Throughout the development of Nursing as a field of specialization, there were numerous theories formulated by renowned nurse scientists to explain the nature of Nursing as a distinct science, and the relationship of nurses to various clienteles, may they be individuals, families, or groups. Among the nurse researchers who laid the foundation for contemporary nursing would be Virginia Avenel Hernderson. Henderson was a nurse theorist who has contributed significantly to nursing ideals and nursing practice. She has been called the "First Lady of Nursing and the First Truly International Nurse" because of her writings, research presentations and contacts with nurses that profoundly affected nursing and gave an impression on the recipients of care by nurses throughout the world.
The significance of a theory to Nursing as a profession as stated by Virginia Henderson:
"NURSING is rooted from the needs of humanity and is founded on the ideal of service. And that, “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a means of locomotion for the infant, knowledge and confidence for the mother and the mouthpiece for those too weak or withdrawn to speak."
Virginia Henderson was famous for her Definition of Nursing which states that "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."
This statement still holds true. Nurses, especially those assigned in acute care - where most nurses play an active role, are concerned with taking care of patient's needs and assisting them with activities of daily living - activities that the clients would have been capable of doing had they not been sick or incapacitated. Nurses are also crucial instruments for dying patients to have peaceful death and in consoling loved ones when the inevitable happens.
However, it is also interesting to know that Henderson's Definition of Nursing is not only applicable in nursing practice but is also important in the nursing academe and realm of nursing research. Professors and clinical instructors use nursing theories, such as Henderson's, to structure their pedagogical approach while nurse researchers use theories as framework for their particular research study.
A.K.A.: First Lady of Nursing Born: November 30, 1897, in Kansas City, Missouri Died: March 16, 1996 at age 98 at the Connecticut Hospice, Branford. CT Father: Atty. Daniel B. Henderson Mother: Lucy Minor (Abbot) Henderson
“ 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 peaceful death) that he would perform unaided if he had the necessary strength, will or knowledge.”
Early education at home in Virginia with her aunts, her sister and an uncle, Charles Abbot, at his school for boys in the community Army School of Nursing, Washington, D.C.
Graduated in 1921 at Teachers College, Columbia University (Bachelor of Science degree completed in 1931 while Masters of Science degree in 1934)
Career in Nursing:
Henry Street Visiting Nurse Association, New York, New York (1921)
Norfolk Protestant Hospital, Norfolk, Virginia as an Instructor and Educational Director (1924-1929)
Strong Memorial Hospital, Rochester, New York as a Supervisor and Clinical Instructor at the Outpatient Department (1930)
Teachers College, Columbia University, New York as an Instructor and Associate Professor (1934-1948)
Yale University School of Nursing, New Haven, Connecticut as a Research Associate (1953-1971) and as a Research Associate Emeritus (1971-1996)
Honors and Awards:
The honors bestowed on Henderson are numerous. To mention just a few, she held honorary degrees from thirteen universities; she was selected at the American Nurses Associations Hall of Fame and had the Sigma Theta Tau International Library named in her honor. She was honored by the Virginia Nurses Association in 1988 when the Virginia Historical Nurse Leadership Award was presented to her. In 2000, the Virginia Nurses Association recognized Henderson as one of fifty-one Pioneer Nurses in Virginia. She was also the recipient of the Virginia Historical Nurse Leader Award and was awarded the first Christianne Reimann Prize in June 1985 due to the transnational scope of her work. She received honorary doctorate degrees from the prestigious universities like University of Western Ontario, University of Rochester, Yale University, Rush University, Pace University, Catholic University of America, Old Dominion University, Boston College, Thomas Jefferson University, Emory University and many others. She was also a fellow of the American Academy of Nursing and a member of the American Nurses Association Hall of Fame.
Who can find a good natured Nurse? For her price is far above silver and gold. She seeks medicines and skills, and works willingly with others.
She gives of herself and considers her own desires last. A heartwarming smile is hers, and is made beautiful in her eyes.
She girds herself with honor and strengthens her ability with patience. She perceives that her work is good. Her candle does not go out by night. She lays her hands upon understanding.
