Running head: COMPARATIVE ANALYSIS PAPER

Comparative Analysis Paper

Emily Antil
SUNY Polytechnic Institute
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Historical Background

Virginia Henderson was born in Kansas City, Missouri on March 19, 1897 (Butts & Rich,

2018). She attended school as a child but received no formal diploma (Halloran, 2018). This

delayed her nursing aspirations for a short time. However, her nursing career began during

World War I where she cared for the sick and wounded in the military (Butts & Rich, 2018). She

was able to graduate from the Army School of nursing in 1921 and returned to school in 1926 to

obtain her Bachelor of Science and Masters of Arts in nursing education from Columbia

University Teachers College (Butts & Rich, 2018). She taught nursing at the Teachers College

and Yale University for several years (Butts & Rich, 2018). In 1939 Macmillan Publishing

Company requested Henderson contribute to writing the fourth edition of their Harmer textbook

(Halloran, 2018). This book was a standard reference for nursing at the time (Halloran, 2018).

In 1955 Henderson revised the Harmer textbook once again and introduced her own

definition of nursing (Halloran, 2018). This definition was widely taught in schools for several

decades (Butts & Rich, 2018). Her textbook was used universally in nursing schools and helped

to standardize the nursing practice (Halloran, 2018). She is often referred to as the Florence

nightingale of her time (Gonzalo, 2019). She authored several other books all based on her

experiences with nursing and the field of medicine (Butts & Rich, 2018). She was awarded 12

honorary doctoral degrees as well as the International Council of Nursing’s Christiane Reimann

Prize (Butts & Rich, 2018). Henderson’s work strongly influenced the future development of

nursing.
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Description of Nursing Theory

Of her contributions, perhaps her most widely known theory was the Need Theory

(Gonzalo, 2019). She used this theory to define the unique practice of nursing. Her theory

revolved around several assumptions. The first being that the nurse is to act as a substitute for

what the patient is lacking until the patient is able to care for themselves again (Henderson,

1997). According to Henderson (1997) it is essential to help the patient “gain independence as

rapidly as possible” (p.22). She emphasized the nurse should be willing to serve and act in

various roles depending on patient needs. (Henderson, 1997). In her theory this continues until

the patient is able to achieve independence (Henderson, 1997).

The second assumption is that the nurse should work with the patient rather than for the

patient (Henderson, 1997). She emphasized the need for the nurse and patient to work together to

create a successful plan of care (Henderson, 1997). She also noted the nurse’s plan should

remain the same regardless of a physical or mental diagnosis, as she believed the two were

deeply connected (Henderson, 1997).

Henderson’s theory explored the fundamentals of basic human needs and how nurses can

work to help their patients satisfy those needs (Butts & Rich, 2018). She elaborated on her theory

by developing a list of 14 basic needs that nursing care is comprised of (Butts & Rich, 2018).

The list of these needs includes items related to physical wellbeing as well as emotional and

spiritual wellbeing (Butts & Rich, 2018). These needs have frequently been used as a framework

for quality nursing care.

Theory Usefulness
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Henderson’s theory influenced the way nursing developed and is still relevant to the

practice of nursing today. In 2013 a study was done applying Henderson’s theory to childbirth

education. The author, Renee Waller-Wise, used the 14 basic needs of nursing as a framework to

help her facility reach Magnet Accreditation. Waller-Wise (2013) explained that Henderson’s

theory is ideal for the use of childbirth education because it acknowledges that although the

patient is not necessarily sick, the nurse must still offer their assistance in maintaining patient

health. The author then goes on to break down each of the 14 basic needs and explain their

individual relevance to childbirth education. She emphasized that Virginia Henderson’s

definition of nursing theory was essential as the framework in which to base her curriculum

(Waller-Wise, 2013). The article fails to conclude if Magnet Accreditation was achieved for this

facility but still highlights the importance of having a strong theoretical framework for improved

practice. Although this article was based in labor and delivery, Henderson’s 14 basic needs ae

interchangeable across all specialties of nursing.

Another study was conducted using Henderson’s framework to identify the sleep needs of

an elderly population. This study used the 14 basic nursing needs to identify and measure

potential issues in sleeping patterns. The researchers created a questionnaire structurally based

on Henderson’s theoretical framework. Through analyzing this questionnaire, the study was able

to conclude that age, smoking, and pain when moving were major factors that impacted quality

of sleep (Clares, Freitas, Galiza & Almedia, 2012). These results were significant in that these

seniors can now identify and seek further assistance with their sleep related needs (Clares at al.,

2012). The authors concluded that the knowledge they were able to obtain by using Henderson’s

framework helped to improve the care provided to this senior population (Clares et al., 2012).
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Henderson’s theory helped create a systematic way to study, analyze, and develop essential

nursing interventions.

Related Concept

The nursing need theory focuses strongly on the concept of independence. Independence

in relation to patient care is best defined as the ability to initiate actions, achieve, and make

decisions by ones self (Hughes, 2004). Independence is an essential part of healing for many

patients. Many existing programs in hospitals work to facilitate patient independence. Allowing

patients to do as much for themselves as possible has shown to have positive outcomes in a

variety of illnesses (Hughes, 2004). Patient independence is frequently used as a standard to

determine successful outcomes. Comparing patients baseline independence to their current health

status is often how health care providers gauge patient progress in healing.

