Running head: elisabeth kubler-ross and ida jean orlando applied Summary: Elisabeth Kubler-Ross and Ida Jean Orlando
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- Comparison/Contrast/Applied Theory Paper Compare and Contrast Theorists Related to Nursing Grading Sheet See syllabus for directions.
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Applied Summary: Elisabeth Kubler-Ross and Ida Jean Orlando Erick Nery Azusa Pacific University School of Nursing UNRS 306 Theoretical Foundations for Nursing Professor Patricia Hanes, PhD, MSN, MAED, RN, CNE December 8, 2014 Applied Summary: Elisabeth Kubler-Ross and Ida Jean Orlando This paper analyzes and compares two specific theories utilized in the health care setting, Elisabeth Kubler-Ross’ The Five Stages of Grief Model and Ida Jean Orlando’s theory regarding the nursing process discipline. Kubler-Ross’ theory examines death and the dying process, while Orlando’s theory focuses on the nursing process and the nurse-patient relationship. Kubler-Ross’ model is more specific to a target population, focusing on the dying patient, while Orlando’s theory applies to a broader population and involves more of a mutual interaction between the nurse and the patient; however, both focus on the nurse-patient interaction, making them widely utilized in the clinical setting.
Elisabeth Kubler-Ross published her ideas and concepts regarding her model on the stages of grief in her book On Death and Dying. She developed her model after interviewing “over two hundred dying patients” (Kubler-Ross, 1969, p. 38). The five stages of her grief model are denial, anger, bargaining, depression, and acceptance; the individual can also move forward and backwards through the stages (Potter et al., 2013, p. 710). The initial stage, usually temporary, is the denial stage, where denial acts as a “buffer,” as the individual is initially shocked by the aspect of dying (Kubler-Ross, 1969, p. 39). The second stage is considered the anger stage, for the individual is not prepared for his or her life to end “prematurely” (Kubler-Ross, 1969, p. 51). The third stage is bargaining, in which the individual attempts to “postpone” his or her death by making a promise in return for postponement (Kubler-Ross, 1969, p. 83-84). Usually, this attempt at bargaining is made with God, somebody who the individual perceives as having the power to grant the postponement. The fourth stage is depression, as the individual feels a “sense of great loss” (Kubler-Ross, 1969, p. 85). The individual can no longer deny the impending death or bargain for more time. Kubler-Ross differentiates between two types of depression, reactive depression and preparatory depression. Reactive depression is concerned with the external factors or issues that result from the individual’s death, such as arrangement of family household or childcare. Preparatory depression takes into account the “impending loss” (Kubler-Ross, 1969, p. 86-87). The individual is in a sorrowful state; he or she is going to lose everything and everyone that were loved. The fifth and final stage is acceptance, for the individual has fully expressed his or her feelings in the previous stages. It is a phase “void of feelings,” where the individual comes to an inner peace (Kubler-Ross, 1969, p. 112-113). Ida Jean Orlando developed her theory regarding the nursing process after seeking answers regarding the nursing role. Orlando’s background in mental health helped her integrate mental health concepts into the nursing curriculum. She analyzed thousands of interactions between the nurse and patient to evaluate nursing practices as beneficial or unsatisfactory (Tyra, 2008, p. 231). She first published her conclusions in her book The Dynamic Nurse-Patient Relationship (Alligood, 2014, p. 55). Her theory involved the notion that nursing is a “unique and independent” profession, focusing on meeting an individual’s immediate needs through interaction and collaboration (George, 1995, p. 161). However, she was dissatisfied with her work, for it did not incorporate formal research methods, being “deficient in objective validity” (Orlando, 1972, p. 1). She then refined her theoretical framework in her book The Discipline and Teaching of Nursing Process, as she expands on developmental nursing formulations that collaborate to define the nursing system, specifically the “function, authority, process, discipline, and training” in the nursing practice (Orlando, 1972, p. 18). Orlando defines nursing function as “meeting the patient’s immediate needs for help,” and, therefore, this function allows nurses to take authority (Orlando, 1972, p. 20-24). The nursing process starts when the nurse reacts and takes action to a patient reaction and action. Each reaction is composed of the individual’s initial perception, thought, and feeling. This cycle continues throughout the nurse-patient relationship (Orlando, 1972, p. 24-26). Discipline and training are necessary throughout the process to effectively fulfill the nursing function (Orlando, 1972, p. 29-33).
