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Ernestine Wiedenbach Theory

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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 nurse’s 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 nurse’s 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 patient’s need for help, it is based on nursing purpose. Observable actions which are affected by the nurse’s beliefs and feelings in meeting the patient’s need show the nursing practice.

The art of nursing is when the nurses understood patient’s 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 Master’s 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

Wiedenbach’s theory is based on identifying a patient’s need-of-help through nursing interaction and nursing action. The process by which a patient’s 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 nurse’s 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 nurse—client 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 self-sustaining 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 1950’s. 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 patient’s 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 nursing’s 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.

Conclusion

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. 

Publications& References

Wiedenbach, E. (1963). The helping art of nursing. American Journal of Nursing, 63(11),  54-57.

Weidenbach, E. (1964).  Clinical nursing: A helping art. New York: Springer.

Wiedenbach, E. (1965). Family nurse practitioner for maternal and child care.  Nursing Outlook, 13(12), 50.

Wiedenbach, E. (1967). Family-centered maternity nursing (2nd ed.). New York: G. P. Putman's Sons.

Wiedenbach, E. (1968). The nurse's role in family planning: A conceptual base for practice. Nursing Clinics of North America, 3(2) ,  355-365.

Wiedenbach, E. (1970). Nurses' wisdom in nursing theory.  American Journal of Nursing, 70(5), 1057-1062.

Schmidt, J. (1972). Availability: A concept of nursing practice. American Journal of Nursing 72(6), 1086-1089.

Meleis, Afaf Ibrahim Theoretical Nursing: Development and Progress

Current Nursing.com Nursing Theories. "The Helping Art of Clinical Nursing"  (1900-1998) 

http://currentnursing.com/nursing_theory/Ernestine_Wiedenbach.html

http://www.rnpedia.com/home/notes/fundamentals-of-nursing-notes/nursing-theorist

http://www.collegesanddegrees.com/health/nursing/theories

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