She stretches out her hand to the poor; yet, she reaches forth hands to the needy. She is not afraid of sorrow, for her trust is in God. Pride and humility are her clothing, and she shall rejoice in time to come.
She opens her mouth with comfort, and in her tongue is the law of kindness. Her associates rise up and call her blessed; her patients also praise her kindness.
Many daughters have helped others, but you excel them all.
Favor is deceitful, and beauty is vain. But a Nurse that fears the Lord -- She shall be praised!
It is equated with independence or ability to perform activities without any aid in the 14 fundamental or basic human needs.
Nurses need to stress promotion of health, prevention of illness and its cure.
Necessary strength, will, and knowledge is important in achieving health.
Health is basic to human functioning.
Health promotion is more important than care of the sick.
“It is the quality of health rather than life itself, that margin of mental physical vigor that allows a person to work most effectively and to reach his highest potential level of satisfaction in life”
-Henderson and Nite, 1978
It encompasses all external conditions and influences that affect life and development.
Society wants and expects nurses to act for individuals who are unable to function independently; in return, the nurse expects the society to contribute to nursing education.
The environment may also include individuals in relation to families and the settings in which an individual learns unique pattern for living.
There are seven essentials that must be present in the environment which include light, temperature, air movement, atmospheric pressure, appropriate disposal of waste, minimal quantities of injurious chemicals, and cleanliness of any surfaces coming in contact with individual.
The environment can act positively or negatively upon the patient.
It can an also be altered in such a way to support a patient.
Definition of Nursing states that, "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 emphasized the art of nursing and identified 14 basic human needs of patients which comprises the components of nursing care core.
Henderson wrote her definition of nursing before the development of theoretical nursing. She described nursing roles in relation to patient needs instead of creating a general theory of nursing. The nurse's goal is to make the patient "complete" ,"“whole", or "independent." In turn, the nurse collaborates with the physician's therapeutic plan. He/she provides individualized care. and utilizes nursing research as a source of standards for rendering care to clients.
Henderson's work is widely used by nurses in different nations because of its practicality and realistic application in nursing practice. The nursing assessment, diagnosis, plan and evaluation parallels the doctors' general decision-making processes.
"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."
Blais et al. (2002). Professional nursing practice: Concepts and perspectives (4th ed.). Upper Saddle River, NJ: Pearson Prentice Hall.
D’Antonio et al. (eds.). (2007). Nurse’s work: Issues across time and place. New York: Springer Publishing.
Cora Anonuevo et al. Theoretical Foundations of Nursing.UP Open University
If you must get sick, a Nurse is the nicest thing that can happen to you.
Nurse come in all sizes, shapes, colors and ages. Efficiently cheerful, they will rustle past you many times a day.
When Hercules cleaned the Augean Stables, he set a standard which the Nurse surpasses each day. Buoyed by an immense sympathy for mankind and undismayed by experiences with particular members of that, at times, cantankerous race, they perform miracles of devotion with effortless cheer.
When you rub your Alladin's Lamp (or sound your buzzer) your little Genie appears. Perhaps they have been summoned needlessly a dozen times already. But they are cheerfully ready to soothe you, to help you down your medicine, to smooth down your bed, to answer your fears.
The Nurse is the Doctor's guard against forgetfulness, his questioning conscience, at times his challenge, and at all times his skilled right arm.
Their charming cap (well, use to be anyway) perches undisturbed through the roughest day. They have no self for themselves. Their all is for their patients. If they are short with one patient, it is because they are pressing to return to the one whose need is greater.
The Big Show (life itself) must go on. This is the Nurse's creed, their battle, their drive. They will fight to the end with every trick, every knowledge, ever passion.
At the end of the day, the Nurse returns home, physically weary, but with their inner light glowing brightly, for they have richly earned the peace within themselves.
If you must get sick, you are mighty lucky to have a Nurse happen to you.
Underlying Assumptions Based on Virginia Henderson’s Definition of Nursing
1. Independence is valued by the nurse and the patient, more than dependence.
The client’s independence is promoted and encouraged. The phenomenon of goal attainment is quite clearly stated within Henderson’s definition of nursing in the final sentence: “And to do this in such a way as to help him gain independence as rapidly as possible.” Ultimately, the sooner the person can care for himself or herself, find health information, or carry out prescribed treatments, the better off the person is. It is hoped that the recipients of care feel that the choice is their own.
