The revolutionary and visionary theory of Henderson

Posted: June 16, 2011 in Footnotes, Nars, Theoretical Foundations, UP

Figure this out. Forty years ago, if you want to be a registered nurse, you have to set up a trolley in preparation for a medical procedure as one of central items in the final examination (Mc Mahon & Pearson, 1998).

  Virginia Avenel Henderson, dissatisfied with the blurring definitions of nursing,  revolutionized the image of a nurse as a distinct independent practitioner in her pioneering theory, “Definition of Nursing”. In her seminal work, Nature of Nursing (1964), she called for “an occupation or especially a profession whose services affect human life to define its functions.”

This is the reason why I think every nurse should know by heart this widely immortalized theory. Being guided with his “functional roles and professional boundaries”, the nurse safeguards himself and the public as well.

Let me illustrate. We often encounter individuals with cough and colds asking us nurses for prescription of drugs. Being fully aware with our scope of practice as stipulated in the Nursing Law (RA 9173), we are not authorized to prescribe drugs. Instead, we tailor health teachings as our independent and interdependent roles (e.g., increase fluid intake, rest, intake of vitamin C rich foods, consult doctor if symptoms still persist).

The above example illustrates why the Definition of Nursing by Henderson was used as “a legal definition of nursing”, and was adopted by World Health Organization Expert Committee on Nursing Practice in 1995 (Kim, 2010). Henderson called for regulating nursing practice by licensure.

Another recurring theme among nursing theories is the concept of ‘independence’. This has been referred to by Henderson as ‘healthy independence’, which she stressed out as the goal of the concept of nursing. With this goal in mind, she defined nursing as:

“… Assisting 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 as cited by Anonuevo et al, 2000).”

The activities being referred to in the definition are operationalized into “14 basic human needs” which the nurse should address in the process of providing “basic nursing care to promote human welfare” (Henderson, 1980). Ability to meet the basic human needs unaided is tantamount to independence and health.

Self-determination and self-reliance is an indispensable ultimate goal of any health models. The “person” mentioned in theory of the “Mother of Modern Nursing” is both in the disease and wellness state, though wellness isn’t explained explicitly in the theory. Instead, the person is largely seen on the passive, dependent state in the disease continuum. The roles then of the nurse are to substitute, help and work with the patient, together with his family, to meet his healthy independence as rapidly as possible.

For example. There are still incidences of tuberculosis in the government hospital where I work amidst the short course chemotherapy campaign of the Department of Health. Rural farmers with history of chronic smoking rushed to hospital presenting dyspnea and hemoptysis . History further revealed failure to complete the therapy. CXR result shows pulmonary tuberculosis, hematology results reveal anemia, leukocytosis with predominance of lymphocytes, decreased serum albumin. Utilizing Henderson’s theory, I will respond by maintaining airway, promoting rest and adequate nutrition, preventing further infection, placing the patient on isolation, initiating peripheral IV and administering antibiotic and antifibrinolytic as ordered.

Nurses nowadays are so astute in meeting the physiologic needs of patients. We assist them to have the physiologic “strength”. We fail to meet the psychological/emotional, learning, spiritual and social/recreation needs of our clients (i.e. these need s constitute the #10-#14th basic needs according to Henderson). Basing from my example, I may explore the reasons why adherence to treatment regimen is low. Doing so may serve as my basis in conducting health education to provide “knowledge” and motivate my clients to have the “will” to be responsible on their own health. This clearly pinpoints how Henderson organized nursing problems rather than medical diagnosis. By having the necessary strength, knowledge and will, independence is attainable, as posited by Henderson.

The assumption on the Activities of Daily Living (ADL), also known as basic needs, still remains true and valid today. Though in Henderson’s theory, almost more than half of the activities focuses on physiologic needs, she advocated “holism” to include the psychosocial and spiritual dimensions of a person.

In order to promote independence on the patient, the nurse must be competent. Henderson advocated for academic preparation of a nurse in a higher institution of learning which gives her the “broadest possible understanding of humanity and the world which they live” (Henderson, 1977). Her advocacy, alongside with her proposal on the three phases of curriculum design, dramatically changed the nursing education and is prevalent in the baccalaureate programs in our county today.