Henderson’s Need Theory strongly emphasized the importance of the role of the nurse in

facilitating patient independence. Henderson (1997) explained that it was the primary role of the

nurse to assist the patient in performing activities they would normally do for themselves. For

modern day nurses this usually means assistance with tasks such as bathing, eating, dressing or

ambulating. These tasks are ones that nurses help patients complete daily. She noted that the

nurse facilitated this independence by acting as a substitute in areas where the patient was unable

due to illness (Henderson, 1997).

She felt the nurse’s goal should be to make the patient complete and in order to be

complete the patient must be independent (Gonzalo, 2019). Only once this concept is achieved is

the nurses’ job complete (Henderson, 1997). Hospitals generally do not discharge patients unless
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they feel the patient is well enough to care for themselves independently. Even after discharge,

programs such as home health aides or rehabilitation services are often put in place to ensure a

successful patient outcome. Henderson believed that increasing the patient’s independence

would greatly decrease their time spent in the hospital and hasten their healing (Gonzalo, 2019).

Many of these theories on the concept of independence Henderson discussed are still carried out

today.

Concept Usefulness

The article Promoting Self-Management and Patient Independence by Sara Hughes

studied the concept of independence in relation to the nurse’s role and patient outcomes. Hughes

explored a variety of nursing theories and their emphasis on establishing and maintaining patient

independence. The article focused on the nurse’s role in encouraging patients to provide their

own care. Hughes (2004) explained how experts often encourage those with chronic health issues

to take control of their own care but also recognize the importance of professional support in

maintaining independence. Although the nurse can complete tasks for the patient, it is essential

they instead encourage the patient to do for themselves.

She further explained that self-management approaches to patient care produce better

outcomes when compared to clinically based approaches (Hughes, 2004). The nurses focus

should not be on completing clinical tasks, but on ensuring the patient can participate in carrying

out these tasks. She asserted that every interaction with a patient is an opportunity for the nurse

to promote self-management (Hughes, 2004).

Overall, Hughes (2004) highlighted the need for the nurse to work with and not for the

patient for them to sustain a state of ideal health. She asserted that using problem solving,

decision making, resource use, partnerships, and taking action the nurse can work alongside the
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patient to achieve optimal health results (Hughes, 2004). Allowing the patient to do for

themselves while inpatient promotes a better sense of independence after discharge. Her article

concluded that patients with a greater sense of independence have better overall outcomes

(Hughes, 2004). Hughes article validated Henderson’s theory of nursing in that it emphasized the

importance of patient independence in overall wellness.

Another study was conducted involving the concept of independence on people with

intellectual disabilities. Overall, this study observed how both patients and caregivers viewed the

concept of independence and how they could work together to improve it. It noted that people

with intellectual disabilities often struggle with managing everyday tasks but also consider their

independence to be very important (Sandjojo, Gebherdt, Zedlitz, Hoekman, Haan, Evers, 2019).

This article is especially valid when discussing Henderson’s theory because it elaborated on the

effects of independence not only physical but mental health.

These authors described independence as a continuum, with total care on one end and

complete independence on the other (Sandjojo et al., 2019). This is important because it

addressed that not all people view independence in the same way. It stated that no person is

completely independent in all areas, but everybody can be assisted by others to achieve the

highest level of independence possible (Sandjojo et al., 2019). Independence is individualized

and each individual has a different baseline. It explained that encouraging independence is an

individualized task that should be an ongoing lifelong form of support (Sandjojo et al., 2019). In

this case, independence was a key factor is mental wellbeing.

Many of the subjects of this study noted that they defined independence not only as the

ability to do for yourself, but the ability identify situations in which help is needed and ask for it

accordingly (Sandjojo et al.,2019). In this instance, where physical independence may be limited
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it is replaced by the ability to ask for help. This study paralleled Henderson’s Need Theory by

using independence as a marker for both physical and mental wellness.

Barriers to independence in this study were noted to be lack of caregiver time or

knowledge, lack of interest or motivation from the subject, and unchangeable physical or mental

limitations (Sandjojo et al.,2019). This study concluded that both caregivers and persons with

intellectual disabilities seek to obtain a greater level of independence in order to achieve a better

quality of life (Sandjojo et al., 2019). Facilitating independence had a positive outcome for not

only the patient, but the caregiver as well. This corroborates Henderson’s idea that independence

is an essential part of wellness.

Relationship of Theory and Concept

Commonalities

Henderson’s nursing need theory and the concept of independence are strongly

connected. Her theory was rooted in promoting patient autonomy. Henderson firmly believed it

was the role of the nurse not to do, but to help. Although she agreed that clinical skills were

essential, it seems her focus was placed more on developing a trusting coexistence with the

patient. She believed that clinical tasks were only a small portion of a much larger picture. The

framework of her entire theory revolved around the notion of independence. Without this

concept, Henderson’s theory would lack structure and application. Henderson’s emphasis on the

nurse being a substitute in areas where the patient is lacking emerge with the concept of wellness

through doing for ones self. Henderson’s theory is one that is still applicable today in many areas

of nursing. Henderson’s 14 basic needs were all based on things a person of optimal health

would be able to perform independently.

