Introduction
of Virginia Henderson
Virginia A. Henderson,
a Modern-Day
Mother of Nursing, has earned the title "foremost
nurse of the 20th century” or “The
Nightingale of Modern Nursing”. Her contributions
are compared to those of Florence Nightingale because of their far-reaching
effects on the national and international nursing communities. She was born
in Kansas City, Missouri, in 1897.
She did diploma in nursing from the Army School of Nursing
at Walter Reed Hospital, Washington, D.C. in 1921.In 1923, she started teaching nursing at the
Norfolk Protestant Hospital in Virginia. In 1929, she entered Teachers College at
Columbia University for Bachelor’s Degree in 1932; Master’s Degree in 1934. She was recipient of numerous
recognitions, well known nursing educator and a prolific author. An
inspiration to nurses everywhere, she has influenced nursing practice,
education, and research throughout the world. She has written several text
books in nursing field. She died
on March
19, 1996 at 99 years of age.
Theory Background
·
She called her definition of nursing her “concept”
(Henderson1991)
·
She emphasized the importance of increasing the
patient’s independence so that progress after hospitalization would not be
delayed (Henderson,1991)
·
"Assisting individuals to gain independence in
relation to the performance of activities contributing to health or its
recovery" (Henderson, 1966).
·
She categorized nursing activities into 14
components, based on human needs.
·
She described the nurse's role as substitutive
(doing for the person), supplementary (helping the person), complementary
(working with the person), with the goal of helping the person become as
independent as possible.
·
Her definition of nursing was:
"The
unique function of the nurse is to assist the individual, sick or well, in the
performance of those activities contributing to health or its recovery, or to a
peaceful death, that he would perform unaided if he had the necessary strength,
will, or knowledge, and to do this in such a way as to help him gain
independence as rapidly as possible."1966
Assumptions of Henderson’s Basic Needs Nursing
Theory
v
Individuals
have biological, psychological, social, & spiritual components or needs.
v
Nursing
activities are categorized into 14 components & are based on human needs.
v
These
components are closely paralleled to Maslow’s hierarchy of human needs.
v
Health
is the achievement of independence defined as the individual’s ability to
function.
v
Independence
and dependence (due to illness) are on a continuum and it is the nurse’s role
to assist the individual regain independence (see diagram)
v
The
nurse has 3 primary roles with the goal of working with the person to become as
independent as possible.
v
These
roles are: Substitutive (doing for the person)
Supplementary (helping the person)
Complementary (working with the person)
The 14
components
·
Breathe normally.
·
Eat and drink adequately.
·
Eliminate body wastes.
·
Move and maintain desirable postures.
·
Sleep and rest.
·
Select suitable clothes-dress and undress.
·
Maintain body temperature within normal range by
adjusting clothing and modifying environment
·
Keep the body clean and well groomed and protect
the integument
·
Avoid dangers in the environment and avoid injuring
others.
·
Communicate with others in expressing emotions,
needs, fears, or opinions.
·
Worship according to one’s faith.
·
Work in such a way that there is a sense of
accomplishment.
·
Play or participate in various forms of recreation.
·
Learn, discover, or satisfy the curiosity that
leads to normal development and health and use the available health facilities.
Comparison with Maslow's Hierarchy of Need
|
Maslow's
|
Henderson
|
|
Physiological needs
|
Breathe normally
Eat and drink adequately Eliminate by all avenues
of elimination Move and maintain desirable posture Sleep and rest Select
suitable clothing Maintain body temperature Keep body clean and well groomed
and protect the integument
|
|
Safety Needs
|
Avoid environmental dangers and avoid injuring
other
|
|
Belongingness and love needs
|
Communicate with others
worship according to one's faith
|
|
Esteem needs
|
Work at
something providing a sense of accomplishment
Play or
participate in various forms of recreation
Learn,
discover, or satisfy curiosity
|
Henderson’s theory and the four
major concepts
|
Major
Concepts
Human
or Individual
·
Have basic needs that are component of health.
