Ernestine Wiedenbach’sThe Helping Art of Clinical

Nursing

Josephine Ann J. Necor, RN

Ernestine Wiedenbach• was born in August 18, 1900, in

Hamburg, Germany.

• Conceptual Model: “The Helping Art of Clinical Nursing".

• Education:– B.A. from Wellesley College in

1922– R.N. from Johns Hopkins

School of Nursing in 1925– M.A. from Teachers College,

Columbia University in 1934– Certificate in nurse-midwifery

from the Maternity Center Association School for Nurse-Midwives in New York in 1946.

Ernestine Wiedenbach• Career:

– Wiedenbach joined the Yale faculty in 1952 as an instructor in maternity nursing.

– Assistant professor of obstetric nursing in 1954 and an associate professor in 1956.

– She wrote Family-Centered Maternity Nursing in 1958.

– She was influenced by Ida Orlando in her works on the framework.

• She died on March 8, 1998.

The Helping Art of Clinical Nursing

- Philosophy or Metatheory

Theoretical Sources

• Ida Orlando Pelletier - understanding of the use of self and the effect the nurse’s thoughts and feelings has on the outcome of her actions.

• Patricia James and William Dickoff, - identified elements of a prescriptive theory in Wiedenbach’s work, which she developed more fully in Meeting the Realities in Clinical Teaching.

PRESCRIPTIVE THEORY

• Wiedenbach's prescriptive theory is based on three factors:

The central purpose which the practitioner recognizes as essential to the particular discipline.

The prescription for the fulfillment of central purpose.

The realities in the immediate situation that influence the central purpose.

Use of Empirical Evidence

• 1994 - At this time, there is no specific research supporting

Wiedenbach’s work.

• Little research has been done using her theory.

Major Conceptsand Definitions

The patient

• any person who has entered the healthcare system and is receiving help of some kind, such as care, teaching, or advice.

• need not be ill since someone receiving health-related education would qualify as a patient.

A need-for-help

• "any measure or action required and desired by the patient that has the potential to restore or extend the ability to cope with the demand implicit in his situation.”

• It is crucial to nursing profession that a need-for-help be based on the individual perception of his own situation.

Nurse

• The nurse is a functioning human being.

• The nurse not only acts, but thinks and feels as well.

• For the nurse whose action is directed toward achievement of a specific purpose, thoughts and feelings have a disciplined role to play.

The Purpose

• Purpose - that which the nurse wants to accomplish through what she does – is the overall goal toward which she is striving, and so is constant.

• The nurse’s reason for being and for doing.

• It is all of the activities directed towards the overall good of the patient.

The Philosophy

• An attitude toward life and reality that evolves from each nurse’s beliefs and code of conduct, motivates the nurse to act, guides her thinking about what she is to do and influences her decisions.

• Philosophy underlies purpose, and purpose reflects philosophy.

The Practice

• Overt action, directed by disciplined thoughts and feelings toward meeting the patient’s need-for-help, constitutes the practice of clinical nursing

• It is goal-directed, deliberately carried out and patient-centered.

THE PRACTICE

• Knowledge, Judgment, and Skills are three aspects necessary for effective practice.

• Identification, ministration, and validation are three components of practice directly related to the patient’s care. Coordination of resources is indirectly related to it.

PRACTICE: Knowledge

• Knowledge encompasses all that has been perceived and grasped by the human mind; its scope and range are infinite.

• Knowledge may be:– factual– speculative or– practical

PRACTICE: Judgment•  Clinical Judgment  represents the

nurse’s likeliness to make sound decisions.

• Sound decisions are based on differentiating fact from assumption and relating them to cause and effect.

• Decisions resulting from the exercise of judgment will be sound or unsound according to whether or not the nurse has disciplined the functionng of her emotions and of her mind.

PRACTICE: Skills

• Skills represent the nurse’s potentiality for achieving desired results.

• Skills comprise numerous and varied acts , characterized by harmony of movement, expression and intent, by precision, and by adroit use of self.

• May be classified as to: -Procedural skills -Communication skills

Components of Practice Directly Related to Patient’s Care

• Identification• Ministration• Validation

Component of Practice Indirectly Related to Patient’s Care

• Coordination of Resources- Reporting- Consulting- Conferring

The Art

• Application of knowledge and skill to bring about desired

results.

THE ART

• Four Main Goals:–understanding patients needs

and concerns–developing goals and actions

intended to enhance patients ability and

–directing the activities related to the medical plan to improve the patients condition. 

THE ART

• Nursing art involves three initial operations:

• Stimulus• Preconception• Interpretation

THE ART

• The nurse reacts based on those operations. Her actions may be:

• Rational action• Reactionary action• Deliberative action

MAJORASSUMPTIONS

Nursing

Nurses ascribe to an explicit philosophy. Basic to this are:1. Reverence for the gift of life2. Respect for the dignity, worth, autonomy, and individuality of each human being3. Resolution to act dynamically in relation to one’s beliefs

Person• Each Person  is endowed with

a unique potential to develop self-sustaining resources.

• People generally tend towards independence and fulfillment of responsibilities.

• Self-awareness and self-acceptance are essential to personal integrity and self-worth.

• Whatever an individual does at any given moment represents the best available judgment for that person at the time.

Health

• Not defined nor discussed in

Wiedenbach’s model.

Environment

• Wiedenbach does not specifically adrdress the

concept of environment. She

recognized the potential effects of environment,

however.

TheoreticalAssertions

Clinical Nursing – the relationship between its focus and constituents

LOGICAL FORM

• Induction

• Situation-producing prescriptive theory

ACCEPTANCE BY THE NURSING COMMUNITY

Practice

• More acceptable today than on 1950’s and 1960’s

• In the 1980’s the health care industry provided the supposedly unique concept of Family Centered Care, which Wiedenbach addressed some 20 years ago

EDUCATIONWiedenbach proposed that nursing education serves the practice in four major ways:1. It is responsible for the preparation of

future practitioners of nursing.2. It arranges for nursing students to gain

experience in clinical areas of hospitals or the homes of their patients

3. Its representatives may function in the clinical area and may work closely with the staff

4. It offers educational opportunities to the nurse for special or advanced study

RESEARCH

• Before the development of Wiedenbach’s model, nursing research focused more on the medical model than on a nursing model.

• In her model, focus of nursing research is to be related to the patient’s response to the health care experience.

FURTHER DEVELOPMENT

• Pioneer in the writing of nursing theory

• Needs to be further developed by more clearly defining the concepts of health and environment.

• The component of nursing art needs to be identified in operational way.

CRITIQUE

• Clarity – concepts and definitions are clear, consistent, and intelligible

• Simplicity – too many relational statements

CRITIQUE

• Generality – broad; concept of need-for-help not applicable to some patients

• Empirical Precision – partially met; difficult to test

• Derivable Consequence – fulfills the purpose for which it was developed – to describe professional practice

References

• www.currentnursing.com

• Tomey, A.M., (1994). Nursing Theorists and Their Work. 3rd ed. Missouri: Mosby

THANK YOU!