Virginia Henderson: Nursing Need Theory Study Guide

Henderson's whole theory comes down to one bedside instinct: do for the patient what they would do for themselves if they had the strength, will, or knowledge, and get them back to doing it on their own as fast as possible. This guide covers her biography, career, and works, then the major concepts, metaparadigm, components, and assumptions of the Need Theory.

Biography of Virginia Henderson

Virginia Avenel Henderson (November 30, 1897 – March 19, 1996) was a nurse, theorist, and author known for her Need Theory and for defining nursing as: "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." She is also called "The First Lady of Nursing," "The Nightingale of Modern Nursing," "Modern-Day Mother of Nursing," and "The 20th Century Florence Nightingale."

Early Life

Henderson was born in Kansas City, Missouri, in 1897, the fifth of the eight children of Lucy Minor Abbot and Daniel B. Henderson. She was named after the state her mother longed for. At age four she returned to Virginia and began schooling at Bellevue, a preparatory school owned by her grandfather William Richardson Abbot. Her father was a former Bellevue teacher and an attorney who represented Native American tribes in disputes with the U.S. Government, winning a major case for the Klamath tribe in 1937.

Education

Henderson was educated at home in Virginia with her aunts and her uncle Charles Abbot, at his school for boys. In 1921 she received her Diploma in Nursing from the Army School of Nursing at Walter Reed Hospital, Washington D.C. In 1923 she began teaching nursing at the Norfolk Protestant Hospital in Virginia. In 1929 she entered Teachers College at Columbia University, earning her Bachelor's Degree in 1932 and her Master's Degree in 1934.

Career

After her 1921 diploma, Henderson worked at the Henry Street Visiting Nurse Service for two years. She briefly considered switching professions but stayed, going on to reshape how nurses saw their work through research that built the intellectual foundation of the profession.

From 1924 to 1929 she was an instructor and educational director at Norfolk Protestant Hospital in Norfolk, Virginia. In 1930 she was a nurse supervisor and clinical instructor in the outpatient department of Strong Memorial Hospital in Rochester, New York. From 1934 to 1948, 14 years, she was an instructor and associate professor at Teachers College, Columbia University. From 1953 she was a research associate at Yale University School of Nursing, and a research associate emeritus from 1971 to 1996.

She traveled the world at the invitation of professional societies, universities, and governments to inspire nurses and other health professionals. She consistently stressed the nurse's duty to the patient over the doctor, and her work, including a widely used system for recording patient observations, helped establish the science of nursing.

Need Theory

The Need Theory emphasizes increasing the patient's independence and focusing on basic human needs so that progress after hospitalization is not delayed.

Works of Virginia Henderson

In 1939 she authored three editions of Principles and Practices of Nursing, a widely used text. Her Basic Principles of Nursing, published in 1966 and revised in 1972, has appeared in 27 languages through the International Council of Nurses.

Her most demanding achievement was a research project that gathered, reviewed, cataloged, classified, annotated, and cross-referenced every known piece of nursing research published in English, producing the four-volume Nursing Research: Survey and Assessment (written with Leo Simmons, published in 1964) and the four-volume Nursing Studies Index, completed in 1972.

Principles and Practice of Nursing

Henderson co-authored the fifth (1955) and sixth (1978) editions of Textbook of Principles and Practice of Nursing after the original author, Bertha Harmer, died. Until 1975 the fifth edition was the most widely adopted nursing textbook in English and Spanish.

At age 75 she began the sixth edition. Over the next five years she led Gladys Nite and seventeen other contributors to synthesize the literature she had indexed. Drawing on a 50-year career and a review of every principal author writing in English, she produced a work that critiqued health care and gave nurses a way to correct its shortcomings. It argued on two levels that health care would be reformed by individual nurses who help patients become independent when those patients are educated and encouraged to care for themselves. She stripped medical jargon from the text and declared it a reference for anyone wanting to guard their own or their family's health or care for a sick relative or friend.

Basic Principles of Nursing Care

In 1953, while completely rewriting the Harmer and Henderson Textbook on the Principles and Practice of Nursing, she used her own description of nursing. After publication, the International Council of Nurses asked her to write an essay on nursing applicable anywhere in the world and relevant to nurses and patients alike. The result, Basic Principles of Nursing (ICN, 1960), became a landmark, considered the 20th-century equivalent of Nightingale's Notes on Nursing. The ICN publication is available in 29 languages and used worldwide.

Nursing Studies Index

In 1953 she accepted a position at Yale University School of Nursing as a research associate on a project to survey nursing research in the United States. The survey exposed the absence of organized literature on which to base clinical nursing studies. Henderson was funded to direct the Nursing Studies Index Project from 1959 to 1971, producing the four-volume Nursing Studies Index (ICN, 1963), the first annotated index of nursing research published between 1900 and 1960.

Awards and Honors of Virginia Henderson

Henderson received honorary doctorates from the Catholic University of America, Pace University, University of Rochester, University of Western Ontario, Yale University, Rush University, Old Dominion University, Boston College, Thomas Jefferson University, Emory University, and many others.

In 1977 she was made an Honorary Fellow of the American Academy of Nursing, and the following year an Honorary Fellow of the Royal College of Nursing of the United Kingdom. In 1985 she was honored at the Nursing and Allied Health Section of the Medical Library Association, and that same year received the first Christiane Reimann prize from the International Nursing Council (ICN), nursing's highest and most prestigious award. In 1988 the Virginia Nurses Association presented her the Virginia Historical Nurse Leadership Award.

