Ernestine Wiedenbach's Helping Art of Clinical Nursing   by Lisa Wright Eichelberger DSN, RN

Wiedenbach believed that there were 4 main elements to clinical nursing.  They included: a philosophy, a purpose, a practice and the art.

The nurses philosophy was their attitude and belief about life and how that effected reality for them. Philosophy is what motivates the nurse to act in a certain way (Tomey & Alligood, 2002). 

Wiedenbach also believed that there were 3 essential components associated with a nursing philosophy (George, J. 2002): 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.

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 (Tomey & Alligood 2002).

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.

 Wiedenbach  defined key terms commonly used in nursing practice. These definitions themselves do not fully define the profession, however confusion over commonly used terms continues to plaque nursing even today as we see with the lack of a uniform nursing language and the difficulties in coding data and reimbursement issues. In specifically defining what each of these terms mean within the context of her theory, Wiedenbach imparts clarity and power to her work, and sets the stage for productive exploration and debate. She defined the following:

1. 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.
2. 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.
3.  [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.
4. 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.
5. 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.

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 (Sitzman & Eichelberger 2003)