Virginia Hendersons Need Based Theory And ImplicationsBiography
Virginia Avernal Henderson was born in Kansas City Missouri on November 30, 1897. She was the fifth of eight children born to Daniel B and Lucy Minor Henderson (McBride, 1996). She was named after her mother’s home state of Virginia and was later educated there at a boys’ school run by her grandfather (Thomas). Henderson furthered her education at the U. S. Army School of Nursing in Washington D. C. and graduated in 1921. She attended the Teachers College at Columbia University where she earned her Bachelor of Science degree and her Master of Science Degree in 1932 and 1934 respectively. She taught there from 1934 until 1948 and in 1953 went to work at Yale School of Nursing (McBride, 1996).
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During World War I, Miss Henderson, which she preferred to be called, took a temporary job caring for the wounded. After that she worked as a public health nurse in Washington D. C. and New York City. The experienced she received in the 1920’s inspired her to work as a nurse; a career she initially thought she would only stay in for a few years. It was here where she abandoned her aspirations to be an interior designer and focused on nursing as her new career (McBride, 1996).
It was her work as an educator and a researcher at the Teachers College of Columbia University and Yale School of Nursing that Henderson is most known for (Thomas, 1996). The naming of the Sigma Theta Tau International University after Henderson made her the most famous nurse of the 20th century.
On March 19, 1996, at the age of 96, after having chocolate cake and saying her good-byes to family and friends she quietly passed away (McBride, 1996).
Leadership Style
Henderson was an elegant lady who was a gracious hostess, had a great sense of humor, and was full of wisdom (McBride, 1996). She taught health professionals that they should work together in a harmonious team towards a common goal for the patients and families they served (Henderson, 2000, p. 96K). “Effective nurse leaders are those who engage others to work together effectively in pursuit of a shared goal” (Whitehead, Weiss & Tappen, 2010, p. 4). She has shown that over and over in her role as a nurse leader. The style of leadership that she has demonstrated is considered democratic. A democratic leadership is characterized by guidance rather than control by the leader (Whitehead, et al., 2010, p. 6).
Henderson possessed the leadership trait “management of attention; these leaders were able to communicate a sense of goal or direction to attract followers” (Whitehead, et al., 2010, p. 5). She claimed that excellence in nursing is dependent upon what each individual brings to it, and that it can be measured by the quality of the individual’s personal life, by contribution as a member of a community, and by the professional services he or she offers to society. Excellence, to Henderson, suggests the well-rounded or complete person (Henderson, 2000, p. 96K).
She defined the function of a nurse as doing things for patients that were not physically able to or had the required knowledge. She stated that nurses should help the patient either become healthy or die peacefully. She also taught nurses should help their patients become independent and, able to perform relevant activities for themselves as quickly as possible. She stressed the nurse’s duty is to the patient rather than to the doctor (Thomas, 1996).
Henderson taught that no member of the team should make such high demands on another that they could not do their job properly. She also said that no member of the team should be diverted from their duties by non-medical activities such as cleaning, clerking and filing (Henderson, 1964, p. 63).
Communication and Crusades
Virginia Henderson’s greatest achievement was a nineteen year research project which concluded with her publication of the five volume “Nursing Research: Survey and Assessment”, co-written with Leo Simmons and published in 1964. During this time she gathered, reviewed, catalogued, classified and cross-referenced every known piece of research on nursing published in English (Thomas, 1996). She felt proud to play a part in steering the electronic networking system of information, which was developed to provide nurses with current, jargon-free information wherever they were based. Henderson stated “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 (Thomas, 1996).
She knew that people are motivated by compassion to help others and she encouraged others to put that first. She stated that the nurse who complements the dependant, sick or well- by supplying him with strength, knowledge, or will he needs for wholeness must be judged excellent (Henderson, 2000, p. 96). Henderson was admired by a lot of her peers as well as other educational theorists. Edward Halloran’s recently edited A Virginia Henderson Reader (1995) and stated “it is the best source available today for a compilation of Miss Henderson’s own thinking. When you glance through that volume, you are struck with the currency of her ideas. She recognized early on the importance of an outcomes orientation, health promotion, continuity of care, patient advocacy, multidisciplinary scholarship, integration of the arts and sciences, and boundary spanning. Her elegant definition of nursing, with its emphasis on complementing the patient’s capabilities, provides a clear direction for what nursing should be–a wonderful counter force to the confusion that surrounds a health care system increasingly preoccupied with bottom line rather than enduring values” (McBride, 1996).
