The Nature of Nursing

Author(s): Virginia Henderson

Source: The American Journal of Nursing , Aug., 1964, Vol. 64, No. 8 (Aug., 1964), pp.
62-68
Published by: Lippincott Williams & Wilkins

Stable URL: https://www.jstor.org/stable/3419278

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 Th~e NJature of Nursingf

One nurse's personal concept of the has never been satisfying to the oc- sented, in fact, my point of view
essential function of nursing, and of cupation as a whole or to many ofmodified by the thinking of others in
the implications of this concept its individual members. For exam- the group. Although this statement
for nursing practice, research, and ple, in 1933 and 1934, Effie J. Tay-
was included in the report of the re-
education. gional conferences, it has never been
lor defined nursing as "adapting pre-
scribed therapy and preventivecited directly (6).
VIRGINIA HENDERSON treatment to the specific physicalAnother approach to defining
and-psychic needs of the individ- nursing was the American Nurses'
ual" (2,3). She also added, "The real
It is self-evident that an occupation, Association's five-year investigation
and especially a profession whose depths of nursing can only be madeof the nurse's function. Studies were
services affect human life, mustknown
de- through ideals, love, sym-
made in 17 different states, and the
pathy,
fine its function. Nursing's attempt to knowledge, and culture, ex-
results summarized in Twenty Thou-
pressed through the practice of ar-
do so has a long, and still unfinished, sand Nurses Tell Their Story (7).
history. tistic procedures and relationships."
And, following this, the various ANA
Inevitably, we go back to Florence In these statements, made 30 years
sections developed statements on the
Nightingale. In her Notes on Nurs- ago, Miss Taylor anticipated somefunctions,
of standards, and qualifica-
ing: What It Is and What It Is Not, tions for practice in the fields of
the current emphasis on patient-cen-
she says, in essence, that what nurs- tered care and a liberal education nursing represented.
ing has to do is to ". . . put the pa- for the nurse. Whether or not these research ef-
tient in the best condition for nature Immediately after World War forts give us a satisfying description
to act upon him" (1). There is no II, the rumblings of dissatisfac- of the nursing function is open to
doubt that Miss Nightingale's con- tion with the ambiguous position question, but certainly they throw
cept influenced the development of considerable light on what nurses
of nursing heard during the first half
modern nursing more than any oth- of the century, developed into a ma-
were actually doing in the 1950's, and
er. Some nurses still cite this as the jor explosion of discontent. In 1946,
on what they consider their proper
definition they find most helpful. the American Nurses' Association functions.
But with the passage of the nurseasked certain nursing leaders to for- Now, just as at the turn of the
registration act in England and state
mulate their definitions of nursingcentury, the necessity for a legal
nurse practice acts in the United and devoted a session at that year'sdefinition of nursing practice re-
States around the turn of the cen- convention to the subject(4). mains. The most recent official state-
tury, it became necessary to describe About this time, Esther Lucilement (1962) on the subject, was de-
nursing in such a way as to protectBrown was asked by the National signed for inclusion in nurse practice
the public and the nurse. The defi-Nursing Council to study the needsacts (8). This statement, although still
of society for nursing. Included very
nitions at this time were necessarily in general and inclusive, suggests
concerned with what the nurse was that the nurse can observe, care for,
her report is a definition of nursing
legally empowered to do and, as developed by a group of nurse ex- and counsel the patient and can su-
most nurses were then working asperts-an excellent statement, but pervise so other health personnel with-
private practitioners in homes andgeneral any health worker might out herself being supervised by the
hospitals, most of the legal defini-claim it also applies to his field(5).physician. It implies a more independ-
tions implied that the nurse oper- Three regional conferences were ent function for the nurse than did
ated under the supervision of a phys-also held in connection with Miss previous official statements (9).
ician. They failed to identify thatBrown's study. At one of these aWhile the official statements on
aspect of her work that was inde- small committee, of which I was nursing
a may serve the purpose for
pendent or self-directed. member, developed a definition thatwhich they are intended, there is
The idea of the nurse as merelywas much more specific than the abundant evidence that they have
the physician's assistant, however,one previously referred to; it repre-
not satisfied everyone. And, in recent

