Ernestine Wiedenbach’s

The 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 Concepts
and 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
 MAJOR
ASSUMPTIONS
Nursing
Nurses ascribe to an explicit
philosophy. Basic to this are:
1. Reverence for the gift of life
2. Respect for the dignity,
worth, autonomy, and
individuality of each human
being
3. 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.
Theoretical
Assertions
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
 EDUCATION
Wiedenbach 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!