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Lippincott Williams & Wilkins

The Helping Art of Nursing


Author(s): Ernestine Wiedenbach
Source: The American Journal of Nursing, Vol. 63, No. 11 (Nov., 1963), pp. 54-57
Published by: Lippincott Williams & Wilkins
Stable URL: http://www.jstor.org/stable/3453018
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THE
HELPING ART
OF
NURSING

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Ernestine Wiedenbach
"Nursing is a helping art-a de. goal is to help a particular patient, they are founded on assumption or
liberate blending of thoughts, then her thoughts and feelings will on fact; and, finally, it is to appraise
need to be directed to the complex their usefulness as contributors to the
feelings, and overt actions. It is
process of deciding whether the pa- fulfillment of the nurse's purpose of
practiced in relation to an indi-
vidual who is in need of help, is tient needs help; what help he needs; nursing.
and how she may provide it in a way To cite a not uncommon nursing
triggered by a behavioral stimu- that will be helpful to him. The overt situation:
lus from that individual, is The light over the door of Room
acts which the nurse carries out in
rooted in an explicit philosophy, 10 on the medical unit went on for
response to each of these questions
and is directed toward fulfill- are the apparent parts of nursing on the sixth time in the space of about
ment of a specific purpose," which results depend. The thoughts one hour. When the nurse, rushing
says this nurse-philosopher. and feelings that precede and ac- down the corridorto give an injec-
Here she relates her basic philos- company each act are the less appar- tion to a patient, saw it, she groaned
ophy to the work of the ward. ent parts of nursing; yet, because and thought, "That Mrs. Bradley!"
they set direction for each act, they Does she think I have nothing to do
YOU ever tried to take stock are the real determiners of the results except to take care of her?"
HAVE the nurse achieves. As soon as the nurse had given the
of the thoughts you think and
the feelings you feel as you go about To take stock of thoughts and feel- injection, she went to Room 10 and,
your nursing? ings is, first of all, to recognize their in a slightly edgy tone asked, "What
Thoughts and feelings, including reality and their relationship to each would you like now, Mrs. Bradley?"
reactions, are integral parts not only other; next, it is to ascertain whether Plaintively the answer came, "I
of what we do or say but also of how Miss Wiedenbach (B.A., Wellesley College;
can't sleep."
we do it. In nursing, in which action Johns Hopkins, Baltimore, Md.; M.A., Colum- "Perhapsa sleeping pill will help,"
is directed toward achievement of a bia University), who has the certificate in the nurse responded and added,
specific purpose, thoughts and feel- nurse-midwifery from the Maternity Center "The doctor left an order for one in
Association, is professor of obstetric nursing case you needed it."
ings have a disciplined role to play. at Yale University. This article is a part of
They need to be recognized, respect- her forthcoming book, Clinical Nursing--A
Without waiting for a reply, the
ed, and directed toward the goal the Helping Art, to be published in the spring nurse left, returnedin a few minutes
nurse is trying to reach. If the nurse's by the Springer Publishing Company. with the sedative, and gave it to Mrs.