Sigma Theta Tau International named the Virginia Henderson Global Nursing e-Repository (the Virginia Henderson International Nursing Library) in her honor; the Indianapolis library has been available electronically since 1994. In 2000 the Virginia Nurses Association recognized her as one of the 51 Pioneer Nurses in Virginia. She is also a member of the American Nurses Association Hall of Fame.

Death

Henderson died on March 19, 1996, at a hospice in Branford, Connecticut. She was 98. Her remains were interred in her family's plot in the churchyard of St. Stephen's Church, Forest, Bedford County, Virginia.

Virginia Henderson's Need Theory

Henderson developed the Need Theory to define the unique focus of nursing practice: increase the patient's independence to speed their progress, and meet the basic human needs they cannot meet on their own.

"I believe that the function the nurse performs is primarily an independent one – that of acting for the patient when he lacks knowledge, physical strength, or the will to act for himself as he would ordinarily act in health or in carrying out prescribed therapy. This function is seen as complex and creative, as offering unlimited opportunity to apply the physical, biological, and social sciences and the development of skills based on them." (Henderson, 1960)

Assumptions of the Need Theory

Nurses care for patients until they can care for themselves again. Patients want to return to health. Nurses are willing to serve, and "nurses will devote themselves to the patient day and night." And the "mind and body are inseparable and are interrelated."

Major Concepts of the Nursing Need Theory

The major concepts, the nursing metaparadigm as the theory defines it:

Individual

Individuals have basic health needs and require assistance to reach health and independence, or a peaceful death. A person achieves wholeness by maintaining physiological and emotional balance. Henderson defined the patient as someone who needs nursing care but did not limit nursing to illness care: the patient is a sum of parts with biopsychosocial needs, and mind and body are inseparable and interrelated.

Environment

The Need Theory does not explicitly define the environment, but maintaining a supportive environment conducive to health is one of Henderson's 14 activities for client assistance. Her theory supports the role of private and public health agencies in keeping people healthy, and she held that society expects the nurse to act for individuals who cannot function independently.

Health

Health is not explicitly defined but is taken as balance in all realms of human life, equated with independence, the ability to perform the 14 components or basic human needs without aid. Nurses are central to promoting health, preventing illness, and curing. Henderson noted good health is a challenge affected by age, cultural background, emotional balance, and other factors.

Nursing

Henderson wrote her definition of nursing before theoretical nursing developed. She defined nursing as "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 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." The goal is to make the patient complete, whole, or independent, while collaborating with the physician's therapeutic plan.

Nurses temporarily assist an individual who lacks the strength, will, and knowledge to satisfy one or more of the 14 basic needs: "The nurse is temporarily the consciousness of the unconscious, the love life for the suicidal, the leg of the amputee, the eyes of the newly blind, a means of locomotion for the infant, knowledge, and confidence of the young mother, the mouthpiece for those too weak or withdrawn to speak." And: "…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 them as soon as possible."

The nurse is expected to carry out a physician's therapeutic plan, but individualized care comes from the nurse's creativity in planning. The nurse should be an independent practitioner capable of independent judgment. In Nature of Nursing she describes the nurse's role as "to get inside the patient's skin and supplement his strength, will or knowledge according to his needs." The nurse assesses the patient's needs, helps meet them, and provides an environment where the patient can act unaided.

14 Components of the Need Theory

The 14 components cover physiological, psychological, spiritual, and social needs.

Physiological

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 the environment.
8. Keep the body clean and well-groomed and protect the integument.
9. Avoid dangers in the environment and avoid injuring others.

Psychological (Communicating and Learning)

10. Communicate with others in expressing emotions, needs, fears, or opinions.
11. Learn, discover, or satisfy the curiosity that leads to normal development and health, and use available health facilities.

Spiritual and Moral

11. Worship according to one's faith.

Sociological (Occupation and Recreation)

12. Work in such a way that there is a sense of accomplishment.
13. Play or participate in various forms of recreation.

Henderson's 14 Components Applied to Maslow's Hierarchy of Needs

The 14 components map onto Abraham Maslow's Hierarchy of Needs. Components 1 to 9 fall under Physiological Needs, with the 9th also under Safety Needs. The 10th and 11th fall under Love and Belongingness, and the 12th, 13th, and 14th under Self-Esteem Needs.

Analysis of the Need Theory

The 14 activities are not the whole of what human beings need for health and survival, and today there may be added needs nurses should provide for. Henderson did not spell out whether the activities are prioritized or whether the first is a prerequisite to the rest, though it is notable that she characterized human needs against Maslow's hierarchy. Some activities apply only to fully functional individuals, which sits in tension with her stated goal, since some patients will always require aided care. Because the theory has no conceptual diagram, the interconnections among its concepts and subconcepts are not delineated.

Strengths

Henderson's concept of nursing is widely accepted today. Her theory and 14 components are relatively simple, logical, and applicable to individuals of all ages.

Weaknesses

There is no conceptual diagram tying the 14 concepts and subconcepts together. On the dying process, there is little explanation of what the nurse does to provide a "peaceful death."

Application of the Need Theory

In practice, nurses can set goals around Henderson's 14 components, and meeting those needs is a strong basis for improving nursing care. In research, each of the 14 concepts can anchor a study, though the statements were not written in testable terms.