Nursing Process Theory Critique

Abstract

Ida Jean Orlando-Pelletier relied on her empirical studies on patient-nurse relationships in the American setting and emerged with the nursing process theory. The theory remains one of her main contributions to nursing and guides nursing practice concerning patient participation in care. This study highlights the theory's characteristics, making it an important nursing tool. The main idea of the given theory is that patient participation is paramount in nursing practice, and deliberative actions in the nursing process require consideration. These actions ensure that nurses meet the immediate needs of their patients individually and completely. Due to the definition of its main concepts, which include health, human being, nursing, and need, the theory provides clear interaction between them and establishes how they affect nursing practice. While one tends to ignore the roles that the caretakers and family can play in patient care, the theory remains an important framework for the participatory assessment, diagnosis, nursing plan implementation, and evaluation of the roles of nurses. It also insists on developing a favorable nurse-patient relationship, the foundation of participatory or patient-centered care. It is testable, just like several other nursing theories, because it is based on the actual empirical study conducted at the McLean Hospital in the early 1960s. Thus, it is a tool for informing about crucial decisions made during the early years of nursing practice, which is especially important for novice nurses and nursing students.

The Nursing Process Theory

Among the most reliable nursing theories is the nursing process theory that Ida Jean Orlando advanced. The latter defines a nurse’s role in managing a patient’s immediate needs (Black, 2014) and emphasizes the importance of the nurse-patient relationship for delivering quality nursing care. This study presents Orlando’s theory as a reliable guide to nursing practice connected with meeting the immediate individual needs of patients through encouraging favorable patient-nurse relationships and patient participation during care delivery.

Meaning

Main Idea

Orlando’s theory has clearly outlined the ideas concerning nursing practice. First, a nurse must investigate a patient's needs to meet them in the immediate situation. Second, the theory stipulates that the patient’s expression in seeking help, either explicitly or implicitly, needs to cause appropriate reactions and consequent deliberative actions of a nurse (Nursing Process Theory, 2016). The theory indicates that nurses should use their perception to explore the behavior of patients. Another critical idea emphasizes the need for the involvement of patients in care for themselves.

The nursing process theory is based on several assumptions. The first one is that unmet needs, as well as the nursing process itself, distress the patients. Second, the theory assumes that any patient responds to distress in his/her unique way. Third, nursing offers necessary mothering and/or nurturing, similar to how a mother nurtures her children (Nursing Process Theory, 2016). Fourth, as a practice, nursing involves people, health, and the environment. It also assumes that every patient should be able to tell what he/she needs (Black, 2014). Further, according to Orlando’s theory, patient participation must produce the nurse’s reactions and/or actions.

Main Concepts

Ida Orlando’s nursing process theory defines the human being, health, nursing, and need as the main concepts of nursing practice. The human being is the determinant of the dynamism of any developed nurse-patient relationship and should be the focus of nursing. In this case, one’s health determines a person’s distress level, which makes him/her require help. According to the analyzed theory, nursing is unique in nature and independent in its attempt to respond to the needs of a given patient (Nursing Process Theory, 2016). As a concept of the nursing process theory, a need comprises of the requirement(s), which, once offered to a patient, can relieve his/her immediate distress and enhance the well-being.

Relationship Between the Concepts and Their Influence on Each Other

The four major aspects above are related. They also affect each other. Nursing as a concept should focus on addressing the needs of human beings. The needs of patients are different and base on their health status (Nursing Process Theory, 2016). Nursing tries to establish the actual communication of the needs of human beings. It facilitates the development of a nursing plan with deliberative actions, which enables the nurses timely and effectively meet the needs of the patients. The interaction between a nurse and a patient informs the reaction and actions of the first; it should continue until all the patient’s needs are clarified and met.

Origins of the Theory

Orlando developed her theory in the late 1950s but proposed it only in 1961. At that time, nurses focused on automatic actions rather than deliberative ones. The nursing process theory recommends the latter. It means that patient participation did not get proper consideration in nursing earlier, and the role of nurses was to do what they thought was right according to their independent assessment of the patients’ needs. Nursing schools also provided an unclear definition of a nurse's role in meeting a patient's immediate needs (Nurse Theorists). Therefore, Ida Orlando presented the effective nursing practice theory, later named “Orlando’s nursing process theory.” According to Black (2014), the theory highlighted the patient-nurse reciprocal relationship where a patient's participation in the care delivery process was fronted as imperative in nursing practice.

The theorist relied on the evidence and/or knowledge she acquired from the empirical study conducted at the McLean Hospital in the US to develop the concept. In her inductive empirical study, where she recorded about 2000 observations on the interactions between nurses and patients, Orlando realized the need to introduce patient participation in their treatment (Nursing Process Theory, 2016). Her observations, including tape-recorded nursing unit conversations at the McLean Hospital, acted as evidence, which assisted in developing the theory to front the need for implementing deliberative nurse’s actions instead of automatic ones.

