The Helping Art of Clinical Nursing was developed by Ernestine Wiedenbach. It defines
nursing as the practice of identifying a patient's need for help through the observation
of presenting behavior and symptoms, exploration of the meaning of those symptoms,
determination of the cause of discomfort, the determination of the patient's ability
to resolve the patient's discomfort, or determining if the patient has a need of help
from the nurse or another health care professional.
Wiedenbach's model of nursing defines the patient as any person receiving help of some
kind from the health care system. Help can include care, teaching, and advice. In this
nursing theory, a patient does not need to be ill or injured since health education
qualifies someone as a patient.
A patient's need for help is defined as a measure desired by the patient that can
potentially restore or extend the patient's ability to cope with situations that
affect health. In this nursing theory, it is crucial that a patient's need for help
come from the individual patient's perception of his or her own situation.
The nurse is a functioning human being who not only acts, but thinks and feels. A
nurse uses his or her knowledge in his or her role. Knowledge encompasses all that
has been perceived and grasped by the human mind. It may be factual, speculative,
Wiedenbach explains that clinical judgment represents the nurse's likeliness to make
sound decisions, which 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, as well as increased clarity
of professional purpose. In the theory, nursing skills are carried out in order to
achieve a specific patient-centered purpose rather than the completion of the skill
itself being the end goal. Skills are made up of a variety of actions, and are characterized
by harmony of movement, precision, and the effective use of self.
The Helping Art of Clinical Nursing addresses the definition of a person, as well. The
theory states that each person, whether a nurse or patient, has a unique potential to
develop self-sustaining resources. People tend to be independent and fulfill their own
responsibilities. In Wiedenbach's theory, self-awareness and self-acceptance are essential
to personal integrity and self-worth; whatever an individual does at any given moment is
representative of the best judgment available for that person in that moment.
Wiedenbach identifies four main elements of clinical nursing. They are a philosophy, a
purpose, a practice, and the art.
The nurse's philosophy is his or her attitude and belief about life and how that attitude
affected his or her reality. The three essential components associated with nursing
philosophy are a reverence for life; respect for the dignity, worth, autonomy, and
individuality of each human being; and a resolution to act on personally and professionally
A nurse's purpose is that which the nurse wants to accomplish through what he or she does.
It is all the activities directed toward the overall good of the patient. The practice of
nursing is the observable actions that are affected by the nurse's beliefs and feelings
about meeting the patient's need for help.
The art of nursing includes understanding a patient's needs and concerns, developing
goals and actions intended to enhance a patient's ability, and directing the activities
related to the medical plan to improve the patient's condition. The nurse also focuses
on prevention of complications that can come up due to re-occurrence, or the development
of new concerns.
Within the model is the prescriptive theory based on three factors: the central purpose
which the nurse recognizes as essential to the particular discipline, the prescription
for the fulfillment of the central purpose, and the realities in the immediate situation
that influence the central purpose.