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Henderson believed that patients should be taught to understand their medical charts. She believed that if a patient understood their medical records and had access to sources that explained medicine that the patients would not -over-use the medical care system. She stated, “If you want to develop a mature and helpful philosophy about maintaining your health, you need to understand the means by which physicians’ clinical judgments are made and tested” (Henderson, 1996, p. 16N). This can be accomplished by communicating with the patients. The more the patients know the more empowerment they will have over their illness; they will want to do more to prevent any further complications, and the chances are greater for medical compliance.
Conflict Resolution
As a youth, Virginia Henderson’s family was quite vocal and they often stayed up late into the night discussing subjects of truth, beauty, charm or goodness. It was through these discussions, or rather arguments, that she learned how to defend her theories. She learned that her expressed views would be met with an opposing response. In her article, “Excellence in Nursing,” she is quoted as saying, “No persons brought forward as exemplifying charm, beauty, or goodness were unanimously agreed upon by the others. In fact, it was dangerous to set up one’s idol for it was sure to be knocked down” (Henderson, 2000, p. 96I).
Barriers that Henderson and other nurses had to face in the past are legal issues and nursing activities, which made the nursing profession’s position in healthcare ambiguous and misunderstood. Nurses have long struggled for rightful recognition by physicians and other healthcare members. Issues that arose were, nurses practicing independently, nurses diagnosing and treating patients. The roles of medical providers may be clear-cut in legislative controls, but human needs have always overridden legal barriers (Thomas, 1996). In the Nature of Nursing, Henderson stated ” 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” (Henderson, 1964).
Henderson used her wisdom and charm to defy stereotypes. She had the ability to question the fashionable emphasis on nursing process, reminding us all that problem solving does not belong to any one profession (McBride, 1996). She was also passionate about our “ailing health care system”. She was glad that nurses were now recognized as providers of primary health care, yet knew that they often were frustrated because within the system, they were often unable to provide the supportive care that they believed was needed. She felt that nurses were unable to make health prevention a priority and that with more and more health agencies coming under corporate management, that it is increasingly difficult to preserve human values in health care. She thought that now, more than ever that the provision of universal health education should be instituted in grade-schools, colleges and beyond.
Role Model
Henderson is a wonderful role model for today’s nurses. She spent her adult life in search for better ways to care for the patient. She defined what is now called the Henderson Theory which organized patient care into fourteen basic needs of the whole person and includes psychological, sociocultural, spiritual, and developmental. Using these principles the nurse and patient can together work to meet these needs and attain client-centered goals (Potter & Perry, 2009, p. 50).
As a nurse I would incorporate these qualities in how I take care of my patients, whether it’s being an advocate for them, caring for their well being or sitting and talking with them. Patients are already going through the stress of being sick and they should be able to rely on us as nurses to be empathetic, caring, understanding and helping them gain back their independence.
Miss Henderson identified with her patients. She knew this was a difficult task that demanded knowledge, skills,
Virginia Henderson’s Need Based Theory and Practice Implications
- Katherine Rose
Virginia Henderson’s Theory of Principles and Practice of Basic Nursing Care
According to Nicely and DeLario (2010) Virginia Henderson’s theory, Need Based, which is derived from the Principles and Practice of Nursing is a grand theory that focuses on nursing care and activities of daily living. This theory is appropriate to my future practice setting as a Family Nurse Practitioner within the Emergency Department or Fast Track/Urgent Care setting. This theory is applicable within this setting since “meeting patient needs in the areas of respiration, nutrition, elimination, body mechanics, rest and sleep, keeping clean and well groomed, controlling the environment, communication, human relations, work, play, and worship (Masters, 2015, p. 384), as these will be advanced nursing care areas that I will need to promote for my patients basic needs.
