2. Ernestine Wiedenbach
• was born in August 18, 1900, in
• Conceptual Model: “The Helping
Art of Clinical Nursing".
– 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.
3. Ernestine Wiedenbach
– 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
– She was influenced by Ida
Orlando in her works on the
• She died on March 8, 1998.
5. 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.
6. PRESCRIPTIVE THEORY
• Wiedenbach's prescriptive theory is based
on three factors:
The central purpose which the practitioner
recognizes as essential to the particular
The prescription for the fulfillment of
The realities in the immediate situation that
influence the central purpose.
8. Use of Empirical Evidence
• 1994 - At this time, there is no specific
research supporting Wiedenbach’s work.
• Little research has been done using her
10. 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
11. 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.
• 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.
13. 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.
14. 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
15. 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
16. 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.
17. PRACTICE: Knowledge
• Knowledge encompasses all that has been
perceived and grasped by the human
mind; its scope and range are infinite.
• Knowledge may be:
– speculative or
18. 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
• 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.
19. 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:
23. THE ART
• Four Main Goals:
– understanding patients needs and
– developing goals and actions intended
to enhance patients ability and
– directing the activities related to the
medical plan to improve the patients
24. THE ART
• Nursing art involves three initial
25. THE ART
• The nurse reacts based on those
operations. Her actions may be:
• Rational action
• Reactionary action
• Deliberative action
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
3. Resolution to act
dynamically in relation to one’s
• Each Person is endowed with a
unique potential to develop self-
• People generally tend towards
independence and fulfillment of
• Self-awareness and self-
acceptance are essential to
personal integrity and self-
• Whatever an individual does at
any given moment represents
the best available judgment for
that person at the time.
• More acceptable today than on 1950’s and
• In the 1980’s the health care industry
provided the supposedly unique concept of
Family Centered Care, which Wiedenbach
addressed some 20 years ago
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
• Before the development of Wiedenbach’s
model, nursing research focused more on
the medical model than on a nursing
• In her model, focus of nursing research is
to be related to the patient’s response to
the health care experience.
38. FURTHER DEVELOPMENT
• Pioneer in the writing of nursing theory
• Needs to be further developed by more
clearly defining the concepts of health and
• The component of nursing art needs to be
identified in operational way.
• Clarity – concepts and definitions are
clear, consistent, and intelligible
• Simplicity – too many relational
• 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
At Yale, Wiedenbach’s theory development benefited from her contact with other faculty members.
Ida Orlando Pelletier stimulated Wiedenbach’s 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, who taught a course in nursing theory, reviewed the manuscript for Wiedenbach’s book, Clinical Nursing: A Helping Art. In it they identified elements of a prescriptive theory, which Wiedenbach developed more fully in Meeting the Realities in Clinical Teaching.
At present there is no specific research supporting Wiedenbach’s work. Her model was developed on the basis of her years of experience in clinical practice and teaching.
The patient is any person who has entered the healthcare system and is receiving help of some kind, such as care, teaching, or advice from a member of the health profession or from a worker in the field of health.“
the demand implicit in his situation = various life situations that affect health and wellness.”
The thoughts she thinks and the feelings she feels as she goes about her nursing are important; they are intimately involved not only in what she does but also in how she does it. They underlie every action she takes, be it the form of a spoken word, a written communication, a gesture, or a deed of any kind.
It stems from both her culture and subculture, and is an integral part of her. It is personal in character, unique to each nurse, and expressed in her way of nursing.
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.
Knowledge may be acquired by the nurse. It has potentiality for use in directing, reaching, coordinating, and planning care of the patient, but is not sufficient to meet his need-for-help. Must be supplemented by opportunity for the nurse to function in a nurse-patient relationship with responsibility to exercise judgment and to implement skills for the benefit of the patient.
Knowledge may be:
Factual – something that may be accepted as existing or as being true
speculative – encompasses theories, general principles offered to explain phenomena, beliefs or concepts, and the content of such special subject areas as natural sciences, the social sciences, and the humanities
Practical – knowing how to apply factual or speculative knowledge
Judgment is personal in character, it will be exercised by the nurse according to how clearly she envisions the purpose to be served, how available relevant knowledge is to her at the time, and how she reacts to prevailing circumstances such as time, setting, and individuals.
