VIRGINIA HENDERSON’S NURSING NEED THEORY

Biography of Virginia Henderson

Virginia Avenel Henderson was described in so many names. Some called her “The
Nightingale of Modern Nursing”. Others named her as “Modern-Day Mother of Nursing”
and “The 20th Century Florence Nightingale”. She was born on November 30, 1897 in
Kansas, Missouri and was the fifth of eight children of Daniel Brosius Henderson and
Lucy Minor Abbot.

 The Henderson family moved to Virginia in 1901, where Miss Henderson grew into
adulthood. In 1918, she entered the Army School of Nursing in Washington, DC, and in
1921, she received her nursing diploma. She worked at the Henry Street Visiting Nurse
Service for 2 years after graduation. Henderson, very much wanted to teach nursing,
therefore accepted her first instructor position in 1924 at the Norfolk Protestant
Hospital in Virginia. 

In 1934 and for the next fourteen years, she remained at Teachers College, Columbia
University where she joined the teacher's faculty and earned her Bachelor of Science
and Master of Arts degree in nursing education.

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)

  In 1953, Henderson accepted a research associate position in Yale University School of

Nursing. The project was designed to survey and assess the status of nursing research in
the United States. From 1959 to 1971, Henderson was funded to direct the Nursing
Studies Index Project. The result of the project was the publication of the four-volume
Nursing Studies Index, the first annotated index of nursing research. Henderson had
now deserved the title of research associate emeritus at Yale University. At 75 years of
age, Henderson focused her career on international teaching and speaking
engagements.

Henderson died on March 19, 1996. When she was 98 years old. The Sigma Theta Tau
International Nursing Library is named in her honour.
Achievements

She is a recipient of numerous recognitions for her outstanding contributions to

nursing.

 Well known nursing educator and a prolific author.

 received honorary doctoral degrees from the Catholic University of America,

Pace University, University of Rochester, University of Western Ontario,Yale
University

 Warranted an obituary in the New York Times, Friday March 22. 1996.

 Honoured at the Annual Meeting of the Nursing and Allied Health Section of the
Medical Library Association In 1985.

Contributions  

In 1937 Henderson and others created a basic nursing curriculum for the National
League for Nursing in which education was “patient cantered 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
90’s. 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). 
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 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.

 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 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).

Virginia Henderson also believed that it was important that nursing be based on
evidence, and that research was a critical component of improving nursing practice. She
believed all nurses should have access to literature on nursing and current nursing
research to help better their practices, and to this end, she worked to develop an index
of nursing.

Virginia Henderson's Contribution to Nursing Theory:

Nursing Need Theory: - Introduction

Henderson's Need Theory emphasizes the importance of patient independence so that

the patient will continue to progress after being released from the hospital. Henderson
described the role of the nurse as one of the following: substitutive, which is doing
something for the patient; supplementary, which is helping the patient do something; or
complementary, which is working with the patient to do something. All of these roles
are to help the patient become as independent as possible. 

She categorized nursing activities into fourteen components based on human needs.
The fourteen components of Henderson's concept are as follows:

1. Breathe normally. Eat and drink adequately.

2. Eliminate body wastes.

3. Move and maintain desirable postures.

4. Sleep and rest.

5. Select suitable clothes-dress and undress.

6. Maintain body temperature within normal range by adjusting clothing and

modifying environment.

7. Keep the body clean and well groomed and protect the integument.

8. Avoid dangers in the environment and avoid injuring others.

9. Communicate with others in expressing emotions, needs, fears, or opinions.

10. Worship according to one's faith.

11. Work in such a way that there is a sense of accomplishment.

 12. Play or participate in various forms of recreation.

13. 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

While a nurse's job is to care for patients, it is also to help patients be able to care for
themselves when they leave the healthcare facility. This will help ensure that the patient
has fewer setbacks during recovery from the illness or injury, and will help the
transition into self-care be smoother since a nurse will be helping and supervising along
the way until the patient goes home. For those nurses who work in rehabilitation,
Henderson's theory is one that can be easily used every day, and it will be the patients
who benefit from it.