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Uniqueness

There are however areas of Henderson’s theory that are unique from the concept of

independence. She speaks many times on the connectedness of the mind and body. In several of

her works she explains how physical stress will result in mental stress and vise versa. Although

this is also a major idea in her theory, it does not strongly correlate with the concept of

independence. This idea of Henderson’s is one that stands alone.

Application of Theory and Concept

Education

Henderson’s theoretical framework, when combined with the concept of independence,

has several implications in modern-day nursing practice. It can be effectively applied to the areas

of advanced practice, education, and leadership. As demonstrated by Waller-Wise (2013),

Henderson’s 14 basic nursing needs can be utilized as a framework for education. Utilizing a

nursing theory is an important asset in an educator’s contribution to teaching (Waller-Wise,

2013). Henderson’s theory is an effective conceptual framework in which to develop an

educational curriculum (Waller-Wise, 2013). Having a structured reference in which to develop a

lesson plan is beneficial to nurses seeking careers as educators.

Advanced Practice

The Need Theory can also be applied to advanced practice. Henderson’s theory detailed

14 basic needs that APNS can directly apply to their nursing care (Butts & Rich, 2018). These

needs can be used to identify problems and plan interventions (Butts & Rich, 2018). An
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advanced practice nurse that is better able to identify patient needs can create a more accurate

plan of care.

Hughes (2004) and Sandjojo (2019) described situations in which promoting patient

independence improved overall quality of care. Hughes (2004) demonstrated how improved

independent health behavior improved symptom relief and prevented further health problems.

Sandjojo (2019) also asserted that independence has been known to be related to increased

feelings of satisfaction. An advanced practice nurse that understands this concept can better

promote independence among their own patient group and improve their quality of care.

Leadership

Lastly, this theory and concept can be translated over into nurse leadership. Hughes

encouraged nurses to promote critical thinking and problem solving among patients. She

explained in order to problem solve, people must be able to think for themselves (Hughes, 2004).

Although her article is patient directed, this concept can also be translated over into employee

relations.

A nurse leader can encourage independent decision making among coworkers to create a

more functional work environment. Hughes (2004) also describes the importance of coaching to

facilitate independence. Coaching, Hughes (2004) says, is an effective way of promoting

learning and self-management. A nurse leader is expected to act as a coach for those they are

leading. Facilitating independent thinking is essential not only for patients, but for employees as

well.

Research Direction

Nursing is a continually changing field. Although Henderson’s theory and the concept of
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independence are currently very well interconnected, as nursing progresses so will each of these

concepts. Technology has changed considerably since Henderson first published her definition of

nursing. Technology will eventually play a role in guiding future application of Henderson’s

theory and the concept of independence. As Sanjojo et al. (2019) pointed out, independence can

be viewed on a scale. Will the definition and requirements of independence change as new

medical technology is created? How will the 14 basic human needs change as our resources

change?

As nursing has progressed, nurses have gained significantly more independence in their

practice. Hughes (2004) pointed out that it is essential for the nurse to facilitate independence in

their patients wherever possible. As the scope of nursing practice grows how will this growth

effect a nurse’s ability to promote patient independence? As this happens will the structural

concepts of Henderson’s theory still be applicable to nursing? In what ways will an expanded

scope change the nurse’s approach to helping achieve independence?

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References

Clares J. W. B, Freitas, M. C., Galiza, F. T., Almeida, P. C. (2012). Sleep and rest need of
seniors: a study grounded in the work of Henderson. Acta Paul Enferm, 25(1), 54-59.

Butts, J. & Rich, K. (2018). Philosophies and theories for advanced nursing practice (3rd ed.).
Burlington, MA: Jones and Bartlett

Gonzalo, A. (2019). Virginia Henderson; nursing need theory. Retrieved from

https://nurseslabs.com/virginia-hendersons-need-theory/

Halloran, E. J. (2018). Virginia A. Henderson: 1897-1996. Retrieved from

https://www.aahn.org/henderson

Henderson, V. (1997). Basic principles of nursing care. New Haven, Connecticut: International
Council of Nurses

Hughes, S. A. (2004) Promoting self-management and patient independence. Nursing Standard,

19(30), 47-52.

Sandjojo, J., Gebhardt, W. A., Zedlitz, A. M. E. E., Hoekman, J., Hann, J. A., Evers, A. W. M.
(2019). Promoting independence of people with intellectual disabilities: a focus group
study perspective from people with intellectual disabilities, legal representative, and
support staff. Journal of Poilicy and Pactice in Intellectual Disabilities, 16.
doi:10.1111/jppi.12265

Waller-Wise, R. (2013). Utilizing Henderson’s nursing theory in childbirth education.

International Journal of Childbirth Education. Retrieved from
https://www.thefreelibrary.com/_/print/PrintArticle.aspx?id=334177950
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