2. Health has a meaning shared by the society at large.
Henderson explained how the factors of age, cultural background, physical and intellectual capacities, and emotional balance affect one’s health. These conditions are always present and affect basic needs. Because of her concern for the welfare of people, Henderson believed that nurses “should be in the forefront of those who work for social justice, for a healthful environment, for access to adequate food, shelter, and clothing, and universal opportunities for education and employment, realizing that all of these as well as preventive and creative health care are essential to the well-being of citizens.” By working on various social issues, nurses can have an impact on people’s health.
3. Individuals desire health or a peaceful death and will act in such a way to achieve this.
The individual pertains to person/s who are considered recipient/s of the nurse's action. Of foremost importance is that they should have good recognition of their present condition and by all means work towards the acquisition of the desired health state.
4. Individuals will perform activities leading to health if they have the knowledge, capacity or will.
The individual is by nature functional and can care for himself. However, due to the presence of a health condition, their capacity for self-care is compromised or limited. The role of the nurse enters the picture to be of assistance to the individual in providing for needs until such time that the individual learns the necessary skills and knowledge to care for self again in order to achieve optimum health.
5. The individual’s goal and the nurse’s goal are congruent.
Activities by the nurse can only be meaningful if they are also compliant with the individual's goal for health. Therefore, the nurse should explore about the individual's goal for care and integrate this in providing nursing care. Moreover, the uniqueness of the individual's condition should also be acknowledged to make nursing actions more salient to the person's needs.
6. The 14 basic needs represent nursing’s basic function.
Henderson considered the biological, psychological, sociological, and spiritual components. Her 14 components of nursing function can be categorized in the following manner. The first nine components are physiological; the tenth and fourteenth are psychological aspects of communicating and learning; the eleventh component is spiritual and moral; and the twelfth and thirteenth components are sociologically oriented to occupation and recreation. She referred to humans as having basic needs that are included in the 14 components. However, she further stated, “It is equally important to realize that these needs are satisfied by infinitely varied patterns of living, no two of which are alike.”
7. Nursing’s goal may be subsumed into the medical treatment plan.
Henderson also emphasized that nursing activities are planned with the individual; however, it must also be in accordance with the therapeutic regimen of the physician. Likewise, nurses also take responsibility for the care of the person in the absence of the physician.
8. The major explicit assumption is Henderson’s contention that the nurse is an independent practitioner.
However, she also contends that the nurse is the primary helper in carrying out physician’s prescriptions.
As a member of the health care team, Henderson expects nurses to carry out the therapeutic plan of the physician. This nursing function is believed to foster the therapeutic nurse-client relationship. As a member of the interdisciplinary health team, the nurse assists the individual to recovery or to provide support in dying. The ideal situation for a nurse is full participation as a team member with no interference with the nurse’s unique functions. The nurse serves as a substitute for whatever the patient lacks in order to make him or her “complete,” “whole,” or “independent,” considering the person's physical strength, will, or knowledge to attain health.
Contributors: Araullo, Dennis - Cavite, Philippines Bautista, Irene Kate- Las Pinas City, Philippines Bernardo, Marlon - Marilao, Philippines
walk through those doors with pride, Who's life will i save tonight? Someone is waiting for me, Someone is alive today because of my duty. Sometimes we cry cause we can't save them all, God sometimes won't let us interfere when he calls. A baby's first breath when he looks at me, The joy of my first delivery. The tear i wipe a way with my own hands, The life ending of a gentle old man. The night seems so dark and the morning so bright. Being a nurse you see life in a different light. Who will i save tonight? Who will hold my hand during their last breath with no fright? Who will enter this world on my shift? How many mothers will greet their babies with a kiss? I don't know who these special people are but i will meet them with every call I will hold them tight and help the pain I will hold them up when they feel faint. I will be strong when i am needed That is my job, I am a nurse..that is my duty.
