11 Apr 2022


Middle Range Nursing Theory: Deliberative Nursing Process Theory

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The fundamental action that nurses always take is conversing with their patients and allowing them to be aware of the medical care plan for the day. Despite the fact that this nursing care plan is important for nurses, there are major eventualities that may arise in the course of patient recovery. A qualified must understand ways of addressing such emergencies in order to make the patient get back to recovery. Nurses have the duty of ensuring that they put up strategies of identifying these problems as soon as they arise in the process of recovery of a patient and quickly solve them. Therefore, it is not right for a nurse to rigidly stick to the set nursing care plan because then they may not be able to successfully tackle health problems when they arise during the recovery process of a patient. Orlando was able to come up with a model of ensuring there is the provision of effective nursing care. The deliberative nursing process enables the nurses to make an effective nursing care plan, which can also be adapted to emerging complexities and challenges in the recovery of the patient.

The deliberative nursing process theory was developed by Ida Orlando in the year 1950 (Faust, 2002). Orlando developed this theory inductively based on an empirical study of the practice of nursing. In a period of three years, Orlando was able to record about 2000 observations of the interactions between a nurse and patient. In her records, she had the two categories of good or bad. Based on the observations of the interactions between a nurse and patient, Orlando developed the deliberative nursing process theory that was first published in the year 1961 (Faust, 2002). The observations were conducted at the McLean Hospital and continuously tape-recorded. In 1999, a website page about the theory of Orlando was started. This theory remains to be one of the most used middle-range nursing models across the world because of its effectiveness in the healthcare practice.

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The scope of this theory falls in the middle range nursing model. It is an explanatory theory, which seeks to explain the right nursing process for the nurses (May, 2013). The main proposition of this theory is that patients do hold their interpretations as well as meanings of the various situations hence there is a need for nurses to always establish the validity of their inferences and examinations with the clients before making conclusions (Faust, 2002). The purpose of this theory is to assist the practice of nursing, particularly in instances where an emergency problem arises in the course of patient recovery. Regarding the theory, Orlando highlights that the primary duty of a nurse is to establish the immediate needs of a patient and meet them. This theory asserts that all behaviors of patients may be a cry for assistance. Therefore, this theory seeks to inform nurses that they have to search and find out the nature of the distress in a patient and offer the exact assistance that they need.

Some of the major concepts in this theory include the four nursing metaparadigm concepts. The nursing metaparadigm entails concepts such as person, environment, health and nursing. Orlando used only three nursing metaparadigm concepts in her theory and they include health, nursing and person (Faust, 2002). Orlando, in the theory of deliberative nursing process, uses the concept of a person as she stresses on the individuality as well as the dynamic nature of the relationship that exists between a patient and nurse. The conclusion of Orlando on this human concept is that the needs of a person should be the focus of a nurse. There is also the concept of health in this theory, where Orlando replaces it by a sense of lacking help, which is the cause of the need for nursing assistance (Faust, 2002). The other concept is the relationship between the nurse and patient, where she says actions taken and conclusions made by the former must be informed and validated by the needs of the latter. In the theory of deliberative nursing process, the concept of nursing is taken to be unique and interdependent in its concerns for a person's need for assistance within an immediate circumstance (Faust, 2002). Efforts to address a person's need for assistance are implemented in an interactive situation between the nurse and the patient.

There are significant assumptions applied in this theory. Some of the assumptions made include:

Patients become distressed by the emotions of helplessness when they cannot go on with their needs by themselves

Nursing practice normally increases the distress of a patient, considering the character of the profession

The response of patients is unique and individualistic

Mothering, as well as nursing analogues, are normally offered to an adult with a child by nursing 

For proper communication of their needs, patients require assistance for they are always uncomfortable about their dependency needs. 

Individuals can be secretive about their needs, perceptions, and feelings

The situation between nurse and patient is quite dynamic with actions as well as reactions under the influence of both the two parties 

Theory analysis and evaluation

According to Orlando, her theory is based on the specific concepts of the function of professional nursing, behavior presentation, instant reaction, the discipline of the process of nursing and improvement. It has to be understood that the function of professional nursing is the underpinning principle of the theory presented by Orlando. The primary function of professional nursing is finding out the help needs of a patient and providing solutions. She asserts the fact that nursing is a profession that is meant to be responsive to the individuals who suffer or are experiencing a sense of helplessness (Faust, 2002). The focus of the entire process of health care is supposed to be on the immediate experience of a patient and provision of direct help to a patient in wherever place or environment they are in order to prevent or cure the feeling of vulnerability in the patient. Therefore, the purpose of professional nursing is well achieved when the need of a patient is discovered and met by the nurse. 

The presentation of behavior is another significant concept in this theory of deliberative nursing process. Orlando notes that presenting behavior is one of the problematic situations of a patient. It is through the behavior presented by a patient that the nurse finds out the exact immediate need, which has to be met (May, 2013). Orland observes in her theory that a nurse has to first acknowledge the situation as problematic in order to notice the immediate need, which is supposed to be met. Orlando suggests that the only way in which patients demonstrate their immediate need for help is through behavior (Faust, 2002). It is worthy to note that the presenting behavior in a patient acts as the stimulus, which causes the nurse to have an automatic internal response leading to the reaction of the patient. The behavior of a patient shows their distress as a result of their immediate need, which they cannot meet by themselves.

There is also the concept of immediate reaction. This immediate reaction refers to the internal response. The perceptions of patients stimulate an automatic emotion that makes them to act. This forms the immediate response of the patient, which also demonstrates the manner in which the nurse experiences the interaction with the patient (May, 2013). Moreover, it has to be understood that the behavior of the patient stimulates the reaction of the nurse, which makes up the start of the nursing process (May, 2013). The nurse acts in a deliberative or automatic way. Notably, the deliberative actions of nurses emanate from the correct identification of the immediate needs of a patient through validation of the nurse's response to the behavior of the patient. 

There is also an important mention of the nursing process discipline as the proper investigation into the immediate needs of as patient by analyzing their behaviors. The nurse is not supposed to assume that their reactions are correct until they are validated by checking them with the exact behavioral responses of the patient (Faust, 2002). Each action or conclusion of the nurse must be explored based on the manner it affects the patient. This is the basis of the nursing process discipline.

This theory is quite effective and has been applied in many cases within the nursing profession. The fact that it leads to effective results when applied has given it popularity in the field of nursing. It is simple to understand considering the fact that it is a middle range nursing theory. The model of the nursing process that is suggested by Orlando is quite simple to follow. Moreover, the theory is highly applicable in many disciplines of healthcare because it offers the ability for adapting to the instant problems that may arise in the process of patient recovery. Therefore, its flexibility is its highest strength. Therefore, it is important that Orlando's deliberative nursing process theory be applied extensively by everybody within the nursing profession. 


Faust, C. (2002). Orlando's deliberative nursing process theory: a practice application in an extended care facility.  Journal of gerontological nursing 28 (7), 14-18.

May, B. A. (2013). Orlando’s Nursing Process Theory in Nursing Practice. Nursing Theory: Utilization & Application , 285.

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