Theory

This page was last updated on November 6, 2010

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“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; 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
• 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 the US 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)
• 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 ).

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 theorists

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

interaction
Need theorists Outcome theorists
Theorists
King

Orlando
Johnson
Peterson and
Abdellah Levine
Zderad
Henderson
Orem Rogers
Paplau
Roy
Travelbee

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

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).
• 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 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 Henderson’s definition of nursing

Two events are the basis for Henderson’s 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.

He believed the principles and practice or nursing must be built upon and
derived from the definition of the profession.

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

• 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.

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.

Henderson’s 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 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?

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 physician’s therapeutic plan
Individualized care is the result of the nurse’s 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
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.

Nursing Process Henderson’s 14 components and definition of

nursing

Nursing Henderson’s 14 components

Assessment

Nursing Analysis: Compare data to knowledge base of

Diagnosis 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 Document how the nurse can assist the

implementation individual, sick or well.

Nursing Assist the sick or well individual in to

implementation 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 Henderson’s 14 components and definition of
evaluation 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

Eat and drink adequately Eliminate

by all avenues of elimination Move
Physiological
and maintain desirable posture Sleep
needs
and rest Select suitable clothing
Maintain body temperature Keep
body clean and well groomed and
protect the integument

Avoid environmental dangers and

Safety Needs
avoid injuring other

Communicate with others

Belongingness
and love needs
worship according to one's faith
Work at something providing a sense of
accomplishment

Esteem needs Play or participate in various forms of

recreation

Learn, discover, or satisfy curiosity

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 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 Henderson’s definition of nursing
• 14 components
• Major four concepts
• Nursing process with Henderson’s 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 didn’t 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.

Reference

1. Timber BK. Fundamental skills and concepts in Patient Care,

7th edition, LWW, N
2. George B. Julia , Nursing Theories- The base for professional
Nursing Practice , 3rd ed. Norwalk, Appleton & Lange.
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. Potter A Patricia, Perry G Anne (1992) Fundamentals Of
Nursing –Concepts Process & Practice 3rd ed. London Mosby
Year Book.
7. Vandemark L.M. Awareness of self & expanding
consciousness: using Nursing theories to prepare nurse –
 therapists Ment Health Nurs. 2006 Jul; 27(6) : 605-15
8. Reed PG, The force of nursing theory guided- practice. Nurs
Sci Q. 2006 Jul;19(3):225

9. Delaune SC,. Ladner PK, Fundamental of nursing, standard

and practice, 2nd edition, Thomson, NY, 2002

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