Transcript Ida Jean Orlando - John R Richardson RN Nursing Portfolio

Ida Jean Orlando
Deliberative Nursing Practice
Evidence Based Practice
Angela Common, David Feiertag, Stacie
Koelewyn and John Richardson
Ferris State University
NUR 324
Theory Overview
Orlando's theory was
developed in the late
1950s from observations
she recorded between a
nurse and patient.
The role of the nurse is to
find out and meet the
patient's immediate need
for help. The patient's
presenting behavior may
be a plea for help,
however, the help needed
may not be what it
appears to be.
Theory Overview Cont.
Nurses need to explore with patients the
meanings of their behavior.
This process helps the nurse find out the
nature of the distress and what help the
patient needs.
The use of her theory keeps the nurse's
focus on the patient. The strength of the
theory is that it is clear, concise, and easy
to use.
Theory Overview Cont.
While providing the overall framework for
nursing, the use of her theory does not
exclude nurses from using other theories
while caring for the patient.
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.
Orlando’s evidence based research is full circle
(Mercy Medical
Center, 2009)
Rationale for Use of Nursing
Theory
Nursing educators use Orlando’s
theory because it allows students to
focus on the many aspects of
communication between the student
and patient.
Administrators have adopted Orlando’s
theory throughout nursing departments
as it has shown to increase
effectiveness in meeting patients needs
and increase decision making skills
among staff nurses.
Rationale for Use of Nursing
Theory
Nurses, physicians, and families benefit
from the use of Orlando’s theory because
of the overall increase in patient
satisfaction. When patients are satisfied,
they make things easier for those who
care for them.
Rationale for Use of Nursing
Theory Cont.
Orlando’s Theory
Educators
Administrators
Nurses
Physicians
Families
Research Studies
Research studies
selected were chosen
based off of the four
metaparadigms of
nursing which include
person, environment,
health, and nursing.
Orlando’s theory is
primarily focused
toward the mental
well being of the
patient as it relates to
communication.
Person
Based on her observations, Orlando believes that people
behave both verbally and nonverbally.
People are able to meet their own needs for help in
some situations.
People become distressed if they are unable to meet
their own needs.
Nurses should check in with their patients often to
determine if they have new needs for help.
Person
Positive Patient Centered Outcomes
Study was based in a State Psychiatric Hospital using
two similar type units. Thirty patients were involved with
similar diagnosis. Nineteen in the test group and eleven
in the control.
It was a twelve week study.
Ten nurses participated six were trained in Orlando’s
Deliberate theory and its clinical application. All ten RN’s
were trained to use a the Bockenhauser-Potter Scale of
Immediate Distress (BPSID).
The BPSID was developed as a five point scale to
subjectively measure the patient’s immediate level of
distress.
Stress levels were measured before and after each
interaction.
Positive Patient Centered
Outcomes Cont.
Results
Scales showed a decrease in
the patient’s distress levels in
the study group.
Additionally nurses reported
greater satisfaction with having
a “road map” to patient
interactions.
Positive Patient Centered Outcomes
Limitations
Very small study limited in patient numbers and nurse
numbers.
Short study.
Limited patient type.
Considering the limited time of use and small amount of
training received, the nurses demonstrated a good
success rate using the theory.
The success of the study implies that the use of
Orlando’s Deliberate Nursing Process in nurse patient
interactions immediately reduces the amount of stress
demonstrated by a patient. Reducing stress may lead to
improved outcomes for patients across the spectrum of
nursing practice.
Environment
The nurse-patient interactions occur in a healing and therapeutic
environment ideally.
If a nurse ignores the patient’s needs, then the area of care can
become a non-therapeutic environment which is harmful to the
patient both physically and mentally.
When a nurse responds to a patient’s verbal and non-verbal
behavior positively, there is an emotionally healthy environment.
It is possible for a patient to react negatively to a situation that is
intended to be therapeutic and helpful, and that is why a nurse
must continually reevaluate the patient’s condition and behavior.
Environment
ICU Psychosis
A study supported by the Agency for Healthcare
Research and Quality used Orlando’s theory to
understand the needs of critically ill patients
(Agency for Healthcare Research and Quality,
2001) .
The study interviewed stable Intensive Care Unit
(ICU) patients as well as floor status patients
who had recently been in the ICU who had spent
at least 3 days in an ICU (Agency for Healthcare
Research and Quality, 2001) .
Stressed?
ICU Psychosis Cont.
Orlando’s theory helped this study to focus on the
patient’s perception of feeling safe. The patient’s
perception of feeling safe is influenced by their friends
and family, ICU staff, religious beliefs, and what they
understood about their care.
The study showed that poor communication between the
medical team and the patient caused the patients to
become fearful and paranoid in relation to the staff.
According to Orlando, the role of the nurse is to find out
and meet the patient’s immediate need for help: the
study showed that nurses can work with families and
patients to build a trusting relationship and decrease
internal stress.
ICU Psychosis Cont.
This study fails to focus on the ICU patients that are
unable to verbalize their discomforts. In this study, tape
recorded interviews were analyzed to model the
psychosocial needs of the patient, the study did not look
at the physical needs.
