The Helping Art of Clinical Nursing

INTRODUCTION

• Ernestine Wiedenbach was born in August 18, 1900, in Hamburg, Germany.
  
• Wiedenbach's conceptual model of nursing is called ' 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..
• 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.

CONCEPTS AND DEFINITIONS

•  Wiedenbach  defined key terms commonly used in nursing practice.

The patient

• "Any individual who is recieving 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 is any person who has entered the healthcare system and is receiving help of some kind, such as care, teaching, or advice.
• The patient need not be ill since someone receiving health-related education would qualify as a patient.

A need-for-help

• A need-for-help is defined as "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 own situation.

Nurse

• The nurse is functioning human being.
• The nurse no only acts, but thinks and feels as well.

Knowledge

• Knowledge encompasses all that has been percieved and grasped by the human mind.
• Knowledge may be :
  • factual
  • speculative or
  • practical

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.
• Sound Judgment is the result of disciplined functioning of mind and emotions, and improves with expanded knowledge and increased clarity of professional purpose.

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 (whether nurse or patient), 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.

KEY ELEMENTS

• Wiedenbach proposes 4 main elements to clinical nursing. 
  • a philosophy
  • a purpose
  • a practice and
  • the art.

The Philosophy

• The nurses' philosophy is their attitude and belief about life and how that effected reality for them.
• Wiedenbach believed that there were 3 essential components associated with a nursing philosophy:
  • Reverence for life
  • Respect for the dignity, worth, autonomy and individuality of each human being and
  • resolution to act on personally and professionally held beliefs.

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.

The Practice

• Practice are those observable nursing actions that are affected by beliefs and feelings about meeting the patient’s need for help. 

The Art

• The Art of nursing includes
  • 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 nurses also focuses on prevention of complications related to reoccurrence or development of new concerns.

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 fullfillment of central purpose.
• The realities in the immediate situation that influence the central purpose.

Diagram

CONCLUSION

• Nursing is 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.

PUBLICATIONS

1. Wiedenbach, E. (1963). The helping art of nursing.  American Journal of Nursing, 63,  54-57.
2. Weidenbach, E.  (1964).  Clinical nursing: A helping art.  New York: Springer. 
3. Wiedenbach, E. (1965). Family nurse practitioner for maternal and child care. Nursing Outlook, 13, 50.
4. Wiedenbach, E. (1968). The nurse’s role in family planning: A conceptual base for practice.  Nursing Clinics of North America, 3,  355-365.
5. Wiedenbach, E. (1970). Nurses’ wisdom in nursing theory.  American Journal of Nursing, 70, 1057-1062.

RESEARCH ON WIEDENBACK'S THEORY

• Nickel S, Gesse T, MacLaren A. Ernestine Wiedenbach. Her professional legacy. J Nurse Midwifery. 1992 May-Jun;37(3):161-7.
• Ernestine Wiedenbach. Her professional legacy.
• Sculpting a nurse-midwifery philosophy. Ernestine Wiedenbach's influence.