Theory:

Theory refers to a coherent group of general propositions used as

principles of explanation.

Nursing theory:

Defined as a creative and rigorous structuring of ideas that project a

tentative, purposeful and systematic view of phenomena. Through systematic

inquiry, whether in nursing research or practice, nurses are able to develop

knowledge relevant to improving the care of patients.

 Nursing theory is the term given to the body of knowledge that is used to

support nursing practice.

 Nursing theory is a framework designed to organize knowledge and explain

phenomena in nursing, at a more concrete and specific level.

 A nursing theory is a set of concepts, definitions, relationships, and

assumptions or propositions derived from nursing models or from other

disciplines and project a purposive, systematic view of phenomena by

designing specific inter-relationships among concepts for the purposes of

describing, explaining, predicting, and /or prescribing.

 Each discipline has a unique focus for knowledge development that directs

its inquiry and distinguishes it from other fields of study.(Smith & Liehr,

2008).
 Theory-guided, evidence-based practice is the hallmark of any professional

discipline.

 Nursing is a professional discipline (Donaldson & Crowley, 1978).

 Almost 90% of all Nursing theories are generated in the last 20 years.

 Nursing models are conceptual models, constructed of theories and concepts

 A paradigm is a model that explains the linkages of science, philosophy, and

theory accepted and applied by the discipline.

METAPARADIGMS IN NURSING

Person

 Recipient of care, including physical, spiritual, psychological, and

sociocultural components. Individual, family, or community

Environment

 All internal and external conditions, circumstances, and influences affecting

the person

Health

 Degree of wellness or illness experienced by the person

Nursing

 Actions, characteristics and attributes of person giving care.

 VIRGINIA HENDERSON’S NEED THEORY

“The Nightingale of Modern Nursing”

“Modern-Day Mother of Nursing.”

"The 20th century Florence Nightingale."

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

Virginia Henderson 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

Her stature as a nurse, teacher, author, researcher, and consumer health

advocate warranted an obituary in the New York Times, Friday March 22.

1996.

In 1985, Miss Henderson was honoured 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 which education was “patient centred and

organized around nursing problems rather than medical diagnoses”

 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)

Although she was retired, she was a frequent visitor to nursing schools

well into her nineties.

O’Malley (1996) states that Henderson is known as the modern-day mother

of nursing. 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 ). She argued that

nurses needed to be prepared for their role by receiving the broadest

understanding of humanity and the world in which they lived.

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

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)

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.

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 famous 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".

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.

Furthermore, the principles and practice or nursing must be built upon and

derived from the definition of the profession. Although official statements on

the nursing function were published by the ANA in 1932 and 1937,

Henderson viewed these statements as nonspecific and unsatisfactory

definitions of nursing practice. Then in 1955, the earlier ANA definition was

modified. 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 are that:

"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.

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.

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?

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 bea 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 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.

Nursing Process Henderson’s 14 components and definition of nursing

Nursing Assessment: Henderson’s 14 components, Analysis Compare data to

knowledge base of health and disease.

Nursing diagnosis: Identify individual’s ability to meet own needs with or

without assistance, taking into consideration strength, will or knowledge.

Nursing plan: Document how the nurse can assist the individual, sick or well.

Assist the sick or well individual in to performance of activities in meeting

human needs to maintain health, recover from illness, or to aid in peaceful

death.

Nursing implementation: Implementation based on the physiological principles,

age, cultural background, emotional balance, and physical and intellectual

capacities. Carry out treatment prescribed by the physician.

Nursing evaluation: 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.

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, bio physiology, 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..."

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.

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.

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?

Example:

Shia, 25 years old, has been taken to the Emergency Room of Veterans

Regional Hospital after sustaining multiple injuries from a mountain hiking

accident with her two friends. The incident happened so fast that her friends

couldn’t do something to stop her from falling. She accidentally slipped on a

rock and fell from a small cliff. Luckily, her head didn’t hit the rocks. X-rays

were taken which revealed fractures on the right femur, 3rd and 4th ribs and a

fractured right wrist. Surgery was immediately done to correct some of the

dislocated bones and to stitch some open wounds. She was placed on several

casts, and an external fixator, to support fractured bone, was attached on her

right leg, which limited her movement for months. Her family frequented their

visits and tried to raise her confidence and assured her that all would be fine.

