Virginia Henderson Theory Presentation By Kirsten Kulkarni Neeta Monteiro Pierre Nkurunziza

Why this theorist’s model/theory? “The Nightingale of Modern Nursing.” “Modern-Day Mother of Nursing.” “The 20th century Florence Nightingale.” “The first lady of Nursing” “First truly international nurse”

Virginia Avenel Henderson 1897-1996 Nursing Theorist Virginia Avenel Henderson 1897-1996

Background Born in Kansas City Missouri, in 1897 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 two years after graduation

Background 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, and Master’s Degree in 1934 In 1939, she revised: Hamer’s classic textbook of nursing for its 4th edition, and later wrote the 5th edition incorporating her personal definition of Nursing (Henderson, 1991)

Background Joined Columbia as a member of the faculty, remained until 1948 Since 1953, a research associate at Yale School of Nursing Recipient of numerous recognitions Her work influenced the nursing profession throughout the world A well known nursing educator and a prolific author

Background Honorary doctoral degrees from the Catholic University of America, Pace University, University of Rochester, University of Western Ontario, Yale University (held honorary degrees from 13 universities). In 1985, honored at the Annual Meeting of the Nursing and Allied Health Section of the Medical Library Association Died: March 19th , 1996

Theory history Henderson did not intend to develop a theory of nursing She attempted to define the unique focus of nursing She emphasized on basic human needs as the central focus of nursing practice. Two events that lead to the creation of the definition of Nursing * Helped revise a Nursing textbook * She was concerned that many states had no provision for nursing licensure

Nursing defined by Henderson Virginia Henderson’s 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).

Henderson’s philosophy “She emphasized the importance of increasing the patient’s independence so that progress after hospitalization would not be delayed. 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.”

Original purpose Improving patient’s outcomes by application of nursing process Collaborative care Patient centered care Amelioration of health in general

Virginia Henderson’s 14 Components She categorized nursing activities into 14 components, based on human needs 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 the 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

Breathe normally 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 the 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 Breathe normally

The 14 components 1. Breathe normally

14 components 2. Eat and drink adequately

14 components 3. Eliminate body wastes

14 components 4. Move and maintain desirable postures

14 components 5. Sleep and rest

14 components 6. Select suitable clothes- dress and undress

14 components 7. Maintain body temperature within normal range by adjusting clothing and modifying environment

14 components 8. Keep the body clean and well groomed and protect the integument

14 components 9. Avoid dangers in the environment and avoid injuring others.

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

14 Components 11. Worship according to one’s faith

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

14 components 13. Play or participate in various forms of recreation

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

The 14 components Physiological : The first 9 components Psychological: 10th and 14th Spiritual : 11th component Sociological : 12th and 13th

Comparison with Maslow’s Hierarchy of Needs

Internal Theory Analysis Relative importance of concepts. Is each given equal weight? Each of the 14 components as described by Virginia Henderson are given equal importance. Nevertheless the patient may need assistance with only some of the components at a given time depending on the patient’s health condition.

The Collaborative Team

Henderson’s Theory and the four major concepts 1. Individual Have basic needs that are components 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

Four major concepts 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

Four major concepts Environment (continued) 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.

Four major concepts 3. Health Definition based on individuals ability to function independently outline in the 14 components. Nurses need to stress promotion of health and prevention and cure of disease. Good health is a challenge. Is the individual able to meet these needs independently? Good health is a challenge. Affected by age, cultural background, physical, and intellectual capacities, and emotional balance. Is the individual able to meet these needs independently?

Four major concepts 4.Nursing Temporarily assisting an individual who lacks the necessary strength, will, and knowledge to satisfy one or more of the 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.”

Four major concepts Nursing (continued) Henderson’s classic definition of nursing Carry out physician’s therapeutic plan. Individualized care is the result of the nurse’s creativity in planning care.

Four major concepts Nursing (continued) 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.”

Four major concepts Nursing (continued) Nurse should have knowledge 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.”

Four major concepts Nursing (continued) Nurse has responsibility to *assess patient’s needs *help individual meet their need *provide a safe environment

Assumptions The major assumptions of the theory are: “Nurses care for patients until patient can care for themselves once again”. Patients desire to return to health (not explicit). Nurses are willing to serve and that “nurses will devote themselves to the patient day and night”. Nurses should be educated at the university level in both arts and science.

External Analysis Semantic clarity The terminologies that are used in this theory are clear, easily understandable and simple. Structural Clarity There is no model to represent this theory. Simplicity This theory is simple and easy to use

External analysis Generalizability This theory is applicable to people of all age groups, cultures, gender, health conditions and different settings. Accessibility Information regarding this theory is accessible, but newer theorists have since then developed ideas that are built from the concepts proposed in this theory.(An example of this is Orem’ s basic needs theory)

External Analysis How is this theory applicable to nursing clinical practice or education or administration? Practice Assists nurses in everyday experiences Serves as a guide in the nursing process Provides a rationale for effective decision making and implementation Nursing care evaluation criteria Facilitates communication among the health care team members Ideas are developed and words are defined Enhance autonomy

External Analysis Education Provide a general focus for curriculum design Guide curricular decision making Research Offers a framework for generating knowledge and new ideas Helps discover knowledge gaps Gives a foundation for other theories

Bibliography of Virginia Henderson 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 1950-1970- Analysis of Nursing Theory Images of Nursing The development of Henderson’s definition of Nursing

School of thoughts in Nursing theories 1950-1970 Need Theorists Interaction Theorists Outcome Theorists Abdellah King Henderson Orlando Johnson Orem Peterson and Zderad Levine Paplau Rogers Travelbee Roy Wiedenbach

Analysis of Nursing Theories According to 1st School Focus Problem Human Being A set of needs or problems A development being Patient Need Deficit Orientation Illness, disease Role of nurse Dependent on medical practice Beginnings of independent functions Fulfill needs requisites Decision making Primarily health care professional

Henderson’s Theory Background Henderson’s concept of nursing was derived from her practice and education, therefore her work is inductive She called her definition of nursing her “Concept” (Henderson 1991) (Henderson, 1991)

Henderson’s Theory Background

Henderson’s Theory 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 -- Nursing Intervention Nursing assessment -- Nursing implementation Nursing diagnosis -- Nursing Evaluation Nursing plan

Characteristic of Henderson’s Theory Interrelation of concepts Concepts are borrowed from other disciplines Her definition and components are logical and the 14 components are a guide for the individual and nurse in reaching the chose goal Theories should be relatively simple yet generalizable- Henderson’s theory can be applied to individuals of all ages

Characteristics of Henderson’s theory Theories can be the bases for hypotheses that can be tested- Her definition of nursing cannot be viewed as a theory, therefore it is not possible to generate testable hypotheses. However some questions to investigate the definition of nursing and the 14 components may be useful.

Characteristics of Henderson’s Theory Theories contribute to and assist in increasing the general body of knowledge within the discipline through 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.

Characteristics of Henderson’s Theory 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.

Usefulness Nursing education has been deeply affected by Henderson’s clear vision of the function of the nurse. Published in nursing textbooks from 1930’s -1960’s. Still important in evaluating nursing care in the 21st century Henderson’s other concepts have been used from 1930’s to present.

Limitations Lack of conceptual linkage between psychological and other human characteristics No concept of the holistic nature of human being The relationship between the components is unclear Lacks inter-relate of factors and the influence of nursing care

Limitations (continued) Assisting the individual in the dying process she includes 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 In Education In Research Personal practice

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.

References