VIRGINIA AVENAL HENDERSON

Liz Anne Asebo-Vista, RNGraduate SchoolOur Lady of Fatima University

VIRGINIA HENDERSON The theorist was born November 30, 1897, in Kansas

City, Missouri, but spent her formative years in Virginia. In 1924, she graduated from the Army School of Nursing in Washington, DC, a federally funded diploma program to help overcome a nurse shortage. She earned a bachelor’s degree in 1934 from Teacher’s College, Columbia University, in New York City. She served on the faculty there from 1934 to 1948. Over the ensuing years, she revised the Textbook of the Principles and Practice of Nursing and published Basic Principles of Nursing for the International Council of Nursing (ICN). She then joined the Yale University faculty, where she continued to work after she retired until her death on March 9, 1996, at the age of 98.

VIRGINIA HENDERSON “First Lady of Nursing” “First Truly International Nurse” Began her career in public health nursing in the Henry

Street Settlement. Visiting Nurse Service in Washington D.C. First full-time instructor in nursing in Virginia when she

was at Norfolk Protestant Hospital. Active in the Graduate Nurses Association of Virginia. Early Advocate for the Introduction of Psychiatric Nursing

in the curriculum and served on a committee to develop such a course at Eastern State Hospital in Williamsburg, Virginia in 1929.

VIRGININA HENDERSON Outstanding teacher during her years at Teachers

College Her revision of Bertha Harmer’s Textbook of the

Principles and Practice of Nursing became widely used. Nursing Research: A Survey and Assessment an

important publications that grew out of Henderson’s year at Yale University

Directed a 12-year project entitled Nursing Studies Index, four volumes recognized as an essential reference for many years

In her book Nature of Nursing, she expressed her belief about the essence of nursing and influenced the hearts and minds of those who read it.

VIRGINIA HENDERSON At the age of 75, she directed her career to international

teaching and speaking. Selected to the American Nurses Association Hall of Fame Had the Sigma Theta Tau International Library named in

her honor Honored by the Virginia Nurses Association in 1988 when

the Virginia Historical Nurswe Leadership Award was presented to her.

In 2000, the Virginia Nurses Association recognized Henderson as one of the fifty-one Pioneer Nurses in Virginia

Halloran wrote, “Henderson was to the twentieth century as Nightingale was to the nineteenth. Both wrote extensive works that have influenced the world.”

METAPARADIGM IN NURSING Person

Referred person as a patient. “Person is an individual who require

assistance to achieve health and independence, or in some cases, a peaceful death

METAPARADIGM IN NURSING Health

Viewed health as a quality of life and is very basic for a person to function fully.

Health requires independence and interdependence.

Influenced by both internal and external factors.

She gave emphasis in prioritizing health promotion as more important than care of the sick.

METAPARADIGN IN NURSING Environment

It is important for a healthy individual to control the environment, but as illness occurs, this ability is diminished or affected.

In caring for the sick, it is the responsibility of the nurse to help the patient manage his surroundings to protect him from harm or any mechanical injury

The nurse must be educated about safety and must be aware of different social customs and religious practices to assess dangers.

Nurse must provide physicians data about the safety needs of the patient, the nurse’s observations and judgment regarding these needs as the latter uses this as the basis in prescribing protective devices.

METAPARADIGM IN NURSING Nursing

Asserted that nurses function independently from the physician, but they must promote the treatment plan prescribed by the physician.

Help both the sick and well individual. The care given by the nurse must empower the patient

to gain independence as rapidly as possible Nurse must be knowledgeable in both biological and

social sciences and must have the ability to assess basic human needs.

Henderson’s definition of nursing was considered as the “signature” of the profession.

14 BASIC NEEDS Breathing normally Eating and drinking adequately Eliminating body wastes Moving and maintaining a desirable position Sleeping and resting Selecting suitable clothes Maintaining normal body temperature by

adjusting clothing and modifying the environment Keeping the body clean and well groomed to

promote integument (skin) Avoiding dangers in the environment and

avoiding injuring others

14 BASIC NEEDS Communicating with others in expressing

emotions, need, fears or opinions Worshipping according to one’s faith Working in such a way that one feels a sense of

accomplishment Playing or participating in various forms of

recreation Learning, discovering or satisfying the curiosity

that leads to normal development and health, and using available health facilities.

THE NURSE-PATIENT RELATIONSHIP The nurse as a substitute for the patient. In times

of illness, when the patient cannot function fully, the nurse serves as the substitute as to what the patient lacks.

The nurse as a helper to the patient. In situations where the patient cannot meet his basic needs, the nurse serves as a helper to accomplish them.

The nurse as a partner with the patient. The nurse and the patient formulate the care plan together. Both as an advocate and as a resource-person, the nurse can empower the patient to make effective decisions regarding his care plans.

THE N URSE-PHYSICIAN RELATIONSHIP Nurse and the patient , as partners,

formulate the plan of care, it must be implemented in such a way that will promote the physician’s prescribed therapeutic plan.

