ERNESTINE WIEDENBACHS PRESCRIPTIVE THEORY

INTRODUCTION

Ernestine Wiedenbach was born in August 18, 1900, in Hamburg, Germany. Wiedenbach's conceptual model of nursing is called ' The Helping Art of Clinical Nursing"

Education:
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B.A. from Wellesley College in 1922 R.N. from Johns Hopkins School of Nursing in 1925 M.A. from Teachers College, Columbia University in 1934 Certificate in nurse-midwifery from the Maternity Center Association School for Nurse-Midwives in New York in 1946..

Career:
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Wiedenbach joined the Yale faculty in 1952 as an instructor in maternity nursing.

Assistant professor of obstetric nursing in 1954 and an associate professor in 1956.

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She wrote Family-Centered Maternity Nursing in 1958. She was influenced by Ida Orlando in her works on the framework.

She died on March 8, 1998.

CONCEPTS AND DEFINITIONS

Wiedenbach defined key terms commonly used in nursing practice.

The patient

"Any individual who is recieving help of some kind, be it care, instruction or advice from a member of the health profession or from a worker in the field of health."

The patient is any person who has entered the healthcare system and is receiving help of some kind, such as care, teaching, or advice.

Thus to be patient one does not necessarily have to be sick. Someone receiving preventive health-related education would qualify as a patient.

A need-for-help A need is anything that the individual may require to maintain or sustain himself comfortably or capably in his situation

A need-for-help is defined as "any measure or action required and desired by the individual and that has the potential for restoring or extending his ability to cope with the demands implicit in his situations.

It is crucial to nursing profession that a need-for-help be based on the individual perception of his own situation.

Nurse

The nurse is functioning human being. The nurse as such she not only acts, but thinks and feels as well.

Purpose

Purpose that which the nurse wants to accomplish, what she does, is the overall goal towards which she is striving, and so is constant. Practice Action directed by disciplined thoughts and feelings toward meeting the patients need for help constitutes the practice of clinical nursing. It is a goal directed, deliberately carried out and patient centered. Knowledge, judgement, and skills are three aspects necessary for effective practice. Knowledge

Knowledge encompasses all that has been percieved and grasped by the human mind.

Knowledge may be :
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Factual speculative or practical

Judgment

Clinical Judgment represents the nurses 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.

Nursing Skills

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.

Person

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.

Wiedenbachs Prescriptive theory is a situation producing theory Her explanation of prescriptive theory is that ; it may be described as one that conceptualizes both ad desired situation and the prescription by which it is to be brought about. Thus theory directs action toward an explicit goal.Three ingredients essentisl to the Prescriptive theory are; Central purpose: The nurses central purpose in nursing is the nurses professional commitment. To formulate ones purpose in nursing is a soulsearching experience. The prescription: Indicates the broad general action that the nurse deems appropriate to fulfillment of her central purpose. The Realities: Are the aspects of the immediate nursing situation that influence the results and the fulfillment of the central purpose.

The diagrammatic representation of prescriptive theory is as follows:

Realities Central purpose in nursing prescription

Realities

Realities

Three components for nursing philosophy: Central purpose: The nurses central purpose defines that quality of health she defines that quality of health she desires to effect or sustain in her patients and specifies what she recognizes to be her special responsibility in caring for the patient. Wiedenbach identifies three essential components for a nursing philosophy. Reverence for the gift of life. Respect for the dignity, worth, autonomy, and individuality of each human being. Resolution to act dynamically in relation to ones beliefs. The prescription; Actions appropriate to implement a plan to carry out the actions in accordance with the central purpose. Actions may be voluntary (intended response), or involuntary (unintended response). The three voluntary actions are : Mutually understood and agreed upon action. The recipient understands the implication of the action and is receptive to it.

 Recipient-directed action. Recipient directs the way the action is carried out. Practitioner-directed action. Practitioner carries out the action. Actions may be voluntary (intended response), or involuntary (unintended response). Realities There are five realities: The agent; Has 4 basic responsibilities To reconcile assumptions about the realities. To specify the objectives. To practice nursing according to the objectives. To engage in related activities that contributes to self-realization and the improvement of nursing. Recipient The recipient, or patient is vulnerable and is depended on others for help and risks losing their individually, dignity, worth, and autonomy. Goal The goal is the directed outcome the nurse wishes to achieve. Mean The means comprise the activities that the nurse is empowered to achieve the goals. Framework The framework consists of the human, environmental, professional, and organizational facilities. Weidencachs conceptualization of nursing practice and process Nursing practice is an art, which the nursing action is based on the principles of helping. Consists of 4 actions. Reflex (spontaneous).

 Conditioned (automatic). Impulsive (impulsive). Deliberate (responsible).

The nursing practice has 3 components. Identification of the patients needs. Ministration of help needed. Validation of the action taken. The clinical nursing has 4 components 1. Philosophy, personal position of the nurse toward reality. 2. Purpose, overall goal. 3. Practice, includes 4 components: Identification or need for help. Ministration of help needed. Validation of the help needed. Coordination of help and resources for help. 4. Art of clinical nursing requires using individual interpretations of behavior in meeting needs for help. CONCLUSION

Nursing is the practice of identification of a patients need for help through

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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 patients 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 patients need for help. Bibliography

Chinn, P., & Jacobs, M. (Eds.). (1987). Theory and nursing (2nd ed.). St.Louis: C.V. Mosby. George, J. (Ed.). (1985). Nursing theories: the base for professional nursing practice (3rd ed.). Norwalk, Connecticut: Appleton & Lange.