Contributor: Peggy Chinn
August 27, 2018
Author – Ernestine Wiedenbach, BA, RN, MA
Year First Published – 1964
Four components of clinical nursing: philosophy, purpose, practice and art.
Goal-directed nursing care
Deliberative nursing care
The purpose of clinical nursing is to help individuals to overcome barriers to respond to a particular situation. This purpose is the embodiment of meeting needs for help, which implies goal-directed, deliberate, patient-centered practice actions that require the following: (1) knowledge (factual, speculative, and practical), (2) judgment, and (3) skills (procedural and communication). Practice includes the following four components: (1) identification of the perceived need for help, (2) ministration of help needed, (3) validation that help given was the help needed, and (4) coordination of help and resources for help. The helping process is triggered by patient behavior that the nurse perceives and interprets. In interpreting behavior the nurse compares the perception to an expectation or hope. Nursing actions may be rational, reactionary, and deliberative. A rational response by the nurse is based on the immediate perception without going beyond to explore hidden meaning. A reactionary response is taken in reaction to strong feelings. Deliberative actions—the desirable mode—intelligibly fulfill nursing’s purpose. Identification of needs for help involves the following: (1) observing inconsistencies, acquiring information about how patients mean the cue given, or determining the basis for an observed inconsistency; (2) determining the cause of the discomfort or need for help; and (3) determining whether the need for help can be met by the patient or whether assistance is required. Once needs for help are identified, ministration and validation that help was given follow.
Wiedenbach, E. (1964). Clinical nursing: A helping art. New York: Springer
Ernestine Wiedenbach (1900 – 1996)
Ernestine Wiedenbach was born in 1900 in Hamburg, Germany, and her family moved to New York in 1909. She earned a Bachelor of Arts from Wellesley College in 1922 and her Registered Nurse’s license from the John Hopkins School of Nursing in 1925. She got her Masters of Arts from Teachers College, Columbia University in 1934. In 1946, Wiedenbach earned a certificate in nurse-midwifery from the Maternity Center Association School for Nurse-Midwives in New York, and taught there until 1951. In 1952, she joined the faculty of Yale University as an instructor in maternity nursing. She became an assistant professor of obstetric nursing in 1954. When the Yale School of Nursing established a master’s degree program, she became an associate professor and was the director of the major in maternal and newborn health nursing. She was co-author of the classic practice-oriented theory papers published as an outcome of the 1968 Theory Development Conferences:
Dickoff, J., James, P., & Wiedenbach, E. (1968). Theory in a Practice Discipline: Part II. Practice Oriented Research. Nursing Research, 17(6), 545.
Dickoff, J., James, P., & Wiedenbach, E. (1968). Theory in a practice discipline. Part 1: Practice-oriented theory. Nursing Research, 17, 415–435.
For more information, see Nickel, S., Gesse, T., & MacLaren, A. (1992). Ernestine Wiedenbach. Her professional legacy. Journal of Nurse-Midwifery, 37(3), 161–167. Retrieved from