UTILIZING ORLANDO’S NURSING PROCESS THEORY
Utilizing Orlando’s Nursing Process Theory:
Caring For a Laboring Patient Upon Epidural Insertion
Natalie L. Bell
Dixie State College of Utah
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UTILIZING ORLANDO’S NURSING PROCESS THEORY
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Utilizing Orlando’s Nursing Process Theory:
Caring For a Laboring Patient Upon Epidural Insertion
Orlando’s nursing process theory is a widely used component among nurses.
It helps the nurse to envision the “big picture” and provides patients with optimal
care. In order to convey how Orlando’s nursing process can be incorporated, a
personal clinical experience is described in a narrative form preceded by a brief
history of this particular nurse theorist.
Ida Orlando, a well-known nurse theorist, was born in 1926 in the state of
New York. She first attended nursing school at the New York Medical College School
of Nursing. In the year of 1951, she received her Bachelor of Science degree in
public health nursing from St. John’s University and her master’s degree in nursing
to follow from Columbia University (Chitty & Black, 2011).
In 1961, Orlando wrote a book titled, The Dynamic Nurse-Patient
Relationship: Function, Process and Principles. In this book, Orlando presented what
would be known as a nursing process theory. This theory includes the method in
which nurses process what they observe while caring for a patient as well as their
reactions to the patient’s behavior and subjective material. According to Chitty &
Black, “Orlando’s theory is specific to nurse-patient interactions. The goal of the
nurse is to determine and meet the patients’ immediate needs and to improve their
situation by relieving distress or discomfort” (p. 315). When a nurse takes action
according to the patient’s behavior, it is important to take deliberate action contrary
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to automatic action. By doing so, nurses are enabled to provide the most effective
patient care (Chitty & Black, 2011).
By utilizing Orlando’s theory, a nurse is guided by the interaction between
the patient, observations, and understanding the patient’s verbal needs. It creates
an opportunity to save time and energy by efficiently accomplishing the task at hand
due to carefully considering what the patient is saying and verifying the patient’s
needs with them (Chitty & Black, 2011).
Incorporating Orlando’s nursing process theory into nursing practice is
beneficial for the nurse as well as the patient. When a patient is in need of
specialized care, it is critical to achieve a positive outcome in a short amount of time.
Time is not always in a nurse’s favor. Examples include an emergency or when a
patient is in pain, stressed or uncomfortable. Patients experience events in the
hospital setting that compel them to rely on their nurses. A nurse holds the
responsibility of solving the problem at hand while keeping the patient safe and
satisfied. Practicing with Orlando’s nursing process theory is a wonderful aide in
order to accomplish the best patient care.
A patient is admitted to the Labor and Delivery floor in a small community
hospital. While expecting her first child, this is also her first experience as a patient
in the hospital. Her surroundings are unfamiliar and she finds herself unsettled
thinking about what her labor experience may entail. Labor is painful and is
considered to be an extremely intense experience, especially for nulliparous women
(O’Hana et al., 2008). This patient finds herself signing a consent form for an
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epidural in hopes that it may relieve her stress related to uterine contraction pain.
While sifting through the consent form, she briefly reads the list of risk factors
related to epidural anesthesia. The nurse, incorporating Orlando’s nursing process
theory is observing the patient’s reactions and strives to calm her nerves while
educating her about the process of an epidural. Anesthetists are required to obtain
a consent form from laboring women before an epidural to explain the possible side
effects, risks involved, as well as the benefits and explanation of the procedure
(Middle & Wee, 2009).
Epidural anesthesia is common during childbirth. An anesthesiologist or
nurse anesthetist inserts a needle followed by a catheter into the epidural space.
The catheter is inserted approximately 2.5 cm into the epidural space (Kundra, et al.,
2009). The patient is usually bending over, slightly curving their back in the sitting
position. The catheter is then secured in the space ready for a bolus or continuous
infusion. Risks and complications upon insertion include hypotension, bradycardia,
motor block, and/or urinary retention. It is the nurse’s role to carefully monitor and
take necessary action if any untoward event occurs (Chumbly & Thomas, 2010).
