients
at risk for self-harm.
Houle,
P. (1997) Ida in action. BayState Nurse News, 5(10),
12. BayState Area State Nurses Association Newsletter.
Includes Maine, New Hampshire, and Vermont. New Hampshire
Hospital in Concord.
Potter,
M. L. (in press). Deliberative Nursing Process. In Peterson,
S. J., & Bredow, T., Middle Range Theories: Application
to Nursing Research. Philadelphia: Lippincott:.
Potter,
M.L. & Bockenhauer, B.J. (2000). Implementing Orlando’s
nursing process theory: A pilot study. Journal of Psychosocial
Nursing nd Mental Health Services, 38(3), 14-21.
Potter,
M. L., & Dawson, A. M. “From safety contract to
safety agreement.” (2001). Journal of Psychosocial
Nursing and Mental Health Services 39(8), 38-45.
Potter, M. & Tinker, S. (2000). Put power in
nurses' hands Orlando's nursing theory supports nurses-simply,
Nursing Management, 7, 40-41. http://www.nursingmanagement.com
Christopher L. Laurent, MS, RN,
Christopher
L. Laurent, US Navy Captain, has been using Orlando’s
theory since obtaining his master’s in nursing. His
publication on nursing leadership provides an example
of the difference between using Orlando’s theory as
opposed to management. In addition to his publication
on using Orlando’s theory he has generously provided
in a power point presentation the use of Orlando theory.
Captain
Laurent’s power point presentation based on Orlando’s
theory addresses Assessment, Plan, Implementation, and
Evaluation with a Patient Focus. It appears, with permission,
in a power point presentation.
View
Presentation here.
Laurent,
C. L. (2000). A nursing theory for nursing leadership.
Journal of Nursing Management, 18(2), 83-87.
Also
an article about controlling managers is an informative
adjunct to his practice. Laurent, C.L. (2000). Control
addicts: A 12 program for nurse managers. Nursing
Forum, 35(4), 15-22.
Valentine, S. O. Nursing leadership and the new nurse Web date 03/30/03
http://juns.nursing.arizona.edu/articles/Fall%202002/Valentine.htm
Nancy
M. Shea, Linda McBride, Christopher Gavin, and
Mark Bauer
In an Veterans Administration (VA) ambulatory psychiatric
practice in Providence, RI Shea, McBride, Gavin,
and Bauer (1987) used Orlando’s theoretical model with
patients (N = 76) having a bipolar disorder. Their research
results indicate that there were: higher patient retention,
reduction of emergency services, decreased hospital
stay, and increased satisfaction. They recommended its
use throughout the VA system. Currently Orlando’s model
is being used in a multi-million dollar research study
of patients with a bipolar disorder at 12 sites in the
VA system (McBride, Telephone interview, July, 2000).
McBride
and colleagues continue its use in practice and research
at the Veteran Administration Hospital in Providence,
RI.
Bauer,
M. S. (2001). The collaborative practice model for bipolar
disorder-Design and implementation in a multisite randomized
controlled trial. Bipolar Disorders 3(5), 233-244.
Bauer,
M.S., & McBride, L.(2002). Structured group psychotherapy
for bipolar disorder (2nd Ed). New York:
Springer Publishing Co.
Shea,
N. M., McBride, L. Gavin, C., & Bauer, M. (1997).
The effects of ambulatory collaboration practice model
on process and outcome of care for bipolar disorder.
Journal of the American Psychiatric Nurses Association
3(2), 49-57.
Mertie.
L. Potter, ND, ARNP, CS
and Barbara
Jo Bockenhauer, MS, RNC
In a pilot study, Potter and Bockenhauer (2000) found
positive results after implementing Orlando’s theory.
These included: positive, patient-centered outcomes,
a model for staff to use to approach patients, and a
decrease in patient’s immediate distress. The study
provides variable measurements that might be used in
other research studies.
Potter,
M.L. & Bockenhauer, B.J. (2000). Implementing Orlando’s
nursing process theory: A pilot study. Journal of
Psychosocial Nursing nd Mental Health Services, 38(3),
14-21.
Individual
practitioners
Martha
Brown, BS, RN, Mimi Dye, MSN, ANP,
Julie
Felty, BS,
Numerous individual nurses use Orlando’s theory to guide
their practice, however few are known. In the Lincoln,
Nebraska at the Public Health Department Martha Brown
uses Orlando's theory with both English and non-English
speaking patients (Brown, e-mail communication, February,
2000, also refer to Alligood & Marriner, Nursing
Theory Utilization and Application, 2nd ed.2002).
In
the Boston area Julie Felty, a psychiatric nurse uses
Orlando’s theory in private practice with patients who
range in age from 17 to 96 and who have various diagnoses.
In 1993 Felty along with Susan Donaldson, MD, used Orlando’s
theory in establishing a 12-bed Department of Mental
Health unit in Waltham, MA. The use of physical restraints
was essentially eliminated (e-mail communication June,
2000).
In
addition to her consultation with the New Hampshire
Hospital Mimi Dye, as an advanced registered nurse practitioner
uses Orlando’s theory with patients in her private practice.
According
to Artinian Orlando deserves credit for providing clear
guidelines for the use of the interaction theory for
the nurse to use with patients in psychiatric nursing
.
Artinian,
B. (1983) Implementation of the intersystem patient-care
model in clinical practice. Journal of Advanced
Nursing, 8, 117-124.
Numerous
students in master's nursing programs learn about Orlando's
theory and many incorporate it into their practice.
Alligood,
M. R., & Marriner Tomey, A. (2002). Nursing theory—utilization
& application (2nd ed.). St. Louis: Mosby—Year
Book.
Additional
References
Schmieding,
N. J. (1986). Orlando’s theory. In P. Winstead-Fry (Ed).
Case studies in nursing theory (pp. 1-36). New York:
National League for Nursing.
Schmieding,
N. J. (1987). Problematic situations in nursing: Analysis
of Orlando’s theory based on Dewey’s theory of inquiry.
Journal of Advanced Nursing, 12(4), 431-440.
