untitled

consultation, i.e., conferencing, and seeking help

or advice; and collaboration, i.e., giving assistance or

cooperation with members of other professional or

nonprofessional groups concerned with the individ-

ual’s welfare. The content of the fourth circle repre-

sents activities which are essential to the ultimate

well-being of the experiencing individual, but only

indirectly related to him: nursing education, nursing

administration and nursing organizations. The outer-

most circle comprises research in nursing, publication

and advanced study, the key ways to progress in every

area of practice.

Wiedenbach’s nursing practice application of
her prescriptive theory was evident in her practice
examples. These often related to general basic nurs-
ing procedures and to maternity nursing practice.
In discussing the practice and process of nursing,
she stated:

The focus of Practice is the experiencing individual,

i.e., the individual for whom the nurse is caring, and

the way he and only he perceived his condition or sit-

uation. For example, a mother had a red vaginal dis-

charge on her first postpartum day. The doctor had

recognized it as lochi, a normal concomitant of the

phenomenon of involution, and had left an order for

her to be up and move about. Instead of trying to get

up, the mother remained, immobile in her bed. The

nurse who wanted to help her out of bed expressed

surprise at the mother’s unwilling to do so, when she

seemed to be progressing so well. The mother ex-

plained that she had a red discharge, and this to her

was evidence of onset of hemorrhage. This terrified

her and made her afraid to move. Her sister, she

added, had hemorrhaged and almost lost her life the

day after she had her baby two years ago. The nurse

expressed her understanding of the mother’s fear, but

then encouraged her to compare her current experi-

ence with that of her sister. When the mother tried to

do this, she recognized gross differences, and accepted

the nurse’s explanation of the origin of the discharge.

The mother then voiced her relief, and validated it by

getting out of bed without further encouragement

(Wiedenbach, 1962, pp. 6–7).

Wiedenbach considered nursing a “practical

phenomenon” that involved action. She believed

that this was necessary to understand the theory

that underlies the “nurse’s way of nursing.” This in-

volved “knowing what the nurse wanted to accom-

plish, how she went about accomplishing it, and in

what context she did what she did” (Wiedenbach,

1970, p. 1058). Realizing her early efforts to link

theory, practice, and merit, and to include these

also in nursing education, Wiedenbach stated:

May each of you spark nurses in and of the future, to

make theory a conscious part of their practice. The

opportunity you have to do this is exciting! And it

is rewarding, for, by helping nurses to uncover the

theory that underlies their practice, you are paving

the way for them to render a finer quality of service to

the patient, and to gain a deepened sense of fulfill-

ment for themselves (Wiedenbach, 1970, p. 15).

ORLANDO

Orlando’s theoretical work was based on analysis of

thousands of nurse-patient interactions to describe

major attributes of the relationship. Based on this

work, her later book provided direction for under-

standing and using the nursing process (Orlando,

1972). This has been known as the first theory of

nursing process and has been widely used in nurs-

ing education and practice in the United States and

across the globe. Orlando considered her overall

work to be a theoretical framework for the practice

of professional nursing, emphasizing the essential-

ity of the nurse-patient relationship. Orlando’s the-

oretical work reveals and bears witness to the

essence of nursing as a practice discipline.

While there is little evidence in the literature

that Orlando’s theory has been directly used in

nursing practice, it is highly probable that nurses

familiar with her writing used her work to guide or

CHAPTER 7 Twentieth-Century Nursing:Wiedenbach, Henderson, and Orlando’s Theories and Their Applications 75

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FIGURE 7–1 Professional Nursing practice focus and compo-
nents.Reprinted with permission from the Wiedenbach Reading
Room (1962),Yale University School of Nursing.