Fundamentals of Nursing

Virginia Henderson Nursing Theory

Health care around the world and especially in the Western world, has undergone extreme changes over the past few decades, however, the basic principles of nursing such as caring for the sick and elderly have remained the same. Many of those principles come from the teaching of Virginia Henderson. Her interactional theory of holistic care has helped to form the philosophical base of twentieth century nursing. Following the guidelines set by Nightingale, Ms. Henderson was a humanist who “viewed the education of patients and families as core to nursing care” (Sanford, 2000, p.

1).

Her theory of nursing brought to the forefront the idea of the nurse as patient educator. It is for this reason I have chosen Virginia Henderson’s theory, coupled with a Christian Worldview of Nursing, to base my practice of care at the bedside in the intensive care unit (ICU) where I work. The aspect of seeing the entire person as a whole and not in parts is an important aspect in the delivery of my care.

I also believe that a patient’s faith and religion play a key role in their well-being, both as an inpatient and in the community which they reside.

Therefore, it is important to care for the entire patient. The fourteen points of Virginia Henderson’s theory, which I will later describe, allow me to implement this theory of practice at the bedside. There is no irrelevant part of the patient’s care; all parts are equally important, as I will discuss.

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Worldview Henderson’s theory is considered a grand theory of nursing. Grand theories consist of a global conceptual framework that defines broad perspectives for nursing practice, ways of looking at nursing phenomena from a distinct nursing perspective.

Grand theory explicates key concepts and principles of the discipline. There are three behavioral theories associated with the profession of nursing: interactive, systems and developmental. Systems theory posits that a person lives within a multidimensional world of systems where stress is present in all interactions. Systems exist in any grouping, from the physical, social and psychological system of the individual to organizations, communities, families and cultures. The developmental model posits that a process of growth exists for all things – animate and inanimate.

There is cause and effect that may be explained in terms of four levels of development; unidirectional, spiral effect, cyclic and branching out (Tourville and Ingalls, 2003). The theories of Virginia Henderson fall within the third category of behavioral theory, that of the interactive model. Tourville and Ingalls (2003), explain the interactive model as emphasizing “the importance of interpersonal relationships between the nurse and the person. It focuses on identifying any interpersonal problems and providing intervention techniques to “promote optimal socialization” (Fawcett, 1984, p. 16).

Benoliel (1977) stated that “the interactive model sees human beings as creatures who define and classify situations, including themselves, and who choose ways of acting toward and within them” (p. 110). Benoliel (1977) also states that The four main characteristics of the interactive model are perception (how people view the world, people, events), communication (transferring information), role (e. g. , parent, spouse, citizen, worker), and self-concept (how people view themselves) (p. 24).

Henderson’s fourteen areas of nursing care are based on health being defined in terms of the physical, psychological, spiritual/moral, and sociological aspects of an individual, formed the foundation for her teaching of principles and practice. The physical area included breathe normally, eat and drink adequately, eliminate body wastes, move and maintain desirable positions, sleep and rest, select suitable clothing, maintain normal body temperature, keep the body clean and well-groomed and avoid dangers and injuries.

In the psychological area, the nurse was responsible for communicating with others in expressing emotions, needs, fears or opinions, learning, discovering or satisfying the curiosity that leads to normal development and health and use the available health facilities. In the spiritual or moral area, the nurse should worship according to one’s faith, and in the sociological area he or she should work with a sense of accomplishment and play or participate in various forms of recreation (Henderson, 1966, p. 22-23).

The belief that nursing met a specific need and fulfilled a worthy contribution to society fostered the definition for “Functions of the Professional Nurse”, which was adopted by the International Council of Nurses. She proposed that the art of nursing begins with caring, extends to being able to communicate (to listen, empathize and provide support) and ends with the integration of the individual and the job.

Henderson and Nite (1978) postulated that Assisting individuals (sick or well) with those activities contributing to health, or its recovery or to peaceful death, that they perform unaided, when they have the necessary strength, will or knowledge; nursing also helps individuals carry out prescribed therapy and to be independent of assistance as soon as possible (p. 14). Nursing, according to Ms. Henderson, includes both independent and interdependent aspects that must be taken into consideration in the development of the nurse and of nursing as a profession (Evers, 2003).

My perspective of the activities of nursing is geared towards Virginia Henderson’s grand theory. All fourteen points ensure complete and holistic care of the patient. There is an exchange that takes place between those who provide care and those cared for that goes beyond the empirical reality of the moment and incorporates the spiritual. The ‘art’ of providing care includes an aspect of caring that has metaphysical origins and connotations. It concerns all aspects of the human experience, physical, psychological, spiritual and social.