Nursing is an independent profession that centers on the provision of basic nursing care. It revolves around helping patients successfully perform the 14 basic needs and is able to make independent judgment that does not include, diagnosing, prescribing, or making prognosis which are the functions of a physician. The nurse is equipped with knowledge and skills in both biological and social sciences as a guide in the performance of duties. Moreover, being considered as the most continuous service compared to other medical fields, the nurse is expected to devout self in aiding patients attain independence or utmost capabilities in the performance of the basic needs. However, if these are unobtainable, the nurse assists the patient in achieving a peaceful and dignified death.
The Nurse- Patient Relationship
CAPTION: Breathing is one of the fundamental basic needs. For a patient who cannot breathe on his own, the nurse will serve as the patient’s temporary breath.
The nurse can act on three levels during a nurse- patient relationship related to the patient’s dependency for the fulfillment of the 14 basic needs: the nurse as a substitute for the patient; as a helper to the patient; as a partner with the patient.
“… temporarily the consciousness of the unconscious, the love life for the suicidal, the leg of the amputee, the eyes of the newly blind, a means of locomotion for the infant, knowledge and confidence of the young mother, the mouthpiece for those too weak or withdrawn to speak…”
During times of severe illness, the nurse acts as a substitute for the incapacities of the patient in order to preserve the patient’s wholeness or independence. This inability to perform basic needs out of a disease is due to the lack of physical strength, will, or knowledge.
“Independence is a relative term. None of us is independent of others, but we strive for a healthy interdependence, not a sick dependence.”
At times of recovery, the nurse shifts from the position of being the patient’s sole provider of needs to that of a helper to aid the patient acquire or regain independence. The patient is seen therefore as somebody who has an aim of regaining self- control or achieving a state of health.
“…get inside the skin of each of her patients in order to know what he needs.”
By becoming partners, the nurse and patient work together in planning for care. The nurse must also be able to assess beyond patient’s needs, including the conditions and pathologies that alter these needs.
“In every situation, nurses who know physiologic and psychologic reactions to temperature and humidity, light and color, gas pressures, odors, noise, chemical impurities, and microorganisms can organize and make the best use of the facilities available.”
Nurses must know how to alter the environment to help the patient promote health. Moreover, the nurse and the patient work together for a common goal: independence or peaceful death. Goals of the nurse include promotion of activities to keep the patient as “normal” as possible and promotion of health more than cure interventions.
The Nurse- Physician Relationship
CAPTION: Nurse’s role is beyond following medical orders.
The nurse and the physician have a common goal of preservation and restoration of health. However, their means of achieving this goal is different. The primary role of the physician is the diagnosis and treatment “cure” of the disease whereas the primary role of the nurse is the “care” process, consisting of caring, helping, comforting, and guiding. Nevertheless, both disciplines have a shared responsibility and are not exclusive of each other.
During the performance of their roles, nurses according to Henderson do not follow physician’s order but rather care plan devised by the nurse and the patient should be in accordance to the therapeutic regimen of the physician. Nurses also take the responsibility of health management in the absence of the physician.
The Nurse as a Member of the Health Team
CAPTION: Henderson also tried to illustrate the unique functions of the health care team members using the wedges on a pie graph. The distribution of sections depends on the patient’s current needs. The sections change as the patient progresses, and the ultimate goal is for the patient to have the greatest part of the pie slice.
The nurse works collaboratively with other health professionals in providing for the client’s total care. They should not do each other’s job and should not impose demand on any member of the health team. The participation of each health team member depends on the patient’s needs and therefore changes as patient progresses towards independence. In the end, there will be less participation of the health care team as the patient is able to independently perform the basic needs.
All the members of the health care team should consider the patient as the central figure and should regard their respective disciplines as providing assistance to the patient. More importantly, they should help the patient realize his own capacitance for self- care and work towards aiding the patient gain independence in meeting needs. The sooner the patient cares for self and follows the therapeutic regimen, the better he will become.
Marriner, A. (1986). Nursing Theorists and Their Work. St. Louis: CV Mosby.
Henderson, V. and Nite, G. (1978). The Principles and Practice of Nursing. New York: Macmillan.