54 JOURNALOF NURSING
THEAMERICAN

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Bradley. Then she left to care for Bradley to help her understand why Every condition or situation which
another patient down the hall. she was repeatedly calling her, not may befall an individual has as its
Ten minutes later, the light over only might Mrs. Bradley have felt counterpart the way the individual
the door of Room 10 went on again. encouraged to reveal what was understands, thinks, and feels about
The nurse, with mounting resent- troubling her, but the nurse, in all it. The counterpart, though frequent-
ment, responded to the signal, and probability, would have felt her own ly disregarded, is significant because
then returned to other responsibilities resentment gradually subside. it is the propelling force behind mo-
only to be interrupted after a short Would the nurse have appraised tivation. The condition may influence
interval by another flash of the light her thoughts and feelings as useful the individual's capacity to function;
over the door of Room 10. contributors to the fulfillment of her but his perception of it influences his
This nurse wanted to help Mrs. purpose of nursing? In all probability, will to function. The condition itself
Bradley. Again and again she re- yes-provided, of course, that she was and the person's perception of it thus
sponded to her signal light, asked clear about her purpose. Without may represent two distinct, though
what she wanted, and provided what clarity about her purpose, the nurse related, areas of responsibility.
she thought was needed. It is doubt- lacks a beacon toward which to di- The doctor's primary responsibility
ful, however, that the result she rect her nursing acts and runs the is recognized to be the patient's con-
achieved through her nursing, was danger of dissipating her energies by dition. He diagnoses it, searches for
the one for which she hoped. responding aimlessly to a patient's its cause, and may initiate action not
What would have happened, one numerous spot requests. Had the only to cure or control it, but to pre-
may wonder, if the nurse had taken nurse, alerted by her feelings, tried vent its recurrence as well. The
stock of her thoughts and her feel- to verify the assumption on which nurse's primary responsibility, al-
ings when the signal light went on her thoughts were based, she might though seldom specifically defined,
the second, the third, or fourth time? have been able to identify Mrs. is, I think, the patient's perception of
Would she have recognized the Bradley's problem, and then, with his condition. She has the opportuni-
reality of those thoughts and feelings purpose as her guide, directed her ty, by virtue of her close and con-
and their relationship to each other? action toward its effective resolution. tinuous association with her patient,
Awareness that she had both to detect how he is experiencing his
thoughts and feelings would perhaps condition and why he experiences it
Articulating a Philosophy
have brought awareness of their in- as he does. She can initiate action to
terrelatedness. For instance, just as Philosophy may be thought of as enhance his motivation to cope with
she recognized the light over the an aggregate of personal beliefs, re- his condition in his situation and to
door as a signal to her to investigate flecting one's attitude toward life or make the best use of measures de-
the reason for its appearance, so she reality. These beliefs stem from each signed-and recommended-to give
might have been helped to recognize individual's culture and subculture him immediate and lasting relief.
the heightened feelings that she felt and are an integral part of him. It is a Fulfillment of the purpose involves
as a signal to her to investigage the useful exercise to try to articulate essentially three major units of nurs-
reason for their occurrence. The light one's basic beliefs, for only through ing practice: (1) identification of the
appeared because Mrs. Bradley awareness of them, can the individ- individual's need for help, (2) min-
flicked the switch. The heightened ual make effective use of them in his istration of help needed, and (3)
feelings, however, occurred because daily living. A philosophy of nursing, validation that the help given was
of the nurse's interpretation of the I believe, is part of the nurse's phi- indeed the help needed. To pull
meaning of the repeated reappear- losophy of life, narrowed, possibly, to these units out of the myriad moves
ance of the light. To investigate the beliefs she holds in relation to the gift the nurse makes as she cares for pa-
reason for her heightened feelings of life, to the patient under her care, tients each day is no easy task. Sel-
thus, the nurse would need to try to and to herself as a responsible mem- dom do they appear as distinct enti-
establish the cause of the thoughts ber of the nursing profession. ties as they are here described, nor
that made up the interpretation. Philosophy underlies purpose, and do they always follow in logical se-
Would the nurse have recognized purpose reflects philosophy. The pur- quence. One or two of them may be
that her thoughts were founded not pose of nursing, which stems in part there by implication only. To gain
on fact, but on an assumption based from such a philosophy, is what the clearer understanding, however, not
on her interpretation of Mrs. Brad- nurse strives to accomplish in rela- only of exactly what the nurse may
ley's motive for repeated turning on tion to every individual under her do, but of how she may go about
her signal light? It is possible, of care. I have conceptualized this pur- doing it, each unit needs to be set
course, that Mrs. Bradley actually pose to be: to facilitate the efforts of apart, looked at closely, and brokern
believed that the nurse had nothing the individual to overcome the ob- down into its elements.
to do except to care for her. The stacles which currently interfere with Before beginning examination of
nurse, however, made no effort to his ability to respond capably to de- the units of nursing practice, one may
verify this assumption. Instead, she mands made of him by his condition, well ask, "What is meant by 'need,'
suppressed her thought and let edgi- environment, situation, and time. and what is meant by 'help'?"
ness creep into her voice. On the Paraphrased, it may be expressed For the purpose of this discus-
other hand, had she expressed the as: to meet the need the individual sion, a need is thought of as anything
question in her mind and asked Mrs. is experiencing as a need-for-help. the individual requires to maintain