Henderson claimed that her intention was clearly to develop her “own concept of nursing”, not a theory. Although it is not written in testable terms, her 14 basic needs can be reformulated into research questions (Mc Ewan & Wills, 2007).

In an article written by Nicely, Bruce, DeLario and Ginger (2011), the theory of Virginia Henderson was utilized creatively in the practice and principles of nursing as applied to organ donation after brain death in the clinical practice. This shows how the theory can be feasible in clinical research.

 

Conclusion

I advocate for the Theory of Nursing by Henderson primarily because of its simplicity, depth and breadth.

It defines the basic, functional unique roles of a nurse. It establishes “our true identity “(i.e. who are we, what are we supposed to do). Expanded roles (i.e. advanced practice nursing, terminal academic degrees) of nurses as evident today trace its roots to this theory. Helping the physician to cure the patient has been underscored not as the primary function of a nurse.

It determines the scope of nursing, and has become an instrument in legislation of nursing (i.e. what we are legally empowered to do).

It advocates patient’s independence by increasing his knowledge, will and strength. This has been a precursor and recurring theme to other nursing theories.

The 14 basic needs, which serves as the primary targets in delivering basic nursing care, remains valid today. It can be applied in various health conditions across life span. We unconsciously and deliberately assess these needs in the delivery of care.

It calls for nurse’s competence obtained from rigorous academic preparation on the nursing art, science and related skills.

They say no single theory that can define the whole aspect of a certain phenomenon. Definition of Nursing by Henderson has some limitations, too.

It draws largely on the biomedical model which in one way or the other may deemphasize other needs of patient (e.g. psychosocial needs.) The impact of empiricism of medicine during that era affected the inception of the theory.

It appears very stringent, impersonal and concrete. The “heart” of nursing isn’t fully elaborated; rather, the “hands” and “mind” only of a nurse. It fails to capture the humanitarian and moral aspect of nursing. The “intimate and essential service that is constant and comforting and promotes speedy independence in meeting the basic human needs is the universal element in the concept of nursing.” Henderson identified “service” as the central element of nursing in contrast to the prevailing concept of “care” (Henderson, 1977). This belief for me isn’t strength or weakness of the theory, but rather a variation on how the proponent viewed the phenomenon of nursing.

The concept of dying, prioritization of problems, interrelatedness on the concepts of needs and wellness are not fully explained. The focus of care is only the individual, not the family, group or community. Henderson further questioned the “nursing process” reminding us all that problem solving is not exclusive to any profession (McBride, nd). The nursing process according to her highlights only the science of nursing, excluding the art of nursing. However, the problem solving approach can also be used in her thesis.

 

References

Anonuevo, C. et al. (2000). N207 Theoretical Foundations of Nursing (module). Philippines: UP Ope University.

Henderson, V. (1964). The Nature of Nursing. American Journal of Nursing, 64 (8), 64. Retrieved June 13, 2011, from http:///www.jstor.org/pss/3419278.

___________. (1980). Preserving the Essence of Nursing in a Technological Age. Journal of Advanced Nursing, 5 (3), 245-260.

Kim, H.S. (2010). The Nature of Theoretical Thinking in Nursing (Third Edition). New York: Springer Publishing Company.

McBride, A.B. (nd). In Celebration of Virginia Avenel Henderson. Retrieved June 12, 2011, from http://healthsci.clayton.edu/eichelberger/in_celebration_of_virginia_avene.htm.

McEwan, M., & Wills, E. (2007). Theoretical Basis for Nursing (Second Edition). Philippine Edition: Lippincott Williams & William.

McMahon, R. , & Pearson, Allan. (1998). Nursing as Therapy (Second Edition). United Kingdom: Nelson & Thornes.

Nicely, Bruce, DeLario and Ginger. (2011). Virginia Henderson’s principles and practice of nursing applied to organ donation after brain death. Progress in Transplantation. North American Transplant Coordinators Organization provided by ProQuest & InforLearning Company. Retrieved June 12, 2011, from http://findarticles.com/p/articles/mi_qa4117/is_201103/ai_n57242444/?tag=mantle_skin;content.

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