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The Nursing Department of New Hampshire Hospital, a large, university-affiliated state psychiatric facility, has a succinct mission statement: to care for patients using a process that demonstrates excellence in each nurse-patient interaction. Operationalizing this mission statement stimulated some challenging questions. What is the definition of excellence as it refers to nurse-patient interactions? Can excellence in nursepatient interactions be measured by examining patient outcomes? Does our current nursing practice need to change in order to consistently achieve excellence? Attempts to answer these questions led to a firm commitment to the use of a particular nursing theory to guide our practicethat of Ida Jean Orlando.
This article describes the process used to make that commitment and tested its value through research. We hypothesized that Orlando Nursing Theory (ONT)-based practice, when compared with use of a non-specified nursing practice, would help RNs achieve more successful patient outcomes, namely, reduced patient distress levels.
The decision to use nursing theory to help define excellence in nursepatient interactions was guided by nursing leaders within the facility who had worked in a theory-based nursing care environment. Once the decision was made to use a theory base to achieve our departmental vision, we convened a committee of RNs from both line and staff positions to conduct a rigorous review of nursing theories. After receiving the feedback of the entire nursing staff (registered nurses, licensed practical nurses, and mental health workers), the committee chose Ida Jean Orlando's theory. Rationale for this choice include (a) the theory's complementary relationship to the vision of the department, (b) the theory's clarity of purpose to assist the nurse in identifying and meeting the patient's needs, (c) the theory's emphasis on the interpersonal communication process, and (d) the relative simplicity of its language.
Our effort to define a product that was the outcome of excellence in each nurse-patient interaction was grounded in one of Orlando's core beliefs: professional nursing is based upon an independent function resulting in its own unique product. Orlando (1987) notes that the "product of service should answer the question: what characterizes the behaviour of the person served after the professional function is carried out? (p. 410)"
It is Orlando's (1961) premise that the product of good nursing is the reduction in the patient's level of...