Virginia Henderson: Nursing Need Theory

Biography and works of "The First Lady of Nursing"

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Virginia Henderson Nursing Need Theory

Learn about the Nursing Need theory of nurse theorist Virginia Henderson in this nursing theories guide! Get to know also Henderson’s biography, career, and works that helped shape nursing. In the second section, will explain the major concepts, the nursing metaparadigm, subconcepts, components, and assumptions of Henderson’s Nursing 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 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.” Henderson is also known as “The First Lady of Nursing,” “The Nightingale of Modern Nursing,” “Modern-Day Mother of Nursing,” and “The 20th Century Florence Nightingale.”

Early Life

Virginia 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 her schooling at Bellevue, a preparatory school owned by her grandfather William Richardson Abbot.

Her father was a former teacher at Bellevue and was an attorney representing the Native American Indians in disputes with the U.S. Government, winning a major case for the Klamath tribe in 1937.

Education

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

Career

In 1921 after receiving her Diploma, Virginia Henderson worked at the Henry Street Visiting Nurse Service for two years after graduation. She initially planned to switched professions after two years, but her strong desire to help the profession averted her plan. Throughout the years, she helped remedy the view of nurses in part through exhaustive research that helped establish the scholarly underpinnings of her professions.

From 1924 to 1929, she worked as an instructor and educational director in Norfolk Protestant Hospital, Norfolk, Virginia. The following year, in 1930, she was a nurse supervisor and clinical instructor at the outpatient department of Strong Memorial Hospital, Rochester, New York.

From 1934 to 1948, 14 years of her career, she worked as an instructor and associate professor at Teachers College, Columbia University in New York. Since 1953, Henderson was a research associate at Yale University School of Nursing and as a research associate emeritus (1971 -1996).

Henderson when she was a research associate at Yale
Henderson when she was a research associate at Yale

Throughout her career, she traveled the world at the invitation of professional societies, universities, and governments to share and inspire not just nurses, but also other health-care professionals.

She consistently stressed a nurse’s duty to the patient rather than to the doctor and her efforts provided a basis to the science of nursing, including a universally used system of recording observations of the patient and have helped make nurses far more valuable to doctors.

Need Theory

Among her other works, Henderson’s widely known contributions to nursing is the Need Theory. The Need Theory emphasizes on the importance of increasing the patient’s independence and focus on the basic human needs so that progress after hospitalization would not be delayed. The Need Theory is discussed further below.

Works of Virginia Henderson

Beginning in 1939, she was the author of three editions of “Principles and Practices of Nursing,” a widely used text, and her “Basic Principles of Nursing,” published in 1966 and revised in 1972, has been published in 27 languages by the International Council of Nurses.

Her most formidable achievement was a research project in which she gathered, reviewed, catalogued, classified, annotated, and cross-referenced every known piece of research on nursing published in English, resulting in the four-volume “Nursing Research: Survey and Assessment,” written with Leo Simmons and published in 1964, and her 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 when the original author, Bertha Harmer, died. Until 1975, the fifth edition of the book was the most widely adopted nursing textbook in English and Spanish by various schools of nursing.

At age 75, she began the sixth edition of the Principles and Practice of Nursing text, over the next five years of her life, she led Gladys Nite and seventeen other contributors to synthesize the professional literature she completed indexing. During her 50-year career in nursing and opportunity to review the writings of all principal authors who wrote in English, she fashioned a work that both thoroughly criticized health care and offered nurses an opportunity to correct the shortcomings. The book, operating on two levels, argued that health care will be reformed by the individual nurses who will enable their patients to be independent in health care matters when patients are both educated and encouraged to care for themselves. She took this philosophy to new heights by eliminating medical jargon from the text and declaring it as a reference for those who want to guard their own or their family’s health or take care of a sick relative or a friend.

Basic Principles of Nursing Care

Book cover of Basic Principles of Nursing by Virginia Henderson
Book cover of Basic Principles of Nursing by Virginia Henderson

In 1953, she was completely rewriting the Harmer and Henderson Textbook on the Principles and Practice of Nursing when she utilized her description of nursing. After the textbook was published, Henderson was asked by the International Council of Nurses to write an essay on nursing that was considered applicable in any part of the world and relevant to both nurses and their patients, sick or well. The Basic Principles of Nursing (ICN, 1960) resulted from this and became one of the landmark books in nursing and is considered the 20th century equivalent of Nightingale’s Notes on Nursing. The ICN publication is available in 29 languages and is in current use throughout the world.

Nursing Studies Index

The Nursing Studies Index (ICN, 1963) is one of the prominent works of Henderson. In 1953, she accepted a position at Yale University School of Nursing as a research associate for research project designed to survey and assess the status of nursing research in the United States. After the completion of the survey, it was noted that there is an absence of an organized literature upon which to base clinical studies about nursing. Henderson was funded to direct the Nursing Studies Index Project from 1959 to 1971, the outcome was the publication of the four-volume Nursing Studies Index, the first annotated index of nursing research published between 1900 and 1960.

