VIRGINIA HENDERSONS 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 5th child of a family of 8th 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; Bachelors Degree in 1932,
Masters 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: Harmers 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. OMalley (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
Need theorists

interaction Theorists

Outcome theorists

King

Abdellah
Henderson
Orem

Orlando

Johnson

Peterson and Zderad

Levine

Paplau

Rogers

Travelbee

Roy

Wiedenbach

Analysis of nursing theories according to 1st School

Focus

Problems
A set of needs or problems.

Human being
A developmental being.
Patient

Need Deficit

Orientation

Illness, disease
Dependent on medical practice.

Role of nurse

Beginnings of independent functions

Fulfill needs requisites

Decision making

Primarily health care professional

Hendersons Theory Background

Hendersons 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 Hendersons view to recognize the importance of increasing the
patients 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).

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).

The development of Hendersons definition of nursing

Two events are the basis for Hendersons development of a definition of nursing.

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

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, Hendersons first definition of nursing was published in Bertha Harmers
revised nursing textbook.
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 ones 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.

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 assumptions of the theory aret:

"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.

Hendersons theory and the four major concepts

1. 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.

2.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

3. Health:

Definition based on individuals 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 individuals ability to meet these
needs independently?

4. 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 physicians therapeutic plan Individualized care is the
result of the nurses creativity in planning for care.

Use nursing research

o Categorized Nursing : nursing care
o 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 patients 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."

Hendersons 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 Hendersons definition of
nursing and to the 14 components of basic nursing care.
Nursing Process
Nursing
Assessment

Hendersons 14 components and definition of nursing

Hendersons 14 components

Nursing Diagnosis Analysis: Compare data to knowledge base of health and disease.
Nursing plan

Identify individuals 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 Hendersons 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

Comparison with Maslow's Hierarchy of Need

Maslow's

Henderson
Breathe normally

Physiological
needs

Safety Needs

Belongingness
and love needs

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
Avoid environmental dangers and avoid injuring other

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

Characteristic of Hendersons 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.. Maslows 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 Thorndikes 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 Hendersons clear vision of the functions
of nurses.

The principles of Hendersons 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
(OMalley, 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 individuals 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 functions.

In Education:

Provide a general focus for curriculum design

Guide curricular decision making.

In Research:

Offer a framework for generating knowledge and new ideas.

Assist in discovering knowledge gaps in the specific field of study.

Offer a systematic approach to identify questions for study; select variables,

interpret findings, and validate nursing interventions.

Approaches to developing nursing theory

Borrowing conceptual frameworks from other disciplines.

Inductively looking at nursing practice to discover theories/concepts to

explain phenomena.

Deductively looking for the compatibility of a general nursing theory with

nursing practice.

Questions from practicing Nurse about using Nursing theory

Practice

Does this theory reflect nursing practice as I know it?

Will it support what I believe to be excellent nursing practice?

Can this theory be considered in relation to a wide range of nursing situation?

Personal Interests, Abilities and Experiences

What will it be like to think about nursing theory in nursing practice?

Will my work with nursing theory be worth the effort?

Summary

Background

Achievements

Publications

Analysis of Nursing theories

Development of Hendersons definition of nursing

14 components

Major four concepts

Nursing process with Hendersons theory

Comparison with Maslow's Hierarchy need

Assumptions

Usefulness

Testability

Characteristics

Limitation

Conclusion
In conclusion, Henderson provides the essence of what she believes is a definition of nursing.
She didnt intend to develop a theory of nursing but rather she attempted to define the unique
focus of nursing. Her emphasis on basic human needs as the central focus of nursing practice has

led to further theory development regarding the needs of the person and how nursing can assist in
meeting those needs. Her definition of nursing and the 14 components of basic nursing care are
uncomplicated and self-explanatory.
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