Ernestine Wiedenbach’s

The Helping Art of Clinical

Nursing

Reported by:
Dan Hannah Marie W. Duran
Athena Shaina Catubig
I. Historical Evolution of the Theory/Background of the Theorist

- Ernestine Wiedenbach was born to an affluent German family in 1900 but they
immigrated to the United States during her childhood years.
- Her interest in Nursing started during her younger years while watching the care of
her sickly grandmother and listening to stories by her sister’s friend who was a
medical intern by that time.
- She graduated from Wellesley College in 1922 with a degree in Liberal Arts. Upon
graduation she enrolled in Nursing much to the dismay of her parents.
- Ernestine first entered the Post Graduate Hospital School of Nursing but after a
conflict with the school administration she was expelled.
- In her stead, Adelaide Nutting, a John Hopkins alumnus, intervened and got in touch
with Elsie Lawler, the head of the John Hopkins School of Nursing. She was granted
admission with the condition that she would never organize or support student
rebellion at John Hopkins. She compiled and graduated in 1925.
- Because of her bachelor’s degree, she was offered a supervisory position upon
graduation at John Hopkins Hospital.
- Later on, she transferred to Bellevue in New York and continued her studies
obtaining an M. A. from Teachers College, Columbia University in 1934. She then
moved out of hospital setting and worked as a public health nurse for the
Association for Improving Conditions of the Poor at the Henry Street Settlement.
- She later on left clinical nursing altogether to work as a professional writer for the
American Journal of Nursing under the Nursing Information Bureau. During her
stint as a writer, she was able to fully developed her writing skills and was also able
to gain many important professional contacts.
- During World War II, while still working with the Nursing Information Bureau, she
helped prepare nurses entering the war. A minor heart condition prevented her
from helping overseas.
- At the end of World War II, Ernestine was persuaded by Hazel Corbin, director of the
Maternity Centre Association of New York, to go back to direct patient care. She
enrolled as a student midwife at the School for Midwives at 45 years old. She
practiced as a nurse-midwife at the Maternity Center Association and taught
evening classes at Teachers College.
- In 1952, she joined the faculty at Yale University where she met Ida Jean Orlando
Pelletier, Patricia James and William Dickoff. Orlando, being a nurse theorist herself,
stimulated Wiedenbach to understand the concept of self and the effect a nurse’s
thoughts and feelings to the outcome of her actions. James and Dickoff meanwhile
were professors of Philosophy and taught at nursing programs in Yale. They
persuaded Wiedenbach to develop her theory.
- Wiedenbach retired and moved to Florida in 1966 after an active and successful
academic career. She died at the age of 97 on March 8, 1998.
 II. Wiedenbach’s Approach to the Development of the Model

Definition of Four Major Concepts

• Person - posessess self-direction and relative independence, makes best use of ca-
pabilities, fulfils responsibilities, has resources to maintain self; in other word, is a
functioning being (Wiedenbach as cited by Meleis, 2010)

- whether nurse or patient endowed with a unique potential to develop self-sustaining

resources. People generally tend toward independence and ful-
filment of responsibilities (Eichelberger and Sitzman, 2011)

• Nursing - a helping art with knowledge and theories. A goal-directed and deliberate
blending of thoughts, feelings, perceptions and actions to understand the patient
and his condition, situation and needs, to enhance his capability, improve his care,
prevent recurrence of problem and real with anxiety, disability or distress (Wieden-
bach, 1964)

- effective identification of a patient’s need for help through observation of

presenting behaviours and symptoms, exploration of the meaning of those symptoms
with the patient and codetermining the cause(s) of discomfort

• Health - Not defined. However, she supports the World Health Organization’s defini-
tion of health as a state of complete physical, mental and social well-being and not
merely the absence of disease and infirmity (George, 2008)

• Environment - Conglomerate of objects, policies, setting, atmosphere, time, human

beings, happenings past, current or anticipated that are dynamic, unpredictable,
exhilarating, baffling and disruptive (Wiedenbach, 1970)

III. Content: The Helping Art of Clinical Nursing

Wiedenbach defines nursing as "the practice of identifying a patient's need for help
through observation of presenting behaviors and symptoms, examination of the
meaning of those symptoms with the patient, determining the cause(s) of discomfort,
and assessing the patient's ability to resolve the discomfort or if the patient has a need
for support from the nurse or other healthcare professionals."
 The primary objective of nursing is identifying a patient's need for help. The nurse
facilitates the medical plan of care and also develops and implements a nursing plan of
care based on the requirements and preferences of the patient if the need for
assistance requires involvement. A nurse uses sound judgement when giving treatment
by consciously, repeatedly, and thoroughly identifying symptoms.

