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1.The nurse’s central purpose in nursing is the
nurse’s professional commitment.For Wiedenbach,
the central purpose in nursing is to motivate the
individual and/or facilitate his efforts to over-
come the obstacles that may interfere with his
ability to respond capably to the demands made
of him by the realities in his situation
(Wiedenbach, 1970, p. 4). She emphasized that
the nurse’s goals are grounded in the nurse’s
philosophy, that “those beliefs and values that
shape her attitude toward life, toward fellow
human beings and toward herself.” The three
concepts that epitomize the essence of such a
philosophy are: (1) reverence for the gift of life;
(2) respect for the dignity, autonomy, worth,
and individuality of each human being; and (3)
resolution to act dynamically in relation to
one’s beliefs (Wiedenbach, 1970, p. 4). She rec-
ognized that nurses have different values and
various commitments to nursing and that to

To formulate one’s purpose in nursing is a

“soul-searching experience.”

formulate one’s purpose in nursing is a “soul-
searching experience.” She encouraged each
nurse to undergo this experience and be “willing
and ready to present your central purpose in
nursing for examination and discussion when
appropriate” (Wiedenbach, 1970, p. 5).
2.The prescription indicates the broad general ac-
tion that the nurse deems appropriate to fulfill-
ment of her central purpose.The nurse will have
thought through the kind of results to be sought
and will take action to obtain these results,
accepting accountability for what she does and
for the outcomes of her action. Nursing action,
then, is deliberate action that is mutually under-
stood and agreed upon and that is both patient-
directed and nurse-directed (Wiedenbach,
1970, p. 5).
3.The realities are the aspects of the immediate nurs-
ing situation that influence the results the nurse
achieves through what she does(Wiedenbach,
1970, p. 3). These include the physical, psycho-
logical, emotional, and spiritual factors in which
nursing action occurs. Within the situation are
these components:

• The Agent, who is the nurse supplying the
  nursing action;
  
  
  • The Recipient, or the patient receiving this
    action or on whose behalf the action is
    taken;
  
  
  • The Framework, comprised of situational fac-
    tors that affect the nurse’s ability to achieve
    nursing results;
  
  
  • The Goal, or the end to be attained through
    nursing activity on behalf of the patient;
  
  
  • The Means, the actions and devices through
    which the nurse is enabled to reach the
    goal.
  
  
  
  

ORLANDO

Nursing is responsive to individuals who suffer or an-

ticipate a sense of helplessness; it is focused on the

process of care in an immediate experience; it is con-

cerned with providing direct assistance to individuals

in whatever setting they are found for the purpose of

avoiding, relieving, diminishing or curing the indi-

vidual’s sense of helplessness. (Orlando, 1972)

The essence of Orlando’s theory, the Dynamic

Nurse-Patient Relationship, reflects her beliefs that

practice should be based on needs of the patient

and that communication with the patient is essen-

tial to understanding needs and providing effective

nursing care. Following is an overview of the major

components of Orlando’s work.

1.The nursing processincludes identifying needs

of patients, responses of the nurse, and nursing

action. The nursing process, as envisioned and

practiced by Orlando, is not the linear model

often taught today, but is more reflexive and

circular and occurs during encounters with

patients.

2.Understanding the meaningof patient behavior

is influenced by the nurse’s perceptions,

thoughts, and feelings. It may be validated

through communication between nurse and pa-

tient. Patients experience distress when they

cannot cope with unmet needs. Nurses use di-

rect and indirect observations of patient behav-

ior to discover distress and meaning.

3.Nurse-patient interactionsare unique, complex,

and dynamic processes. Nurses help patients ex-

press and understand the meaning of behavior.

The basis for nursing action is the distress expe-

rienced and expressed by the patient.

4.Professional nursesfunction in an independent

role from physicians and other health-care

providers.

CHAPTER 7 Twentieth-Century Nursing:Wiedenbach, Henderson, and Orlando’s Theories and Their Applications 73