The purpose of this study was to determine whether the effectiveness of senior nursing students’ immediate responses to patients is influenced by type of distress presented by patients or by type of student degree programme. Forty-four ADN and 31 BSN seniors from four schools agreed to participate. Subjects viewed two videotaped simulations of ‘patients’ complaining of pain and two of ‘patients’ manifesting emotional distress. Content validity of simulations was established through nurse experts. After each tape, subjects answered four research questions based on Orlando's nursing process concept. The fourth question asked what subjects would say initially to ‘the patient’. The data revealed eight response categories which were scored according to their congruence with Orlando's concepts. Independent categorization of responses yielded a 0.92 interrelated reliability; t-tests indicated that type of distress was related to response effectiveness (P<0.01) but type of degree was not (P >0.01). The presumed emphasis on communication and psychosocial foundations in BSN curricula may not translate into more effective exploratory skills in these students. These skills are a key component of the complex assessment skills which enable nurses to ‘diagnose human responses’ to health problems. Orlando's model is recommended for teaching BSN students to conceptualize the interactional process and its goals.