V I R G I N I A H E N D E R S O N

“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."

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

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 .

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

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” Although her major clinical experiences were in medical-surgical hospitals.

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

Virginia Henderson defined nursing as "assisting individuals to gain independence in relation to the performance of activities contributing to health or its recovery"

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.

The 14 Basic Needs

1. Breathe normally. 2. ]Eat and drink adequately.

3. Eliminate body wastes.

4. Move and maintain desirable postures.

5. Sleep and rest.

6. Select suitable clothes-dress and undress.

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

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

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

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

11. Worship according to one’s faith.

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

13. Play or participate in various forms of recreation.

14. 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 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 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 Assessment

Henderson’s 14 components

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 implementation

Document how the nurse can assist the individual, sick or well.

Nursing implementation

Assist the sick or well individual in to performance of activities in 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

Theories can inter-relate 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.

Her ideas of nursing practice are well accepted throughout the world as a basis for nursing care.

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.

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 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. 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.

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?

ERNESTINE WIEDENBACH

"My thesis is that nursing art is not comprised of rational nor reactionary actions but rather of deliberative action." Wiedenbach, 1964

INTRODUCTION

Ernestine Wiedenbach was born in August 18, 1900, in Hamburg, Germany. Wiedenbach's conceptual model of nursing is called ' The Helping Art of Clinical

Nursing".

Education:

o B.A. from Wellesley College in 1922

o R.N. from Johns Hopkins School of Nursing in 1925

o M.A. from Teachers College, Columbia University in 1934

o Certificate in nurse-midwifery from the Maternity Center Association School for Nurse-Midwives in New York in 1946..

Career:

o Wiedenbach joined the Yale faculty in 1952 as an instructor in maternity nursing.

o Assistant professor of obstetric nursing in 1954 and an associate professor in 1956.

o She wrote Family-Centered Maternity Nursing in 1958.

o She was influenced by Ida Orlando in her works on the framework.

She died on March 8, 1998.

CONCEPTS AND DEFINITIONS

Wiedenbach defined key terms commonly used in nursing practice.

The patient

"Any individual who is recieving help of some kind, be it care, instruction or advice from a member of the health profession or from a worker in the field of health."

The patient is any person who has entered the healthcare system and is receiving help of some kind, such as care, teaching, or advice.

The patient need not be ill since someone receiving health-related education would qualify as a patient.

A need-for-help

A need-for-help is defined as "any measure desired by the patient that has the potential to restore or extend the ability to cope with various life situations that affect health and wellness.

It is crucial to nursing profession that a need-for-help be based on the individual perception of his own situation.

Nurse

The nurse is functioning human being. The nurse no only acts, but thinks and feels as well.

Knowledge

Knowledge encompasses all that has been perceived and grasped by the human mind.

Knowledge may be :

o factual

o speculative or

o practical

Judgment

Clinical Judgment represents the nurse’s likeliness to make sound decisions. Sound decisions are based on differentiating fact from assumption and relating

them to cause and effect.

Sound Judgment is the result of disciplined functioning of mind and emotions, and improves with expanded knowledge and increased clarity of professional purpose.

Nursing Skills

Nursing Skills are carried out to achieve a specific patient-centered purpose rather than completion of the skill itself being the end goal.

Skills are made up of a variety of actions, and characterized by harmony of movement, precision, and effective use of self.

Person

Each Person (whether nurse or patient), is endowed with a unique potential to develop self-sustaining resources.

People generally tend towards independence and fulfillment of responsibilities.

Self-awareness and self-acceptance are essential to personal integrity and self-worth.

Whatever an individual does at any given moment represents the best available judgment for that person at the time.

KEY ELEMENTS

Wiedenbach proposes 4 main elements to clinical nursing. o a philosophy

o a purpose

o a practice and

o the art.

The Philosophy

The nurses' philosophy is their attitude and belief about life and how that effected reality for them.

Wiedenbach believed that there were 3 essential components associated with a nursing philosophy:

o Reverence for life

o Respect for the dignity, worth, autonomy and individuality of each human being and

o resolution to act on personally and professionally held beliefs.

The Purpose

Nurses purpose is that which the nurse wants to accomplish through what she does.

It is all of the activities directed towards the overall good of the patient.

The Practice

Practice are those observable nursing actions that are affected by beliefs and feelings about meeting the patient’s need for help.

The Art

The Art of nursing includes o understanding patients needs and concerns

o developing goals and actions intended to enhance patients ability and

o directing the activities related to the medical plan to improve the patients condition.

The nurses also focuses on prevention of complications related to reoccurrence or development of new concerns.

PRESCRIPTIVE THEORY

Wiedenbach's prescriptive theory is based on three factors:

The central purpose which the practitioner recognizes as essential to the particular discipline.

The prescription for the fulfillment of central purpose.

The realities in the immediate situation that influence the central purpose

Diagram

CONCLUSION

Nursing is the practice of identification of a patient’s need for help through o observation of presenting behaviors and symptoms

o exploration of the meaning of those symptoms with the patient

o determining the cause(s) of discomfort, and

Determining the patient’s ability to resolve the discomfort or if the patient has a need for help from the nurse or other healthcare professionals