Elisabeth Kubler-Ross’ model poses strengths and weaknesses when utilized in nursing practice today. Her model does not explicitly define or incorporate the nursing metaparadigm; however, it does include concepts related to the metaparadigm, specifically person, nursing, and environment, to a certain degree. Her model touches on the person’s interactions with his or her surroundings, but she does not go into much detail. Health cannot be adequately applied to her model, for her model focuses on death and the process of dying. This process involves verbal and nonverbal expression of feelings and perspectives of the dying patient, allowing for better understanding of the person’s experience. This then enables better coping outcomes. In addition, the grief model by Kubler-Ross somewhat oversimplifies the process of death and dying to denial or acceptance. One study further states that it is necessary to include aspects of despair, maturation, and acute problems in addition to perspectives on denial and acceptance (Renz et al., 2012, p. 283). There are several other variables, emotions, and feelings that individuals experience during difficult times. Through inclusion of all aspects of the patient, a better overall picture of the individual is developed; therefore, it is necessary to incorporate all perspectives and emotions specific to the individual in order to achieve a better understanding of his or her grief process. This oversimplification, however, also allows for easier comprehension, and it forms a basic foundation for more complex aspects regarding grief and loss. Simplification of the model to its five grief stages enables a broader application to different aspects and situations, allowing all individuals, regardless of background, to apply and understand the model. Ida Jean Orlando’s theory also contains positive and negative aspects in today’s nursing practice. Her framework, which helped form the foundation of future theories, gave nurses an outline of how to provide quality and effective care, as well as provide definitions regarding the unique professional role of nursing. Her multifaceted theory involves the nursing metaparadigm, specifically person, health, and nursing (George, 1995, p. 169). Orlando outlines how effective nursing care of the person leads to positive outcomes and health promotion. Her theory, however, does not fully incorporate the environment and the people surrounding the patient, for it focuses mainly on the nurse and patient interaction. Individuals are part of a family or a community, and their interaction with it also impacts their overall health. In addition, Orlando’s theory focuses mainly on immediate needs, with little focus on long term needs (George, 1995, p. 175). When a patient is first admitted, discharge planning, illness prevention, and long term goals are immediately considered, for course of hospitalization and illness are viewed as temporary.
The Five Stages of Grief Model by Kubler-Ross is especially utilized in modern health care and nursing practice, prominently in hospice and palliative care. While providing “quality end-of-life care,” the nurse is able to utilize this model to understand the process in which the patient learns to cope and accept the situation (Renz et al., 2012, p. 283). Through understanding of the process the dying patient experiences, nurses and other health care staff are able to improve the relationship with the patient and meet the patient’s needs. Identifying the stage the dying patient is experiencing facilitates connection and communication, allowing for overall enhanced quality care. In addition, the model is incorporated in social work, as social workers deal with death and dying on a daily basis (Simpson, 2013, p. 81-82). Use of this model allows social workers to comprehend the experience and perspectives of the dying patient and the patient’s family and loved ones, as well as their own attitudes toward death. Analysis of their own perspectives enables them to interact with all their patients professionally. Orlando’s revolutionary theory facilitates effective nurse-patient interactions and identification of patient-specific needs, making it widely used in nursing today. Quality communication and incorporation of patient perspectives leads to positive outcomes and enhanced therapeutic relationships in many clinical settings (Doherty & Thompson, 2014, p. 502-504). Thorough assessment and interaction with the patient enables mutual identification of needs and appropriate actions to meet those needs. For example, a patient with an amputation of the left leg has needs regarding mobility, and therefore, goals and interventions for the patient focus on fall reduction safety measures and ambulation assistance. Addressing specific patient needs through interaction and communication leads to successful patient-specific outcomes, for each patient is different.