62 AUGUST 1964 AMERICAN JOURNAL OF NURSING

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VIRGINIA HENDERSON, noted nursing educator, author, researcher, and lecturer,
is currently directing the preparation of an index to nursing research at Ydle
University, to be published in four volumes. The first, Vol. IV 1957-1959, was
published this year. For the past 10 years she has been working on a research
project with Leo Simmons at Yale. The result of this, Nursing Research, a Survey
and Assessment, also appeared in print this year. To nurses throughout the
country, Miss Henderson's name is familiar as coauthor of the textbook, Principles
and Practices of Nursing. To nurses throughout the world, she is known fcr her
Basic Principles of Nursing Care, published in 1958 by the International Council those too weak or withdrawn to speak, and so
of Nurses, London, England, and, since then, translated into 10 languages. The
quotation on this page is taken from that booklet.
VOLUME 64, NUMBER 8
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"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 neces-
sary strength, will or knowledge. And to do
this in such a way as to help him gain inde-
pendence as rapidly as possible. This aspect
of her work, this part of her function, she ini-
tiates and controls; of this she is master. In
addition she helps the patient to carry out
the therapeutic plan as initiated by the physi-
cian. She also, as a member of a medical team,
helps other members, as they in turn help her,
to plan and carry out the total program wheth-
er it be for the improvement of health, or the
recovery from illness or support in death. No
one of the team should make such heavy de-
mands on another member that any one of
them is unable to perform his or her unique
function. Nor should any member of the med-
ical team be diverted by nonmedical activities
such as cleaning, clerking, and filing, as long
as his or her special task must be neglected.
All members of the team should consider the
person (patient) served as the central figure,
and should realize that primarily they are all
"assisting" him. If the patient does not un-
derstand, accept, and participate in the pro-
gram planned with and for him, the effort of
the medical team is largely wasted. The soon-
er the person can care for himself, find health
information, or even carry out prescribed
treatments, the better off-he is.
"This concept of the nurse as a substitute
for what the patient lacks to make him 'com-
plete,' 'whole,' or 'independent,' by the lack
of physical strength, will or knowledge, may
seem limited to some. The more one thinks
about it, however, the more complex the
nurse's function as so defined proves to be.
Think how rare is 'completeness,' or 'whole-
ness' of mind and body: to what extent good
health is a matter of heredity, to what extent
it is acquired, is controversial but it is gen-
erally admitted that intelligence and education
tend to parallel health status. If then each man
finds 'good health' a difficult goal, how much
more difficult is it for the nurse to help him
reach it: she must, in a sense, get 'inside the
skin' of each of her patients in order to know
what he needs. She is temporarily the con-
sciousness of the unconscious, the love of life
for the suicidal, the leg of the amputee, the
eyes of the newly blind, a means of locomo-
tion for the infant, knowledge and confidence
for the young mother, the 'mouthpiece' for
on." Virginia Henderson
AUGUST 1964 63
 NATURE OF NURSING ily health service," "comprehensive might help the individual patient.
care," or "rehabilitation." And although, during my pediatric
But there was, for me, an influ- nursing affiliation, I first experienced
ence
years, with the development of in these early student days that the satisfaction-and saw the supe-
vary-
per-to negate this mechanistic riority-of a "case" as opposed to a
tended
ing types and grades of nursing
sonnel, the difficulty of defining
approach to patient care. Annie W. "functional" assignment, the care was
function has been compounded. Goodrich was dean of my school, the too mechanistic to teach me the true
Probably the effort of organized
Army School of Nursing, and when- vale of patient-centered care.
ever she
nursing to formulate a statement ofvisited our unit she lifted With this background and after a
our sights above techniques and year of visiting nurse work I became
its function will always be unfin-
ished business since conditions routines. She saw nursing as a the only full-time instructor in a
"world-wide
change from one era to the next and social activity," a crea- school of nursing. Here I was forced
with the culture 'or nature of a so-
tive and constructive force in society,to learn as I taught. I at least sensed