·
Requiring assistance to achieve health and
independence or a peaceful death.
·
Mind and body are inseparable and interrelated.
·
Considers the biological, psychological,
sociological, and spiritual components.
·
The theory presents the patient as a sum of parts
with biopsychosocial needs.
·
Society or Environment
Settings
in which an individual learns unique pattern for living.
·
All external conditions and influences that
affect life and development.
·
Individuals in relation to families
·
Minimally discusses the impact of the community
on the individual and family.
·
society wants and expects the nurse’s
service of acting for individuals who are unable to perform
the 14 activities unaided
·
She supports the tasks of private and
public health agencies keeping people healthy.
Health
·
Definition based on individual’s ability to
function independently as outlined in the 14 components.
·
Nurses need to stress promotion of health and
prevention and cure of disease.
·
Good health is a challenge -affected by age,
cultural background, physical, and intellectual capacities, and emotional
balance Is the individual’s ability to meet these needs independently.
·
Nursing
Temporarily
assisting an individual who lacks the necessary strength, will and knowledge
to satisfy 1 or more of 14 basic needs.
·
Assists and supports the individual in life
activities and the attainment of independence.
·
Nurse serves to make patient “complete”
“whole", or "independent."
·
The nurse is expected to carry out
physician’s therapeutic plan Individualized care is the result of the
nurse’s creativity in planning for care.
·
“Nurse should have knowledge to practice
individualized and human care and should be a scientific problem solver.”
·
In the Nature of Nursing Nurse role is,” to get
inside the patient’s skin and supplement his strength will or knowledge
according to his needs.”
|
Sub
concepts
·
14
Activities for Client Assistance
Physiological
1. Breathe normally
2. Eat and drink adequately
3. Eliminate body wastes
4. Move and maintain desirable postures
5. Sleep and rest
6. Select suitable clothes – dress and undress
7. Maintain body temperature within normal range by adjusting clothing and
modifying environment
8. Keep the body clean and well groomed and protect the integument
9. Avoid dangers in the environment and avoid injuring others
Psychological Aspects of Communicating and Learning
10. Communicate with others in expressing emotions, needs, fears, or opinions
14. Learn, discover, or satisfy the curiosity that leads to normal
development and health and use the available health facilities
Spiritual and Moral
11. Worship according to one’s faith
Sociologically Oriented to Occupation and Recreation
12. Work in such a way that there is sense of accomplishment
·
13. Play or participate in various forms of recreation
“It is equally important to realize that these needs are satisfied by
infinitely varied pattern of living, no two of which are alike.” (Henderson,
1960)
|
Henderson’s and Nursing Process
”Summarization
of the stages of the nursing process as applied to Henderson’s definition of
nursing and to the 14 components of basic nursing care.
|
Nursing
Process
|
Henderson’s
14 components and definition of nursing
|
|
Nursing
Assessment
|
Henderson’s
14 components
|
|
Nursing
Diagnosis
|
Analysis:
Compare data to knowledge base of health and disease.
|
|
Nursing
plan
|
Identify
individual’s ability to meet own needs with or without assistance, taking
into consideration strength, will or knowledge.
|
|
Nursing
implementation
|
Document
how the nurse can assist the individual, sick or well.
|
|
Nursing
implementation
|
Assist
the sick or well individual in to performance of activities in meeting human
needs to maintain health, recover from illness, or to aid in peaceful death.
|
|
Nursing
process
|
Implementation based on the
physiological principles, age, cultural background, emotional balance, and
physical and intellectual capacities.
Carry out treatment prescribed
by the physician.
|
|
Nursing evaluation
|
Henderson’s 14 components and
definition of nursing
Use the acceptable definition of;
nursing and appropriate laws related to the practice of nursing.
The quality of care is
drastically affected by the preparation and native ability of the nursing
personnel rather that the amount of hours of care.
