Question

Some nurses at a nursing home describe a particular resident as a “difficult patient.” How does use of Orlando’s theory of the deliberative nursing practice influence the way you think about and interact with patients who are regarded as “difficult”?

Answer 1

One important thing that nurses do is converse with the patients and let them know what the plan of care for the day is going to be.

Ida Jean Orlando was one of the first nursing theorists to write about the nursing process based on her own research. Her nursing process discipline is rooted in the interaction between a nurse and a patient at a specific time and place. A sequence of interchanges involving patient behavior and nurse reaction takes place until the patient’s need for help, as he perceives it, is clarified. The nurse then decides on an appropriate action to resolve the need in cooperation with the patient. This action is evaluated after it is carried out. If the patient behavior improves, the action was successful and the process is completed. If there is no change or the behavior gets worse, the process recycles with new efforts to clarify the patient’s behavior or the appropriate nursing action. Her Deliberative Nursing Process Theory focuses on the interaction between the nurse and patient, perception validation, and the use of the nursing process to produce positive outcomes or patient improvement. Orlando's key focus was to define the function of nursing.

1. The nursing process is set in motion by the Patient Behavior. When a patient has a need for help that cannot be resolved without the help of another, helplessness results. All patient behavior, verbal ( a patient’s use of language ) or non-verbal ( includes physiological symptoms, motor activity, and nonverbal communication) , no matter how insignificant, must be considered an expression of a need for help and needs to be validated . If a patient’s behavior does not effectively assessed by the nurse then a major problem in giving care would rise leading to a nurse-patient relationship failure. Overtime. the more it is difficult to establish rapport to the patient once behavior is not determined. Communicating effectively is vital to achieve patient’s cooperation in achieving health.

2. The Patient behavior stimulates a Nurse Reaction. Exploration with the patient helps validate the patient’s behavior. The beginning of the nurse patient relationship takes place. It is important to correctly evaluate the behavior of the patient using the nurse reactions steps to achieve positive feedback response from the patient. The steps are as follows:

• The nurse perceives behavior through any of the senses
• The perception leads to automatic thought
• The thought produces an automatic feeling
• The nurse shares reactions with the patient to ascertain whether perceptions are accurate or inaccurate

The nurse consciously deliberates about personal reactions and patient input in order to produce professional deliberative actions based on mindful assessment rather than automatic reactions.

3. Critically considering one or two ways in implementing Nurse Action. For an action to have been truly deliberative, it must undergo reflective evaluation to determine if the action helped the client by addressing the need as determined by the nurse and the client in the immediate situation. When providing care, nursing action can be done either automatic or deliberative.

Automatic reactions stem from nursing behaviors that are performed to satisfy a directive other than the patient’s need for help.
For example, the nurse who gives a sleeping pill to a patient every evening because it is ordered by the physician, without first discussing the need for the medication with the patient, is engaging in automatic, non-deliberative behavior. This is because the reason for giving the pill has more to do with following medical orders (automatically) than with the patient’s immediate expressed need for help.

Deliberative reaction is a “disciplined professional response” It can be argued that all nursing actions are meant to help the client and should be considered deliberative. However, correct identification of actions from the nurse’s assessment should be determined to achieve reciprocal help between nurse and patient’s health. The following criterias should be considered.

Deliberative actions result from the correct identification of patient needs by validation of the nurses’s reaction to patient behavior.

• The nurse explores the meaning of the action with the patient and its relevance to meeting his need.
• The nurse validates the action’s effectiveness immediately after compelling it.
• The nurse is free of stimuli unrelated to the patient’s need (when action is taken).

The action process in a person-to-person contact functioning in secret. The perceptions, thoughts, and feelings of each individual are not directly available to the perception of the other individual through the observable action.

The action process in a person-to-person contact functioning by open disclosure. The perceptions, thoughts, and feelings of each individual are directly available to the perception of the other individual through the observable action.

Patients have their own meanings and interpretations of situations and therefore nurses must validate their inferences and analyses with patients before drawing conclusions