Nursing Theories

A companion to nursing theories

Virginia Henderson’s Need Theory

“Nursing theories mirror different realities, throughout their development; they reflected the interests of nurses of that time.”

Introduction

•   “The Nightingale of Modern Nursing”

•   “Modern-Day Mother of Nursing.”

•  "The 20th century Florence Nightingale."

•  "little Miss 3x5"

• Born in Kansas City, Missouri, in 1897 and is the 5^th child of a family of 8^th children but spent her formative years in Virginia

• Received a Diploma in Nursing from the Army School of Nursing at Walter Reed Hospital, Washington, D.C. in 1921.

•   Worked at the Henry Street Visiting Nurse Service for 2 years after graduation.

•  In 1923, she accepted a position teaching nursing at the Norfolk Protestant Hospital in Virginia, where she remained for several years

•  In 1929, Henderson determined that she needed more education and entered Teachers College at Columbia University where she earned her;   Bachelor’s Degree in 1932, Master’s Degree in 1934.

•  Subsequently, she joined Columbia as a member of the faculty, where she remained until 1948(Herrmann,1998)

•  Since 1953, she has been  a research associate at Yale University School of Nursing.

•  Died: March 19, 1996. 

Achievements                                                                                    

•  Is the recipient of numerous recognitions for her outstanding contributions to nursing?

•  VH was a well known nursing educator and a prolific author.

•   She has received honorary doctoral degrees from the

  • Catholic University of America

  • Pace University,

  • University of Rochester,

  • University of Western Ontario,

  • Yale University

• Her stature as a nurse, teacher, author, researcher, and consumer health advocate warranted an obituary in the New York Times, Friday March 22. 1996. 

•  In 1985, Miss Henderson was honored at the Annual Meeting of the Nursing and Allied Health Section of  the Medical Library Association. 

Contribution

• In 1937 Henderson and others created a basic nursing curriculum for the National League for Nursing in which education was “patient  centered and organized around nursing problems rather than medical diagnoses” (Henderson,1991) 

•  In 1939, she revised: Harmer’s classic textbook of nursing for its 4th edition, and later wrote the 5th; edition, incorporating her personal definition of nursing (Henderson,1991)

• Although she was retired, she was a frequent visitor to nursing schools well into her nineties.

• O’Malley (1996) states that Henderson is known as the modern-day mother of nursing. Her work influenced the nursing profession in America and throughout the world

• The founding members of ICIRN (Interagency Council on Information Resources for Nursing) and a passionate advocate for the use and sharing of health information resources.

• In 1978 the fundamental concept of nursing was revisited by Virginia Henderson from Yale University School of Nursing ( USA ). She argued that nurses needed to be prepared for their role by receiving the broadest understanding of humanity and the world in which they lived.

Publications

• 1956 (with B. Harmer)-Textbook for the principles and practices of Nursing.

• 1966-The Nature of Nursing. A definition and its implication for practice, Research and Education

• 1991- The Nature of Nursing Reflections after 20 years

Analysis of Nursing Theory

• Images of Nursing, 1950-1970

• The First School of Thought: Needs

• This school of thought includes theories that reflect an image of nursing as meeting the needs of clients and were developed in response to such questions as

• What do nurses do?

• What are their functions?

• What roles do nurses play?

• Answers to these questions focused on a number of theorist describing functions and roles of nurses.

• Conceptualizing functions led theorists to consider nursing client in terms of a Hierarchy of needs. When any of these needs are unmet and when a person is unable to fulfill his own needs, the care provided by nurses is required.

• Nurses then provide the necessary functions and play those roles that could help patients meet their needs.

School of thought in Nursing Theories-1950-1970

Analysis of nursing theories according to 1st School

Henderson’s Theory Background

• Henderson’s concept of nursing was derived form her practice and education therefore, her work is inductive.

• She called her definition of nursing her “concept” (Henderson1991)

• Although her major clinical experiences were in medical-surgical hospitals, she worked as a visiting nurse in New York City. This experience enlarges Henderson’s view to recognize the importance of increasing the patient’s independence so that progress after hospitalization would not be delayed (Henderson,1991)

• Virginia Henderson defined nursing as "assisting individuals to gain independence in relation to the performance of activities contributing to health or its recovery" (Henderson, 1966, p. 15).