Successful outcomes of nursing
care are based on the speed with which or degree to which the patient
performs independently the activities of daily living
|
Strength and weakness of
Henderson’s theory
Strength:
·
There is interrelation of concepts.
·
Concepts of fundamental human needs, biophysiology,
culture, and interaction, communication are borrowed from other discipline.
E.g. Maslow’s theory.
·
Her definition and components are logical and the
14 components are a guide for the individual and nurse in reaching the chosen
goal.
·
Relatively simple yet generalizable.
·
Applicable to the health of individuals of all
ages.
·
Can be the bases for hypotheses that can be tested.
·
Assist in increasing the general body of knowledge
within the discipline.
·
Her ideas of nursing practice are well accepted.
·
Can be utilized by practitioners to guide and
improve their practice.
Weakness:
·
A major shortcoming in her work is the lack of a
conceptual linkage between physiological and other human characteristics.
Analysis
One
cannot say that every individual who has similar needs indicated in the 14
activities by Henderson are the only things that human beings need in attaining
health and for survival. With the progress of today’s time, there may be added
needs that humans are entitled to be provided with by nurses.
The prioritization of the 14 Activities was not clearly explained whether the
first one is prerequisite to the other. But still, it is remarkable that
Henderson was able to specify and characterize some of the needs of individuals
based on Abraham Maslow’s hierarchy of needs.
Some of the activities listed in Henderson’s concepts can only be applied to
fully functional individuals indicating that there would always be patients who
always require aided care which is in contrary to the goal of nursing indicated
in the definition of nursing by Henderson.
Because of the absence of a conceptual diagram, interconnections between the
concepts and sub concepts of Henderson’s principle are not clearly delineated.
Application to Practice
Current
practice– cardiac step down unit specializing in heart failure. Goal of nursing
care is to return the patient to his/her optimal self care ability via
education on diet, medications, daily weights and follow up appointments to the
physician
Challenges
– due to co morbidities associated with heart failure, some patients may not
have the desire or capability to return to their pre-admission state,
therefore, the nurse must accept the patient’s perspective and definition of
“wellness”
Research
Testability
of the practice and outcomes of nursing. “Each of the 14 activities can be the
basis for research” (Wills, 2007, p.140)
Interpretation: quantitative and qualitative research has been beneficial
in evaluating this theory due to the combination of actions (14 activities) and
the assumed devotion of the nurse to his/her patients (affective evaluation)
Conclusion
Virginia believed that the
function the nurse performs is primarily an independent one – that of acting
for the patient when he lacks knowledge , physical strength, or the will to act
for himself as he would ordinarily act in health, or in carrying out prescribed
therapy. This function is seen as complex and creative, as offering unlimited
opportunity for the application of the physical, biological, and social
sciences and the development of skills based on them.
Henderson
provides the essence of what she believes is a definition of nursing. Her
definition of nursing and the 14 components of basic nursing care are
uncomplicated and self-explanatory.
“The most FAMOUS NURSE of the 20th century.
Miss Henderson gave our profession its identity.
Her work is the soul of Modern Nursing.” (McBride)
References
1.
George B. Julia , Nursing Theories- The base for
professional Nursing Practice , 3rd ed. Norwalk, Appleton & Lange.
2.
Potter A Patricia, Perry G Anne (1992) Fundamentals
Of Nursing –Concepts Process & Practice 3rd ed. London Mosby Year Book.
3.
Wills M.Evelyn, McEwen Melanie (2002). Theoretical
Basis for Nursing Philadelphia. Lippincott Williams& wilkins.
4.
Meleis Ibrahim Afaf (1997) , Theoretical Nursing :
Development & Progress 3rd ed. Philadelphia, Lippincott.
5.
Taylor Carol,Lillis Carol (2001)The Art &
Science Of Nursing Care 4th ed. Philadelphia, Lippincott.
6.
Vandemark L.M. Awareness of self & expanding
consciousness: using Nursing theories to prepare nurse –therapists Ment Health
Nurs. 2006Jul; 27(6):605 15
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