ciety. But so long as available defini- and, having a powerful intellect and the need for more knowledge and
tions are unsatisfying to nurses, or boundless compassion for humanity, clarification of my ideas and, fortu-
too general to guide practice, re- she never failed to infect us with "the nately for all concerned, I went back
search, and education, individualsethical significance of nursing"(10). to school.
will continue to search for state- It is to her that I attribute my early Except for a brief period of clini-
ments that fulfill their needs. discontent with the regimentalized cal supervision and teaching at the
patient care in which I participated Strong Memorial Hospital, I re-
DEVELOPMENT OF A CONCEPT
and the concept of nursing as merely mained at Teachers College, Colum-
ancillary to medicine. But while Miss bia University-as student and teach-
My interpretation of the nurse's
Goodrich
function is the synthesis of many in- presented us with the er-for some 20 years, and during
fluences, some positive and somehighest aim for nursing she left us tothis time my concept of nursing was
translate it into concrete acts. I
negative. Before discussing it, how- not so much changed as clarified. It
ever, and identifying the mostneeded
sig- some one to "show me"-as is impossible to identify all the per-
Lizaits
nificant experiences leading to sons and experiences that brought
Doolittle sang, when words had
formulation, I should first makeceased
clear to be enough for her. I sel-
this about, but a few stand out.
that I do not expect everyonedom,to if ever, saw graduate nurses Caroline Stackpole based her
agree with me. Rather, I wouldpractice teaching of physiology on Claude
urge nursing; never my teachers.
every nurse to develop her ownTheir Bernard's dictum that health de-
con- teaching was in a classroom.
A positive nursing experience,
cept; otherwise, she is merely imitat- pends upon keeping the lymph con-
however,
ing others or acting under authority. was a summer spent, stant
when around the cell(11). This em-
In my own case I felt as though I was still
I a student with the Henry phasis on the unit structure taught
was steering an uncharted course Street Visiting Nurse Agency. Here me relationships in what were, up to
until I resolved certain doubts about I began to discard the formal ap- that time, unrelated laws of health.
my true function as a nurse. proach to patients approved in the Miss Stackpole was a master teacher
My basic training was largely in a general hospital. In fact, I acquired who was never satisfied until the
general hospital where, for the nurse, a skepticism of medical care in hos- student answered his own question.
technical competence, speed of per- pitals that remains with me. Seeing Jean Broadhurst, a microbiologist,
formance, and a "professional" (ac- the sick return to their homes follow- had this same concept of teaching.
tually an impersonal) manner were ing hospitalization, I began to real- Primarily from those two, I acquired
stressed. We were introduced to ize that the seemingly successful in- an analytic approach to all aspects
stitutional regimen nevertheless of- of care and treatment.
nursing as a series of almost unre-
ten failed to change the factors in Now, as I read reports of malnu-
lated procedures, beginning with
making an unoccupied bed and pro- the patient's way of living that had trition from therapeutic diets, emo-
gressing to, say, aspiration of bodyhospitalized him in the first place. tional and physiological crises from
Even today I question whether ourendocrine therapy, drug-induced
cavities. In this era, ability to cathe-
terize a patient seemed to qualify traditional
a hospital routines and skin lesions, and the varied compli-
practices can really prepare a pa- cations from cortisone administra-
student for "night duty" where,
without any previous experiencetient
in for a return to health. Nowherc tion, I think to myself: "the con-
the administration of a service, during
she my entire student experience, stancy of the intercellular fluids has
seems to me, did I have the oppor- been dangerously reduced." Ever
might have the entire care of 30 itsick
souls and bodies. tunity to see or practice individual- since I grasped this danger I have
ized care-to acquire the human
An authoritarian type of medicine believed that a definition of nursing
relations skills that I needed. My psy- should imply an appreciation of the
and nursing were practiced in this
hospital. Teaching was based on the chiatric nursing affiliation concen- principle of physiological balance.
textbook. Not even lip service was trated on disease entities and their It makes so vivid the importance of
given "patient-centered care," "fam- treatment, not on how the nurse forcing fluids, of feeding the coma-