VOL. 63, NO. 11 NOVEMBER


1963 * 55

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or sustain himself in his situation; The first is the nurse's use of her let the patient know how the nurse is
help is thought of as any measure or powers of observation. This means interpreting his behavior and to ask
action that enables the individual to that she does not just look and listen, him if that is how he means it. A
overcome whatever interferes with but that she looks and listens third is to admit to the patient that
his ability to function capably in re- for inconsistencies between what her the nurse does not understand how
lation to his situation. A need-for- patient says and the way he looks as he means a phrase she heard him use,
help, then, is any measure or action he says it; between the way he looks a look she noticed on his face, or a
required and desired by the individu- and the way she expected him to special gesture she observed, and
al that has potential for restoring or look; between what he says and what ask him for clarification.
extending his ability to cope with the she expected him to say; or between In identifying an individual's need-
demands implicit in his situation. what she hears him say or sees him do, for-help a third step is to determine
Functional ability, or ability to and her concept of what he might the cause of the discomfort which
cope, is an intrinsic quality of the in- say or do if he were comfortable, or the nurse has ascertained the patient
dividual. It is something he must de- capable, in his present situation. is experiencing. Had the nurse found
velop within himself; no one can give Think back to Mrs. Bradley's re- out from Mrs. Bradley, for instance,
it to him or develop it in him or for peatedly turning on her signal light. why she was unable to sleep, before
him. By the same token, help to be Her action was inconsistent with the giving her the sedative, she might
helpful must be used by the individu- nurse's expectation as a result of the have learned that Mrs. Bradley's
al and succeed in enhancing or ex- help she thought she had given and need was for something other than a
tending his capability. with her concept of how Mrs. Brad- pill. The cause of her wakefulness
A helping measure such as a med- ley would act were she comfortable may have been worry about her
ication, a treatment, advice or infor- or capable of making use of the in- children at home, a concern which a
mation, may be offered to an individ- tended helping measure. These in- telephone call to the family might
ual, but unless he accepts it and al- consistencies, of which the nurse may have relieved. It may have been a
lows it to fulfill its intent, its effective- have been aware but apparently did fear of being alone, a concern that
ness may be minimized or destroyed. not recognize as significant, might might have been allayed by leaving
The actual use the individual may have served as clues that Mrs. Brad- the door ajar and giving assurance
make of any helping act or measure ley was experiencing distress. that the nurse was near. Or it may
is under control of his entire nervous Recognition of inconsistencies does have been any one of a dozen other
system, and because he is a physi- not mean that the need-for-help has conditions or situations. Without
cally- physiologically- psychologically been revealed. It merely alerts the knowing the cause of the individual's
reacting being, his response to the act nurse to the possible presence of a discomfort or incapability, the prob-
may be voluntary or involuntary. need-for-help. lem, and the need to which it gives
The regulatory mechanism of the in- A second step is to gain under- rise, cannot, with assurance, be re-
dividual's nervous system may be at- standing of how the patient means solved.
tenuated by traumatic environmental the cue-the word, look, manner, or To determine the cause of the in-
factors or by emotional conflicts. gesture that triggered the nurse's dividual's discomfort, one or several
When this occurs, the individual's recognition of an inconsistency. For detecting measures, in addition to ob-
ability to respond capably to de- instance, a nurse saw a mother sit- servation and direct questioning, may
mands made of him may be im- ting in bed, weight shifted to one need to be applied. Included among
paired as long as the causative side, lips tight and brow furrowed. them might be inspection, palpation,
factors or emotional conflicts remain. To her question, "How are you this and taking the patient's temperature,
Such interference with his coping morning?" the mother answered, pulse, and respirations. Such a search
ability usually causes the individual without looking at the nurse, "Fine." for the cause may lead the nurse to
to feel distress, which he is apt to The nurse then queried, "How do the patient's problem and thus to the
manifest through his behavior. you mean, fine? You look to me as need he is experiencing. It does not
though you felt anything but fine." tell her, however, whether the need
And the mother answered, this time is a need-for-help.
Identifying the Need-for-Help
looking at the nurse, "I wasn't sure A fourth step is to establish wheth-
Crucial to the helping art of nurs- you really wanted to know. It's my er the individual is able to meet his
ing is identification of the individual's stitches. They hurt!" The meaning of need himself or whether he requires
need for help. To take help-inten- this mother's ambiguous behavior help to do so. The nurse may find
tioned action without first finding out could not be determined until she, this out by asking the patient; or she
what is interfering with the individ- herself, clarified it. may do so by offering a suggestion
ual's ability to meet his own need, Clarification of what a patient may of what to do and noting whether he
whether he wants help, what help he mean by his behavior may be gained seems willing to act on her sugges-
can use, and how he will be able to in a variety of ways. One that has tion.
use it, is to court defeat. As in the been found effective is to describe, in To determine whether the help the
instance of the nurse and Mrs. Brad- a wondering kind of way, the incon- nurse may intend to give is accepta-
ley, nursing action may not have the sistencies the nurse may have ob- ble to the individual, the nurse again
desired results. served in the individual's behavior will need to use her powers of ob-
To identify an individual's need- and ask him to help her understand servation. This time she will look and
for-help involves four distinct steps. how he means them. Another is to listen for consistencies between the