Procedural – potentialities for implementing procedures that the nurse may need to initiate and carry out in order to identify and meet her patient’s need-for-help
Communication – capacities for expression of thoughts and feelings that the nurse desires to convey to her patient and others associated with his care. Verbal/nonverbal
Identification – individualization of pt, his experiences, recognition of perception of his condition
Ministration – providing the needed help; requires identification of need-for-help, selection of helping measure appropriate to that need, and acceptability
Validation – evidence that the patient’s functional ability was restored as a result of the help given
While striving for continuity and unity, the nurse coordinates all services provided to the patient so care will not be fragmented. Reporting, consulting, conferring are functional elements of coordination
Stimulus – pts presenting behavior
Preconception – expectation of what the pt may be like
Interpretation – comparison of perception with expectation or hope. Perception is an interpretation of the stimulus and may misinterpret the patient’s behavior
Rational action – overt act taken in response solely or mainly to the doer’s immediate perception of another’s action – verbal or nonverbal-or situation
Reactionary action – in contrast with rational action, is an overt act taken spontaneously in response to strong feelings the doer experiences when he compares his perception of another’s behavior or situation with his expectation or hope about that behavior
Deliberative action – in contrast with both. Overt act which although not failing to take account of the doer’s immediate perceptions and feeling-reactions is, nonetheless based solely on those perceptions and feelings.
The rationale for nursing is stated in.., “the reason she has come into being is a patient who needs her help”
The definitions of nursing, patient, and need-for-help, and the relationships among these concepts imply health-related concerns in the nurse-patient situation
It is inferred that the environment may produce obstacles resulting in a need-for-help experienced by the person.
Identification – 1. nurse observes
2. Nurse explores meaning of behaviors
3. Nurse determines cause of discomfort/incapability
4. Nurse determines if pt can resolve or he has need-for help
Ministration – nurse makes plan to meet nees, presents it to pt; if pt agrees, nurse implements; if pt disagrees, explore cause of non-acceptance; if has an interfering problem, nurse explores pt’a ability to solve the problem; forms again a plan, presents, asks pt’s concurrence to plan and accepts suggestions for implementation
Validation – if need-for-help was met; nurse perceives if pt’s behavior is consistent with her concept of comfort and clarifies; nurse takes appropriate action based on feedback
Wiedenbach developed this model through induction. The reasoning method in inductive logic begins with observation of specific instances and then combines the specifics into a more generalized whole. The common features of the specific instances allow for grouping the specifics into a larger set of phenomena. An analysis of clinical experiences leads to the development and interrelationships of concepts for Wiedenbach’s model.
Dickoff, James, and Widenbach have identified four levels of theory development in a practice discipline. In order of increasing sophistication they are factor-isolating, factor-relating, situation-relating, and situation-producing.
Today, nurses are applying Wiedenbach’s concepts to their clinical practice more so than did nurses in 1950’s and 1960’s. According to Wiedenbach, the practice of clinical nursing is an”Overt action, directed by disciplined thoughts and feelings toward meeting the patient’s need-for-help.”
She made an article entitled “Childbirth as Mothers say they like it” which notes that mothers wanted childbirth to be as natural as possible. They wanted instructions on childbirth, father participation, full participation in the labor and delivery process, and rooming-in with their infant in the postpartum periods. But not until 1970’s were some or most of theses needs for help met.
1 – sound knowledge of normal and pathological states, understanding of human psychology, competence in clinical skills, ability to initiate and maintain therapeutic communication, sound judgment and decision-making
REQUIRES GENERAL EDUCATION FOR NURSES
Graduate study – means to extend personal limits of practice, potential for imaginative practice
Her model would support research designed to promote family relationships, to control factors responsible for disabling conditions, and to foster sound health practices.
Her model of clinical nursing is one of the early attempts to systematically describe what it is that nurses do and what nursing is all about.
Need for help, nursing practice, nursing art. All of these concepts are interrelated, equal in importance, and have no meaning aside from their interrelation. Relationships between the major components can be linked , but it is difficult to diagram some of the concepts in the model.
In addition, the concepts describe or explain the phenomena but does not predict.
Generality – the scope of the concepts of patient, nursing, and need-for help are very broad and thus possesses generality. However, the concept of need-for-help is based on the patient’s recognition of his/her need for help. This is not applicable to the infant, comatose patient or many physiologically or psychologically incompetent persons.
Also, the assumption that nurses do not share a similar philosophy of nursing lessens the generality of the model.
Empirical Precision – Substantiation of a theory is accomplished through research, and thus usefulness of the theory is determined. Concept of nursing practice and need-for-help are operationally defined and measurable. However, the concept of need-for-help is not always applicable. There is also a little attempt to operationally define nursing art.
Derivable consequences – refer to the overall effect of theory and its importance to nursing research, practice, and education; The theory focuses on nurse-patient interactions and regards the patient from a holistic point of view. Her work influenced the work of other early scholars, including Peplau and Orlando