Awards and Honors of Virginia Henderson

There are numerous honors and awards bestowed upon Virginia Henderson.

She received honorary doctorate degrees 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 created an Honorary Fellow of the American Academy of Nursing. On the subsequent year, she was created an Honorary Fellow of the Royal College of Nursing of the United Kingdom for her unique contribution to the art and science of nursing.

In 1985, Henderson was honored at the Annual Meeting of the Nursing and Allied Health Section of the Medical Library Association. At the same year, she received the very first Christiane Reimann prize from the International Nursing Council (ICN), the highest and most prestigious award in nursing due to the transnational scope of her work.

In 1988, she was honored by the Virginia Nurses Association when the Virginia Historical Nurse Leadership Award was presented to her.

Virginia Henderson. Photo via: lewebpedagogique
Virginia Henderson. Photo via: lewebpedagogique

The Virginia Henderson Global Nursing e-Repository or The Virginia Henderson International Nursing Library was named in her honor by the nursing society, Sigma Theta Tau International, for the global impact she made on nursing research. The library, in Indianapolis, has been available in electronic form through the Internet since 1994.

In 2000, the Virginia Nurses Association recognized Henderson as one of the 51 Pioneer Nurses in Virginia. She is also a member of the American Nurses Association Hall of Fame.

Death

Henderson's tombstone Photo via: AAHN.org
Henderson’s tombstone Photo via: AAHN.org

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

Virginia Henderson’s Need Theory

The Nursing Need Theory was developed by Virginia Henderson to define the unique focus of nursing practice. The theory focuses on the importance of increasing the patient’s independence to hasten their progress in the hospital. Henderson’s theory emphasizes on the basic human needs and how nurses can assist in meeting those needs.

“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 for the application of the physical, biological, and social sciences and the development of skills based on them.” (Henderson, 1960)

Assumptions of the Need Theory

The assumptions of Virginia Henderson’s Need Theory are: (1) Nurses care for patients until they can care for themselves once again. Although not precisely explained, (2) patients desire to return to health. (3) Nurses are willing to serve and that “nurses will devote themselves to the patient day and night.” (4) Henderson also believes that the “mind and body are inseparable and are interrelated.”

Major Concepts of the Nursing Need Theory

The following are the major concepts (nursing metaparadigm) and definitions of the Need Theory of Virginia Henderson.

Individual

Henderson states that individuals have basic needs that are component of health and require assistance to achieve health and independence or a peaceful death. According to her, an individual achieves wholeness by maintaining physiological and emotional balance.

She defined the patient as someone who needs nursing care but did not limit nursing to illness care. Her theory presented the patient as a sum of parts with biopsychosocial needs and the mind and body are inseparable and interrelated.

Environment

Although the Need Theory did not explicitly define the environment, Henderson stated that maintaining a supportive environment conducive for health is one of the elements of her 14 activities for client assistance.

Henderson’s theory supports the tasks of the private and the public health sector or agencies in keeping the people healthy. She believes that society wants and expects the nurse’s service of acting for individuals who are unable to function independently.

Health

Although not explicitly defined in Henderson’s theory, health was taken to mean balance in all realms of human life. It is equated with the independence or ability to perform activities without any aid in the 14 components or basic human needs.

Nurses, on the other hand, are key persons in promoting health, prevention of illness and being able to cure. According to Henderson, good health is a challenge because it is affected by numerous factors such as age, cultural background, emotional balance, and others.

Nursing

Virginia Henderson wrote her definition of nursing before the development of theoretical nursing. 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 nurse’s goal is to make the patient complete, whole, or independent. In turn, the nurse collaborates with the physician’s therapeutic plan.

Nurses temporarily assist an individual who lacks the necessary strength, will, and knowledge to satisfy one or more of the 14 basic needs. She states: “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”

Additionally, she stated 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 definition of nursing distinguished the role of a nurse in health care: The nurse is expected to carry out a physician’s therapeutic plan, but individualized care is the result of the nurse’s creativity in planning for care.

The nurse should be an independent practitioner able to make an independent judgment. In her work Nature of Nursing, she states the nurse’s role is “to get inside the patient’s skin and supplement his strength, will or knowledge according to his needs.” The nurse has the responsibility to assess the needs of the patient, help him or her meet health needs, and provide an environment in which the patient can perform activity unaided.

14 Components of the Need Theory

The 14 components of Virginia Hendersons Need Theory show a holistic approach to nursing that covers the physiological, psychological, spiritual and social needs.

14-Components-Virginia-Henderson-2
Click image to enlarge.