There are motivational factors that made Orlando create the nursing process theory. The first emerged from her realization of the profound need to adequately address patients' immediate needs under nurses’ care. Second, due to her baseline study observation, the theorist knew that the nurses needed to assess and investigate patients’ behavior because she realized the disregard towards patient participation in care (Black, 2014). Further, according to the “Nursing Process Theory” (2016), Orlando’s philosophy motivated her; it is based on the idea that nursing can only be achieved once a nurse is able and well-positioned to recognize and address the needs of the patients.

The theorist's approach to developing the theory was an empirical study on the dynamism of the patient-nurse relationship. Over three years, the scientist collected evidence that included 2000 recorded observations of nurse-patient relationship development (Nursing Process Theory, 2016). The observations tagged as either bad or good formed the basis of the theory of the importance of a functional nurse-patient relationship for nursing practice.

Usefulness

The nursing process theory remains a useful tool in the field of nursing. Its main usefulness lies in the fact that it makes sure that nurses understand every patient’s needs to be able to lighten their distress. Its stipulations are practical since they advocate for patient participation in the assessment, diagnosis, care delivery, and evaluation of the chosen nursing plans (Black, 2014). It helps nurses optimally meet the needs of patients and, thus, avoid unnecessary repeat treatment. The theory also allows a nurse to understand and even predict a patient’s health outcomes in the nursing process. Predicting health outcomes informs decision-making that concerns providing the medication and care needed to prevent a patient’s condition deterioration.

The nursing process theory applies to many medical situations. For instance, it can be utilized when an elderly person with COPD exacerbation has been admitted to a nursing unit and looks distressed. The nurse should not just provide medication based on the conventional treatment method recommended for COPD but also investigate what other needs the patient wants to be addressed. These may include malnutrition and consideration of allergic factors that lead to the exacerbation of the condition.

Testability

The nursing process theory is testable since it is based on the empirically precise study. For example, the basis of the test can be the impact of involving patients in clinical assessment on their outcomes in different nursing units or the impact of patient involvement in care on nurses’ professional growth and independence that the theorist fronted (Black, 2014). Orlando’s theory has generated numerous research topics in perioperative nursing, patient-centered care, nursing institutional administration, and other fields. Anne Hapoja (2014) relied on the nursing process theory to develop her research thesis at the Novia University of Applied Sciences; it focused on creating a tool that could enhance nursing practice.

Orlando’s theory contributes to the ideal nursing process. First, it states that nurses should individually involve their patients in the nursing plan (Nurse Theorists). Second, the theory also stipulates that nurses should enable their patients to recognize and clearly outline the distressing factors to be able to address them in the nursing plan. Third, the theorist claims that deliberative actions should be considered since they are more evidence-based and ensure appropriate solutions to patients’ problems (Nursing Process Theory, 2016). Lastly, Orlando’s theory stipulates that nursing plans need evaluation, especially if there is a decline in patient health status after treatment.

Overall Evaluation

The nursing practice theory is comprehensive and specific. It is simple and direct in application on various nursing practice platforms. The theory is even applicable or adaptable to other nursing fields, including emergency departments and critical care units (Nursing Process Theory, 2016). Therefore, it is generalizable, and one can apply it in the patient condition assessment, diagnosis, management, and evaluation processes.

Regarding strengths, the nursing process theory offers patients assurance that the nurses will individually take care of them; furthermore, patients themselves will be actively involved in the process. Second, for nurses, it is a reliable guide to assessing and managing objectively observable patient outcomes (Nursing Process Theory, 2016). The weakness of the theory lies in the fact that it fails to define the aspect of the environment and limits the development of related research hypotheses. Another weak point of the theory is that it targets only patients' short-term and immediate needs, especially the conscious ones.

I would utilize Orlando’s theory for several reasons. First, it forms an effective guide to assessing, diagnosing, and implementing the nursing plan for a patient and its evaluation for improvement. Second, the theory will help me avoid repeated assessment and making diagnosis, which commonly occur when patients do not participate in care for them. Lastly, I would use the theory to learn my patients’ adaptive modes to always provide appropriate medication and care.

Conclusion

In conclusion, Ida Jean Orlando-Pelletier presents a clear approach to meeting the immediate needs of the patients to nursing practitioners. The theory guides nursing practice through encouraging patient participation in individual care for themselves. It, however, ignores the potential contribution that family members can make to care delivery. Weaknesses aside, Orlando’s theory is a useful guide to the optimal meeting the patients’ needs by nursing practitioners.