The Gestalt approach to nursing and the inclusion of caring as a primary requisite is the heart of the concept of interactive theory as it applies to nursing and as presented by Ms. Henderson. Virginia Henderson’s definition of nursing focused on the function of nursing as being able to assist the individual, sick or well, in attaining and, or, maintaining health. The nurse was meant to respect the choices of the individual by providing care that the patient would perform if he or she was not ill or had appropriate knowledge.

The purpose was to bring a sense of independence and dignity to the sick and infirm and to aid and facilitate a return to independence, all of which are my goal when caring for someone in the ICU. Sanford (2000) states that Henderson’s definition defines and explains nursing’s professional relationship with a person experiencing illness, recovering health, or relinquishing life. Her definition speaks to the importance of empowering the receiver of a nurse’s care; empowerment is achieved through mutual sharing of knowledge, strength, and personal and collective will (p. 3).

The nurse becomes a ‘partner’ with the patient to care for that person. Concept of Nursing Virginia Henderson believed that patient care was, and is, the major objective of nurses (Tourville and Ingalls, 2003). According to Henderson (1966) the purpose of nursing was To assist the individual, sick or well, in the performance of those activities contributing to health or its recovery (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 gain independence as rapidly as possible (p. 21).

She maintained a holistic approach, believing that the mind and body were one entity and that the patient should be cared for as a complete person – not just as a body in need of healing (Tourville and Ingalls, 2003). As an ICU nurse, I have easily placed Virginia Henderson’s theory to practice. After reviewing many nursing theorist before writing this paper, I have concluded that my practice of nursing encompasses all fourteen points of her theory. The patient must be seen as a whole and not as a sum of the parts. If one is to view the patient as parts, part of the clinical picture may be missed.

I view my care as assisting the patient in activities that they would normally do for themselves if they were able. I foster my patients to gain their independence as quickly and safely as possible. I continually advocate for the patient and family while they are in the ICU. This also carries through to carrying for a dying patient and their family as well. I strive to ensure that the patient and family wishes are carried out as they have stated. I recall one patient that I recently cared for in the ICU. Mr. A. had overdosed on cocaine and was now unresponsive on a ventilator.

His care encompassed the fourteen points of care outlined by Ms. Henderson in her theory. In the next several paragraphs, I will demonstrate how my practice encompasses Ms. Henderson’s theory. Practice Implications With Henderson’s theory in mind, I turn to my practice utilizing the very foundation of her theory. Being an ICU nurse I often see many people at their most vulnerable. One particular patient that I recently had the privilege of caring for, Mr. A. , was a drug overdose. Mr. A. had a total downtime of fifteen minutes.

With my new learned knowledge of Henderson’s theory and the Christian worldview of nursing at hand, I decided to truly compare my practice to a theoretical framework of nursing. I proceeded through my day caring for Mr. A. He was unable to breathe on his own and required a ventilator to assist him in breathing and to protect his airway. Mr. A. was also febrile with a temperature of 102. 8 degrees Fahrenheit. Mr. A. was being sedated at the beginning of my shift but the medications were turned off to ascertain his neurological status. By the middle of the day, with the sedation off, it became evident that there no response from Mr. A.

It was noted, however, that Mr. A. was demonstrating decorticate posturing; an ominous sign for me as a seasoned nurse. Mr. A. truly fell into Henderson’s grand theory of nursing. Here was a patient that, because of his condition, required the complete care of my nursing knowledge and interventions. He was unable to control his body temperature and he was clearly unable to breathe on his own. Mr. A could not even reposition himself, which put him at an extremely high risk for a bedsore. I would have to reposition Mr. A. to protect his skin integrity.

Mr. A. had hypoactive to no bowel sounds and it was determined that tube feedings would not be started yet. Mr. A. was not unable to control his bowel or bladder nor could he communicate this very basic need. A Foley was inserted to manage his urine and I would continue to monitor his bowel activity. Keeping with Henderson’s activities of nursing I based my interventions on “breathe normally, eat and drink adequately, eliminate body wastes and move and maintain desirable postures” (Nunnery, 2005, p. 72)

Because of the swelling within his brain, Mr. A. was unable to regulate his core temperature. I proceeded to give Mr. A. a Tylenol suppository to control his temperature. I removed the sheets covering Mr. A. in an effort to assist his body in cooling itself down. I also had at my disposal a cooling blanket if all else failed. I related this aspect of my caring to Henderson’s activity of “maintaining body temperature within normal range by adjusting clothing and modifying the environment” (Nunnery, 2005, p. 72) Mr. A. required frequent bathing. His temperature had made him extremely diaphoretic. Knowing that this can contribute to skin breakdown, I ensured to clean and keep Mr. A’s skin as dry and clean as possible. This follows with Ms.