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, 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 bio psychosocial 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

”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

Characteristic of Henderson’s theory

 There is interrelation of 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 are borrowed from other discipline.Eg.. Maslow’s Hierarchy of
human needs; concept of interaction-communication i.e. nurse-patient
relationship

 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.
  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.

Professional implications

 The booklet that Virginia Henderson wrote outlining her definition of nursing,
called "Basic Principles of Nursing Care," was published in 1960 and has since
been translated into more than 20 languages. It is a widely read and widely used
booklet that has had a significant impact on many nurses. Henderson believed
that the nurse should help the individual achieve independence as much as
possible, and that the nurse should take a patient centred approach to nursing to
be based in evidence and research. She also believed that a nurse should be
considered an independent member of the total health care team, and that the
nurse should only perform nursing functions, neither performing the diagnosis,
prescription, and prognosis functions of a physician or any tasks such as serving
food and cleaning that were not directly related to helping the patient with the
fourteen basic nursing functions.

APPLICATION TO NURSING PRACTICE

Henderson's Definition of Nursing is still directly applicable to professional nursing

today. Nurses function to assist patients in activities of daily living, especially those who
are incapable of doing so because of a debilitating condition.

The 14 Fundamental Needs described by Henderson, has been very influential in the
practice of nursing. It is very evident in the clinical settings how the nurse carries the
tasked to assist the client in meeting his or her needs - may it be physical, social,
emotional or spiritual by addressing the patient’s ability to breath normally, eat and
drink adequately and eliminate body wastes as primary concerns that the nurse should
address.

The devotion of nurses in the actual practice of 24hour – 7days a week reflects its
incomparable value in task performance for it is the goal of nursing to promote a higher
level of client dependence. But in the event that they still lack the strength and
knowledge, nurses act as a temporary proxy in helping them meet their needs that
neither the client nor the family can provide.

With the increasing incidence of stroke who’s suffering from disabilities including
paralysis, the forth activity of “moving and maintaining desirable posture” for patient’s
assistance can contribute to prevention of further bedsore and its complications. The
paralyzed patient in the hospital primarily needs the nurses’ assistance in moving about
and assuming various positions in the bed. While the patient remains helpless as to
movement, the nurse aids the patient with the use of her knowledge and skills. Through
turning patient to sides, chest tapping and the likes, pneumonia and pressure sores
could be a distant possibility. Furthermore, during the whole hospitalization process,
the nurse not only assists the client with mobility but also educates the client and the
family as well. Through that, patient independence will be promoted as the client gains
the strength and ability to perform activities of daily living. The family, too, acquiring
knowledge in the care of a family member with disability can take on the challenge of
caring and assisting the client at home after being discharged from the hospital.

Breathing is vital and Henderson’s first basic need of breathing normally is at most
assessed at all times. Administration of oxygen should be given accordingly. Her
application on nursing gives assertion to initiate immediate provision of biological
needs such as nasogastric tube insertion for feeding to maintain nourishment, while
catheterization is suggested for patients requiring general surgeries to help them
excrete waste while on the process of inability to do it consciously.

Meeting the 14 fundamental needs of the client has been a great basis to further
improve our performances towards nursing care. It has been the day-to-day
components of delivering nursing care core from infancy to senescence.

She further elaborated that the mind and body is inseparable and comprised as one
entity. Her patient-centered theory stressed the importance of the nurse's relationship
to the patient and the development of nursing practices. As a direct care giver, it will be
rewarding to see the patient as he progresses to independence. The promotion of
assessment, planning, implementation and evaluation of the 14 components of basic
nursing as a core basis should be considered at all times.

