Process TheoriesProcess Theories

Ida Jean Orlando-Pelletier

August 12, 1926 –

Nursing Process

“The dynamic nurse-patient relationship: Function, process and principles”

Based on the interaction between the patient and the nurse

Nursing Process

•Orlando did not define health but

assumed that freedom from mental

or physical discomfort and feelings of

adequacy and well-being contribute

to health.

Health

• Finding out and meeting the client’s immediate need for help.

Professional Nursing

Verbal behavior

- encompasses all the patient's

use of language

Nonverbal behavior

-includes physiological

responses, motor activity,

vocal activity

Inconsistency between these two types of behavior should alert the nurse

that the client needs help.

All patient behavior, no matter how insignificant, must be considered an

expression of need for help until its meaning is understood.

Improvement in patient's behavior indicating resolution of the need is the

desired result.

Verbal & Non-verbal Behavior

•Environment: Not fully defined

•Person: A unique individual behaving verbally and non-

verbally.

Environment

Person

Stages of Clinical

Competence

Patricia Benner

How nurses learn to do

nursing (stages of clinical

competence)

Central Theme

Stage 1:Novice

• No experience of the situations in which

one is expected to perform

• Is taught rules to help one perform

• Rules are context-free and

independent of specific cases tend

to be applied universally (limited &

inflexible)

• “Just tell me what I need to do and I'll do

it.”

Stage 2: Advanced Beginner

• Can demonstrate marginally acceptable

performance

• Has experience with enough real

situations (sometimes with the help of a

mentor) recurring meaningful

situational components

• Based on experience, begins to

formulate principles to guide action

• Has been on the job in the same or similar

situations two or three years

• Does not have enough experience to

recognize a situation in terms of an overall

picture or in terms of which aspects are

most important

Stage 3: Competent

• Begins to see one’s actions in terms of

long-range goals or plans of which one is

consciously aware competence

• Considerable conscious, abstract, analytic

contemplation of the problem

plan perspective

plan efficiency and organization

Stage 3: Competent

• Lacks speed and flexibility but with a

feeling of mastery and the ability to

cope with and manage the many

contingencies of clinical nursing

Stage 3:

Competent

• Perceives the meaning of a situation in

terms of long-term goals (holistic

understanding)

• Based on experience: what events to

expect in a given situation need to

modify plans in response to events

improved decision making

Stage 4:

Proficient

• Can recognize when the expected

normal picture does not materialize

• Performance guided by maxims that

provide direction as to what must be

taken into account & that reflect

nuances of the situation improved

decision making

Stage 4:

Proficient

• With an enormous background of

experience

• Has an intuitive grasp of each situation

zeroes in on the problem without wasteful

consideration of a large range of

unfruitful, alternative diagnoses and

solutions

Stage 5:

The Expert

• No longer relies on maxims to connect

understanding of the situation to an

appropriate action

• Operates from a deep understanding of

the total situation

• Performance fluid and flexible and highly

proficient

Stage 5:

The Expert

• Uses analytic tools for situations with

which the nurse has had no previous

experience & when the expert gets a

wrong grasp of the situation and then

finds that events and behaviors are not

occurring as expected

Stage 5:

The Expert

• A self-interpreting being. They do

not come into the world predefined

but gets defined in the course of

living a life.

Person

• Benner used the term situation rather than environment. Situation conveys a

social environment with social definition and meaningfulness.

Environment

• Based on the lived experience of being healthy or ill.

Health

• A caring relationship, an enabling condition of connection and concern

Nursing

Ernestine Wiedenbach

1900 -1999

Ernestine Wiedenbach

1900 -1999

The Prescriptive Theory of NursingThe Prescriptive

Theory of Nursing

• Quality of health that the nurse desires to sustain in her patient and specifies what she recognizes to be her responsibility in caring.

Central Theme

• Nurse = philosophy• Patient =

autonomy & individuality

• Nurse + patient prescription or plan for care

Central Theme

• A directive to activity which specifies the nature of action and the thinking process.–Voluntary action

• Mutually understood and agreed upon

• Recipient-directed• Practitioner directed

Prescription

• Agent – practicing nurse who is committed and competent in nursing

• Recipient – patient who has the ability to cope with problems

• Goal – desired outcome; what the nurse wishes to achieve

• Means – activities and devices used to attain goal

• Framework – the context in which nursing is practiced and constitutes currently existing limits

5 Realities

Nursing Classificatio

n

Main theme: Classification of nursing

diagnoses, interventions & outcomes

Joyce Fitzpatrick

Classification of nursing diagnoses,

interventions & outcomes

* North American Nursing Diagnosis

Association

Central Theme

*