Henderson, V. (1966). The Nature of Nursing a Definition and Its implications fro Practice, Research and Education. New York: Macmillan
I dedicate myself to thee, 0 Lord, my God, this work I undertake Alone in thy great name, and for thy sake. In ministering to suffering I would learn The sympathy that in thy heart did burn. Take, then, mine eyes, and teach them to perceive The ablest way each sick one to relieve. Guide thou my hands, that e'en their touch may prove The gentleness and aptness born of love. Bless thou my feet, and while they softly tread May faces smile on many a sufferer's bed. Touch thou my lips, guide thou my tongue, Give me a work in sermon for each one. Clothe me with patience, strength all tasks to bear, Crown me with hope and love, which know no fear, And faith, that coming face to face with death Shall e'en inspire with joy the dying breath. All through the arduous day my actions guide, All through the lonely night watch by my side, So I shall wake refreshed, with strength to pray, Work in me, through me, with me, Lord, this day.
An accomplished author, avid researcher and a visionary, Virginia Henderson, is considered to be the most important nursing figure in the 20th century.
APPLICATION TO NURSING PRACTICE
Henderson's Definition of Nursing is still directly applicable to professional nursing today. Nurses function to assist patients in activities of daily living, especially those who are incapable of doing so because of a debilitating condition.
The 14 Fundamental Needs described by Henderson, has been very influential in the practice of nursing. It is very evident in the clinical settings how the nurse carries the tasked to assist the client in meeting his or her needs - may it be physical, social, emotional or spiritual by addressing the patient’s ability to breath normally, eat and drink adequately and eliminate body wastes as primary concerns that the nurse should address.
The devotion of nurses in the actual practice of 24hour – 7days a week reflects its incomparable value in task performance for it is the goal of nursing to promote a higher level of client dependence. But in the event that they still lack the strength and knowledge, nurses act as a temporary proxy in helping them meet their needs that neither the client nor the family can provide.
With the increasing incidence of stroke who’s suffering from disabilities including paralysis, the forth activity of “moving and maintaining desirable posture” for patient’s assistance can contribute to prevention of further bedsore and its complications. The paralyzed patient in the hospital primarily needs the nurses’ assistance in moving about and assuming various positions in the bed. While the patient remains helpless as to movement, the nurse aids the patient with the use of her knowledge and skills. Through turning patient to sides, chest tapping and the likes, pneumonia and pressure sores could be a distant possibility. Furthermore, during the whole hospitalization process, the nurse not only assists the client with mobility but also educates the client and the family as well. Through that, patient independence will be promoted as the client gains the strength and ability to perform activities of daily living. The family, too, acquiring knowledge in the care of a family member with disability can take on the challenge of caring and assisting the client at home after being discharged from the hospital.
Breathing is vital and Henderson’s first basic need of breathing normally is at most assessed at all times. Administration of oxygen should be given accordingly. Her application on nursing gives assertion to initiate immediate provision of biological needs such as nasogastric tube insertion for feeding to maintain nourishment, while catheterization is suggested for patients requiring general surgeries to help them excrete waste while on the process of inability to do it consciously.
Meeting the 14 fundamental needs of the client has been a great basis to further improve our performances towards nursing care. It has been the day-to-day components of delivering nursing care core from infancy to senescence.
She further elaborated that the mind and body is inseparable and comprised as one entity. Her patient-centered theory stressed the importance of the nurse's relationship to the patient and the development of nursing practices. As a direct care giver, it will be rewarding to see the patient as he progresses to independence. The promotion of assessment, planning, implementation and evaluation of the 14 components of basic nursing as a core basis should be considered at all times.
