Ernestine Wiedenbachs

The Helping Art of Clinical

Nursing

Josephine Ann J. Necor, RN

Ernestine Wiedenbach

was born in August 18, 1900, in

Hamburg, Germany.

Conceptual Model:

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 NurseMidwives in New York in 1946.

The
Helping Art of Clinical
Nursing".

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 wroteFamily-

Centered Maternity
Nursingin 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

nurses thoughts and feelings has

on the outcome of her actions.
Patricia James and William Dickoff, identified elements of a prescriptive
theory in Wiedenbachs 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
Wiedenbachs 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

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 nurses reason for being and
for doing.

The Philosophy
An attitude toward life and
reality that evolves from each
nurses 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 patients needfor-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
patients 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
ClinicalJudgment represents the
nurses 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

PRACTICE: Skills
Skills represent the nurses
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

Components of Practice
Directly Related to Patients
Care
Identification
Ministration
Validation

Component of Practice
Indirectly Related to
Patients 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
ones beliefs

Person
EachPerson is endowed with
a unique potential to develop
self-sustaining resources.
People generally tend towards
independence and fulfillment of
responsibilities.
Self-awareness and selfacceptance are essential to
personal integrity and selfworth.
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
Wiedenbachs
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
1950s and 1960s
In the 1980s 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

RESEARCH
Before the development of
Wiedenbachs 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

patients 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

References
www.currentnursing.com
Tomey, A.M., (1994). Nursing
Theorists and Their Work. 3rd ed.
Missouri: Mosby

THANK YOU!