64 AUGUST 1964 AMERICAN JOURNAL OF NURSING

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tose, or of relieving oxygen want. grams with constant evaluation ofMiss Orlando's conclusions, and fur-
Dr. Edward Thorndike's work in the patient's needs and progress to- ther convinced me, that the most ef-
psychology, also at Teachers Col- ward the goal of independence. fective nursing involves a continuous
lege, provided some parallel gen- My participation in preparing theanalysis and validation of the nurse's
eralizations, or fixed points, in the 1937 Curriculum Guide, in the workinterpretation of the patients' needs.
psychosocial realm. His study of the of the NLNE's special committee on
fundamental needs of man made me postgraduate clinical courses, and UNIQUE FUNCTION
realize that illness all too often places in the regional conferences asso- In 1958 the nursing service com-
a person in a setting where shelter ciated with Miss Brown's study, allmittee of the International Council
from the elements is almost the only forced me to express in writing theseof Nurses asked me to describe my
fundamental need that is fully met. evolving concepts of nursing. It wasconcept of basic nursing. The result-
In most hospitals the patient cannot not until the 1940's, however, that Iing statement (page 63), published
eat as he wishes, his freedom of could test my ideas in actual prac-in pamphlet form by the ICN in
movement is curtailed, his privacy is tice, when we developed at Teach-1961, was an adaptation of the defi-
invaded; he is put to bed in strange ers College a unique-at least, for nition of nursing in Harmer and Hen-
nightclothes, making him feel as un- that time-type of advanced study inderson and represented the final
attractive as a punished child; he is medical-surgical nursing. crystallization of my ideas on the
separated from the objects of his af- This course was unique because itsubject (15).
fection; he is deprived of almost ev- was organized around nursing prob- It is my contention that the nurse
ery diversion and of his work, and is lems rather than medical diagnoses is, and should be legally, an inde-
reduced to dependence on persons and diseases of body systems. Thependent practitioner, so long as she
who are often younger than he is, associated field experience gave the
is not diagnosing or treating disease
and sometimes less intelligent and graduate nurse student an opportu- or making a prognosis, for these
courteous. nity, for example, to increase herfunctions fall in the physician's
competence in helping a patient torealm. But the nurse is the authority
From the time I saw hospitaliza-
cope with such problems as long-on basic nursing care. And, by basic
tion in this light I have questioned
term illness, impending surgery, thenursing care, I mean helping the pa-
every nursing routine or restriction
that is in conflict with the individ-
relative isolation necessitated by atient with the following activities or
communicable disease, or the de- providing conditions under which he
ual's fundamental need for shelter,
food, communication with others,pression following the loss of an armcan perform them unaided:
or a leg. It was one of the first ad-
and the company of those he loves; 1. Breathe normally
for opportunity to win approval, vanced
to clinical courses where stu- 2. Eat and drink adequately
dominate and be dominated, to dents actually nursed patients and 3. Eliminate body wastes
lear, to work, to worship, and toconducted nursing clinics and inter- 4. Move and maintain desirable
play. In other words, I have since disciplinary conferences around the posture
conceived it to be the aim of nursing care of the patients they nursed. 5. Sleep and rest
to keep the individual's day as nor- Exchanging views with the able 6. Select suitable clothes-dress
mal as possible-to keep him in "the nurses associated with me in plan- and undress
stream of life" to the extent that it is ning or teaching this course, and 7. Maintain body temperature
consistent with the physician's thera-with the students, who were oftenwithin normal range by adjusting
peutic plan. experienced and expert, was of im-clothing and modifying the environ-
Soon after this enlightenment I measurable benefit to me in clarify-ment

saw the work of Dr. George G. ing my ideas. Therefore, in the 1955 8. Keep the body clean and well
Deaver and the physical therapists revision of Harmer and Henderson's groomed and protect the integument
associated with him at the Institute The Principles and Practice of Nurs- 9. Avoid dangers in the environ-
for the Crippled and Disabled in ing, I was able to present what ment and avoid injuring others
New York City. It seemed to me seemed to me a tested and specific 10. Communicate with others in
that in their work I was witnessing definition of nursing(12). expressing emotions, needs, fears,
the implementation of many ideas I Since that time the writings of et cetera
had been accumulating. And I saw psychiatric nurses, particularly those 11. Worship according to one's
that much of the effort of rehabilita- of Gwen Tudor (Will) and Ida Or- faith
tion went into building the pa- lando (Pelletier) have made me 12. Work in such a way that there
tient's independence-the independ- realize how easily the nurse can act is a sense of accomplishment
ence of which hospital personnel had on misconceptions of the patient's 13. Play, or participate in various
unwittingly deprived him or had, at needs if she does not check her in- forms of recreation
least, failed to encourage. Nothing terpretation of them with him(13, 14. Learn, discover, or satisfy the
has made my concept of nursing 14). The continuing work of facultycuriosity that leads to "normal" de-
more concrete than the insistence of and students at the Yale University velopment and health and use the
these workers on individualized pro-School of Nursing has reinforced available health facilities.

