Theory Usage and Application

Ernestine Wiedenbach (1900-1998)

"The Helping Art of Clinical Nursing"
"My thesis is that nursing art is not comprised of rational nor reactionary actions but rather of
deliberative action." Wiedenbach, 1964
Introduction
Ernestine Wiedenbach (1900-1998) was an early nursing leader who is probably best known for
her work in theory development and maternal infant nursing. She believes that there are four
elements to her concept The Helping Art of Clinical Nursing which are: a philosophy, a
purpose, a practice and the art.
If a nurses attitude and belief is what motivates him/her to act in certain ways, he/she is guided
on nursing philosophy. Three components that may affect the nurses philosophy are reverence
for life, respect for the dignity and individuality of each human being, and resolving to act on
personal and professional beliefs. When a nurse wants to accomplish through what he/she does
which is primarily identifying a patients need for help, it is based on nursing purpose.
Observable actions which are affected by the nurses beliefs and feelings in meeting the patients
need show the nursing practice.
The art of nursing is when the nurses understood patients needs and concerns.
About the Theorist
Ernestine Wiedenbach professional educator, writer, practices as nurse-midwife
1900 born
1922 B.A. from Wellesley College
1925 Graduated at John Hopkins School of Nursing and was offered a Supervisory position
thereafter.
1934 earned her Masters Degree and a Certificate in Public Health from Teachers College,
Columbia University
1946 Earned a degree in Midwifery and a Certificate in Nurse-Midwifery from the Maternity
Center Association for Nurse-Midwives in New York.
1952 appointed as instructor in maternity nursing to the faculty of Yale University School of
Nursing
1954 became Assistant Professor of Obstetric Nursing
1956 became Associate Professor of Obstetric Nursing
1958 Wrote a nursing classic, Family-Centered Maternity Nursing a comprehensive text on
obstetrical nursing.
1964 Published her second book Clinical nursing: A helping art. New York: Springer.
1992 Became an inspiration to the article written by Nickel, Gesse and MacLaren entitled
"Ernestine Wiedenbach: Her Professional Legacy".
1966 Retired from service. She never married and died at the age of 97 on March 8, 1998.
Development of Theory
Wiedenbachs theory is based on identifying a patients need-of-help through nursing interaction
and nursing action. The process by which a patients need is identified involves a philosophical
and /or holistic approach as well as nursing knowledge and experience.
Basic Concepts

Wiedenbach conceptualizes nursing as the practice of identification of a patient's need for help
through observation of presenting behaviors and symptoms, exploration of the meaning of those
symptoms with the patient, determining the cause(s) of discomfort, and determining the patient's
ability to resolve the discomfort or if the patient has a need for help from the nurse or other
healthcare professionals. Nursing primarily consists of identifying a patient's need for help. If the
need for help requires intervention, the nurse facilitates the medical plan of care and also creates
and implements a nursing plan of care based on needs and desires of the patient. In providing
care, a nurse exercises sound judgment through deliberative, practiced, and educated recognition
of symptoms. The patient's perception of the situation is an important consideration to the nurse
when providing competent care.

Nursing Metaparadigm
The patient
- Any individual who is receiving help of some kind, be it care, instruction or advice from a
member of the health profession or from a worker in the field of health.
- The patient need not be ill since someone receiving health-related education would qualify as a
patient.
A need-for-help
- Any measure desired by the patient that has the potential to restore or extend the ability to
cope with various life situations that affect health and wellness. It is crucial to nursing profession
that a need-for-help be based on the individual perception of his situation.
Nurse
- The nurse is a functional human being who acts, thinks, and feels. All actions, thoughts, and
feelings underlie what the nurse does.
Knowledge
- Knowledge encompasses all that has been perceived and grasped by the human mind.
- Knowledge may be: (1) factual (2) speculative or (3) practical
Judgment
- Clinical judgment represents the nurses likeness to make sound decisions.
- These decisions are based on differentiating fact from assumption and relating them to cause
and effect.
- Sound judgment is the result of disciplined functioning of mind and emotions, and improves
with expanded knowledge and increased clarity of professional purpose.
Environment
- Not specifically addressed
Health

