To put the theory into practice, the nurse derives the patient’s need for assistance based on observation and patient behaviors, including a need for help or need for improvement. Patients who are cognitively or physically impaired are not able to express their needs. The nurse determines the need for help through observation of the patient’s behavior, such as observing restlessness or an adverse change in vital signs. Although some patients may experience little trepidation in expressing their needs, other patients may need encouragement to articulate their problem. Nurses, while performing a functional task such as a physical assessment, will initiate communication with the patient, which in turn may lead to identifying a patient’s need. The nurse’s reaction occurs internally, within the nurse. The nurse’s reaction consists of three components that occur in the sequence of perception, thought, and feeling. The reaction is generated through the nurse’s perception of the patient’s behavior.
The theory is expressed in simple language that breaks down the communication between the nurse and the patient into two primary categories, automatic and deliberative action. When a deliberative action takes place, the patient’s immediate need is met after validation and discussion between the nurse and the patient. An automatic action is explained as an action that is carried out without any discussion or input from the patient. If the nurse uses a deliberative approach and validates the patient’s distress or unmet need, a helpful, trusting relationship is established.
This work proposes a model that affords a visual demonstration of Orlando’s Theory of the Dynamic Nurse-Patient Relationship that can act as a framework to support the examination of patient interactions with both nurses and student nurses.