This study further supports Orlando’s theory in that it
reinforces the need for the nurse to improve
communication and understand the emotional needs of
the patient.
Reflecting on this study, it can be said that nursing is too
often a task oriented profession. The bedside nurse
needs to further develop interpersonal skills for the wellbeing of their patients.
Health
Orlando viewed health as the
absence of physical and
emotional distress and a sense
of well-being.
She also believed that a
person’s degree of well-being
improved as a person’s needs
were continually met (in this
case by the nurse caring for a
patient).
Research Study by Shea, McBride,
Gavin, and Bauer (1987)
At a Veterans Administration ambulatory
psychiatric care clinic in Providence, Rhode
Island; a study was performed using Orlando’s
Nursing Process Theory.
76 patients being treated for bipolar disorder
through the outpatient clinic were placed into a
six month program described as being a “highintensity collaborative practice program”.
Health continued…
The goal of the research study was to establish
the effect of this “high intensity program” on
patient satisfaction, intensity of medication
treatment, and frequency and pattern of patient
use of the clinic’s services.
The patients were assigned to clinical nurse
specialists who served as primary care givers.
The patients were additionally supported by a
psychiatrist as needed.
Health continued…
Results
After applying Orlando’s Nursing Process Theory to
patient care, the following results were discovered:
Increased patient satisfaction
Decreased hospital length of stay
Less emergency services required
Higher patient retention
Increased intensity of medication treatment
Decreased use of costly mental health services
Suggestions on findings
After conducting this research study, Bauer,
McBride, Shea, and Gavin suggested that the
VA should use Orlando’s theory across the
entire organization.
In July of 2000, Orlando’s
theory was being used in a
multi-million dollar study of
patients with bi-polar disorder
at 12 different VA sites.
Successful results
This research study has helped to show the real
health benefits of Orlando’s Nursing Process
Theory when applied to patient care.
This research study is a great example of
benefits to patients in mental health care, but the
principles of Orlando’s theory are basic enough
to be applied to any area of patient care.
Nursing
Communication
Nursing is an autonomous profession that must
work closely together with medical teams
Nurses should pay attention to other nurses
verbal and non-verbal body language to
increase communication
Communication Study Specifics
This study on communication focused on supportive
communication during shift report
Study was in a medical/surgical intensive care unit
Consisted of 4 charge nurses, and 13 staff nurses during
midnight shift
Some were BSN prepared RN’s some were ADN’s
The 4 charge nurses were all women
The 13 staff nurses consisted of eight women, five men
in total
Average time spent in report was 15 minutes 51 seconds
Supportive Behaviors
Study looked for verbal and non-verbal
behaviors between shifts during report
Nurses were filmed during report with no
one else in the room, face to face
Supportive behaviors were classified as,
head nods, praise, support, reassurance,
concern (Hays, page 6).
Results
In 162 charge nurse reports there were no
supportive behaviors observed
Of the oncoming staff getting report from
the charge nurse there were only 11
supportive behaviors observed
– All non-verbal head nods
Results
Supportive behaviors
between staff RN’s
were identified 50%
of the time (6 out of
12 interactions)
Seven of the RN’s in
these interactions
were female, four
male.
All the behaviors
were non-verbal
head nods
Limitations
Nurse’s schedules
The study did not address patient acuity
RN to patient ratio was not factored into the
report analysis
Personal issues (external/internal stresses of the
RN’s)
Cultural differences were not factored into
communication styles
RN’s may have reported differently off camera
Conclusion
There was no positive communication
outcomes from the leadership (Charge
nurses)
Women are more likely to give a
supportive non-verbal then men
Support came from the bedside nurse to
the next bedside nurse
Overall report communication was not
supportive and all non-verbal
Suggestions to change
Managers need to evaluate the
leaders on the floor from supervisor,
to charge, to nurses and techs
In-service for nursing leadership and
communication road blocks
Allow the nurse’s to view their report
Encourage to learn from other’s
mistakes
After one receives report to give an
appraisal or validation of the off
going RN’s work
References
Agency for Healthcare Research and Quality, (May 2001).Quality of
care ICU patients. Agency for Healthcare Research and Quality.
249, 11-12.
Hays, Mary M. (2002).An exploratory study of supportice
communication during shift report. Sourther Online Journal of
Nursing Research. 3, 1-14.
Limos, K., Maglaya, G., Lee, D., (2008). A Close Encounter: Orlando's
Dynamic Nurse-Patient Relationship. Retrieved April 11, 2009,
from http://nursingtheories.blogspot.com/2008/07/closeencounter-orlandos-dynamic-nurse.html
Potter, M.L., & Bockenhauer, B.J. (2000). Implementing Orlando's
Nursing Theory: a pilot study. Journal of Psychosocial Nursing
and Mental Health Services. 38(3), 14-21.
Shea, N., McBride, L., & Bauer, C., Gavin, M. (1997). The Effects of
an Ambulatory Collaborative Practice Model on Process and
Outcome of Care for Bipolar Disorder. Journal of the American
Psychiatric Nurses Association, 3, Retrieved April 11, 2009, from
http://jap.sagepub.com/cgi/content/abstract/3/2/49.