Basic Needs Nursing Theory “The nurse’s role is to “get inside the patient’s skin & supplement his strength, will, or knowledge according to his needs. . .”

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 20^th 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

Online References:

v http://currentnursing.com/nursing_theory/henderson

v http://nurses.info/nursing_theory_person_henderson_virginia

v http://www.nursinglibrary.org