ERNESTINE WEIDENBACH

THE HELPING ART OF CLINICAL NURSING

(NEED FOR HELP)

BACKGROUND OF THE THEORIST:

 Born 1900 in Germany

• She was German national who begun to love nursing when she took care of her ailing grandmother.

• Enrolled in John Hopkins Hospital School of Nursing after graduating in Wellesly College in 1922 with
bachelor’s degree in liberal arts.

• Received her master’s degree and Certificate in Public Health Nursing at Columbia University,
Teacher’s College.

• A nurse-Midwife in Maternity Center Association

• Became a director of graduate programs in maternal newborn health nursing and a faculty at Yale
University School of Nursing in Connecticut.

• She wrote Family Centered Maternity which was published in 1958.

• Passed away in 1996.

• Also wrote “Clinical Nursing a Helping Art” which identified the elements of a prescriptive theory
which she developed it more fully in “Meeting the Realities in Clinical Teaching”.

• Ida Jean Orlando and Pelletier stimulated Weidenbach’s understanding of the use of self and effect of
a nurse’s thoughts and feelings of outcomes of her actions.

PATIENT

• "Any individual who is receiving 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 need not be ill since someone receiving health-related education would qualify as a
patient.

PATIENT

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

• MAJOR DEFINITIONS: •
• NEED – is anything the individual may require to maintain or sustain himself comfortably or capably in
a given situation.

• HELP- is any measure or action that enables individual to overcome whatever interferes with his ability
to function capably in relation to his situation.

Four ways to Identify Need for Help

1. Observation – meaning nurses must observe the behavior of patient consistent or inconsistent of
their comfort. Like Orlando ida,

2. Explore – exploring the meaning of the patients behavior.

3. Determine the cause – determining the cause of discomfort or incapability of the patients, which is
being manifested in your observations.

4. Determine need for help = base on your observations, and once your explore and already determine
the cause, try to determine if the patient is need for help.

• NEED FOR HELP – is any measure or action required and desired by the individual and which has
potential for restoring or extending his ability to cope with the demands implicit of his own situation.

• Nurse – is a functional human being; acts, think and feel as well.

• PURPOSE – that which the nurse want to accomplish through what she does. It is also an overall goal
toward which she is striving so is constant.

• PHILOSOPHY – an attitude towards life and reality that evolves from each nurse’s beliefs and code of
conduct, motivates the nurse to act, guides her thinking what she is going to do and influences her
decisions.

• PRACTICE – an overt action directed by disciplines, thoughts and feelings. It is goal directed,
deliberately carried out and patient centered.

• Three (3) aspects for effective practice:

1. Knowledge – encompasses all that has been perceived and grasped by the human mind.

• Three kinds of knowledge:

1. Factual knowledge – something that may be accepted as existing or as being true.

2. Speculative knowledge – encompasses theories, principles offered to explain phenomena,

beliefs or concepts.

3. Practical knowledge – knowing how to apply factual or speculative knowledge to the situation
at hand.
2. Judgment – making sound decisions. By weighing facts against personal values derived from ideas,
principles and convictions. Judges od the nurses.

3. Skills – represents the nurse’s potentiality for achieving desired results. It is characterized by harmony
of movements, expression and intent.

• Two (2) classification of skills:

1. Procedural skills – are implementing procedures that the nurse may need to initiate and carry
out in order to identify and meet patient’s need for help. Whether it is dependent and
independent functions as long as you implement or place it into actions to the patients so it meets
the needs of the patients

2. Communication skills – are expression of thoughts and feelings that the nurse desires to convey
to her patient and others associated with patient’s care. Will really help the needs of the
patioents.

Communicating = central role of nurse.