VOLUME 64, NUMBER 8 AUGUST 1964 65

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 NATURE OF NURSING rarely speak of the inevitable end of But just as the nui se seeks to meet
the patient's needs during a period
life. Critics of our culture say we are
of dependency, so she also tries to
prone to shrink from the thought and
In helping the patient with thesesight of old age and death. The shorten this period. Before she com-
activities the nurse has infinite need mits any act for the patient, she asks
nurse, however, cannot do this if she
is to fulfill her unique function asherself
for knowledge of the biological and I what part of it he could him-
social sciences and of the skills based
see it. There is a great deal that the
self perform. If he is unable to act at
on them. There are few more com- nurse can do to keep the environ- all, she identifies what he lacks and
plex arts than that of keeping a pa- ment in which death occurs an es- she helps to supply this lack as rap-
tient well nourished and his mouth thetic one, and to relieve the pa-idly as she can. She evaluates her
healthy during a long comatose pe- tient's discomfort with nursing success with each patient according
riod; or of helping the depressed, measures. Even more important, in to the degree to which he estab-
mute psychotic re-establish normal my concept of nursing, is the nurse's
lishes independence in all the activi-
human relations. There is no worker effort to assist the patient toward ties
a that make up for him, a normal
but the nurse who can and will de- "peaceful death" by facing it with
day. The rehabilitation of all pa-
vote herself so consistently day andhim honestly and courageously, thustients, in the hands of such a nurse,
night to these ends. lending it dignity and even an awe-begins with her first service to them.
This unique function of the nursesome beauty. This primary function of the prac-
I see as a complex service. But, in In essence, then, I see nursing as ticing nurse must, of course, be per-
emphasizing this basic function, I doprimarily complementing the pa- formed in such a way that it pro-
not mean to disregard the nurse'stient by supplying what he needs inmotes the physician's therapeutic
therapeutic role. She is in most situa-knowledge, will, or strength to per-plan. That means helping the pa-
tions the patient's prime helper in form his daily activities and also totient carry out prescribed treatments
carrying out the physician's pre-carry out the treatment prescribedor administering the treatment her-
scriptions. for him by the physician. What areself. Again, she will consider herself
the implications of such a concept
If we put total medical care in the more successful if she assists the pa-
form of a pie graph we might assign tient than if she acts for him.
for nursing practice, research, and
wedges of different sizes to members education? Now, in certain situations, the
of what we now refer to as "the nurse may find it necessary to as-
NURSING PRACTICE
team." The wedge must differ in size sume the role of a physician-in hos-
for each member according to the The nurse who sees herself as re-
pitals with no resident physician, for
problem facing the patient; in some instance, or in emergency condi-
inforcing the patient where he lacks
situations certain members of the will, knowledge, or strength must tions. First aid, which has elements
team have no part of the pie at all.
make an effort to know him, to of diagnosis and therapy, is expected
un-
The patient always has a slice, al- of all informed citizens under cer-
derstand him, to "get inside his
tain circumstances.
though that of the newborn infantskin," as we have said. She will listen
or the unconscious adult is only to a him, his family, and his friendsAs long as nurses are better pre-
sliver; his very life depends on oth- pared than any other member of the
with interest. She will be especially
ers, but most particularly on the
aware of her relation with the health
pa- team to act as a physician
nurse. tient and will try to make it a surrogate they will be tempted, in
In contrast, where an otherwise
constructive, or therapeutic one the interests of the patient, to assume
healthy adult is suffering from a skin
realizing that this demands self-un- this role. But it is not, in my judg-
condition such as acne, hederstanding.
and his Finally, and most im- ment, their true role. In assuming it
physician compose the team and
portant, she will give of herself to they not only practice skills in which
they can divide the whole thepie be-
patient. they are ill prepared but rob them-
tween them. If the problem isShe or-be willing, even anxious, selves of the time needed for the
anwill
thopedic disability, the largest slice
to help the patient perform the func- performance of their primary role.
may go to the physical therapist; tions we have just enumerated. In Inevitably it forces nurses to dele-
when a sick child is cared for at cooperation with the patient, his gate their primary function to inade-
home by the mother, then the family,
lat- and other members of the quately prepared personnel. In my
health team, and according to the opinion, the social pressures that
ter's share may be by far the largest.
situation, she will make some sort of have called for a phenomenal in-
But of all the members of the team,
individualized plan, or a daily regi- crease in nurses has also demanded a
excepting the patient and the physi-
cian, the nurse has most often a men that meets the whole range of proportionate increase in doctors.
human needs. She will not be satis-
piece of the pie and, next to theirs, This brings us to the question of
hers is usually the largest share. fied to provide merely shelter, sani-the coordinating, managerial, and
In talking about nursing we tend tary facilities, three meals a day,teaching functions that now con-
to stress promotion of health andand the treatments prescribed by thesume so much of the professional
prevention and cure of disease; we
physician. nurse's time. Nurses must, of course,

