The Helping Art of Nursing

Aisha Lorraine C. Baui

Ernestine Wiedenbach
Introduction
Born in 1900 - Germany Migrated to the United States in 1909 at 9 years old from Germany Bachelor of Liberal Arts from Wellesley College RN from Johns Hopkins School of Nursing Masters of Public Health Nursing from Teachers College at Columbia University Certificate of Nurse-Midwife from New York School for Midwives Developed The Helping Art of Clinical Nursing, defining nursing practice

Ernestine Wiedenbach
Contributions to Nursing
Clinical practice areas included nurse-midwife and public health Wiedenbach established the nurse-midwifery program at Yale University

She taught at Yale along with Ida Orlando and Virgina Henderson
There she also met James Dickoff and Patricia James, professors of the philosophy department, Dickoff and James would provide lectures to the nursing staff on theory Ernestine Wiedenbach along with Virgina Henderson and Ida Orlando are known as the pioneers of nursing theory.

Ernestine Wiedenbach
Contributions to Nursing continued
With her experience in public health and nurse-midwifery she published articles in many journals She has published books on topics including nursing communication, nursing theory, nursing philosophy, and family-centered maternal nursing Components of Wiedenbachs nursing philosophy are incorporated into the professional philosophy statement of the American College of Nurse Midwives

Ernestine Wiedenbach
Introduction to the Helping Art Theory Wiedenbachs theory is based on identifying a patients need-of-help through nursing interaction and nursing action.

The process of identifying a patients need for help involves a philosophical/holistic approach as well as nursing knowledge and experience.
This process answers the question: How do nurses help patients meet their needs, mainly the need-ofhelp? This is known as central purpose.

Ernestine Wiedenbach
Introduction to The Helping Art Theory Wiedenbachs theory defines professional nursing practice. For the nurse to identify the patients need-for-help. This involves a 3 step process
Identification-Is what the patient is saying congruent to how they are acting? Ministration-Develop a plan that is mutually agreed upon Validation-Was the need-for-help met?

Ernestine Wiedenbach
Assumptions
Explicit Each human being is endowed with a unique potential to develop within himself the resources that enable him to maintain and sustain himself. The human being basically strive towards self-direction and relative independence and desire not only to make best use of his capabilities and potentialities, but desire to fulfill his responsibilities as well. The human being needs stimulation in order to make best use of his capabilities and realize his self-worth.

Ernestine Wiedenbach
Assumptions
Whatever the individual does represents his best judgment at the moment of doing it. The helping art of clinical nursing reverence for the gift of life, respect for the dignity, worth, autonomy, and individuality of each human being, and resolution to act dynamically in relation to ones belief. Characteristics of professionalism: clarity of purpose, mastery of skills and knowledge, sustaining purposeful working relationship with others, interests in advancing knowledge and dedication to furthering the goal of mankind.

Ernestine Wiedenbach
Assumptions IMPLICIT Patients are dependent beings normally willing to utilize help. Patients can use their sensitivities to frustrate health caregivers and thwart their efforts to obtain the result they desire.

Individuals like to live an orderly life, and life is an orderly process

Ernestine Wiedenbach
Assumptions Factors such as physical, psychological, and spiritual influence the nursing situation. Individuals want and have the resources to be healthy, comfortable and capable Professional nursing respects dignity, worth, autonomy, and individuality of each human being

Ernestine Wiedenbach
Concepts
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 deal with anxiety, disability, or distress Goal of nursing -To facilitate the efforts of the individual to overcome the obstacles which currently interfere (or maybe later interfere [1970b, p. 1058]) with his ability to respond capably to demands made of him by his condition, environment, situation, and time. To meet the need the individual is experiencing as a need for help.

Ernestine Wiedenbach
Concepts Human being - Possesses self-direction and relative independence, makes best use of capabilities, fulfills responsibilities, has resources to maintain self; in other words, is a functioning being. Nursing client - A person who is under the care of some member of health care personnel, who is in a vulnerable position, with a perceived need for help.

Nursing problem - Inability or impaired ability of an individual to cope with situational demands due to interferences (1963, p. 56). Discomfort.

Ernestine Wiedenbach
Concepts
Nursing process - Deliberative, to identify need for help and interferences with ability to cope. Through observation, understanding, and clarification of the meaning of cues, determination of causes of discomfort (through inspection, palpation, temperature, etc.) and determination of whether or not patient is able to meet his own needs. Ministration of help needed and, the last step in the process, validation that help given was indeed help needed. Nursepatient relation -The deliberate use of nurses perceptions, thoughts, feelings, and actions.

Ernestine Wiedenbach
Concepts
Nursing therapeutics Deliberate action that is either nurse directed, patient directed, or mutually understood and agreed on. It is designed to deal with a person who is in need of help by any measure or action required and desired by the individual that has the potential for restoring or extending his ability to cope with the demands implicit in his situation Help, which is any measure or action that enables the individual to overcome whatever interferes with his ability to function capably in relation to his situation. Giving advice, information, referral, ministering or applying a comfort measure. Deliberate actions are mutually understood and agreed on, patient directed, and nurse directed. Communication is an important tool. Helping is based on three principles: inconsistency or consistency, purposeful perseverance and self-extension.