Henderson’s Background and Theory Development
Virginia Henderson, born in 1897, was a world renowned Nurse educator, researcher and author of many nursing textbooks whose career spanned 60 years; considered by many as the modern day Florence Nightingale (Masters, 2015). A profound change occurred in her life which was around the time of WW one, during this time her nursing experience evolved while in school which resulted in obtaining a bachelors and a masters in nurse education (Masters, 2015). This experience was able to help her see a vision for basic nursing care with patient focus on patient independence with activities of daily living (ADLs), being the basis of her framework and practice. Henderson became a professor at Yale University where she wrote many nursing textbooks that emphasized nursing care, studies, principles and practice (Masters, 2015). She was able to define her personal nursing theory and create the theory that focused on basic nursing care and patients ADL’s. Encouraged by her nursing research she was able to speak around the world and focused on an international approach for better patient care (Masters, 2015). According to Masters (2015) Virginia Henderson received several honorary degrees during her respectable nursing career which included the Christiane Reimann Prize from the International Council of Nursing.
Possible Reference for Theory
Due to Virginia Henderson being an author she received a position collecting, reviewing and chronicling every nursing research that has been published allowing her to write volumes on nursing research and studies (Vera, 2014a). This may have allowed her to come up with analytical applications on what nursing was and could have drawn her strengths and assumptions from her review of researched material. Some may say that Maslow’s Hierarchy of Needs was the reference to her theory as the needs are somewhat similar of what actions or roles one may be or need assistance with in order for independence and wellbeing.
Phenomenon of Nursing and Common Problems
The common problems of Virginia Henderson’s need based theory, this theory outlines the 14 components of fundamental nursing care and interventions that patients have or use as part of their independence and ADLs (Masters, 2015). As a future APRN the common problems that are resolved are 14 components that maintain the patient’s physical functions, safety and maintaining a sense of wellbeing and finding oneself in relation to where they see themselves in life (Masters, 2015).
Deductive Reasoning for Theory
Virginia Henderson utilized scientific method which is considered deductive reasoning to come up with the needs based theory. Deductive reasoning allows for an inquiry decision to arrive at a solution to an issue, an action – reaction system where there is a cause to a component there will be an effect on the component, with independence on its own essence with or without external circumstances (Masters, 2015). According to Masters (2015), Virginia Henderson’s utilized the physical, emotional and mental (psychological components) to deductively arrive to this theory even though she did not intend to imply a new nursing theory; the theory is in relation to Maslow’s theory though Henderson was not aware but the 14 sub-concepts relate and coincide with Maslow’s.
Explanation, Definition and Interpretation of Concepts and the Four Metaparadigms
Henderson made an assumption of her work that it was not a nursing theory so she did not fully identify her concepts but researchers were able to come up with concepts from her work that actually follow the common metaparadigm’s of nursing which she included within her definition of nursing. According to Masters (2015), Virginia “did not intend to develop a theory of nursing, she did not develop the interrelated theoretical statements or operational definitions necessary to provide theory testability (p. 390)”. Concepts include person, environment, health and nursing. Person is defined “as the patient who is composed of biological, psychological, sociological, and spiritual components (Masters, 2015, p. 387)”. These compositional segments are not separate entities but help to assist the nurses towards interventions for the 14 components of care, the person and family are not separate either but are considered a whole item (Masters, 2015). Virginia Henderson was able to keep all concepts of theory and definition consistent throughout since they overlapped and interrelated with each other to include a whole person aspect.
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Environment is important to a person’s perception of health and wellbeing but can also affect a person’s physical as well as mental wellbeing. Henderson identified a person’s environment as external elements that help to mold and shape an organisms life and physical change; three areas of environment that are important are biological, physical and behavioral (Masters, 2015). Biological includes anything that is living and breathing organism, such as flora and vertebrate, physical components like basic elements for life such as the sun, elemental chemicals and compounds. Both physical and biological elements work harmoniously together in symbiosis, when something changes it affects the whole ecological system and puts a strain on the symbiotic relationship of the physical and biological environment (Masters, 2015). Behavioral health influences the person and is the last component of environment; influencers include socioeconomic elements, political, cultural, and spiritual aspects.