The community hospital where the laboring patient is admitted has standing
orders specific to the complications listed above. Upon interviewing Lane Hanson, a
Certified Registered Nurse Anesthetist, he explained the appropriate signs a labor
nurse should observe while caring for a patient receiving an epidural. Hanson
described the reason for careful monitoring and the immediate interventions that
need to take place. Because the epidural space can be difficult to find upon epidural
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insertion, the anesthesiologist or nurse anesthetist administers a test dose
preceding the loading dose. The test dose contains lidocaine and epinephrine. If the
catheter is accidentally inserted into a blood vessel, the patient’s heart rate will
quickly rise related to the epinephrine, confirming displacement. If the patient feels
numb immediately, this indicates that the lidocaine has been dosed into the cerebral
spinal fluid, which is potentially fatal. These are symptoms the nurse observes (L.
Hanson, personal communication, October 6, 2012).
The nurse can indeed incorporate Orlando’s nursing process theory while
attending to her laboring patient receiving an epidural. As the nulliparous woman
sets her pen down after signing consent, the nurse assists her to the sitting position
with her legs hanging off the side of the bed, a chair in place for her feet to rest on.
The nurse allows the patient to hold a pillow in a hugging-like manner to help round
out her spine for the small procedure. Upon interacting with the patient, the nurse
encourages the woman by complimenting the remarkable job she is doing in such a
painful circumstance during uterine contractions. The procedure begins and the
test dose is administered. The nurse carefully observes the patient’s heart rate and
listens to the patient while she is asked about numbness, tingling, or a metallic taste
in her mouth. The patient denies any of these symptoms and her heart rate is within
normal limits. The loading dose is completed and the patient is positioned flat for
thirty minutes while the nurse precisely monitors her blood pressure.
During this time of observation for critical signs and symptoms related to
insertion of the epidural, the nurse takes time to communicate with the patient by
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asking questions. She inquires about her leg sensation, her contraction related pain
level, whether or not she presents with a headache, etc. The nurse can easily
conclude according to the patient’s behavior, that this soon to be mom is feeling
relieved and secure. These are important observations for the nurse to consider
concerning her adequate pain relief measures. The nurse proceeds to educate the
patient by explaining how at this time, rest is crucially important. A period of rest as
the baby’s head descends will conserve energy that is required for pushing during
delivery of the infant. The content patient agrees and understands, lays her head
back on her pillow and closes her eyes to dream of the life changing experience that
awaits.
As the nurse reflects upon this scenario, she realizes it was a wonderful
opportunity to use Orlando’s nursing process theory. It was successfully
accomplished on a number of levels. These include the first indication of fright,
nervousness, and uncertainty the nulliparous woman presented with upon
admission. The nurse took measures to calm the patient’s nerves by educating her
on what to expect, encouraging her, and providing additional comfort measures.
The patient was also involved with a common procedure in which many
complications can arise, an epidural. The nurse took this opportunity and
supported the patient throughout in congruence with observing for physiological
signs and symptoms of epidural displacement. The nurse then appropriately
educated the patient about the need to rest. The patient was able to agree without
the burden and load on her mind about the unknown; she took the advice and slept.
UTILIZING ORLANDO’S NURSING PROCESS THEORY
In conclusion, Ida Orlando fabricated a useful tool in which nurses continue
to use in hospital settings today. In this particular circumstance, Orlando’s theory
was exceptionally useful while interacting compassionately with the laboring
patient receiving an epidural.
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References
Chitty, K., & Black, B. (2011). Professional Nursing Concepts & Challenges (6 ed.).
Maryland Heights, MO: Elsevier Inc.
Chumbley, G., & Thomas, S. (2010). Care of the patient receiving epidural analgesia.
Nursing Standard, 25(9), 35-40.
Hanson, L. Personal communication, October 6, 2012
Middle, J. V., & Wee, M. K. (2009). Informed consent for epidural analgesia in labour:
a survey of UK practice. Anaesthesia, 64(2), 161-164. doi:10.1111/j.13652044.2008.05679.x
O'Hana, H., Levy, A., Rozen, A., Greemberg, L., Shapira, Y., & Sheiner, E. (2008). The
effect of epidural analgesia on labor progress and outcome in nulliparous women.
Journal Of Maternal-Fetal & Neonatal Medicine, 21(8), 517-521.
doi:10.1080/14767050802040864