• Three (3) components of practice related to patient care:

1. Identification – involves individualization of the patient, his experiences and recognition of patient’s
perception of his condition. It ascertains;

– whether a patient has a need

– whether he recognizes the need

– what interferes his ability to meet the need

– whether the need represents the need for help

This indentifications should be individualize, just like in the nursing care plan

2. Ministration – is providing the needed help. Requires identification, selection of helping measures
appropriate for the need and the acceptability of the help to the patient. It is just like the
implementation of the nursing care plan of Orlando Ida, where in you put the intervention into actions

3. Validation – evidence that patient’s ability was restored as a result for help given. This is just like the
evaluation phase of Orlando Ida, where in you try to see the results of the help you given to the patients

•COORDINATION - For unity and continuity of care,

• Elements of Coordination:

1. Reporting – act of presenting information either oral or written form and is important to
keep other’s informed about patients health and social history about his current condition,
reaction, progress, care and plan of care. This is being done during endorsement, rounds of
nurses,
 2. Consulting – act of seeking information or of asking advice. Consults the co nurses, doctors
or even their family.

3. Conferring – act of comparing and exchanging ideas.

• ART – the application of skills and knowledge to bring about desired results.

 The art of nursing are directed towards the achievement of four main goals:

1. Understanding patient condition, situation and need.

2. Enhancement of the patient’s capability

3. Improvement of his condition or situation within the framework patient’s plan of care.

4. Prevention of the recurrence of the disease.

• STIMULUS- Patient’s presenting behavior. Whether subjective or objective.

• PRECONCEPTION – the expectation what the patient maybe like.

• INTERPRETATION – is the comparison of perception with expectation or hope.

MAJOR ASSUMPTIONS:

• NURSING:

Nurses desscribe to an explicit philosophy which are:

1. Reverence for the gift of life

2. Respect for dignity, worth, autonomy and individuality of human being.

3. Resolution to act dynamically in relation to one’s beliefs.

For her the nursing is functioning human being as such as she is not only but should think and feel as
well.

• PERSON:

Four assumptions are stated in relation to human nature:

1. Each individual has potential to develop within self wich maybe able to maintain and sustain self.

2. The human being strives toward self direction and relative independence and make use of his
capabilities and potentials as to fulfill his responsibilities.

3. Self awareness and self acceptance are essential to the individual’s sense of integrity and self worth.
4. Whatever the individual does represents his or her best judgment at the moment of his doing.

Anny individual who is receiving help or some kind of whether it is care, instructions, advice from any
member of the health team.

•HEALTH:

Not well defined or discussed.

• ACCEPTANCE BY THE NSG. COMMUNITY:

 ENVIRONMENT:

May produce obstacles resulting in the person experiencing a need for help.

• THEORETICAL ASSERTIONS:

It involves four steps in the identification of patient’s need for help:

1. The nurse uses power of observation to look and listen for actual consistencies and inconsistencies in
the patient’s behavior.

2. The nurse explores the meaning of patient’s behavior with the patient.

3. The nurse determines the cause of patient’s discomfort or incapability.

4. The nurse determines whether the patient can resolve his/her problem or if the patient has a need for
help through observations of the presenting behavior and the symptoms and manifestations of the
patients whether it is sign or symptoms and you try to explore the meaning of those symptoms with the
patients, so you can the causes of those symptoms or the causes of discomfort and the try to resolves in
your ability and try to see if the patient is need some help with the other health team.

In summary, the theory conceptualizes nursing as the practice of identifications of the need and this is
with the help of through observations of the presenting behavior and the symptoms and manifestations
of the patients whether it is sign or symptoms and you try to explore the meaning of those symptoms
with the patients, so you can the causes of those symptoms or the causes of discomfort and the try to
resolves in your ability and try to see if the patient is need some help with the other health team.

So, for her clinical nursing, the art of clinical nursing is directed towards meeting of the patients perceive
needs of health, in innovation of nursing reflects emphasizing of the art or to clinical art of nursing. as
nurses you need to identify the patients needs of help. So if the need of help needs interventions or
their nursing care plan. Base on the needs, we also use sounds assessment, decision making,
deliberative.
• PRACTICE - The practice of nursing is an overt action directed by disciplined thoughts and feelings
toward meeting the patient need for help.

• EDUCATION - It serves nursing practice in four major ways:

1. It is responsible for the preparation of future nurses.

2. It arranges nursing students to gain experiences at home and clinical area.

3. It’s representative may function in the clinical area and work closely with the staff.

4. It offers educational opportunities to the nurse for special or advanced study.

RESEARCH

• The focus of nursing research is related to patient’s response to the health care experience.

