Nursing theories can be applied to clinical situations when caring for patients. To help nurses make effective clinical decisions in providing the best care, knowledge of nursing theories and models are used in their decision-making process. In order to explore a nursing theory, this essay will examine Henderson's theory of nursing, its origins and key features of the theory, and how it relates to personal values and beliefs. This knowledge of nursing theory will help in making informed decisions regarding patient care and how to be prepared for future challenges as a nurse.
Johnson and Weber (2001) describe nursing theory as information of organized facts, principles, and laws related to nursing experiences. Henderson's work is considered a nursing theory because it contains a definition of nursing, a nurse's role and function, and basic needs of nursing care. She focuses on patient care to help patients reach a level of independence and supports her definition with the 14 components of basic nursing care (George, 2002).
Definition of nursing
In 1955, Henderson's definition of nursing is published in The Principles and Practice of Nursing. Henderson stated the following:
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 a peaceful death) that 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 cited in Johnson & Weber, 2001, p. 87).
Henderson's basic nursing care
In 1966, The Nature of Nursing: A Definition and Its Implications for Practice, Research and Education published Henderson's 14 components of basic nursing care:
Eat and drink adequately.
Eliminate body wastes.
Move and maintain desirable positions.
Sleep and rest.
Select suitable clothing-dress and undress.
Maintain body temperature within normal range by adjusting clothing and modifying the 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 (as cited in George, 2002, pp. 26-27).
According to Marriner-Tomey and Alligood (2006), Henderson's work can be seen as a philosophy of nursing. She clarifies her opinions and views of basic nursing care which is published in 1991 of The Nature of Nursing: Reflections After 25 Years. She also describes the nurses relationship to the patient in three levels where the nurse acts as a substitute, helper and partner with the patient. Henderson states that the nurse must "get inside the skin of each of her patients in order to know what he needs" (as cited in Marriner-Tomey & Alligood, 2006, p. 56).
According to Henderson (1990), an excellent nurse can be measured in the following:
Decreased mortality rates among those she serves.
Decreased morbidity rates with respect to certain diseases or conditions such as impetigo in infants, rickets in children, or puerperal sepsis in mothers.
Decrease in symptoms of nursing neglect such as pressure sores or incontinence.
Decrease in psychological withdrawal symptoms, negativism, or mutism.
Decrease in dependency with respect to daily activities or the degree of rehabilitation achieved.
Favorable opinions of care given by the nurse as expressed by the patient, his family, other nurses, or associated medical personnel.
Henderson's nursing theory focuses on the patient problems, education of nurses, and nursing care. Her contributions to nursing education and practice influenced the development of nursing (Kim & Kollak, 1999).
Origins of the Nursing Theory
Development of the theory
Henderson theory is important to nursing as stated by Jezierski (1997), "Virginia Henderson did for twentieth century nursing what Nightingale did for nineteenth century nursing. She was called the Mother of Modern Nursing" (p. 386). According to George (2002), the development of Henderson's definition began before the 1920's when she was a nursing student at the Army School of Nursing. Her nursing education and clinical practice helped influence and form the historical evolution of her definition. While Henderson helped the sick and wounded soldiers during WW1, she realized nursing was about the importance of quickly completing nursing procedures.
Also, Henderson's nursing experience in psychiatric failed to provide insight in prevention of illness. In pediatric care, family support was not taken into account in the needs of the patient. In community health nursing, Henderson's experiences included environment and a person's lifestyle. After graduating in 1921, the focus of Henderson's education involved experiences in nursing, teaching and research, and influences of nursing colleagues which led her to define a nurse's role and function (George, 2002).
According to Johnson and Weber (2001), Henderson's definition can be seen in other nursing theories such as Orem's self care deficit theory and Orlando's nursing process model. In 1953, Henderson and Leo Simmons works in the development of nursing was published in Nursing Research: A Survey and Assessment and Nursing Studies Index. Henderson continued to build on her development of theory throughout her life and educate future nursing professionals.
Henderson's beliefs and values about nursing
Henderson's definition of nursing and the 14 basic needs of nursing, define her values and beliefs which can be described in the following statement:
I believe that the function the nurse performs is primarily an independent one-that of acting for the patient when he lacks knowledge, physical strength, or the will to act for himself as he would ordinarily act in health, or in carrying out prescribed therapy. This function is seen as complex and creative, as offering unlimited opportunity for the application of the physical, biological, and social sciences, and the development of skills based on them (as cited in George, 2002, p. 107).
Henderson's beliefs about nursing include a nurse's responsibility to provide the best care for a patient; maintaining a patient's balance in health; and developing knowledge and skills in nursing to communicate with individuals, families and societies.
Key features of the Theory
Metaparadigm concepts according to Henderson
The four basic metaparadigm concepts in nursing include person, environment, health, and nursing. The person is the patient's interactions with the nurse to facilitate communication. Environment can be a hospital, clinic, or home where communication is involved. Health is a person's well being related to their environment and nursing deals with incorporating a plan of care (Tourville & Ingalls, 2003). Henderson's concept of a person or individual is made up of fourteen basic needs that can be grouped into biological, psychological, sociological, and spiritual components. The physiological component includes Henderson's one to nine needs. Psychological is the tenth and fourteenth need. Sociological is the twelfth and thirteenth need and the spiritual component is the eleventh need (George, 2002). A person requires knowledge and strength to perform activities of daily living and have the essentials for survival. The sick or well individual requires help to become healthy, independent or die peacefully and there is a connection between mind and body (Wesley & McHugh, 1992).
