1. Virginia Henderson Theory Presentation By Kirsten Kulkarni
Neeta Monteiro
Pierre Nkurunziza

2. Why this theorist’s model/theory?
“The Nightingale of Modern Nursing.”
“Modern-Day Mother of Nursing.”
“The 20th century Florence Nightingale.”
“The first lady of Nursing”
“First truly international nurse”

3. Virginia Avenel Henderson 1897-1996
Nursing Theorist
Virginia Avenel Henderson

4. Background Born in Kansas City Missouri, in 1897
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 two years after graduation

5. Background
In 1923, she started teaching nursing at the Norfolk Protestant Hospital in Virginia
In 1929, she entered Teachers College at Columbia University for Bachelor’s Degree in 1932, and Master’s Degree in 1934
In 1939, she revised: Hamer’s classic textbook of nursing for its 4th edition, and later wrote the 5th edition incorporating her personal definition of Nursing (Henderson, 1991)

6. Background
Joined Columbia as a member of the faculty, remained until 1948
Since 1953, a research associate at Yale School of Nursing
Recipient of numerous recognitions
Her work influenced the nursing profession throughout the world
A well known nursing educator and a prolific author

7. Background
Honorary doctoral degrees from the Catholic University of America, Pace University, University of Rochester, University of Western Ontario, Yale University (held honorary degrees from 13 universities).
In 1985, honored at the Annual Meeting of the Nursing and Allied Health Section of the Medical Library Association
Died: March 19th , 1996

8. Theory history Henderson did not intend to develop a theory of nursing
She attempted to define the unique focus of nursing
She emphasized on basic human needs as the central focus of nursing practice.
Two events that lead to the creation of the definition of Nursing
* Helped revise a Nursing textbook
* She was concerned that many states had no provision for nursing licensure

9. Nursing defined by Henderson
Virginia Henderson’s 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” (Henderson, 1966).

10. Henderson’s philosophy
“She emphasized the importance of increasing the patient’s independence so that progress after hospitalization would not be delayed. 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.”

11. Original purpose
Improving patient’s outcomes by application of nursing process
Collaborative care
Patient centered care
Amelioration of health in general

12. Virginia Henderson’s 14 Components
She categorized nursing activities into 14 components, based on human needs
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 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

14. Breathe normally 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 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
Breathe normally

15. The 14 components
1. Breathe normally

16. 14 components
2. Eat and drink adequately

17. 14 components
3. Eliminate body wastes

18. 14 components
4. Move and maintain desirable postures

19. 14 components
5. Sleep and rest

20. 14 components
6. Select suitable clothes- dress and undress

21. 14 components
7. Maintain body temperature within normal range by adjusting clothing and modifying environment

22. 14 components
8. Keep the body clean and well groomed and protect the integument

23. 14 components
9. Avoid dangers in the environment and avoid injuring others.

24. 14 Components
10. Communicate with others in expressing emotions, needs, fears, or opinions

25. 14 Components
11. Worship according to one’s faith

26. 14 components
12. Work in such a way that there is a sense of accomplishment

27. 14 components
13. Play or participate in various forms of recreation

28. 14 components
14. Learn, discover, or satisfy the curiosity that leads to normal development and health and use the available health facilities.

29. The 14 components Physiological : The first 9 components
Psychological: 10th and 14th
Spiritual : 11th component
Sociological : 12th and 13th

30. Comparison with Maslow’s Hierarchy of Needs

31. Internal Theory Analysis
Relative importance of concepts. Is each given equal weight?
Each of the 14 components as described by Virginia Henderson are given equal importance. Nevertheless the patient may need assistance with only some of the components at a given time depending on the patient’s health condition.

32. The Collaborative Team

33. Henderson’s Theory and the four major concepts
1. Individual
Have basic needs that are components 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

34. Four major concepts 2. 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

35. Four major concepts Environment (continued)
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.

36. Four major concepts 3. Health
Definition based on individuals ability to function independently outline in the 14 components.
Nurses need to stress promotion of health and prevention and cure of disease.
Good health is a challenge. Is the individual able to meet these needs independently?
Good health is a challenge. Affected by age, cultural background, physical, and intellectual capacities, and emotional balance. Is the individual able to meet these needs independently?

37. Four major concepts 4.Nursing
Temporarily assisting an individual who lacks the necessary strength, will, and knowledge to satisfy one or more of the 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.”