• The model supports a design to promote family relationships to control factors responsible for
disabling conditions and to foster sound health practices.

• This was reported in nursing periodicals” Nursing Research”.

CLARITY

 Clear, consistent and intelligible.

SIMPLICITY:

•The concepts included need for help, nursing practice and nursing art.

•All concepts are interrelated, equal but no meaning aside from interaction.

• GENERALITY:

•Broad and possess generality.

EMPIRICAL PRECISION:

•Substantiation of theory is through research.

DERIVABLE CONSEQUENCES:

• It describe only professional practice. The theory focus on nurse-patient interactions.

ROSEMARIE RIZZO PARSE

HUMAN BECOMING

Deep concern delicate condiments of being a human and show profound recognition of human freedom
and dignity.

 Educated at Duquesne University, Pittsburgh

 MSN and Ph.D. from University of Pittsburgh
 Published her theory of nursing, Man-Living-Health in 1981
 Name changed to Theory of Human Becoming in 1992
 Editor and Founder, Nursing Science Quarterly
 Has published eight books (9 books) and hundreds of articles about Human Becoming Theory
 Professor and Niehoff Chair at Loyola University, Chicago
 Parse served as a faculty member at the University of Pittsburgh, as well as the Dean of the
Duquesne University School of Nursing. Between 1983 and 1993, she was a professor and
coordinator of the Center for Nursing Research at the City University of New York’s Hunter
College. She was also a professor and the Niehoff Chair at Loyola University in Chicago from
1993 until 2006. Beginning in January 2007, she has worked as a consultant and visiting scholar
at the New York University College of Nursing.
 The Parse theory of human becoming guides nurses In their practice to focus on quality of life as
it is described and lived (Karen & Melnechenko, 1995).
 The human becoming theory of nursing presents an alternative to both the conventional bio-
medical approach and the bio-psycho-social-spiritual (but still normative) approach of most
other theories of nursing. (ICPS)
 The human becoming theory posits quality of life from each person's own perspective as the
goal of nursing practice. (ICPS)
 Rosemarie Rizzo Parse first published the theory in 1981 as the "Man-living-health" theory (ICPS)
 The name was officially changed to "the human becoming theory" in 1992 to remove the term
"man," after the change in the dictionary definition of the word from its former meaning of
"humankind."
 Rosemarie Rizzo Parse created the Human Becoming Theory of Nursing, which guides nurses to
focus on quality of life from each person’s own perspective as the goal of nursing. It presents an
alternative to most of the other theories of nursing, which take a bio-medical or bio-psycho-
social-spiritual approach.
 The goal of the Human becoming nurse is to be truly present with people as they enhance the
quality of life.
 there are some nurses who would prefer to focus on the quality of life of their patients,
particularly from each individual patient’s perspective. The Human Becoming Theory of Nursing,
developed by Rosemarie Rizzo Parse, addresses this very issue.
  The Human Becoming Theory is a combination of biological, psychological, sociological, and
spiritual factors, and states that a person is a unitary being in continuous interaction with his or
her environment. It is centered around three themes: meaning, rhythmicity, and transcendence

How will nurses support the quality of life of the patients.

Three Major Assumptions of Human Becoming

 The theory is structured around three abiding themes: meaning, rhythmicity, and
transcendence.

1. MEANING

 Human Becoming is freely choosing personal meaning in situations in the intersubjective

process of living value priorities.
 Man’s reality is given meaning through lived experiences
 Man and environment cocreate
 The theme of meaning says that Human Becoming is choosing personal meaning in situations,
and that a person’s reality is given meaning through experiences he or she lives in the
environment.

3 Concepts under the MEANING principle

A. Imaging - is an individual’s view of reality. The person has their own of meaning reality, possibility,
and own understanding of consequences. As nurses, we should respect their views, struggles, rejections,
and there are own interpretation about it.