INFLUENCE ON NURSING EDUCATION

Henderson has made numerous contributions in the nursing profession which has been
a basis of most nursing schools. One of her long list of contributions is her well known
definition of nursing which calls for the nurse to be an expert and an independent
practitioner being equipped with the right knowledge in basic nursing care to achieve
its goal’s definition. Her definition along with the 14 basic needs brought tremendous
changes in our field of practice. It has made advancement, especially in the teaching of
nursing interventions relevant to specific disease conditions. The 14 fundamental
needs, as proposed by the theorist, lead a great emphasis on the assistive and
supportive role of the nurse in managing patient care. Moreover, as reflected on
Henderson’s 1959 revision of Harmer’s textbook “Principles and Practice of Nursing”,
the use of nursing process is also significant. The theorist stated that, “In order to meet
the person’s health it is necessary to know him and his family, this can only be
accomplished by being with them and studying them”. She postulates, as part of the
nursing process, that the nurse has to come up with a plan of care and to develop an
effective plan for the patient collection of necessary information (case study) thus
failure to prepare adequate information would result in rendering a low quality of
routine care.

Henderson’s designed three phases of curriculum in her book “The Nature of Nursing: A
Definition and Its Implications for Practice, Research and Education”. It implies that
students should progress through in their learning. The focus in all three phases
remains the same – assisting the patient when he needs strength, will or knowledge in
performing his daily activities or in carrying out prescribed therapy with the ultimate
goal of independence. Furthermore, these three phases of curriculum emphasized the
importance for the students to be involved in the complete study of the patient and all
his needs. She also stressed the importance of having nursing students to develop a
habit of inquiry; take courses in biological, physical, and social sciences and in the
humanities; study with students in other fields, observe effective care, and give effective
care in a variety of settings.

According to Henderson, Nursing is a universal occupation and a higher education

allows us to do it better. She emphasized, which all of us strongly agrees, that education
will bring forth the advance knowledge and gained more confidence to act
independently with unique skills and mastery. Since the patient presents with problems
of greater complexity, it is through advance study that we can explore the in depth
understanding of illness complexities and its management to modify the nurse’s care
plan.

APPLICATION TO NURSING RESEARCH

Research is a breakthrough of unending search for the betterment of patient care.

Henderson’s belief of formulating her work with unending polishing has lead to other
theorists’ well-defined frameworks. Her work has been a foundation for improving the
preparation for nursing. She even emphasized the importance of research in evaluating
and improving the nurses’ practice.
Henderon's theory on the Definition of Nursing and each of the 14 fundamental
components for basic nursing care arose research questions, where nurse’s function to
assume responsibility for identifying problems, for continually validating our functions
for improving the methods we use and for reassuring the effectiveness of nursing care
as well. Maximizing the utilization of different resources of knowledge from the libraries
are encouraged to be used.

She concluded that, “No profession, occupation or industry in this age can evaluate
adequately or improve its practice without research”. Her strong advocacy for nursing
brings forth a challenge to all of us to identify new needs beyond the 14 she
enumerated. Henderson’s believe that research in nursing is essential for nursing
practice in the age of technological advancements.

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
century.

 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.

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

Conclusion

 Henderson provides the essence of what she believes is a definition 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.

References

1. Tomey Marriner Ann., Alligood RaileMartha. Nursing Theorist and their work.
Fifth ed. Published by Mosby. 98-110.

2. George B. Julia , Nursing Theories- The base for professional Nursing Practice ,
3rd ed. Norwalk, Appleton & Lange.

3. Wills M.Evelyn, McEwen Melanie (2002). Theoretical Basis for Nursing

Philadelphia. Lippincott Williams& wilkins.

4. Potter A Patricia, Perry G Anne (2005) Fundamentals Of Nursing –Concepts

Process & Practice 6th edition. London Mosby Year Book

5. Parker, M. (2001). Nursing theory and Nursing Practice. Philadelphia: Davis.

6. Nursing Forum Vol. 38, No. 3, July- September, 2003.

7. http://currentnursing.com/nursing_theory/henderson

8. http://nurses.info/nursing_theory_person_henderson_virginia

9. http://www.mayo.edu/education/nursing_research/henderson