Ida Jean Orlando 1926- Theory of the Nursing Process Discipline The Deliberative Nursing Process Theory was developed by Ida Jean Orlando and consists of the five stages of assessment, diagnosis, planning, implementation, and evaluation. The domain main concepts are: nursing, the process of care in an immediate experience, the goal of nursing, health, sense of environment, human being, nursing client, nursing problem, nursing process, nurse, nursing therapeutics, indirect function, nursing therapeutics, and automatic activities (thoughts, feelings, actions). Orlando believed that the goal of nursing was to respond to individuals who were experiencing a sense of helplessness. She believed the nursing process of care occurred to address immediate patient needs. Orlando described the nursing process as consisting of the interaction of the behavior of the patient and the reaction of the nurse. An assumption of Orlando's theory is that the nurse cannot know that his or her approach is correct or helpful until the patient confirms this is the case (Raingruber, 2017).

Another assumption is that nursing can add to the distress of the patient. Describe a time that one of your nursing interventions added to the distress of a patient. In addition, Orlando assumed nursing offers mothering care in the way a mother cares for a child. Discuss why you agree and/or disagree with that assumption. Orlando also assumed a patient cannot state the nature of his or her distress without the help of a nurse. Orlando also assumed a patient cannot state the nature of his or her distress without the help of a nurse. Finally, Orlando assumed that patients enter into nursing care through medicine. Orlando's theory is only applicable to patients capable of interacting with a nurse, not to an unconscious patient or to one who cannot communicate (Raingruber, 2017).

Orlando's theory stresses the reciprocal relationship between patient and nurse. It emphasizes the critical importance of the patient's participation in the nursing process. Orlando also considered nursing as a distinct profession and separated it from medicine where nurses as determining nursing action rather than being prompted by physician's orders, organizational needs and past personal experiences. She believed that the physician's orders are for patients and not for nurses. She proposed that patients should have their own meanings and interpretations of situations and therefore nurses must validate their inferences and analyses with patients before drawing conclusions (Wayne, 2016).

Compassion unites people in difficult times and is a foundation to building human relationships which can promote both physical and mental health. In the some countries such as United States and United Kingdom, the importance of compassion in care is highlighted in a number of recent healthcare documents arguing that nurses should provide compassionate care to patients. However, there is increasing concern worldwide that despite the growing capabilities and sophistication of healthcare systems, there is a failure at a fundamental level with care and compassion (Bramley, & Matiti, 2014).

There is a need to address and evaluate how compassion can become an integral part of nursing care within teams and there should be an increased focus on a culture of compassion at all levels in nurse education, training and recruitment. Designing and implementing education strategies to meet the challenge of ensuring that nursing care is delivered with compassion is a priority. However, practice development and implementing the evidence base can be a difficult task, particularly when there is a lack of such evidence and/or increasing recognition being given to different sources of evidence (Bramley, & Matiti, 2014).

Orlando's theoretical work was based on analysis of thousands of nurse-patient interactions to describe major attributes of the relationship. Based on this work, her later book provided direction for understanding and using the nursing process. This has been known as the first theory of nursing process and has been widely used in theoretical framework for the practice of professional nursing, emphasizing the essentially of the nurse-patient relationship. Orlando's theoretical work reveals and bears witness to the essence of nursing as a practice discipline. Orlando's work has been used as a foundation for master's theses. Reinforcing Orlando's theory as a practice and conceptual framework continues to be relevant and applicable to nursing situations in today's healthcare environment (Smith & Parker, 2015).
The New Hampshire Hospital, a University-affiliated psychiatric facility, adopted Orlando's framework for nursing practice. Two nursing interventions stemmed directly from the adoption of Orlando's ideas. The researchers developed a structured group curriculum for nurse-led psychoeducational groups in an inpatient setting. Both nurses and patients demonstrated improved comfort, active involvement and learning from combining Orlando's dynamic nurse-patient relationship and a psychoeducational curriculum with training in group leadership (Smith & Parker, 2015).

The nurse-client relationship is the foundation of nursing practice across all populations and cultures and in all practice settings. High quality family Communication is the backbone of the art and science of nursing, it has a significant impact on patient well-being as well as the quality and outcome of nursing care, and is related to patients' family overall satisfaction with their care. The maintenance of high nurse- patient's family communication also depends on the nurse and patients' family. There are challenges in nurse- patients' family communication evidence from four sources. These are personal observation, narratives from client and their families, media reports, and official health reports. It is therapeutic and focuses on the needs of the client. It is based on trust, respect and professional intimacy, and it requires the appropriate use of authority (Loghmani, Borhani & Abbaszadeh, 2014).

The nurse-client relationship is conducted within boundaries that separate professional and therapeutic behavior from non-professional and non-therapeutic behavior. A client's dignity, autonomy and privacy are kept safe within the nurse-client relationship. Within the nurse-client relationship, the client is often vulnerable because the nurse has more power than the client. The nurse has influence, access to information, and specialized knowledge and skills. Nurses have the competencies to develop a therapeutic relationship and set appropriate boundaries with their clients. Nurses who put their personal needs ahead of their clients' needs misuse their power (Loghmani, Borhani & Abbaszadeh, 2014).

The nurse who violates a boundary can harm both the nurse-client relationship and the client. A nurse may violate a boundary in terms of behavior related to favoritism, physical contact, friendship, socializing, gifts, dating, intimacy, disclosure, chastising and coercion. Some boundaries are clear cut. Others are not so clear and require the nurse to use professional judgment. This is true particularly in small communities3 where nurses may have both a personal and a professional role. Employers that provide education, supervision and support related to boundary issues will…