Virginia Henderson's Need Theory

This page was last updated on 23/07/2010

“Nursing theories mirror different realities, throughout their development; they reflected
the interests of nurses of that time.”

Introduction

• “The Nightingale of Modern Nursing”

• “Modern-Day Mother of Nursing.”
• "The 20th century Florence Nightingale."
• "little Miss 3x5"
• 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?

• VH 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 honored 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 centered and organized
around nursing problems rather than medical diagnoses” (Henderson,1991)
• 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

The First School of Thought: Needs

This school of thought includes theories that reflect an image of nursing as meeting the
needs of clients and were developed in response to such questions as:

• What do nurses do?

• What are their functions?
• What roles do nurses play?

Answers to these questions focused on a number of theorist describing functions and

roles of nurses.

Conceptualizing functions led theorists to consider nursing client in terms of a Hierarchy

of needs. When any of these needs are unmet and when a person is unable to fulfill his
own needs, the care provided by nurses is required. Nurses then provide the necessary
functions and play those roles that could help patients meet their needs.

School of thought in Nursing Theories-1950-1970

Need theorists interaction Theorists Outcome theorists

 King

Orlando Johnson

Abdellah Peterson and Zderad Levine

Henderson
Orem Paplau Rogers

Travelbee Roy

Wiedenbach

Analysis of nursing theories according to 1st School

Focus Problems
A set of needs or problems.
Human being
A developmental being.
Patient Need Deficit
Orientation Illness, disease
Dependent on medical practice.

Role of nurse Beginnings of independent functions

Fulfill needs requisites

Decision making Primarily health care professional

Henderson’s Theory Background

• Henderson’s concept of nursing was derived form 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 (Henderson,1991)
• 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" (Henderson, 1966).

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 aret:

• "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.

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 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

3. 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?

4. 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
o Categorized Nursing : nursing care
o 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 be a 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 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."

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.

”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 Henderson’s 14 components and definition of nursing
Nursing Henderson’s 14 components
Assessment
Nursing Diagnosis Analysis: Compare data to knowledge base of health and disease.
Nursing plan Identify individual’s ability to meet own needs with or without
assistance, taking into consideration strength, will or knowledge.
Nursing Document how the nurse can assist the individual, sick or well.
implementation
Nursing Assist the sick or well individual in to performance of activities in
implementation meeting human needs to maintain health, recover from illness, or
to aid in peaceful death.
Nursing process 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 Henderson’s 14 components and definition of nursing

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

Comparison with Maslow's Hierarchy of Need

Maslow's Henderson
Breathe normally

Physiological Eat and drink adequately Eliminate by all avenues of elimination

needs Move and maintain desirable posture Sleep and rest Select suitable
clothing Maintain body temperature Keep body clean and well
groomed and protect the integument

Safety Needs Avoid environmental dangers and avoid injuring other

 Communicate with others
Belongingness
and love needs
worship according to one's faith
Work at something providing a sense of accomplishment

Esteem needs Play or participate in various forms of recreation

Learn, discover, or satisfy curiosity

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, biophysiology, 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..."
• Henderson stated that “Thorndike’s fundamental needs of man” (Henderson,
1991, p.16) had an influence on her beliefs.

Value in extending nursing science

• From an historical standpoint, her concept of nursing enhanced nursing science

this has been particularly important in the area of nursing education.
• Her contributions to nursing literature extended from the 1930s through the 1990s
and has had an impact on nursing research by strengthening the focus on nursing
practice and confirming the value of tested interventions in assisting individuals
to regain health.

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)

Testability

• Henderson supported nursing research, but believed that it should be clinical

research (O’Malley, 1996). Much of the research before her time had been on
educational processes and on the profession of nursing itself, rather than on; the
practice and outcomes of nursing , and she worked to change that.
• Each of the 14 activities can be the basis for research. Although the statements are
not.
 • Written in testable terms, they may be reformulated into researchable questions.
Further, the theory can guide research in any aspect of the individual’s care needs.

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.
• “Peaceful death” is curious and significant nursing role.

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.

In 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?

Summary

• Background
• Achievements
• Publications
• Analysis of Nursing theories
• Development of Henderson’s definition of nursing
• 14 components
• Major four concepts
• Nursing process with Henderson’s theory
• Comparison with Maslow's Hierarchy need
• Assumptions
• Usefulness
• Testability
• Characteristics
• Limitation

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.