However, Shia appeared to manifest self-pity and low self-esteem when she said

“Nothing is fine! I’m paralyzed! I’m worthless now!” after having failed to

bathe and feed herself. Every morning, when her family tries to bathe her, she

will say she’s not paralytic. Sometimes, she also directs her anger to the nurses

by raising her voice during the routine daily care.

Application:

Shia, 25 years old, has been taken to the Emergency Room of Veterans

Regional Hospital after sustaining multiple injuries from a mountain hiking

accident with her two friends. The incident happened so fast that her friends
couldn’t do something to stop her from falling. She accidentally slipped on a

rock and fell from a small cliff. Luckily, her head didn’t hit the rocks. X-rays

were taken which revealed fractures on the right femur, 3rd and 4th ribs and a

fractured right wrist. Surgery was immediately done to correct some of the

dislocated bones and to stitch some open wounds. She was placed on several

casts, and an external fixator, to support fractured bone, was attached on her

right leg, which limited her movement for months. Her family frequented their

visits and tried to raise her confidence and assured her that all would be fine.

However, Shia appeared to manifest self-pity and low self-esteem when she said

“Nothing is fine! I’m paralyzed! I’m worthless now!” after having failed to

bathe and feed herself. Every morning, when her family tries to bathe her, she

will say she’s not paralytic. Sometimes, she also directs her anger to the nurses

by raising her voice during the routine daily care.

In using the 14 Fundamental Needs of Henderson, she would be able to

determine that the ability of Shia to independently perform her activities of

daily living was affected. She depends on others to take care of her. Almost all

her activities are restricted by her impaired mobility.

As the nurse, using the concepts of Henderson, I would prioritize the

intervention towards attainment of independence through the performance of

the basic human needs and restoration of her self-esteem.

As a nurse, being a substitute for the patient, actions must be directed in having

her participate gradually over her care. To boost her confidence and self-esteem,

I will have her make decisions actively over her care with confidence and with

full understanding of her plan of care by explaining it to her and encouraging

her to express her feelings about her condition. This is related to the concept of

Henderson,

the 10th component of basic nursing care: Communicating with others in

expressing emotions, needs, fears, or opinions.

I will be her helping hand when she can’t reach or the voice which would carry

her thoughts to people whose decisions directly affect her care and future. This

is also applied from the 12th component of basic nursing care: Working in such

a way that one feels a sense of accomplishment. As for her family, I will be

there to continuously update and educate them about the progress of Shia’s

condition, I will support them because I know that they are already strained with

their care-giving role.

Summary:

Theory is very important for proving nurse care to the patient. In these

discussed regarding achievements, publications, definitions, theory background,

development of Henderson’s definition of nursing, 14 components of

Henderson’s theory, assumptions, major concepts individual, environment,

health and nursing, characteristics, philosophical aims usefulness and

limitations and purposes of Henderson’s theory.

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.

Bibliography:

Shebeer. P. Basheer. A concise text book of advanced nursing practice,2nd

edition: Hardiya publications.

www.nursing-theory/org.com
 PRESENTATION

ON

VIRGINIA HENDERSON’S

NEED THEORY

Submitted to: submitted by:

Dr.K.T.Sheeba madam T.Manju

Professor, Msc (N) 1st year

HOD of Advanced nursing practice Government college of nursing

Government college of nursing

Subject : Advanced nursing practice

Topic : Virginia Henderson’s needs theory

Group : Msc (N) 1st year

Medium of Instruction : English

Methods of presentation : Class

Date and Time :

Place : Msc (N) 1st year class room

Name of the student : T. Manju

Submitted to : Dr. K. T. Sheeba madam

Professor

A.V Aids : OHP

Chart

PPT

Flip book

Black board
General objectives:

By the end of the presentation students will be able to gain knowledge

about the theory focuses attention of 14 components which are mainly for

proving care to the client. Mainly involves basic needs of whole person. By

Virginia Henderson.

Specific objectives:

By the end of the presentation the students will be able to:

o Introduction to the theorist.

o Introduce the theory.

o Discuss regarding achievements and publications.

o Define nursing according to theorist.

o Explain background development of Henderson’s theory.

o Enlist the components of theory.

o List out the assumptions.

o Explain characteristics and physiological aims of theory.

o Application of theory.