Health was not a component of Henderson concept that was clearly defined but Henderson did imply that health was in relation to one’s independence (Masters, 2015). Basically, the 14 components of basic needs relate to the persons health as health relates to independence with activities of daily living.
Nursing is very clearly defined by Virginia Henderson and she has one of the best known definitions of nursing. According to Virginia Burggraf (2012) Virginia Henderson defined nursing as:
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. And to do this in such a way as to help him gain independence as rapidly as possible.
As for advanced practice nursing fields Virginia Henderson was a proponent for nurses to be independent practitioners she may have not wanted full practice independence as she was not for nurses taking on what she perceived as physician duties such as diagnosis, treatment, and making judgment calls (Masters, 2015).
Proposition of Concepts
Masters (2015) suggest that nurses are viewed as a helper, assistant and companion to a patient’s health role and wellbeing. The relationship aspect is that when a patient is sick the nurse helps the patient to get better and recover, while the patient is in rehabilitation role the nurse assists the patients in achieving independence. Lastly the nurse is a companion during planning of care, goal setting, and preventive maintenance initiatives.
Assumptions of Needs Theory
According to Masters (2015) there are seventeen assumptions of the Needs theory that were implicated from Henderson’s theory they include: Nurses must assist people with illnesses; nurses must collaborate within an interdisciplinary team and become independent professionally from the physician; 14 concepts of nursing describe patient needs and complete nursing functions; goals are achieved with a symbiotic relationship between patient and nurse with health promotion as the nurses main goal; patient and family are one with mind and body being one within the person; assist patient with independence while the patient controls their physiological and psychological harmony; people function in health at all times and must maintain independence and relationships; people maintain health status with knowledge and awareness; illness effects environment conditions and nurses should maintain a safe environment; nurses must be culturally competent and must maintain best practice methods while relying on evidence-based research methods.
As explained above the four major concepts were defined by Virginia Henderson that also describes the four metaparadigm’s as Henderson theory is the foundation of nursing practice. Henderson theory does include sub-concepts which will be explained. These 14 sub-concepts are: normal respiration, proper nutrition and hydration, waste elimination and management, mobility for posture maintenance, sleep and relaxation, proper appearance and grooming, thermoregulation through external factors, safe environment and preventive injury, communicate emotional concerns and distress, spiritual worship, career leading to achievement, recreational activities, and utilization of health resources and using healthcare facilities (Vera, 2014b). These are all relevant elements to an APRN as these can be used within assessment towards finding the patient’s independence level and to assess patient’s assistance in obtaining or maintaining activities of daily living for basic needs (Masters, 2015).
Theoretical Clarity and Applicability
Virginia Henderson theory is very easily understandable and covers a broad range of nursing especially the APRN as independence was a goal for Henderson’s nursing goal besides patient’s health promotion. The definition of nursing is clear and very lucid and applicable to her assumptions and components of theory. Since it was not her motive to come up with a nursing theory consistency within the theory is adequate though death is not clarified as she maintains that nurses should be there for patient death and comfort but no suggestion as what one must do or grief assistance with the family and patient.
Theory Sub-concepts in Practice and Guidance of Nursing Actions
Utilizing Virginia Henderson’s basic needs theory and its 14 concepts will be beneficial in my practice as a new Family Nurse Practitioner. As I would like to work within the emergency department, putting into action clinical provider interventions would lead to examples such as: concept of breathing normally would lead me to administer my patient oxygen with an Albuterol treatment and treat with intravenous Solu-Medrol.
Eating and drinking appropriately, proper nutrition is vital for diabetes management, weight management, heart health, wound healing, autoimmune disease, and patients overall health.
Body waste removal, imbalanced removal of body waste can indicate if there is an organism illness such as C. difficile, being aware of normal elimination methods and treating with antifungals and antibiotics with probiotic treatment for maintenance for good gut health.
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Movement and mobility, it is important to maintain my patients independence so splinting fractures from sports injuries, or advising low impact exercise and flexibility exercises to arthritic and osteoporosis patients are crucial to my practice development.