Ernestine Wiedenbach
Concepts Focus of nursing - Goal-directed activities focused on identifying the patients perception of his condition and his need for help

Environment - Conglomerate of objects, policies, setting, atmosphere, time, human beings, happenings past, current, or anticipated that are dynamic, unpredictable, exhilarating, baffling, and disruptive.
Health - Not defined.

Ernestine Wiedenbach
Concepts
Concepts: art, judgment, knowledge, need-for-help, nurse, patient, purpose, philosophy of nursing

Ernestine Wiedenbach
Metaparadigm Person Weidenbach emphasizes that human individual possesses unique potential, strive toward selfdirection, and needs stimulation. Whatever the individual does represents his or her judgment at the moment. Self-awareness and self-acceptance are essential to the individuals sense of integrity and self-worth.

Ernestine Wiedenbach
Metaparadigm Health Weidenbach does not define the concept of health. However, she supports the World Health Organizations definition of health as a state of complete physical, mental, and social-being, and not merely the absence of disease or infirmity

Ernestine Wiedenbach
Metaparadigm Environment In Weidenbachs work, she incorporates the environment within the realities a major component of her theory. One element of the realities is the framework. According to her, the framework is a complex of extraneous factors and circumstances that are present in every nursing situation. The framework may include objects, such as policies, setting, atmosphere, time of day, humans and happenings.

Ernestine Wiedenbach
Metaparadigm Nursing According to Weidenbach, nursing, a clinical discipline, is a practice discipline designed to produced explicit desired result. The art of nursing is a goal directed activity requiring the application of knowledge and skill toward meeting a need for help experienced by the patient. Nursing is a helping process that will extend or restore the patients ability to cope with demand implicit in the situation

Ernestine Wiedenbach
Elements of Clinical Nursing
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.

Ernestine Wiedenbach
Elements of Clinical Nursing 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.

Ernestine Wiedenbach
Elements of Clinical Nursing The Practice Practice are those observable nursing actions that are affected by beliefs and feelings about meeting the patients need for help.

Ernestine Wiedenbach
Elements of Clinical Nursing 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.

Ernestine Wiedenbach
Prescriptive Theory

Ernestine Wiedenbach
Prescriptive Theory: Central Purpose
Weidenbach emphasizes the second in her work, formulating the following beliefs about the individual: 1. Human beings are endowed with unique potential to develop within themselves the resources that enable them to maintain and sustain themselves. 2. Human beings basically strive toward selfdirection and relative independence, and desire not only to make the best use o f their capabilities and potentialities but also to fulfill their responsibilities.

Ernestine Wiedenbach
Prescriptive Theory: Central Purpose
3. Human beings need stimulation in order to make the best use of their capabilities and realize their self-worth 4. Whatever individuals do represent their best judgment at the moment of doing it. 5. Self-awareness and self-acceptance are essential to the individuals sense of integrity and self-worth. Thus, the central purpose is a concept the nurse has thought through-one she has put into words, believes in, and accepts as a standard against which to measure the value of her action to the patient.

Ernestine Wiedenbach
Prescriptive Theory: Prescription A prescription is a directive activity. It specifies both the nature of the action that will most likely lead to fulfillment of the nurses central purpose and the thinking process that determines it

Ernestine Wiedenbach
Prescriptive Theory: Prescription
A prescription is a directive to at least three kinds of voluntary action: (1) Mutually understood and agreed upon action (the practitioner has evidence that the recipient understands the implication of the intended action and is psychologically, physically and/or physiologically receptive to it. (2) recipient-directed action (the recipient of the action essentially directs the way it is to be carried out.) (3) practitioner-directed action (the practitioner carries out the action. . . ).

Ernestine Wiedenbach
Prescriptive Theory: Realities Wiedenbach defines the five realities as: (1) the agent, (2) the recipient, (3) the goal, (4) the means, and (5) the framework

Ernestine Wiedenbach
Prescriptive Theory: Realities
The agent or nurse has the following four basic responsibilities: 1. To reconcile her assumptions about the realities . . . With her central purpose. 2.To specify the objectives of her practice in terms of behavi oraloutcomes that is realistically attainable.

3. To practice nursing in accordance with her objectives.

4. To engage in related activities which contribute to her self realization and to the improvementof nursing practice.

Ernestine Wiedenbach
Conclusion
The theorists presented in this chapter transformed how nurses thought about their practice and changed the nature of research questions investigated in the discipline of nursing. They provided the rationale to study processes of care and relationships between nurses and patients, as well as the organization and structure of interpersonal relationships. They provided the language, concepts, and outcomes that characterize care, as well as define the nature of the discipline. It is through the theories articulated by the interaction theorists that such concepts as process, validation, interpretation, lived experiences, interaction, interpersonal relations, trust building, forming bonds, and advocacy, among many others, became an integral part of our lexicon. These ideas were pioneering when these theorists took the risk to introduce them, and now we have them as an integral part of our discipline.