B. VALUING – confirming-not confirming of cherished beliefs in light of a personal worldview. Patients

are continuously have their own believes, choices, on how they act and how they think and feel. So this
may be consistent prior to choices or may be shifting on with this priorities. Sometimes they think
anticipated choices ad once the choices and later on they change. Learn about he peoples values by
asking them what is the most important of priorities in them.

C. LANGUAGING – relates to how human beings symbolize and express their imaged realities and their
value.

2. Rhythmicity

 Human Becoming is cocreating rhythmical patterns of relating in mutual process with the
universe.
 Man and environment cocreate (imaging, valuing, languaging) in rhythmical patterns
  Rhythmicity explains that Human Becoming is cocreating rhythmical patterns of relating with the
universe, and that a person and the environment cocreate in rhythmical patterns

A. REVEALING-CONCEALING – is disclosing-not disclosing all at once.

Is the way of persons disclose and keep hidden the persons they are becoming visible or
invisible. There is always more to tell and more to know about self as well as others. Sometimes
people know what they want to say and deliver messages of what is becoming visible to them.
Other times people may surprise themselves. As nnurses, co create what happen with they are
with other person.
B. ENABLING – LIMITING – represents the freedoms and opportunities that surface with the
restrictions and obstacles of everyday living.
Every choice even if they made up pre perfectively has potentials and restrictions. ex. This is the
worst happen to me, in enabling- limiting choosing from the possibility and leaving the
consequences of those choices

C. CONNECTING – SEPERATING – relates to the ways persons create patterns of connecting and
separating with people and projects. Attending or distancing

3. Transcendence

 Transcendence says that Human Becoming refers to reaching beyond the limits a person sets,
and that a person is constantly transforming him or herself.

a) POWERING – conveys meaning about struggle and life and the will to go on despite hardship and
threat.

b) ORIGINATING – concept about human uniqueness. (conforming-not conforming; certainty-

uncertainty). Choosing to be different or to be same with others

c) TRANSFORMING – is about change and shifting views that people have about their lives.

METAPARADIGM OF NURSING

Person

 a person is more than the sum of the parts, the environment and the person are inseparable,
 Open being who is more than and different from the sum of the parts

NURSING

 nursing is a human science and art that uses an abstract body of knowledge to help people. The
theory allows nurses to create a stronger nurse-patient relationship because the nurse is not
 focused on “fixing” problems, but is viewing the patient as a whole person living experiences
through his or her environment.
 Nurses guide individual.families in choosing possinilities thar that change y=he health process

ENVIRONMENT

 Everything in the person and his experiences

 Inseparable, complimentary to and evolving

HEALTH

 Open process of being and becoming. Involves synthesis of values

 Health is not something that we can prescribed or describedby societal norms.but rather it is
lived by individuals.

APPLICATION OF THE THEORY

 A transformative approach to all levels of nursing

 Differs from the traditional nursing process, particularly in that it does not seek to “fix” problems
 Ability to see patients perspective allows nurse to “be with” patient and guide them toward
desired health outcomes
 Nurse-person relationship cocreates changing health patterns
 Nurses do not have a preset agenda or teaching plan about what the person should or ought to
do
 Nurses ask what is the most important for the moment and explore meanings,wishes, intents,
and theses guides the nurses actions
 What may seem important to the nurse may not be what is important to the person.
 Differs from traditional nursing process,particularly in that it does not seek to fix problems
 Ability to see patients perspective allows nurse to “be with” patient and guide them toward
desired health outcomes
 Nurse-person relationship co creates changing health patterns
 From the Human becoming perspective, the discipline’s goal is quality of life
 The goal of the nurse living in human becoming beliefs in true presence in bearing witness and
being with others in their changing health patters

What is life here for you?

What is the most important thing for you?

What does that mean/ Did that mean for you?

MYRA E. LEVINE
Conservation Model

BACKGROUND OF THEORIST:

 1920 – 1996
 Her father has gastrointestinal problem and frequently ill and needs of nursing care
 1949 she graduated chicago
 Civilian nurse for the us army
 msn 1962
 Phd 1992
 Her theory was focused on the preservation of the individual’s wholeness or totality.
 The purpose of her model is to guide the nursing practice of nurses. Focus on the influences and
responses of organism level.