The theory's goal is to support an individual's efforts to get over challenges that are now
limiting his capacity to effectively meet needs made on him by his condition,
environment, situation, and time.

THE FOUR MAIN ELEMENTS TO CLINICAL NURSING

1. THE PHILOSOPHY - The nurses' philosophy is their attitude and belief about life and
how that affected reality for them.

3 essential components associated with a nursing philosophy:

- Reverence for life

- Respect for the dignity, worth, autonomy and individuality of each human being
- Resolution to act on personally and professionally held beliefs.

2. THE PURPOSE - Nurses' purpose is that which the nurse wants to accomplish through
what she does. It is all of the activities directed towards the overall good of the patient
(Tomy & Alligood 2010)

3. THE PRACTICE - Observable nursing actions that are affected by beliefs and feelings
about meeting the patient’s need for help.

4. THE ART OF NURSING - Understanding patients' needs and concerns developing

goals and actions intended to enhance patients' ability to direct the activities related to the
medical plan prevention of complications related to reoccurrence or development of new
concerns.
IV. Wiedenbach’s Prescriptive Theory

Yet another theory is included in Wiedenbach's conceptual framework. The prescription

is the action in which the nurse determines is necessary to accomplish the primary goal.
The nurse will have considered the kinds of outcomes she wants to achieve and will take
steps to do so, assuming responsibility for both her actions and their effects.

Examination of Content

In terms of ideas and description, Wiedenbach's theory is clear, consistent, and

understandable, however it could not be considered simple due to the excess of
relational claims. It is fairly difficult because of its philosophical foundation, however the
idea behind this theory—client entered care—isn't particularly complicated.
Additionally, even if the idea of a need for assistance may not apply to all patients, it
may still be seen as broad because it can be used by other healthcare professionals and
the theory can be used in routine nursing practice. The central ideas of this theory are
concrete since they remain true regardless of the situation or time.

The theory provides guidance for putting the nursing process into practice and has
inspired several attempts to conceptualize the interaction process, but its ability to
prescribe is limited. The theory's applicability is still limited to patients who are
conscious while in a hospital setting, who are primarily motivated to take control of
their own care, who are out of sync with their surroundings, circumstances, or
expectations, and who are able to recognize their need for assistance. Patients who fail
to break away from the norm, do not comply, and do not feel the need for assistance
are not nursing clients. Its application in practice is therefore limited.

Although nurses might not be able to convey the concepts and connections originating
from Wiedenbach, the main elements of her theory are frequently applied. To provide
personalized client care, her theory may be used in regular nursing practice.

Wiedenbach’s theory was also accepted when it came to terms with education by
serving the nursing practice in four major ways

• It is responsible for the preparation of future Practitioners of nursing

• It arranges for nursing student to gain experience in clinical areas of the hospital
or in the homes of patients.
• Its representatives may function in the clinical area and work closely with the
staff
• It offers educational opportunities to the nurse for special or advance study.
(Tomey & Alligood, 2005)
Wiedenbach’s theory is primarily concerned with how patients react to their
experiences receiving medical care. In order to apply the Wiedenbach model to clinical
practice, a nurse must possess knowledge of human psychology, clinical skill proficiency,
and the capacity to sustain contact with the patient and family. The nurse must also use
clinical judgment in making decisions on patient care and be able to comprehend the
behavior of the patient. (2005) Tomey & Alligood.
 The diagram below is an illustration of Wiedenbach's theory in use. A patient with a
fever is receiving nursing care. The theory assists in the creation of a mutually beneficial
interaction between the nurse and the patient.

A patient is experiencing a fever and the nurse plans to do

tepid sponge bath to lower the patient’s temperature.

The patient was observed to be

uncomfortable and irritable.

Nurse thinks of a way on how to approach

the patient and presents the plan

The patient The patient does not

concurs with plan concur with plan

Nurse may seek help in effort to elicit

Nurse suggested a tepid sponge bath
definitive response

Patient Patient does

accepts not accept
suggestion suggestion
Nurse explores for cause of patient’s
nonacceptance
Nurse
performs Patient reveals cause of nonacceptance: Patient does not
TSB on the he is not comfortable in a female nurse reveal cause of
patient touching him nonacceptance

Nurse explores other ways to resolve problem

Patient indicates
ability to resolve
problem. Agreed to
the TSB performed by
a male nurse.
Patient indicates
inability to resolve
problem.
Patient has need for
help
Nurse may seek help from
patients’ family to determine
the cause of nonacceptance.
Nurse thinks of other ways to
lower the patient’s
temperature and go back to
the first box