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CHAPTER 5 NursingTheoristsofHistoricalSignificance 55
Ida Jean (Orlando) Pelletier (1961) views the professional function of nursing
as finding out and meeting the patient’s immediate
Nursing Process Theory need for help. She was one of the first nursing leaders
Ida Jean Orlando developed her theory from a study to identify and emphasize the elements of nursing
conducted at the Yale University School of Nursing, process and the critical importance of the patient’s par-
integrating mental health concepts into a basic nurs- ticipation in the nursing process. Orlando’s theory
ing curriculum. The study was carried out by observ- focuses on how to produce improvement in the patient’s
ing and participating in experiences with patients, behavior. Evidence of relieving the patient’s distress
students, nurses, and instructors and was derived is seen as positive changes in the patient’s observable
inductively from field notes for this study. Orlando behavior. Orlando may have facilitated the develop-
analyzed the content of 2000 nurse-patient contacts ment of nurses as logical thinkers (Nursing Theories
and created her theory based on analysis of these Conference Group & George, 1980).
data (Schmieding, 1993). Meleis (2007) has noted, According to Orlando (1961), persons become
“ . . . Orlando was one of the early thinkers in nursing patients who require nursing care when they have
who proposed that patients have their own meanings needs for help that cannot be met independently
and interpretations of situations and therefore nurses because they have physical limitations, have negative
must validate their inferences and analyses with pa- reactions to an environment, or have an experience
tients before drawing conclusions . . . ” (p. 347). The that prevents them from communicating their needs.
theory was published in The Dynamic Nurse-Patient Patients experience distress or feelings of helplessness
Relationship (1961), which was an outcome of the as the result of unmet needs for help (Orlando, 1961).
project. Her book purposed a contribution to concern Orlando proposed a positive correlation between the
about the nurse-patient relationship, the nurse’s profes- length of time the patient experiences unmet needs
sional role and identity, and the knowledge develop- and the degree of distress. Therefore, immediacy is
ment distinct to nursing (Schmieding, 1993). In 1990, emphasized throughout her theory. In Orlando’s
the National League for Nursing (NLN) reprinted view, when individuals are able to meet their own
Orlando’s 1961 publication. In the preface to the NLN needs, they do not feel distress and do not require
edition, Orlando states: “If I had been more courageous care from a professional nurse. Practice guided by
in 1961, when this book was first written, I would have Orlando’s theory employs a reflexive principle for
proposed it as ‘nursing process theory’ instead of as a inference testing (May, 2010; Schmieding, 2006).
‘theory of effective nursing practice’” (Orlando, 1990, Orlando emphasizes that it is crucial for nurses to
p. vii). Orlando continued to develop and refine her share their perceptions, thoughts, and feelings so
work, and in her second book, The Discipline and they can determine whether their inferences are con-
Teaching of Nursing Process: An Evaluative Study (1972), gruent with the patient’s need (Schmieding, 2006).
she redefined and renamed deliberative nursing pro- Abraham (2011) used Orlando’s theory to help nurses
cess as nursing process discipline. achieve more successful patient outcomes such as fall
Orlando’s nursing theory stresses the reciprocal reduction. Orlando’s theory remains a most effective
relationship between patient and nurse. What the nurse practice theory that is especially helpful to new
and the patient say and do affects them both. Orlando nurses as they begin their practice.
POINTS FOR FURTHER STUDY
n Kaplan, D., & King, C. (2000). Guide to the Ernes- n Orlando, I. J. (1990). The dynamic nurse-patient
tine Wiedenbach papers. Retrieved from: http://hdl. relationship: function, process, and principles
handle.net/10079/fa/mssa.ms.1647. (Pub. No. 15-2341). New York: National League
n May, B. A. (2010). Orlando’s nursing process theory for Nursing.
and nursing practice. In M. R. Alligood (Ed.), Nursing n Orlando interview: Nursing process discipline. In
theory: Utilization & application (4th ed., pp. 337–357). Nurse theorists: Portraits of excellence, Volume 1
Maryland Heights, (MO): Mosby-Elsevier. (video). Athens, (OH): Fitne.