Physiological Components

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

Psychological Aspects of Communicating and Learning

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

Spiritual and Moral

  • 11. Worship according to one’s faith

Sociologically Oriented to Occupation and Recreation

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

Henderson’s 14 Components as Applied to Maslow’s Hierarchy of Needs

Click to enlarge.

Since there is much similarity, Henderson’s 14 components can be applied or compared to Abraham Maslow’s Hierarchy of Needs. Components 1 to 9 are under Maslow’s Physiological Needs, whereas the 9th component is under the Safety Needs. The 10th and 11th components are under the Love and Belongingness category and 12th, 13th and 14th components are under the Self-Esteem Needs.

Analysis of the Need Theory

One cannot say that every individual who has similar needs indicated in the 14 activities by Virginia Henderson are the only things that human beings need in attaining health and for survival. With the progress of today’s time, there may be added needs that humans are entitled to be provided with by nurses.

The prioritization of the 14 Activities was not clearly explained whether the first one is prerequisite to the other. But still, it is remarkable that Henderson was able to specify and characterize some of the needs of individuals based on Abraham Maslow’s hierarchy of needs.

Some of the activities listed in Henderson’s concepts can only be applied to fully functional individuals indicating that there would always be patients who always require aided care which is in contrary to the goal of nursing indicated in the definition of nursing by Henderson.

Because of the absence of a conceptual diagram, interconnections between the concepts and subconcepts of Henderson’s principle are not clearly delineated.

Strengths

Virginia Henderson’s concept of nursing is widely accepted in nursing practice today. Her theory and 14 components are relatively simple, logical, and can be applied to individuals of all ages.

Weaknesses

There is an absence of a conceptual diagram that interconnects the 14 concepts and subconcepts of Henderson’s theory. On assisting the individual in the dying process, there is a little explanation of what the nurse does to provide “peaceful death.”

Application of the Need Theory

Henderson’s Needs Theory can be applied to nursing practice as a way for nurses to set goals based on Henderson’s 14 components. Meeting the goal of achieving the 14 needs of the client can be a great basis to further improve one’s performance towards nursing care. In nursing research, each of her 14 fundamental concepts can serve as a basis for research although the statements were not written in testable terms.

See Also

You may also like the following nursing theories study guides: 

References

References and sources for this study guide about Virginia Henderson and her Need Theory:

  1. Christiane Reimann Prize. (n.d.). Christiane Reimann Prize. Retrieved July 27, 2014, from https://www.icn.ch/about-icn/christiane-reimann-prize/
  2. Home. (n.d.). AAHN Gravesites of Prominent Nurses. Retrieved July 27, 2014, from https://www.aahn.org/gravesites/henderson.html
  3. Mcg, R. (1996, March 21). Virginia Henderson, 98, Teacher of Nurses, Dies. The New York Times. Retrieved July 27, 2014, from https://www.nytimes.com/1996/03/22/arts/virginia-henderson-98-teacher-of-nurses-dies.html
  4. Smith, J. P. (1985), FIRST CHRISTIANE REIMANN PRIZE AWARDED TO VIRGINIA HENDERSON. Journal of Advanced Nursing, 10: 303. doi: 10.1111/j.1365-2648.1985.tb00822.x
  5. Virginia A. Henderson (1897-1996) 1996 Inductee. (n.d.). Virginia A. Henderson (1897-1996) 1996 Inductee. Retrieved July 27, 2014, from https://www.nursingworld.org/VirginiaAHenderson
  6. Virginia A. Henderson (1897-1996) 1996 Inductee. (n.d.). Virginia A. Henderson (1897-1996) 1996 Inductee. Retrieved July 27, 2014, from https://www.nursingworld.org/VirginiaAHenderson
  7. Virginia Avenel Henderson, RN, MA. (n.d.). – Virginia Henderson International Nursing e-Repository. Retrieved July 27, 2014, from https://www.nursinglibrary.org/vhl/pages/vhenderson.html
  8. VIRGINIA HENDERSON. (n.d.). Virginia Henderson and her Timeless Writings. Retrieved July 27, 2014, from https://www.unc.edu/~ehallora/henderson.htm
  9. George B. Julia (2010). Nursing Theories: The Base for Professional Nursing Practice. Pearson Higher Ed USA.
  10. Meleis Ibrahim Afaf (1997). Theoretical Nursing: Development & Progress 3rd ed. Philadelphia, Lippincott.
  11. Henderson, V. (1966). The nature of nursing. In George, J. (Ed.). Nursing theories: the base for professional nursing practice. Norwalk, Connecticut: Appleton & Lange.
  12. Henderson, V. (1991). The nature of nursing: Reflections after 25 years. In McEwen, M. and Wills, E. (Ed.). Theoretical basis for nursing. USA: Lippincott Williams & Wilkins.

Further Reading

With contributions by Wayne, G., Ramirez, Q., Vera, M. 

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