VIRGINIA AVENEL HENDERSON THEORY

BY MRS.HELENA R.JOSEPH,M.SC(N), ASSOCIATE PROFESSOR, SDM INS,SATTUR,DHARWAD.INDIA

AUTOBIOGRAPHY
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 . 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.

ACHIEVEMENTS

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. honored 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 centered and organized around nursing problems rather than medical diagnoses (Henderson,1991) In 1939, she revised: Harmers 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 90s. OMalley (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 HENDERSONS DEFINITION OF NURSING

Two events are the basis for Hendersons 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.

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, Hendersons first definition of nursing was published in Bertha Harmers revised nursing textbook. To her the unique fucntion 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.

MAJOR CONCEPTS

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 individuals 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 individuals 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 physicians therapeutic plan Individualized care is the result of the nurses creativity in planning for care. Use nursing research Categorized Nursing : nursing care 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.

4. NURSING

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 patients 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."

HER THEORY AND THE NURSING PROCESS

CHARACTERISTIC OF HENDERSONS 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.. Maslows Hierarchy of human needs; concept of interactioncommunication 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 Thorndikes fundamental needs of man (Henderson, 1991, p.16) had an influence on her beliefs.

HENDERSONS THEORY 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.

NURSING PROCESS

HENDERSONS 14 COMPONENTS AND DEFINITON OF NURSING

Hendersons 14 components Analysis: Compare data to knowledge base of health and disease. Identify individuals ability to meet own needs with or without assistance, taking into consideration strength, will or knowledge. Document how the nurse can assist the individual, sick or well. 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. Implementation based on the physiological principles, age, cultural background, emotional balance, and physical and intellectual capacities. Carry out treatment prescribed by the physician.

Nursing Assessment Nursing Diagnosis Nursing plan Nursing implementation Nursing implementation

Nursing process

Nursing evaluation

Hendersons 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

USEFULNESS

Nursing education has been deeply affected by Hendersons clear vision of the functions of nurses. The principles of Hendersons 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)

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.

APPLICATION:IMPLICATIONS FOR PRACTICE

The nurse who sees herself as reinforcing the patient when he lacks will, knowledge, or strength will make an effort to know him, understand him, get inside his skin, as I have said. This process of putting oneself in anothers place is always difficult and only relatively successful. It requires a listening ear and constant observation and interpretation of nonverbal behaviour. It also demands of the nurse self-understanding and the recognition of emotions that block her concentration on the patients need and helpful responses to those needs. It calls for a willingness so that a mutual understanding may develop between a nurse and a patient.

The nurse who wants to understand and help each patient will welcome opportunities to see and talk with his friends and family. If the cause of his illness is to be known, if his independence is to be established and a recurrence prevented, the nurse who participates in all these aspects of comprehensive care must work with and through others. Her greatest contribution may be to help a member of the family to understand what the patient needs from him or her. No matter what the setting, the nurse who is reinforcing, or supplementing the patient will help him perform all the 14 fundamental or basic human needs. She will make with the patient, his family and other members of the health team some sort of individualized plan, or daily regimen, that meets the wide range of human needs.

The rehabilitation of all patients in the hands of the nurse begins with her first service to him. With this point of view, and if she has a wide range of competence, the nurse can be the prime rehabilitative agent. Such a nurse judges her success with each patient according to the speed with which or the degree to which he performs independently the activities that make, for him, a normal day. This primary function of the practicing nurse must be performed in such a way that it promotes the physicians therapeutic plan. The means helping the patient carry out prescribed therapeutic treatments or administering the treatment herself.

Finally, to close the discussion of how my definition affects practice, I point out that the nurse who sees her primary function as a direct service to the patient will find an immediate reward in his progress toward independence through this service. To the extent that her practice offers this reward, she will be satisfied; to the extent that the situation deprives her of it, she will be dissatisfied. And she will use whatever influence she has to foster conditions that make social rewards for practice at least commensurate with those for teaching and administration.

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 effectiv e 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

REFLECTIONS
WE MAY NOT BE ABLE TO FORMULATE A CONCEPTUAL FRAMEWORK AND MAY NOT BECOME A GREAT NURSING THEORIST. BUT AS A NURSE WHO SELFLESSLY SERVE MANDKIND, WE ARE A NATURAL HERO. TO CARE IS OUR HABIT, OUR COMPASSION IS PRICELESS, THE STRENGTH WE POSSESS IS NEVER ENDING.SPENDING OUR LIVES IN SERVICE TO OTHERS, WE CAN SOMEHOW SAY, WE MADE A BIG DIFFERENCE IN THEIR LIVES IN OUR OWN LITTLE WAY. ALLOW US TO SHARE SOME EXPERIENCES THAT WOULD SOMEHOW REFLECT THE MAR K WE HAVE LEFT IN THEM.