Virginia Henderson's Need Theory

INTRODUCTION

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• “The Nightingale of Modern Nursing.”
• "Modern-Day Mother of Nursing."
• "The 20th century Florence Nightingale."
• Born in Kansas City, Missouri, in 1897.
• 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, started teaching nursing at the Norfolk Protestant Hospital in Virginia
• In 1929, entered Teachers College at Columbia University for Bachelor’s Degree in 1932, Master’s Degree in 1934.
• Joined Columbia as a member of the faculty, remained until 1948.
• Since 1953, a research associate at Yale University School of Nursing.
• Recipient of numerous recognitions.
• Her work influenced the nursing profession throughout the world.
• honorary doctoral degrees from the Catholic University of America, Pace University, University of Rochester, University of Western Ontario, Yale University
•  In 1985, honored at the Annual Meeting of the Nursing and Allied Health Section of the Medical Library Association.
• Died: March 19, 1996.
• 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)

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” (Henderson1991)
• She emphasized 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 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 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 assumptions of the theory are:

• "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 bio-psychosocial 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
• 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

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

• There is interrelation of concepts in such a way as to create a different way of looking at a particular phenomenon.
• Concepts of fundamental human needs, bio-physiology, culture and interaction, communication are borrowed from other discipline. Eg. Maslow’s Hierarchy of human needs; concept of interaction-communication i.e. nurse-patient relationship
• 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.
• 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.

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)

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.

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.

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