Some similarities arise between the theories behind Kubler-Ross and Orlando through their focus and applicability. Both theories incorporate nursing metaparadigm concepts; therefore, both are utilized in nursing practice to enhance overall quality care and meet the needs of the patient. In some situations, the two theories are utilized together at the same time. For example, a nurse caring for a dying patient evaluates interactions with the patient in order to assess grief stage, coping process, and anticipated needs. In addition, the focus of each theory, in essence, is on the interactions between the nurse and the patient. Both theories were formulated after interviews or observations of nurse-patient interactions. From further analysis of positives and negatives from these encounters, each theorist was able to formulate a framework for future use, study, and development to improve care. The frameworks contrast each other as well, also through focus and applicability. Kubler-Ross’ model incorporates the environment metaparadigm more than Orlando’s theory. Kubler-Ross examines the dying individual’s support system and loved ones, specifically how the individual reacts to losing them and the effect of his or her death on their life (Kubler-Ross, 1969, p. 86-87). Orlando mentions little regarding the patient’s interactions with a support system and the environment. Orlando’s theory, however, involves the health metaparadigm more than Kubler-Ross’ model. Orlando focuses on meeting patient needs to promote health and existence, whereas Kubler-Ross focuses more on the acceptance of inexistence, or death. Furthermore, Orlando’s theory is more general, focusing on the overall nursing process for all patients, while Kubler-Ross’ model focuses more on dying patients’ process of coping. Although both can be used in the same situation, the model by Kubler-Ross is specific to end-of-life care.
Orlando’s theory and Kubler-Ross’ model both involve nursing metaparadigm elements and, therefore, are utilized in nursing, sometimes simultaneously. Kubler-Ross’ model, however, does not fully incorporate the health metaparadigm, while Orlando’s theory does not incorporate the environment metaparadigm. Both involve use of effective communication in order to enhance care. Orlando’s theory targets a broader population, mainly all types of patients, while Kubler-Ross’ target population is more specific to dying patients. Both theoretical frameworks continue to be further studied, analyzed, and developed in nursing practice for better positive patient outcomes. References Alligood, M. R. (Ed.). (2014). Nursing theorists and their work (8th ed., p. 55). St. Louis, MO: Elsevier Mosby. Doherty, M., & Thompson, H. (2014, October). Enhancing person-centered care through the development of a therapeutic relationship [Electronic version]. British Journal of Community Nursing, 19(10), 502-504. George, J. B. (Ed.). (1995). Nursing theories: The base for professional nursing practice (4th ed., pp. 161-175). Norwalk, CT: Appleton & Lange. Kubler-Ross, E. (1969). On death and dying (pp. 38-113). New York, NY: Macmillan Publishing Company. Orlando, I. J. (1972). The discipline and teaching of nursing process (pp. 1-33). New York, NY: G.P. Putnam's Sons. Potter, P. A., Perry, A. G., Stockert, P. A., & Hall, A. H. (2013). Fundamentals of nursing (8th ed., p. 710). St. Louis, MO: Elsevier Mosby. Renz, M., Mao, M. S., Bueche, D., Cerny, T., & Strasser, F. (2012, July 12). Dying is a transition. American Journal of Hospice and Palliative Medicine, 30(3), 283. doi:10.1177/1049909112451868 Simpson, J. E. (2013). Grief and loss: A social work perspective. Journal of Loss and Trauma, 81-82. doi:10.1080/15325024.2012.684569 Tyra, P. A. (2008). In memoriam: Ida jean orlando pelletier. Journal of the American Psychiatric Nurses Association, 231. doi:10.1177/1078390308321092 Appendix Comparison/Contrast/Applied Theory Paper Compare and Contrast Theorists Related to Nursing Grading Sheet See syllabus for directions. It is the student’s responsibility to seek clarification if the assignment is not clear. Read directions in both the syllabus; note additional clarification given in class This paper must be developed using the following criteria and must be in APA format, narrative form, using titles and headings. Please follow the general guidelines for written papers that were included in your syllabus and specific guidelines for this paper in your syllabus. All papers submitted MUST HAVE a title page and reference list in APA format, using headings. The paper is to be 5-6 pages in length. The title page, reference list, and appendices are NOT included in the total number of pages. Please edit your work. Paper is to be written in narrative format. The title of the paper must include the FULL names of both theorists. Follow guidelines for electronic submission.
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