Henderson's concept of environment includes an individual's relationship with family, community involvement, for example private and public agencies, which provide health care and society to help with nursing education (George, 2002). Also, environment can harm a healthy individual through personal factors such as age; and physical factors such as air pollution that can cause illness (Wesley & McHugh, 1992).
Health is defined by Henderson's fourteen basic needs which require an individual to perform effectively. Henderson emphasizes the importance of promoting health and preventing disease because optimal health may be difficult for some to obtain. Also, she discusses how factors such as age, race, emotional balance, and physical and mental abilities influences the health and needs of an individual (as cited in George, 2002, p. 89).
The nursing concept is defined by Henderson as caring for a sick or well individual until they are able to care for themselves independently. Nursing involves being able to work as part of the health care team according to an individualized care plan. Nursing is an understanding of social sciences and humanities which has led to a university nursing education. Also, knowledge of social and religious customs is important to nursing when looking at an individual's health needs (Wesley & McHugh, 1992).
Concepts and propositions of the theory
According to George (2002), there are four main concepts of Henderson's theory which are basic human needs, bio-physiology, culture and interaction-communication. These concepts relate to Henderson's definition of nursing and how they are essential components to nursing. The 14 basic needs can be compared to Maslow's hierarchy of human needs. Physiological and safety needs include Henderson's number one to nine needs. Love and belonging, esteem, and self-actualization needs include Henderson's number ten to fourteen needs.
The bio-physiology concept in Henderson's theory uses knowledge of the human anatomy and biological systems to find out what is the best nursing care to help an individual get better or help prepare for a peaceful death. The culture concept includes family and society which can influence human needs. In Henderson's theory, the nurse can help an individual meet these human needs. The interaction-communication concept uses to establish therapeutic relationship between a nurse and patient, as well as friends and family. The nurse should be able to share feelings and have an understanding for different cultural values and beliefs into the planning of care (George, 2002).
These four concepts of human needs, bio-physiology, culture and interaction-communication connect with each other in Henderson's 14 basic needs of nursing. Bio-physiology concept include Henderson's number one to nine needs. Human needs and culture concepts include a combination of number six to fourteen needs. Interaction-communication concepts include number ten to fourteen needs. By using Henderson's basic concepts of nursing, the appropriate care can be provided to patients (George, 2002).
Henderson's and Maslow's needs table
The following table illustrates how well Maslow's hierarchy of human needs matches with the 14 basic needs of Henderson (Wesley & McHugh, 1992, p.27).
Comparison with Maslow's Hierarchy of Needs
Maslow's Hierarchy of Needs
Henderson's Basic Needs
Eat drink adequately
Eliminate body wastes
Move and maintain desirable positions
Sleep and rest
Select suitable clothing
Maintain body temperature
Maintain bodily cleanliness and grooming
Avoid dangers in the environment
Love and Belonging Needs
Communicate with others to express emotions, needs, fears, or opinions
Worship according to one's faith
10. Communicate with others to express emotions, needs, fears, or opinions
Worship according to one's faith
12. Work that provides a sense of accomplishment
Play or participate in various form of recreation
Learn, discover, or satisfy the curiosity that leads to normal development and health
Theory applied to clinical situations
Theory can help nursing students understand the importance of theory and to determine which theory can be used in clinical situations. According to Colley (2003), nursing theory "gives nurses a sense of identity, and help patients, managers and other healthcare professionals to recognize the unique contribution that nurses make to the healthcare service" (p. 37). Henderson (2006) explains how to teach the concept of nursing. She would pair up a student with a knowledgeable preceptor. The student will watch, than participate until they are able to work independently. Learning to assess the basic needs of a patient, developing and implementing a nursing care plan and evaluating the effectiveness of practice (Johnson & Weber, 2001). Henderson's theory includes her definition of nursing and the 14 basic principles of nursing to help guide nurses in working with individuals, families and groups. Henderson's theory can be used in any clinical situation where a patient does not have the understanding or capacity to perform activities related to health or a peaceful death (George, 2002).
Congruence with the Student's Nursing Practice
Own values and beliefs about nursing
My values about nursing include helping and caring for patients to establish trusting relationships. Religious beliefs and family values such as strength and community are important to me in nursing. As wells as, the value of a higher education to expand my knowledge and skills in critical thinking.
My values and beliefs are similar to those of Henderson's in that we both believe in helping provide the best care with patients, having healthy relationships and the importance of education in nursing.
In conclusion, Henderson's work is considered a nursing theory because it contains a definition of nursing and basic needs of nursing care. She focuses on patient care to help patients reach a level of independence which include nursing care and education. By exploring Henderson's nursing theory and understanding its origins and key features, and how it relates to personal values and beliefs I am able to apply her theory to clinical situations.