66 AUGUST 1964 AMERICAN JOURNAL OF NURSING

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administer nursing services and any scientific backing. It is my con- to have come to a dead end of
teach nursing, but whether they tention that methods in this all-im- evolution, like the frog. The basic
should coordinate the services of the portant area will remain static and techniques of bed-making, blanket-
entire medical team is questionable. invalidated if the nurse fails to study bathing, giving an enema, administer-
I, for one, applaud the investigations them. ing medicines, and the like, seems
on non-nursing coordinators and ad- In a survey and assessment of hardly to have changed within the
ministrators of clinical units (16, 17). nursing research, Leo W. Simmons memory of woman; and few nurses
I am impressed, too, with the em- and I have pointed out the prepon- seem to pause and ask themselves
phasis that Dorothy Smith has re- derance of education and occupa- whether their methods and equip-
cently placed on developing a sys- tional studies over clinical investiga- ment are the best possible, or whether
tem in which the nurse can function tions(19). We tried to identify the in fact they might be better."(21)
as effectively as she knows how(18). conditions that discouraged patient- It is my belief that on every clini-
The nurse who sees her primarycentered research and found: that cal service of a hospital a medical re-
function as a direct service to the pa-the major energies of the occupation
search committee and a nursing re-
tient will find an immediate reward have gone into improving prepara-search committee are needed-both
in his progress toward independencetion for nursing and into learning devoted to the ultimate and common
through this service. To the extenthow to recruit and hold sufficient goal of improving patient care. The
that her practice offers this reward,numbers of workers in the occupa-medical research committee would
it will be satisfying; to the extent tion; that the demand for adminis-study those problems lying wholly
that the situation deprives her of it,trators and teachers almost exhausts in the realm of medical practice; the
she will be dissatisfied. And she will
the supply of degree holders, with nursing research committee would
use whatever influence she possesses the result that nurses with a univer- investigate procedures or problems
to foster conditions that make the sity background tend to study ad- that lie wholly within the realm of
social rewards for practice at leastministrative and educational prob- nursing practice. But still another
commensurate with those for teach- lems; and that those few nurse committee-a joint one which would
ing and administration. practitioners prepared to study nurs- include not only doctors and nurses
ing practice often fail to get the but other specialists as indicated-is
NURSING RESEARCH
support they need from hospital ad- also needed to study such treat-
When a nurse operates under a ministrators, nursing service ments
adminis- or diagnostic tests as are pre-
trators,
definition of nursing that specifies an and physicians. scribed by the physician and carried
area in which she is pre-eminently But if, by definition, nursing has
out entirely or partially by the nurse.
qualified, she automatically imposesan area of independent professional In this era, research is the name
practice,
on herself the responsibility for de- is not clinical nursing we
re- attach to the most reliable type
signing the methods she uses in her search as necessary, if not more of
so, analysis. It is based on the full use
of scientific findings and is the most
than research into other professional
area of expertness. Studies of nursing
functions have shown that, of the
problems? Do we not deny our func-reasonable approach man has in-
hundreds of specific acts performed vented
tion when we fail to investigate it? to the solution of his prob-
by nurses, many are non-nursing Surgeon General's Consultantlems. No profession, occupation, or
The in
Group
nature and could be assigned to oth- industry can, in this age, adequately
on Nursing says, "Nursing re-
search
er personnel; others are medically must be stimulated. Research evaluate or improve its practice with-
prescribed procedures for the in nursing has just begun to yield
design out research. Nursing, if it is truly to
the body of knowledge needed as represent
of which the physician is partially a an area of independent
responsible. But if the nurse basis
carriesfor the improvement of nurs- practice, must therefore assume re-
out the latter procedures and ing care. . . . Much greater supportsponsibility for validating and im-
is lia-
proving the methods it uses.
is required for patient-oriented stud-
ble, in the legal sense, for harmful
iesmust
effects on the patient, then she ini line with the changing pat-
NURSING EDUCATION
terns
share the responsibility for the de-of nursing care"(20).
It is not only in this country that A definition staking out an area of
sign of the procedure with the physi-
cian. the need for research in nursing health and human welfare in which
The activities with which I am practice is recognized. Margaret the nurse is the expert and an inde-
mainly concerned, however, are Jackson, a British physician, has ex- pendent practitioner calls for educa-
those having to do with nursing care pressed some of these ideas simply tion rather than training: a liberaliz-
itself. Most of these procedures-in and directly: ing education, a grounding in the
fact, most aspects of basic nursing, "Research into nursing methods physical, biological, and social sci-
including the nurse's approach to the and appliances possibly began with ences, and the ability to use analytic
patient and what she may and may Eve. Miss Nightingale and the gen- processes. The curriculum must be
not say or do for him-are based on eration of nurses trained under her organized around the nurse's major
tradition or authority, learned by aegis took it, of course, immeasurablyfunction rather than that of the
imitation, and taught with little, if further; but since their day it seemsphysician, as it has been in the past.