The four Conservation Principles with their major nursing goals are:

1. Conservation of energy – refers to all physiologic and psychological processes that sustain life depend
on the body’s energy balance. Refers to the balance of energy intake and output to avoid excessive
fatigue. Includes adequate rest, nutrition, proper exercise.

Example: adjusting to life in the nursing home, improving nutritional status, balancing resident activity,
controlling resident anxiety and pain.

2. Conservation of Structural Integrity – all body systems decline with aging, chronic illness also
produces bodily structural changes.

Example: maintaining or promoting mobility, preventing injury, preventing infection, maintaining skin
integrity. Promote mobility, movement of our body, prevent injury, maintain skin integrity,

3. Conservation of Personal Integrity – Self-integrity is intrinsically bound to to wholeness and all

individuals cherish the sense of self. Recognition, getting respect

Example: Respecting one’s privacy and property’ enhancing self-esteem through good personal hygiene,
grooming, and dress; fostering independence through choice and rehabilitation.

4.Conservation of Social integrity – individual life has meaning only in the context of social life.

Example: Provision of meaningful social activities for residents and staff.

CONCEPTS AND DEFINITIONS:

 CONSERVATION – describes the way the complex systems are able to continue to function even
when severely challenged. Man is able to confront obstacles, adapt accordingly and maintain
their uniqueness and individuality.
  WHOLENESS – emphasizes a sound, organic, progressive, mutuality between diversifies
functions and parts within boundaries or entities.

 ADAPTATION – a process of change wherein a person can keep his integrity within situations
and circumstances of his environment.

 There are three(3) characteristics of adaptation:

1. Historicity base on experiences, personal, genetic

2. Specificity specific response in every situations

3. Redundancy being resistant of medication.

 Internal environment – is composed of physiologic and pathophysiological domains of a person

 Three levels of external environment:

1. Perceptual level – includes all aspects of the world wherein the person is able to intercept
with his sense organs.

2. Operational level – refers to things that physically affect the individual but may not be
perceived by the individual himself.

3.Conceptual level – the environment is the product of cultural patterns characterized by

spirituality and moderated by language, history and thought.

 ORGANISMIC RESPONSE – refers to the person’s ability to adapt to his/her environment.

It is made up of four (4) levels of integration:

1. Fight or flight – a primitive response wherein the individual fight from perceived stressors or
flies away with the said stressors in order to ensure his safety.

2. Inflammatory response – a body defense mechanism that protects the body tissue from
insults in an unfriendly environment.

3. Response to stress – refers to wear and tear of the body tissues that reflects to body’s
response to stressful situations.

4. Perceptual awareness – it occurs as the person experiences life and the world around him.

METAPARADIGM IN NURSING

NURSING:

 Nursing interventions are based on the conservation of the individual’s energy.

  It is also viewed as a profession that is only reserved for those who can complete a graduate
program required by the discipline.

 NURSE:
Is viewed as having the sole duty to bring a body of scientific principles on which decisions
depend into a precise situation which the nurse shares with the patient.

PERSON:

 Describe as a holistic being and a system of systems and its wholeness expresses the
organization of all the contributing parts.

HEALTH:

 It is socially determined by the ability of the person to function in a reasonably normal manner.
 ENVIRONMENT:

Described within the context of how the individual lived his life. It can either be internal or
external.

THEORY APPLICATIONS:

 It can be applied to geriatric patients where majority are elderly patients.

In summary, this mainly focuses in conservation of energy. As nurses we balance the energy the
output and intake to avoid excessive fatigue. We support the adjustment changes in a given situation
especially in geriatric patients. We also control pain and anxiety to conserve our energy, we also adjust
the patient’s activity with appropriate concern, we promote exercise, we rehabilitate the patient’s
abilities and also we limit the patient’s activity. We assist with bathing to conserve their energy. Givig
medication. We try to get patients be comfortable with their beds. Another focus of thie theory is the
conservation of the physical integrity. We maintain muscular and skeletal integrity. Conserve energy
when it comes to physical, social, and structural