• She was one of the first nurses to point out that nursing does not consist of merely following physician's orders.

• 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 famous definition of nursing was one of the first statements clearly delineating nursing from medicine:
  "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 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" (Henderson, 1966, p. 15).

The development of Henderson’s definition of nursing

• Two events are the basis for Henderson’s development of a definition of nursing.

1.  First, she participated in the revision of a nursing textbook.

2.  Second, she was concerned that many states had no provision for nursing licensure to ensure safe and competent care for the consumer.

• In the revision she recognized the need to be clear about the functions of the nurse and she believed that this textbook serves as a main learning source for nursing practice should present a sound and definitive description of nursing.

• Furthermore, the principles and practice or nursing must be built upon and derived from the definition of the profession.

• Although official statements on the nursing function were published by the ANA in 1932 and 1937, Henderson viewed these statements as nonspecific and unsatisfactory definitions of nursing practice.

• Then in 1955, the earlier ANA definition was modified.

• Henderson's focus on individual care is evident in that she stressed assisting individuals with essential activities to maintain health, to recover, or to achieve peaceful death.

• She proposed 14 components of basic nursing care to augment her definition.

• In 1955, Henderson’s first definition of nursing was published in Bertha Harmer’s revised nursing textbook.

The 14 components

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.

10. Communicate with others in expressing emotions, needs, fears, or opinions.

11. Worship according to one’s faith.

12. Work in such a way that there is a sense of accomplishment.

13. Play or participate in various forms of recreation.

14. Learn, discover, or satisfy the curiosity that leads to normal development and health and use the available health facilities.

• The first 9 components are physiological.

• The tenth and fourteenth are psychological aspects of communicating and learning

• The eleventh component is spiritual and moral

• The twelfth and thirteenth components are sociologically oriented to occupation and recreation

Assumption

The major assumption of the theory is that:

• Nurses care for patients until patient can care for themselves once again.

• Patients desire to return to health, but this assumption is not explicitly stated.

• Nurses are willing to serve and that “nurses will devote themselves to the patient day and night”

• A final assumption is that nurses should be educated at the university level in both arts and sciences.

Henderson’s theory and the four major concepts

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, and the patient is neither client nor consumer.

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.

• Supports tasks of private and public agencies

• Society wants and expects nurses to act for individuals who are unable to function independently.

• In return she expects society to contribute to nursing education.

• Basic nursing care involves providing conditions under which the patient can perform the 14 activities unaided

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."

• Henderson's classic definition of nursing:
  "I say that the nurse does for others what they would do for themselves if they had the strength, the will, and the knowledge. But I go on to say that the nurse makes the patient independent of him or her as soon as possible."

• 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.

• Use nursing research

• Categorized

  • Nursing : nursing care

  • Non nursing: ordering supplies, cleanliness and serving food.

• In the Nature of Nursing “ that the nurse is and should be legally, an independent practitioner and able to make independent judgments as long as s/he is not diagnosing, prescribing treatment for disease, or making a prognosis, for these are the physicians function.”

• “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.”

  • And nurse has responsibility to assess the needs of the individual patient, help individual meet their health need, and or provide an environment in which the individual can perform activity unaided.

Henderson's classic definition of nursing

"I say that the nurse does for others what they would do for themselves if they had the strength, the will, and the knowledge. But I go on to say that the nurse makes the patient independent of him or her as soon as possible."

Henderson’s and Nursing Process

• Henderson views the nursing process as “really the application of the logical approach to the solution of a problem. The steps are those of the scientific method.”

• “Nursing process stresses the science of nursing rather than the mixture of science and art on which it seems effective health care service of any kind is based.”

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.

Comparison with Maslow's Hierarchy of Need

Characteristic of Henderson’s theory

• Theories can interrelate concepts in such a way as to create a different way of looking at a particular phenomenon.

• Concepts of fundamental human needs, biophysiology, culture, and interaction, communication and is borrowed from other discipline.E.g.. Maslow’s Hierarchy of human needs; concept of interaction-communication i.e. nurse-patient relationship

• Theories must be logical in nature.