Henderson’s “keep the body clean and well groomed and protect the integument” (Nunnery, 2005, p. 72). Mr. A. had a large family. Mr. A. was Latino and I knew from previous cultural interactions with Latino culture that family and religion played an integral role in caring for such patients. Because Mr. A. could not communicate directly, I ensure that the family knew his condition.

I encouraged the family to discuss their feelings and to ask questions about Mr. A. grim prognosis. I offered the hospital Chaplin if needed and offered to pray with the family at the bedside of Mr. A. I had already prayed that day while caring for Mr. A. but knew that an additional prayer with the family would show my respect for their religion and would strengthen my faith in my God as I cared for Mr. A. I focus this to Henderson’s “communicate with others in expressing emotions, needs, fears or opinions and worshiping according to ones faith” (Nunnery, 2005, p. 72). I would concur, for the most part, with Henderson’s theory but the worship aspect deserves more attention. While Virginia Henderson mentions worship, little more is related to this aspect of caring. Elizabeth O’Brien (2002) points out in her book that Virginia Henderson “did not explore this precept in any detail” (p. 126).

This is where I turn to the Christian worldview of nursing to assist me in my practice at the bedside. According to Shelly and Miller (2006), Christian nursing is defined as A ministry of compassionate care for the whole person, in response to God’s grace toward a sinful world, which aims to foster optimum health (shalom) and bring comfort in suffering and death for anyone in need (p. 244). Shelly and Miller (2006) go on to say that “Christ-inspired nursing lies in its emphasis on caring for the whole person as embodied, respecting each person as created in the image of God” (p. 53).

With these two concepts in mind, I can foster a deeper understanding of what my patient is suffering and better assist them in their health and integrate them into Henderson’s grand theory. There are, however, implications that would tend to limit the use of this theory at the bedside. The multidisciplinary approach to care can hinder implementing my practice the most. With sometimes upwards of seven groups of physicians on a patient’s case, the communications between those groups can breakdown or even become a burden difficult to overcome. I strive to be an advocate for the patient but at times my advocacy appears to fall on deaf ears.

Knowing what the patient and family want often does not coincide with the physicians charge to heal. I look at healing not only as improving health, but in the case of Mr. A. , facilitating the family’s wishes that no more heroics be preformed and that he be allowed to die peacefully and gracefully. This was incorporated into Henderson’s definition, as stated by McEwen and Wills (2007) 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 a peaceful death) (p.139).

Summary The social relevance of Virginia Henderson’s life, philosophies and theories cannot be denied. She places the work of nursing into the realm of ‘art’, providing a humanist view to a profession easily sidetracked by the drudgery of duty. Her principles allow the patient to maintain a sense of dignity and autonomy in a situation where these essential ingredients for self-respect are at risk. John Dewey remarked that “contempt for the body, fear of the senses and the opposition of flesh to spirit” (1934, p. 20) have forced the human ideals to separate from the experience.

Virginia Henderson addressed these issues relative to the responsibilities entailed within nursing. The human experience is multi-faceted and filled with the complexities of different viewpoints and emotional responses. Henderson understands this and understands as well that the nurse must be aware of the person as a whole and to act accordingly.

References

• Benoliel, J. Q. (1977). The interaction between theory and research. Nursing Outlook, 25, 108-113.
• Dewey J. (1934). Art as experience. New York: Perigee Books.
• Evers, Georges (2003). Developing nursing science in europe. Journal of Nursing Scholarship, 35(1): 9-14.
• Henderson, V. (1991). The nature of nursing–Reflections after 25 years. New York: Macmillan.
• Henderson, V. , & Nite, G. (1978). Principles and practice of nursing (6th ed. ). New York: Macmillan.
• McEwen, M. & Wills, E. (2007). Theoretical basis for nursing (2nd ed. ). Philadelphia: Lippincott Williams and Wilkins.
• Nunnery, R. K. (2007). Advancing your career: Concepts of professional nursing (3rd ed.). Philadelphia: F. A. Davis Company.
• O’Brien, E. (2002). Spirituality in nursing: Standing on holy ground (2nd ed. ). Sudbury, MA: Jones and Bartlett Publishers.
• Sanford, Rhea C. (2000). Caring through relation and dialogue: A nursing perspective for patient education. Advances in Nursing Science, 22(3): 1-18.
• Shelly, J. & Miller, A. (2006). Called to care: A Christian worldview for nursing (2nd ed. ). Downers Grove, IL: InterVarsity Press.
• Tourville, C. & Ingalls, K. (2003). The living tree of nursing theories. Nursing Forum, 38(3): 21-32.