56 JOURNALOF NURSING
THEAMERICAN
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patient's behavioral response to her tice, the nurse may call on the full tation. Under some circumstances she
suggestion and her concept of a posi- range of resources to which she has might also determine from the patient
tive response. She will also make sure access, and the greater her stock of that her interpretation of his behavior
that her interpretation of the patient's resources, the greater her potential was the same as his.
response is as the patient meant it. for effective service. Included in the Should the nurse's search for evi-
If she is convinced that the intended range would be her own beliefs, val- dence reveal that the desired results
helping measure is acceptable, she is ues, knowledge, and skills, especially were not obtained, she may need to
ready to carry it out. If, on the other those of communication and of carry- re-examine what she did by asking
hand, she finds that the patient seems ing out procedures of various kinds; herself, "Did I really identify the need
to resist the help she planned to pro- other individuals, like the doctor or for help the patient was experienc-
vide, she will find out from the pa- social worker, whom she may wish ing?" and "Did I provide the help he
tient why he resists her offer of help. to consult or to whom the patient needed in a way that was acceptable
If his reason seems to have validity, may wish to be referred; and facili- to him?" The answer may direct her
she may modify or even abandon her ties of the community and beyond. to a new starting point.
plan. There was the nurse, for in- In ministering to her patient, be The secret of the helping art of
stance, who was caring for Mr. it in the form of giving advice or in- nursing lies in the importance the
Green. formation, of making a referral, of nurse attaches to her thoughts and
Mr. Green refused to get out of applying a comfort measure or of car- feelings and the deliberate use she
bed and into a wheel chair for the rying out a therapeutic procedure, makes of them as she observes her
first time following his operation. the nurse will need to assure herself patient, identifies his need for help,
With encouragementfrom the nurse, of the individual's acceptance of the ministers to his need, and validates
he reluctantly admitted that he "resource" throughout its administra- that the help she gave was helpful.
feared she would not be strong tion. Should the patient become un- If she recognizes her thoughts and
enoughto help him safely into it. The comfortablewith what is being done, feelings, respects their importance,
nurse could understandthe basis of the nurse will need to identify the and disciplines herself to harness
his fear and sought the aid of another cause and, if necessary, make an ad- them to her purpose and her philoso-
nurse to help her give him the sup- justment in her plan of action. phy, not only will she enrich her
port he felt he needed. Again her powers of observation nursing practice, but she will in all
If, however, the patient's reason came into play-to assure herself that probability experience enduring sat-
for resisting seems to be based on the patient's progressive behavioral isfaction from the helping service she
only partial understanding of the response to her ministrations is con- has rendered.
situation, then the nurse may need sistent with her expectation of it. And
to broaden his base of understanding again she finds out whether her in-
before attempting to carry out her terpretation of the patient's behavior
plan. Mrs. Smith's nurse provides an it what the patient means.
example.
Mrs. Smith vociferously objected Validating the Measure
to having an enema following her ad-
missionto the hospital'slabor ward. Validation that the help given was
She dislikedthem, she explained,she indeed the help needed is to find evi-
was having painful contractions,she dence that the desired results were Bibliography
had had no food for six hours, and achieved and the purpose of nursing
she had had a satisfactory bowel fulfilled. This evidence may be ob- ARGYRIS, CHRIS. The organization:
movementjust before coming to the tainable immediately, or it may take what makes it healthy. Harvard
Bsns.R. 36:107-116, Nov.-Dec. 1958.
hospital.The nurseexpressedher un- minutes, hours, or even days. Until CAMERON,JOYCE. The patientneeds to
derstandingof Mrs. Smith'sfeelings the nurse gains evidence from the pa- be understood. IN Nursing and the
and reasons, but then helped her to tient, however, that the intent of Patient's Motivations. (Clinical paper
recognize that there were factors of her ministration was achieved, she no. 19) N.Y. American Nurses' As-
whichMrs.Smithmightnot be aware. cannot be sure that her nursing had sociation, 1962, pp. 5-13.
DUMAS, G. R., AND LEONARD, R. C. Ef-
One was the doctor'sreasonfor want- the desired results. fect of nursing on the incidence of
ing her to have an enema; the other, Evidence must come from the pa- postoperative vomiting. Nurs.Res.
the way the nurse planned to admin- tient, and it is his behavior that pro- 12:12-15, Winter 1963.
HAYAKAWA, S. W. Language in
ister it. This added information vides the clue. Had Mrs. Bradley,
Thought and Action. 3d ed. N.Y.,
helped Mrs. Smith to overcome her for instance, stopped flashing her Harcourt Brace and Co., 1949.
strongresistanceto the enema and to light after administration of the ORLANDO, IDA JEAN. The Dynamic
acceptit withoutfurtherprotest. medication, the nurse would have Nurse-PatientRelationship:Function,
Practice and Principles. N.Y., G. P.
suspected that the sedative had had Putnam's Sons, 1961.
Ministration of Help the desired effect. To be certain that TRYON, PHYLLIS A. The effect of pa-
this was so, however, she would need tient participationin decision making
Once the patient's need-for-help to convince herself that Mrs. Bradley on the outcome of a nursing pro-
has been identified, the nurse is was asleep. Again she would observe, cedure.IN Nursingand the patient's
motivations. (Clinical paper no. 19)
ready to provide the help that is noting consistencies between her pa- N.Y., American Nurses' Association,
needed. In this unit of nursing prac- tient's behavior and her own expec- 1962, pp. 14-18.

VOL. 63, NO. 11 1963 * 57


NOVEMBER

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