Sleep and relaxation is important sub-concept of Henderson theory, maintaining my patients sleep rhythm and patterns by decreasing external stimuli while my patient is in the ED at night, and providing privacy and comfort during the day and more importantly at night will allow a calmer and more enhanced patient experience.
Dressing appropriately is important to the patient’s perception of physical self and wellbeing. Being able to dress independently is an important ADL, within the ER this can be seen when patient is able to wear a gown and apply it on themselves without assistance, providing them time to dress themselves without being an inconvenience to acuity.
Body temperature regulation is important to the patient’s physical health, if a patient can not regulate their temperature heat blankets or mechanical regulated blankets like a Bair hugger can be applied to maintain proper thermoregulation.
Clean body and protection of the skin, importance of promoting proper body hygiene and infection prevention practices and isolation procedures for my fellow employees and nurses and educate them to teach patients as well as family upon entering the ED and seeing the patient.
Avoiding a dangerous environment, it is important to teach staff to transport patients within the ED and to other areas of the hospital is important for their physical health. Properly utilizing body mechanics, identifying fall risk patients intervening by locking bed and wheelchair wheels when necessary and maintaining a clean uncluttered patient room and hallway environment for patient safety.
Communication with others about feelings, it is important to use interpersonal and therapeutic communication and as a future APRN it is vital for me to actively listen to my patients and fellow team. Being able to empathize with a patient can open up to psychiatric, emotional and social traumas one may have occurred during an assessment history intake and being able to empathetically listen while making a proper medical judgement call is important for patients wellbeing.
Spiritual worship is important to the person’s mental and emotional wellbeing. As an APRN allowing others cultural and spiritual options influence their medical decision needs to be respected and nurtured as vital for the patients and families. Assimilation into the healthcare system that may or may not nurture their spiritual/cultural decision. This will increase my spiritual/cultural competence.
Work that increases oneself worth, important for patients mental health, leads to feelings of independence. Allowing one to continue their work and hobby benefits them to feel independent and able to fulfill their ADL’s. So maintaining ones finger after a work related accident by suturing and referral or assistance with a plastic surgeon is important knowledge to maintain in allowing ones independence.
Recreation activities benefits the patients physical health, some patients come to the ED after a sports injury so maintaining a sprain ankle by wrapping it and teaching the patient to utilize crutches and slowly introduce low impact, low weight bearing exercise while teaching proper NSAID administration is important in preserving my patients future recreational activities.
Normal health development and its resources, when I become a new APRN learning the different patients and diagnosis I see and utilizing a cohesive interdisciplinary team who is more knowledgeable as a resource is important for best practices towards the patient for their optimum health.
Conclusion
Virginia Henderson’s needs theory is applicable to many disciplines of nursing with various practice scopes. Utilizing this theory and putting it into action within practice is very adaptable and allows one to reflect on their nursing competency when it involves maintaining a person’s health promotion and independence level. As stated by Masters (2015) with Henderson’s philosophy of applying best practice methods which involve evidence-based research, advanced practice application of theory can be a foundation for their nursing process.
References
Burggraf, V. (2012). Overview and summary: The new millennium: Evolving and emerging nursing roles. OJIN: The Online Journal of Issues in Nursing, 17(2). doi:10.3912/OJIN.Vol17No02ManOS
Masters, K. (2015). Models and theories focused on nursing goals and functions. In J. B. Butts, & K. L. Rich (Eds.), Philosophies and theories for advanced nursing practice (2nd ed., pp. 377-407). Burlington, MA: Jones & Bartlett Learning.
Nicely, B., & DeLario, G. T. (2011). Virginia henderson’s principles and practice of nursing applied to organ donation after brain death. Progress in transplantation, 21(1), 72-77.
Vera, M. (2014). Virginia henderson – The first lady of nursing. Retrieved from http://nurseslabs.com/virginia-henderson/
Vera, M. (2014). Virginia henderson’s nursing need theory. Retrieved from http://nurseslabs.com/virginia-hendersons-need-theory/