• Her definition and components are logical and the 14 components are a guide for the individual and nurse in reaching the chosen goal.

• Theories should be relatively simple yet generalizable.

• Her work can be applied to the health of individuals of all ages.

• Theories can be the bases for hypotheses that can be tested.

• Her definition of nursing cannot be viewed as theory; therefore, it is impossible to generate testable hypotheses.

• However some questions to investigate the definition of nursing and the 14 components may be useful.

• Is the sequence of the 14 components followed by nurses in the USA and the other countries?

• What priorities are evident in the use of the basic nursing functions?

• Theories contribute to and assist in increasing the general body of knowledge within the discipline through the research implemented to validate them.

• Her ideas of nursing practice are well accepted throughout the world as a basis for nursing care.

• However, the impact of the definition and components has not been established through research.

• Theories can be utilized by practitioners to guide and improve their practice.

• Ideally the nurse would improve nursing practice by using her definition and 14 components to improve the health of individuals and thus reduce illness.

• Theories must be consistent with other validated theories, laws, and principles but will leave open unanswered questions that need to be investigated.

Philosophical claims

The philosophy reflected in Henderson's theory is an integrated approach to scientific study that would capitalize on nursing's richness and complexity, and not to separate the art from the science, the "doing" of nursing from the "knowing", the psychological from the physical and the theory from clinical care.

Values and Beliefs

• Henderson believed nursing as primarily complementing the patient by supplying what he needs in knowledge, will or strength to perform his daily activities and to carry out the treatment prescribed for him by the physician.

• She strongly believed in "getting inside the skin" of her patients in order to know what he or she needs. The nurse should be the substitute for the patient, helper to the patient and partner with the patient.  Like she said...
  "The nurse is temporarily the consciousness of the unconscious, the love of life for the suicidal, the leg of the amputee, the eyes of the newly blind, a means of locomotion for the infant and the knowledge and confidence for the young mother..."

• Henderson stated that “Thorndike’s fundamental needs of man” (Henderson, 1991, p.16) had an influence on her beliefs.

Value in extending nursing science

• From an historical standpoint, her concept of nursing enhanced nursing science this has been particularly important in the area of nursing education.

• Her contributions to nursing literature extended from the 1930s through the 1990s and has had an impact on nursing research by strengthening the focus on nursing practice and confirming the value of tested interventions in assisting individuals to regain health.

Usefulness

• Nursing education has been deeply affected by Henderson’s clear vision of the functions of nurses.

• The principles of Henderson’s theory were published in the major nursing textbooks used from the 1930s through the 1960s, and the principles embodied by the 14 activities are still important in evaluating nursing care in thee21st centaury.

• Others concepts that Henderson (1966) proposed have been used in nursing education from the 1930s until the present O'Malley, 1996)

Testability

• Henderson supported nursing research, but believed that it should be clinical research (O’Malley, 1996). Much of the research before her time had been on educational processes and on the profession of nursing itself, rather than on; the practice and outcomes of nursing , and she worked to change that.

• Each of the 14 activities can be the basis for research. Although the statements are not.

• Written in testable terms, they may be reformulated into researchable questions. Further, the theory can guide research in any aspect of the individual’s care needs.

Limitations

• Lack of conceptual linkage between physiological and other human characteristics.

• No concept of the holistic nature of human being.

• If the assumption is made that the 14 components prioritized, the relationship among the components is unclear.

• Lacks inter-relate of factors and the influence of nursing care.

• Assisting the individual in the dying process she contends that the nurse helps, but there is little explanation of what the nurse does.

• “Peaceful death” is curious and significant nursing role.

Purposes of nursing theories

In Practice:

• Assist nurses to describe, explain, and predict everyday experiences.

• Serve to guide assessment, interventions, and evaluation of nursing care.

• Provide a rationale for collecting reliable and valid data about the health status of clients, which are essential for effective decision making and implementation.

• Help to describe criteria to measure the quality of nursing care.

• Help build a common nursing terminology to use in communicating with other health professionals.  

• Ideas are developed and words are defined.

• Enhance autonomy (independence and self-governance) of nursing through defining its own independent