Available nursing scholarship demonstrates that nursing models and theoretical frameworks began to be identified in the 1950s, and provided a wide spectrum of opportunities for the nursing profession to progress from a constricted focus on illness to a broader concern with human needs and individualized care (McCrae, 2012). Ernestine Wiedenbach’s (1900-1996) nursing theory came into the scene in the 1960s and played a significant role not only in shifting the nursing focus from the medical model to a patient model, but also in introducing the notion of caring into nursing (Meleis, 2007). The present paper discusses Wiedenbach’s nursing theory, including its strengths and weaknesses.
Wiedenbach’s nursing theory is to a large extent concerned with the helping art of clinical nursing, with its central tenet being to identify ways nursing professionals can use to help patients meet their needs. The founder of the theory suggested that “help” is a fundamental component of nursing, and entails “all actions that enable individuals to overcome whatever hampers their ability to function” (Meleis, 2007 p. 374). Consequently, the theory focuses attention on directing nursing professionals to “help” patients by identifying their needs and making an informed and professional determination on whether such patients have the capacity to solve their problems or if there is need for nurses to intervene (Sitzman & Eichelberger, 2003).
In addition to focusing on the perception of individuals in need, Wiedenbach’s nursing theory avails interpretation of the invisible act of “caring” and proposes its significance in successful nursing care. In particular, the theory underscores the importance nursing professionals attach to their thoughts and feelings and how deliberately they use them, reverence for life, determination of nursing professionals to act on their personal and professional attitudes and beliefs, as well as respect for the dignity, self-worth, independence, and individuality of each patient (Meleis, 2007). The variables that come out clearly from the theory include comfort, validation, and need for help, not mentioning that it stresses the need for congruent nurse and patients perceptions of the need for help and evaluation for help, as these facilitate effective care and decrease patient discomfort (Sitzman & Eichelberger, 2003). The theory also proposes that (1) nursing professionals should use their perseverance in identifying the need for assistance and providing the needed assistance when inconsistencies are observed among patients, (2) exploration and validation of the nursing professionals’ perceptions, thoughts, and feelings enhance the effectiveness of the assistance provided to patients, and that (3) mutually understood and agreed upon nursing actions will have a beneficial effect on the patient (Meleis, 2007).
It is reported in the literature that Wiedenbach employed a field strategy in identifying elements of nurse-patient interaction and validation, which inevitably contribute substantially to her theory development. According to Meleis (2007), the theorist “focused her conceptualization around problems of discomfort and the need for help and around the function of the nurse in observing, assessing, and exploring and validating feelings, thoughts, and fears” (p. 379). Consequently, one of the strong points of the theory has always being its use of a deliberative process (observing, assessing, exploring) as well as validation not only to evaluate but also to intervene in cases where patients are in need of help.
Wiedenbach’s nursing theory cannot be successfully described without mentioning its four foremost components of clinical nursing. As suggested in Meleis (2007), the four components include: philosophy (attitudes and beliefs about life and how they affect reality), purpose (what a nurse wants to achieve through what she does), practice (observable nursing actions that are influenced by beliefs and feelings about the patient’s need for assistance), and art (understanding the patient’s needs and concerns, developing objectives and actions intended to enhance the patient’s ability, and directing the activities related to the medical plan with the view to enhancing the patient’s condition or treatment outcomes).
Available nursing scholarship has identified several strengths and weaknesses related to the theory. Among the strengths, it is evident that the central ideas and concepts of Wiedenbach’s nursing theory (e.g. nurse-patient interaction, observation and assessment of patient needs, provision of care, persuasion, employment of personal beliefs) are used widely in contemporary nursing practice to address patient health needs and achieve optimal care outcomes. Additionally, the theory emphasizes the fundamental significance of tailoring nursing care to individual patients’ needs and expectations, implying that students of Wiedenbach’s theory can successfully employ it to make sound clinical judgments depending on patients’ perceived needs and concerns (Sitzman & Eichelberger, 2003). Another strong point of the theory is grounded on the fact that it avails practical guidelines for implementing the patient-centered nursing process in healthcare institutions. Some of the theory’s weaknesses include (1) inconsistencies in employing principles, philosophy, and assumptions interchangeably, (2) lack of operationalization of major concepts used in the theory, such as comfort, validation, and need for help, (3) lack of clarity in explaining the relationships between concepts, (4) lack of propositions and linkages between concepts, and (5) lack of prescriptive power due to the noted inconsistencies.
Overall, it is acknowledged in this paper that Wiedenbach’s nursing theory has played a significant role not only in changing the nursing focus from the traditional medical model to a contemporary patient-centered model, but also in introducing the concept of caring into nursing. Many of the theory’s concepts and ideas continue to be used in contemporary practice settings; however, more needs to be done to solve the theory’s inconsistencies as identified in this presentation.
McCrae, N. (2012). Whither nursing models? The value of nursing theory in the context of evidence-based practice and multidisciplinary health care’, Journal of Advanced Nursing, 68(1), 222-229.
Meleis, A.I. (2007). Theoretical Nursing: Development and progress. Baltimore, MD: Lippincott Williams & Wilkins.
Sitzman, K., & Eichelberger, L. (2003). Understanding the work of nurse theorist. Boston: Jones and Bartlett.