Orlando’s Theory of the Deliberative Nursing Process

Contributor: Jacqueline Fawcett
September 8, 2018

Author – Ida Jean Orlando Pelletier, RN, BS, MA

Year First Published – 1961

Major Concepts


  • Need for Help
  • Improvement


  • Perception
  • Thought
  • Feeling


  • Automatic Nursing Process
  • Deliberative Nursing Process
    • Activities
    • Sequence
    • Requirements


  • Observations
    • Direct Observations: Nurse’s Reaction to Patient’s Behavior
    • Indirect Observations: Other Information About the Patient’s Behavior
  • Actions
    • Nurse’s Activity: Deliberative Nursing Clinical Protocols Process
    • Direct Help
    • Indirect Help
  • Reporting
  • Recording

A middle range predictive theory

Brief Description

“Orlando’s work . . . focuses exclusively on the interpersonal process between people and is directed toward facilitating identification of the nature of patients’ distress and their immediate needs for help by means of a deliberative nursing process.” The goal of nursing is to help the patient toward improvement. (Fawcett, J., & DeSanto-Madeya, S. (2013). Contemporary nursing knowledge: Analysis and evaluation of nursing models and theories (3rd ed., p 362). Philadelphia, PA: F. A. Davis.)

Primary Sources

Orlando, I. J. (1961). The dynamic nurse patient relationship. Function, process and principles. New York, NY: G. P. Putnam’s Sons. [Reprinted 1990. New York: National League for Nursing.]

A personal note: Dr. Jacqueline Fawcett used this textbook while an undergraduate student at Boston University School of Nursing (1960-1964), when considerable emphasis was placed on nurse-patient relationships through several semesters of required interpersonal relationships seminars.

Orlando, I. J. (1962). Function, process and principles of professional nursing practice. In Integration of mental health concepts with the human relations professions (pp. 87–106). New York, NY: Bank Street College of Education.

Orlando, I. J. (1972). The discipline and teaching of nursing process. New York, NY: G .P. Putnam’s Sons.

Orlando, I.J. & Dugan, A.B. (1989). Independent and dependent paths: The fundamental issue for the nursing profession. Nursing and Health Care, 10, 76–80.

Pelletier, I. O. (1963). Behind the theory of nursing practice. [Interview with Ida
Orlando Pelletier by the staff of the American Journal of Nursing.] American Journal of Nursing, 63(8), 54.

Pelletier, I. O. (1967). The patient’s predicament and nursing function. Psychiatric Opinion, 4(1), 25–30.


Ida Jean Orlando Pelletier (1926-2007)


  • Diploma, New York Medical College Lower Fifth Avenue Hospital School of Nursing.
  • BS in public health nursing, St. John’s University, Brooklyn, NY (1951).
  • MA in mental health, Teacher’s College Columbia University, New York, NY (1954).


  • Staff nurse positions in clinical agencies in New York City
  • Director of the Graduate Program in Mental Health Psychiatric Nursing , Yale University School of Nursing and Project Director of a National Institute of Mental Health grant; this work led to publication of the book, The Dynamic Nurse Patient Relationship in 1961.
  • Consultant and director of a research project, McLean Hospital, Belmont, MA; This work led to publication of the book, The Discipline and Teaching of Nursing Process in 1972.

(From http://www.nursing-theory.org/nursing-theorists/Ida-Jean-Orlando.php and Peden, A. R., Stalla, J., Rittman, M., & Gullett, D. L. (2015). Nurse-patient relationship theories: Part Three: Ida Jean Orlando’s dynamic nurse-patient-relationship. In M. Smith & M. E. Parker (Eds.). Nursing theories and nursing practice (3rd ed., pp. 82-86). Philadelphia, PA: F. A. Davis.)