INFLUENCE ON NURSING EDUCATION
Henderson has made numerous contributions in the nursing profession which has been a basis of most nursing schools. One of her long list of contributions is her well known definition of nursing which calls for the nurse to be an expert and an independent practitioner being equipped with the right knowledge in basic nursing care to achieve its goal’s definition. Her definition along with the 14 basic needs brought tremendous changes in our field of practice. It has made advancement, especially in the teaching of nursing interventions relevant to specific disease conditions. The 14 fundamental needs, as proposed by the theorist, lead a great emphasis on the assistive and supportive role of the nurse in managing patient care. Moreover, as reflected on Henderson’s 1959 revision of Harmer’s textbook “Principles and Practice of Nursing”, the use of nursing process is also significant. The theorist stated that, “In order to meet the person’s health it is necessary to know him and his family, this can only be accomplished by being with them and studying them”. She postulates, as part of the nursing process, that the nurse has to come up with a plan of care and to develop an effective plan for the patient collection of necessary information (case study) thus failure to prepare adequate information would result in rendering a low quality of routine care.
Henderson’s designed three phases of curriculum in her book “The Nature of Nursing: A Definition and Its Implications for Practice, Research and Education”. It implies that students should progress through in their learning. The focus in all three phases remains the same – assisting the patient when he needs strength, will or knowledge in performing his daily activities or in carrying out prescribed therapy with the ultimate goal of independence. Furthermore, these three phases of curriculum emphasized the importance for the students to be involved in the complete study of the patient and all his needs. She also stressed the importance of having nursing students to develop a habit of inquiry; take courses in biological, physical, and social sciences and in the humanities; study with students in other fields, observe effective care, and give effective care in a variety of settings.
According to Henderson, Nursing is a universal occupation and a higher education allows us to do it better. She emphasized, which all of us strongly agrees, that education will bring forth the advance knowledge and gained more confidence to act independently with unique skills and mastery. Since the patients presents with problems of greater complexity, it is through advance study that we can explore the in depth understanding of illness complexities and its management to modify the nurse’s care plan.
APPLICATION TO NURSING RESEARCH
Research is a breakthrough of unending search for the betterment of patient care. Henderson’s belief of formulating her work with unending polishing has lead to other theorists’ well-defined frameworks. Her work has been a foundation for improving the preparation for nursing. She even emphasized the importance of research in evaluating and improving the nurses’ practice.
Henderon's theory on the Definition of Nursing and each of the 14 fundamental components for basic nursing care arose research questions, where nurse’s function to assume responsibility for identifying problems, for continually validating our functions for improving the methods we use and for reassuring the effectiveness of nursing care as well. Maximizing the utilization of different resources of knowledge from the libraries are encouraged to be used.
She concluded that, “No profession, occupation or industry in this age can evaluate adequately or improve its practice without research”. Her strong advocacy for nursing brings forth a challenge to all of us to identify new needs beyond the 14 she enumerated. Henderson’s believe that research in nursing is essential for nursing practice in the age of technological advancements.
Parker,M. (2001). NursingTheories and Nursing Practice .Philadelphia:Davis.
Mc Ewen, M. & Wills E. (2006). Theoretical Basis for Nursing (2nd ed.). Philadelphia: Lippincott Williams & Wilkins
Nursing Forum Vol. 38, No. 3, July-September, 2003
Journal of Nursing Management, 2000, 8, 83-87
Nursing Theorist and Their Work, 4th Ed. Ann Marriner Tomey and Martha Raile Alligood
Acebuche, Malvin - Dubai, UAE Agtagma, Donna May –Taguig City, Philippines Albiso, Mary Abigail - Davao City, Philippines Ang, Raymond John- Bacolod City, Philippines Batingana, Aisha John - Davao City, Philippines Baylosis, Chino –Davao City, Philippines
We, GROUP A: U.P.O.U. Masters of Arts in Nursing AY: 2009-2010, are the new batch of nurses who considers ourselves apprentices for higher learning in the nursing profession. As part of an evolving discipline, we desire to improve our nursing skills to promote optimum outcomes in our own practice.Therefore, we seek the guidance of a university that can help us achieve our aim. Though we know that advance learning in the face of the demands in our current work is one big challenge, we also acknowledge that this undertaking will enhance our capacity to be flexible and to achieve greater wisdom. We are willing to be trained by masters in the realms of the nursing profession and be enriched by our own experience as we apply the theoretical knowledge in practice.For that reason we salute all of the nurses who like us, chose a challenging path yet fulfilling for our own personal and professional growth and for the people that we will serve. Blog site designed by: I.K.N. Bautista