VOLUME 64, NUMBER 8 AUGUST 1964 67

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 NATURE OF NURSING the preparation of nurses, within the REFERENCES

colleges and universities. 1. NIGHTINGALE, FLORENCE. Notes on

Nursing; What it is and What it is Not
I think that the professional qual- Philadelphia, J. B. Lippincott Co., 1946.
Early emphasis must be given ity to
of nursing service and the appro- 2. SMITH, MARTHA R. A concept of nurs-
ing. Amer.J.Nurs. 33:565, June 1933.
fundamental human needs, to pa-
priateness of a professional prepara- 3. TAYLOR, EFFIE J. Of what is the nature
tion
tients' daily activities, and to the de-have been grasped in many of nursing? Amer.J.Nurs. 34:476, May
1934.
countries,
velopment of the nurse's ability to but the means by which
4. THE biennial. Amer.J.Nurs. 46:728-746,
assess them properly and help these
theideas can be implemented are Nov. 1946.
5. BROWN, ESTHER LUCILE. Nursing
person meet them. In the next slow
stagein developing. It is up to us who
for the Future. New York, Russell Sage
of the professional curriculumshare
the this faith in the social value of Foundation, 1948.
6. NATIONAL NURSING COUNCIL. A
nursing
student might then be introduced to to speed this process.
Thousand Think Together; a Report of
the modifications in nursing care de- Three Regional Conferences Held in Con-
SUMMARY nection with the Study of Schools of
manded by chronological and intel- Nursing. New York, The Council, 1948.
The function we believe the nurse
lectual age, sex, emotional balance, 7. HUGHES, E. C., AND OTHERS. Twenty
state of consciousness, nutritional Thousand Nurses Tell Their Story. Phila-
performs is primarily an independent delphia, J. B. Lippincott Co., 1958.
balance, and other conditions one-that
com- of acting for the patient 8. AMERICAN NURSES' ASSOCIATION.
ANA board approves a definition of nurs-
mon to all patients and found on any he lacks knowledge, physical
where ing practice. Amer.J.Nurs. 55:1474, Dec.
clinical service. This content mightstrength, or the will to act for him- 1955.

