Virginia Henderson has been described as the first lady of nursing. An accomplished author, avid researcher and a visionary, she is considered by many to be the most important nursing figure in the 20th century.
She was born in Kansas City, Missouri on Nov. 30, 1897, the fifth of eight children of Daniel B. and Lucy Minor (Abbot) Henderson. Her father was an attorney for Native American Indians. She Received a Diploma in Nursing from the Army School of Nursing at Walter Reed Hospital, Washington, D.C. in 1921 and 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.
The honors bestowed on Henderson are numerous. To mention just a few, she held honorary degrees from thirteen universities; she was selected to the American Nurses Association Hall of Fame and had the Sigma Theta Tau International Library named in her honor. She was honored by the Virginia Nurses Association in 1988 when the Virginia Historical Nurse Leadership Award was presented to her. In 2000, the Virginia Nurses Association recognized Henderson as one of the fifty –one Pioneer Nurses in Virginia.
Virginia Avenel Henderson died March 19, 1996 at the age of 98 and left behind a corpus of work that is the soul of modern nursing: a definition of nursing with sufficient precision and poetry to become the internationally adopted statement of who we are; three of the Principles and Practice of Nursing that elaborated on the knowledge base necessary to act in terms of the definition; a survey and assessment of nursing research that shifted nursing research away from studying nurses to studying the differences that nurses can make in people’s lives; the Nursing Studies Index that captured the intellectual history of the first six decades of the 20th century.
Metaparadigm in Nursing
Henderson referred to a person as a patient. She stated that the person is an individual who requires assistance to achieve health and independence or in some cases, a peaceful death.
She introduced the concept of the mind and body of a person as inseparable. For a person to function to the utmost, he must be able to maintain physiological and emotional balance.
Henderson viewed health as a quality of life and is very basic for a person to function fully. As a vital need, health requires independence and interdependence.
Since health is a multifactor phenomenon, it is influenced by both internal and external factors which play independent and interdependent roles in achieving health.
She also gave emphasis in prioritizing health promotion as more important than care of the sick.
It is important for a healthy individual to control the environment, but as illness occurs, this ability is diminished or affected. In caring for the sick, it is the responsibility of the nurse to help the patient manage his surroundings to protect him from harm or any mechanical injury. In assuming this role, the nurse must be educated about safety and must be aware of different social customs and religious practices to assess dangers.
Nurses must provide physicians data about the safety needs of the patient, the nurse’s observations and judgment regarding these needs as the latter uses this as the basis in prescribing protective devices. It is also the responsibility of the nurse to recommend changes regarding construction of buildings, purchase of equipment, and maintenance in order for him or her to minimize chances of injury.
Henderson’s classic definition of nursing:
“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 recover (or to a 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 asserted that nurses function independently from the physician, but they must promote the treatment plan prescribed by the physician. Although part of the health care team, the nurse must act independently but in coordination with the therapeutic plan developed by the team.
Another special role of the nurse is to help both the sick and well individual. Care must include people from all walks of life, from the well to the sick, and from the newborn to the dying. The care given by the nurse as Henderson stressed, must empower the patient to gain independence as rapidly as possible.
In the role of the nurse as a health provider, the nurse must be knowledgeable in both biological and social sciences and must have the ability to assess basic human needs. Henderson’s definition of nursing was considered as the signature of the profession.
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.
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. Although official statements on the nursing function were published by the ANA in 1932 and 1937, Henderson viewed these statements as nonspecific and unsatisfactory definitions of nursing practice. Then in 1955, the earlier ANA definition was modified. 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, Henderson’s first definition of nursing was published in Bertha Harmer’s revised nursing textbook.
14 BASIC NEEDS
Henderson conceptualized the 14 Fundamental Needs of humas. These needs are:
- 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.
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
Henderson postulated that nurse functions in relation with the patient, physician and other members of the health team and each type relationship gives nurses specific responsibilities and roles.
The Nurse-Patient Relationship
Henderson stated that there are three levels compromising the nurse-patient relationship:
The nurse as a substitute for the patient. In times of illness, when the patient cannot function fully, the nurse serves as the substitute as to what the patient lacks such as knowledge, will, strength in order to make him complete, whole and independent once again.
The nurse as a helper to the patient. In situations where the patient cannot meet his basic needs, the nurse serves as a helper to accomplish them. Since these needs are needed to achieve health the nurse focuses her attention in assisting the patient meet these needs so as to regain independence as quickly as possible.
The nurse as a partner with the patient. As partners, the nurse and the patient formulate the care plan together. Both as an advocate and as a resource-person, the nurse can empower the patient to make effective decisions regarding his care plans. As the relationship goes on, the patient and the nurse see each other as partners whose interest are the same having the patient achieve health and independence.
The Nurse-Physician Relationship
Henderson asserted that nurses function independently from physicians. Though the nurse and the patient, as partners, formulate the plan of care, it must be implemented in such a way that will promote the physician’s prescribed therapeutic plan. She also insisted that nurses do not follow doctor’s orders; rather they follow in a philosophy which allows physicians to give orders to patients or other healthcare team members. Henderson also indicated that many nursing roles and responsibilities overlap with that those of the physician’s.
The Nurse as a Member of the Healthcare Team
For a team to work together in harmony, every member must work interdependently. The nurse, as a member of the healthcare team, works and contributes in carrying out the total program of care. However, working interdependently, as Henderson indicated, does not include taking other member’s roles and responsibilities.