Nurse do not follow doctor’s order, rather they follow in a philosophy which allows physicians to give orders to patients or other healthcare team members.

THE NURSE AS A MEMBER OF HEALTHCARE TEAM

The nurse, as a member of the healthcare team, works and contributes in carrying out the total program of care. However, working interdependently, as Henderson indicated, does not include taking other member’s roles and responsibilities.

ACCEPTANCE BY THE NURSING COMMUNITY

Practice Assessment Phase – The nurse would

assess the 14 fundamental needs of the patients and check which one is lacking or fully met.

Planning Phase – Involves giving the plan of care to meet the needs and personality of the patient. It must serve as a record and at the same time must fit in the prescribed plan made by the physician.

ACCEPTANCE BY THE NURSING COMMUNITY

Practice Implementation Phase – Nurses uses the 14 basic

needs in answering the factors that are contributing to the illness state of the patient. These intervention are focused on maintaining health, to recover from illness, or to aid in peaceful death.

Evaluation Phase - The nurse and the patient reviews the relationship and decides whether the goals are met or not. The nurse also assess if the patient attained independence and if health is achieved.

ACCEPTANCE BY THE NURSING COMMUNITY

Education - Three phases of curriculum development. First Phase - Emphasis is made on helping the patient

perform activities of daily living. Priorities are given on the fundamental needs of the patient and on the planning of nursing care.

Second Phase – Importance is placed on assisting patients achieved their needs in times of marked body disturbances or illness. The student nurses are confronted with problems with complexity then understands the rationale behind the prescribed therapeutic plans made by the physicians.

Third Phase – Centered on the patient and his family together with the dynamics affecting the relationship inside the unit.

ACCEPTANCE BY THE NURSING COMMUNITY

Research Henderson supported the use of research in

improving the practice of nursing. She supported developing nurses at baccalaureate level, and advocate the use of library use for research purposes.

It is the nurse’s responsibility to identify problems, continuously validate her practice, improving the method used, and reassuring the effectiveness of her care.

ANALYSIS Simplicity

Henderson’s concept of nursing is complex rather than simplistic.

The 14 basic needs had undergone several revisions so as it make it clear, simple and concise.

“The Principles and Practice of Nursing” sixth edition has given an extremely comprehensive and well illustrated explanation that makes the basic needs clear and more understandable.

ANALYSIS Generality

The definitions provided by Henderson are broad in scope. They work in such a way that they cover all areas of nursing practice and could be applied in every setting.

APPLICATION OF HENDERSON’S THEORY Makoy, 25 years old has been taken to the emergency

room of the hospital after sustaining multiple injuries after his motorcycle crashed in the course of his race. Multiple x-rays were taken which revealed fractures on the left femur, 2nd and 3rd ribs, and fractured right wrist. Surgery was immediately done to correct some of the dislocated bones and to stitch some open wounds. He was placed on several casts, and an external fixator, to support fractured bones, was attached on his left leg, which limited his movement for weeks to months. His family frequented their visits and tried to raise his confidence and assured him that all would be fine

APPLICATION OF HENDERSON’S THEORY However, Makoy appeared to manifest

self-pity and lowered self-esteem when he said “Wala na akong career! Baldado na ako. Wala ng kwenta buhay ko!” and after having failed to bathe or feed himself. Every morning, when his family tries to bathe him, he will raise his voice and say he’s not paralytic. At times, he also directs his anger to the nurses by shouting at them during the routine daily care.

ASSESSMENT In using the 14 fundamental needs of Henderson, she

would be able to determine that the ability of Makoy to independently perform his activities of daily living was affected. Eating and elimination patterns are altered as his mobility is restricted by his fixator and casts. He depends on his family and the nurses to take care of him. Almost all of his activities are restricted by his impaired mobility. Because of continued and prolonged state of dependency, Makoy developed a negative self-image and decreased self-esteem manifested by anger directed at his caregivers.

PLANNING As the nurse uses the concepts

introduced by Henderson, she would prioritize her intervention towards the attainment of independence through the performance of the basic human needs and restoration of his self-esteem.

IMPLEMENTATION On the top of the nurse performing as a substitute for

the patient, action must also be directed in having him participate gradually over his care. By empowering and increasing his self-esteem, the nurse can have the patient actively make decisions over his care with confidence and with full understanding of his plan of care. The nurse can also act as support to the family who could already be strained with the care-giving role they have. As the nurse applies the definition of nursing as proposed by Henderson, she would begin to understand the concept behind being the “substitute”of the patient by becoming his hand where he can’t reach or the voice which would carry his thoughts to people whose decisions directly affect his care and future.

EVALUATION Upon entering this phase, the entire process is

evaluated and new goals are to be formulated. As much as possible, the nurse would include Makoy over setting new goals and makes sure that his thoughts and concerns are addressed so as to assert his independence and his role as a partner in his care.

Makoy, as planned, will initiate measures to regain independence and performance of basic needs and to achieve a sense of worth and confidence.

THANK YOU!