38. Four major concepts Nursing (continued)
Henderson’s classic definition of nursing
Carry out physician’s therapeutic plan.
Individualized care is the result of the nurse’s creativity in planning care.

39. Four major concepts Nursing (continued) 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.”

40. Four major concepts Nursing (continued) Nurse should have knowledge
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.”

41. Four major concepts Nursing (continued) Nurse has responsibility to
*assess patient’s needs
*help individual meet their need
*provide a safe environment

42. Assumptions The major assumptions of the theory are:
“Nurses care for patients until patient can care for themselves once again”.
Patients desire to return to health (not explicit).
Nurses are willing to serve and that “nurses will devote themselves to the patient day and night”.
Nurses should be educated at the university level in both arts and science.

43. External Analysis
Semantic clarity The terminologies that are used in this theory are clear, easily understandable and simple. Structural Clarity There is no model to represent this theory. Simplicity This theory is simple and easy to use

44. External analysis
Generalizability This theory is applicable to people of all age groups, cultures, gender, health conditions and different settings. Accessibility Information regarding this theory is accessible, but newer theorists have since then developed ideas that are built from the concepts proposed in this theory.(An example of this is Orem’ s basic needs theory)

45. External Analysis
How is this theory applicable to nursing clinical practice or education or administration?
Practice
Assists nurses in everyday experiences
Serves as a guide in the nursing process
Provides a rationale for effective decision making and implementation
Nursing care evaluation criteria
Facilitates communication among the health care team members
Ideas are developed and words are defined
Enhance autonomy

46. External Analysis
Education
Provide a general focus for curriculum design
Guide curricular decision making
Research
Offers a framework for generating knowledge and new ideas
Helps discover knowledge gaps
Gives a foundation for other theories

47. Bibliography of Virginia Henderson
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
The development of Henderson’s definition of Nursing

48. School of thoughts in Nursing theories 1950-1970
Need Theorists
Interaction Theorists
Outcome Theorists
Abdellah
King
Henderson
Orlando
Johnson
Orem
Peterson and Zderad
Levine
Paplau
Rogers
Travelbee
Roy
Wiedenbach

49. Analysis of Nursing Theories According to 1st School
Focus
Problem
Human Being
A set of needs or problems
A development being
Patient
Need Deficit
Orientation
Illness, disease
Role of nurse
Dependent on medical practice
Beginnings of independent functions
Fulfill needs requisites
Decision making
Primarily health care professional

50. 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” (Henderson 1991)
(Henderson, 1991)

51. Henderson’s Theory Background

52. Henderson’s Theory and Nursing Process
Summarization of the stages of the nursing process as applied to Henderson’s definition of nursing and to the 14 components of basic nursing care.
Nursing process Nursing Intervention
Nursing assessment Nursing implementation
Nursing diagnosis Nursing Evaluation
Nursing plan

53. Characteristic of Henderson’s Theory
Interrelation of concepts
Concepts are borrowed from other disciplines
Her definition and components are logical and the 14 components are a guide for the individual and nurse in reaching the chose goal
Theories should be relatively simple yet generalizable- Henderson’s theory can be applied to individuals of all ages

54. Characteristics of Henderson’s theory
Theories can be the bases for hypotheses that can be tested- Her definition of nursing cannot be viewed as a theory, therefore it is not possible to generate testable hypotheses.
However some questions to investigate the definition of nursing and the 14 components may be useful.

55. Characteristics of Henderson’s Theory
Theories contribute to and assist in increasing the general body of knowledge within the discipline through 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.

56. Characteristics of Henderson’s Theory
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.

57. Usefulness
Nursing education has been deeply affected by Henderson’s clear vision of the function of the nurse.
Published in nursing textbooks from 1930’s -1960’s.
Still important in evaluating nursing care in the 21st century
Henderson’s other concepts have been used from 1930’s to present.

58. Limitations
Lack of conceptual linkage between psychological and other human characteristics
No concept of the holistic nature of human being
The relationship between the components is unclear
Lacks inter-relate of factors and the influence of nursing care

59. Limitations (continued)
Assisting the individual in the dying process she includes that the nurse helps, but there is little explanation of what the nurse does.
“Peaceful death” is curious and significant nursing role

60. Purposes of Nursing Theories
In practice
In Education
In Research
Personal practice

61. 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.

62. References