Friday, January 8, 2010

VIRGINIA HENDERSON’S NEED THEORY

“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."
  • "little Miss 3x5"
  • 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(Herrmann,1998)
  • 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 ( USA ). 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
  • The First School of Thought: Needs
  • This school of thought includes theories that reflect an image of nursing as meeting the needs of clients and were developed in response to such questions as
  • What do nurses do?
  • What are their functions?
  • What roles do nurses play?
  • Answers to these questions focused on a number of theorist describing functions and roles of nurses.
  • Conceptualizing functions led theorists to consider nursing client in terms of a Hierarchy of needs. When any of these needs are unmet and when a person is unable to fulfill his own needs, the care provided by nurses is required.
  • Nurses then provide the necessary functions and play those roles that could

    Henderson’s Theory Background

    The development of Henderson’s 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 components

    • Breathe normally.
    • Eat and drink adequately.
    • Eliminate body wastes.
    • Move and maintain desirable postures.
    • Sleep and rest.
    • Select suitable clothes-dress and undress.
    • Maintain body temperature within normal range by adjusting clothing and modifying environment
    • Keep the body clean and well groomed and protect the integument
    • Avoid dangers in the environment and avoid injuring others.
    • Communicate with others in expressing emotions, needs, fears, or opinions.
    • Worship according to one’s faith.
    • Work in such a way that there is a sense of accomplishment.
    • Play or participate in various forms of recreation.
    • Learn, discover, or satisfy the curiosity that leads to normal development and health and use the available health facilities.

    Assumption

    The major assumption of the theory is that:

    Henderson’s theory and the four major concepts

    Individual

    Environment

    Health

    Nursing

    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.”
  • help patients meet their needs.

Characteristic of Henderson’s 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.. 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.
  • 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 “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 that Henderson (1966) 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 (O’Malley, 1996). 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.

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.

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?

Personal Interests, Abilities and Experiences

  • What will it be like to think about nursing theory in nursing practice?
  • Will my work with nursing theory be worth the effort?

Summary

  • Background
  • Achievements
  • Publications
  • Analysis of Nursing theories
  • Development of Henderson’s definition of nursing
  • 14 components
  • Major four concepts
  • Nursing process with Henderson’s theory
  • Comparison with Maslow's Hierarchy need
  • Assumptions
  • Usefulness
  • Testability
  • Characteristics
  • imitation

Conclusion

In conclusion, Henderson provides the essence of what she believes is a definition of nursing. She didn’t intend to develop a theory of nursing but rather she attempted to define the unique focus 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

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