- Concepts of nursing, client, and need for help and their relationships imply health-related
concerns in the nurseclient relationship.
Nursing Skills
- Nursing skills are carried out to achieve a specific patient-centered purpose rather than
completion of the skill itself being the end goal.
- Skills are made up of a variety of actions, and characterized by harmony of movement,
precision, and effective use of self.
Person
- Each person may it be a nurse or patient, is gifted with a unique potential to develop selfsustaining resources.
- Generally tends toward independence and fulfillment of responsibilities.
- Self-awareness and self-acceptance are essential to personal integrity and seld-worth.
- The things that an individual do at a given circumstance is what represents the best available
judgment for that person at the time.
Description of the Theory
Nursing to Weidenbach as described by Meleis is congruent to the prevailing ideas at Yale in the
late 1950s. However, it was in the early 1960s wherein the nursing focus was shifted from
medical model to patient model as Weidenbach introduced the notion of caring into nursing. In
her early work (1963), she attempted to develop a concept that encompassed all nursing and this
evolved into a prescriptive theory. This addresses core questions like how nurses help meet their
patients needs since according to Weidenbach Help is an integral part or nursing. Help comes in
different ways when we based it on personal or nursing practice. We can intentionally care for
someone and help them overcome any thing that impedes their ability to work, while some can
help without personally caring for that particular person.
Weidenbach identified several explicit and implicit assumptions which guided her theories. One
explicit assumption that Weidenbach stated is whatever the individual does represents his best
judgment at the moment of doing it (1970b,p. 1058). This assumption actually gives a good
conclusion as to how we are as a human being. Assumptions and concepts go well together. For
Weidenbach, one of nursings goals is to promote comfort. She interpreted as well as proposed
the importance of invisible act of caring when it comes to rendering nursing care.
As stated by Meleis, the theory of Weidenbach lacks propositions and linkages between
concepts, but one can derive propositions related to the process of assessment and intervention.
Yes there were some inconsistencies in her assumptions as some theories lack clarity; however,
she made a deliberate effort to identify the philosophical premises on which her theories were
developed.

Assumptions:

Nursing is the practice of identification of a patients need for help through:

1. observation of presenting behaviors and symptoms

2. exploration of the meaning of those symptoms with the patient
3. determining the cause(s) of discomfort, and
4. determining the patients ability to resolve the discomfort or if the patient has a need for
help from the nurse or other healthcare professionals.

Nursing primarily consists of identifying a patients need for help.

PRESCRIPTIVE THEORY 3 FACTORS:

The nurses central purpose in nursing is the nurses professional commitment the
nurses goals are grounded in the nurses philosophy:

1. reverence for the gift of life

2. respect for the dignity, autonomy, worth and individuality of each human being and
3. resolution to act dynamically in relation to ones belief

The prescription indicates the broad general action that the nurse deems appropriate to
fulfillment of her central purpose The nurse will have thought through the kind of
results to be sought and will take action to obtain these results, accepting accountability
for what she does and for the outcomes of her action.

The realities are the aspects of the immediate nursing situation that influence the results
the nurse achieves through what she does.- within the situation are these components:

1. The agent who is the nurse supplying the nursing action

2. The recipient the patient receiving the action
3. The framework situational factors that affect the nurses ability to achieve nursing
results
4.

The Goal the end to be attained through nursing activity

5. The Means the actions and devices through which the nurse is enabled to reach the
goal.

Application in Nursing:
Practice

Her years of experience as a nurse midwife contributed to the area of labor and delivery
process based on the article she published "Childbirth as Mothers Say They Like It"

She believed strongly in patient care

Provides a foundation for assessing, or explaining,patient conditions

Influenced many core concepts in nursing today,including nursing assessment,nursing

process and nursing diagnosis such as self-care deficits

Considered nursing a "practical phenomenon " that involved action

Education

Nursing education serves the practice of nursing in four major ways, as proposed by
Weidenbach (Marriner-Tomey, 1995)

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 the hospital or in
the home of patients
3. Its representatives may function in the clinical area and work closely with the staff.
4. It offers educational opportunities to the nurse for special or advanced study.

Weidenbach's model when applied to the clinical settings requires the nurse to have a
broad knowledge both the normal and the pathological side, an extensive understanding
to human psychology, clinical skills competence, and the nurses' ability to effectively
initiate and maintain good communicate to both patient and family. (Marriner-Tomey,
1995)

Evaluation
The theories made by Weidenbach and the other theorist made way for a more clearer path on
how nurses can render a holistic approach when it comes to nursing care. Weidenbach
emphasized that Help is an integral part of nursing. And with her theory, this undeniably brought
changes as to how nurses thought about their practice and made way for revised research
questions investigated in the discipline of nursing. If we would sum it all up, the ideas
incorporated in the theory are part and parcel of our discipline.