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Nursing Process Theory

Ida Jean Orlando's nursing process theory is an easy to understand theory that relies on deliberative nursing actions rather than an automatic response to patients' needs. It is comprehensive enough to be used in any nursing setting.

Orlando first introduced her theory as a research report while at Yale University in the late 1950s. This later resulted in her book, The Dynamic Nurse-Patient Relationship: Function, Process and Principles, that was published in 1961. She later expanded the nursing theory as part of another research project and wrote The Discipline and Teaching of the Nursing Process in 1972.

Major Concepts

  • The nurse is responsible for finding and meeting the patient's need for help.
  • The patient's behavior may be a request for help but the help needed may not be what it appears to be.
  • Nurses need to use their senses and understanding to validate the meaning of patients' actions.
  • Dialogue between the patient and nurse helps the nurse find the cause of distress and how needs may be met.
Using Orlando's theory, the nursing process is determined by patient behavior, both verbal and nonverbal. If the behavior is not correctly assessed and validated by the nurse, the nursing care will not be successful. Effective communication between the nurse and patient is necessary to meet the patient's needs. A positive nurse-patient relationship occurs when the nurse perceives the patient's behavior, validates his or her reactions and thoughts with the patient and takes deliberative rather than automatic actions. Deliberative action occurs when the patient's needs are met and the meaning of the action is clear.


  • The function of professional nursing is the structural basis for the theory. The purpose of nursing is to discover the patient's needs and provide the help that is needed.
  • The presenting behavior represents the patient's problem and need for help. The nurse responds to this and receives a corresponding response from the patient.
  • The immediate reaction is an automatic, internal response. The three factors that influence the patient's response are thoughts, feelings and actions that influence the nurse's part in the interaction.
  • The nursing process discipline is the inquiry into the patient's needs. The nurse cannot assume that any response is correct until it is shared and validated with the patient. If the nurse does not investigate the patient's reactions, there will be no meaningful communication between the nurse and patient.
  • Improvement of the patient's problem is the goal of nursing care. Evaluation does not measure the nurse's actions but the results of the actions. It determines if the nurse's actions permitted the patient to communicate the need for help and how those needs were met.


  • If patients cannot meet their needs on their own, they have feelings of distress and helplessness.
  • Nursing protocol can add to the stress and anxiety of the patient.
  • Each patient reacts in a different way.
  • Nursing is a mothering profession and can be likened to an adult who nurtures a child.
  • Nursing concerns itself with people, health and the environment.
  • Patients need help expressing their needs. They are not comfortable revealing their dependency needs.
  • Patients may hide or clearly express their thoughts, feelings, perceptions and needs.
  • The nurse-patient relationship is always changing, and the patient and the nurse together affect the actions and reactions.
  • Patients can assign meanings to actions and situations that are not always known by others.
  • Patients' entrance into nursing care is through the medical profession.
  • When nurses have helpful relationships with patients, the patients are able to verbalize the character and meaning of their problems.
  • Observations that are communicated to patients help determine and meet their needs or help decide that there are no needs at that time.
  • Nurses help with needs that patients cannot meet on their own.
The main focus of Orlando's Nursing Process Deliberative Theory is communication between the nurse and the patient. The communication may be verbal or nonverbal but must be validated to be effective. The nurse's role is to determine the patient's immediate need for help and meet that need. The nursing actions are evaluated by results.

Orlando's theory is one of the most effective that is available today. It is concise, easy to understand and keeps the nurse's focus on the patient. It provides a comprehensive framework for nursing but does not preclude the use of other theories.

Publications related to Nursing Process Theory

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