constitute the core of the clinical 9. ---. Professional nursing defined. Amer.
self. We see this function as complex J.Nurs. 37:518, May 1937.
curriculum. Finally, the studentand creative, as offering unlimited 10. GOODRICH, ANNIE W. The Social and
Ethical Significance of Nursing. New
would be helped to study the par- opportunity for the application of York, Macmillan Co., 1932.
the physical, biological, and social 11. KIMBER, DIANA C., AND OTHERS.
ticular needs of each patient, both in
Anatomy and Physiology. 14th ed. New
relation to these more general con-sciences, and the development of York, Macmillan Co., 1961.
skills based on them. We believe so-
ditions and to those stemming from 12. HARMER, BERTHA. Textbook of the
Principles and Practice of Nursing, rev. by
his specific disease, handicap, orciety wants and expects this service Virginia Henderson. 5th ed. New York,
condition. from the nurse and no other worker is Macmillan Co., 1955.
13. TUDOR, GWEN E. A sociopsychiatric
Since the turn of the century,as able, or willing, to give it, nursing approach to intervention in a prob-
prominent American nurses-con- If a nurse believes that she is pre- lem of mutual withdrawal on a mental
hospital ward. Psychiatry 15:193-217,
spicuous among them, Miss Good- eminent in an area of health prac- May 1952.
rich and Miss Watting-and physi- tice, she will try to develop a work- 14. ORLANDO, IDA JEAN. The Dynamic
Nurse-Patient Relationship; Function,
ing milieu in which she can realize Process and Principles. New York, G. P.
cians have said that nursing schools
should be developed within the edu-her potential value to the person Putnam's Sons, 1961.
15. HENDERSON, VIRGINIA. Basic Princi-
served.
cational system-not within the serv- She will also recognize her ples of Nursing Care. London, Interna-
ice institutions-of this country. But responsibility for the validation and tional Council of Nurses, 1960.
16. YANKAUER, RUTH GILLEN, AND LE-
improvement of methods she uses, or
it is not only in this country that this VINE, EUGENE. The floor manager po-
for clinical nursing research. sition-does it help the nursing unit?
need has been recognized. Informed
Nurs.Res. 3:4-10, June 1954.
physicians and educators throughoutInI order to practice as an expert 17. HENDERSON, CYNTHIA. Freeing the
nurse to nurse. Amer.J.Nurs. 64:72-77,
the world expressed this opinion. in her own right and to use the sci- Mar. 1964.
entific approach to the improve- 18. SMITH, DOROTHY M. Myth and method
A revision of established patterns
in nursing practice. Amer.J.Nurs. 64:68-
ment of practice, the nurse needs the
of nursing education calls for strong 72, Feb. 1964.
kind
leadership. At a meeting 20 years ago of education that, in our so- 19. SIMMONS, L. W., AND HENDERSON,
VIRGINIA. Nursing Research; a Survey
when someone was bemoaning the ciety, is available only in colleges and Assessment. New York, .Appleton-
fact that there were no leaders in and universities. Educational pro- Century-Crofts, 1964.
20. U.S. PUBLIC HEALTH SERVICE. To-
nursing coming along to take the grams operated on funds pinched ward Quality in Nursing; Needs and
place of our great women of the from the budgets of service agencies Goals. Report of the Surgeon General's
Consultant Group on Nursing. (Publica-
cannot provide the preparation she
past, Miss Goodrich rose to protest. tion No. 992) Washington, D.C., U.S.
She said that the conditions were needs. Her work demands self-un- Government Printing Office, 1963.
21. JACKSON, MARGARET. Where should
passing that demanded the militantderstanding and a universal sympathy the nurse be trained? 2. In long-stay hos-
personalities of earlier years; for
theand understanding of, diverse pitals. Nurs.Times 51:560-561, May 20,
1955.
idea-not the individual-should human beings. The "liberalizing"22. DENNISON, CLARE. Maintaining the
lead, she said. She believed effect
firmly of a general education must quality of nursing service in the emer-
gency. Amer.J.Nurs. 42:774-784, July
that what she called "the complete
be recognized, for the personality of 1942.

the
nurse"-the woman with social nurse is possibly the most impor-
expe-
rience and a thorough education-
tant intangible in measuring the effect
had proved her worth, not of nursing
only as care. As Clare Dennison This article is condensed from an address (the
administrator and teacher but more Clare Dennison Memorial Lecture) given at
herself once said, "Finally and funda-
the University of Rochester School of Nurs-
particularly as a practitioner. There-mentally the quality of nursing care
ing, April, 1964.

fore she saw as inevitable, rather depends upon the quality of those A biblography accompanying this article is
available from the American Journal of Nurs-
than as something we must fight for,giving care" (22). ing, 10 Columbus Circle, New York 10019.

68 AUGUST 1964 AMERICAN JOURNAL OF NURSING

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