#WeNurses - Thursday 4th April 2019 8pm (GMT Standard Time) Nursing Theorists: Part 1 Virginia Henderson

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Written by Elaine Maxwell 

Nursing has often been seen as a practical rather than a theoretical activity but without theory, the practice is entirely subjective and whether patients benefit is a matter of luck rather than planning.

In fact, nursing has long had implicit theories, even though they were not always written down.  Even Florence Nightingale espoused an implicit theory in her book, Notes of Nursing, Her theory focused on hygiene and supporting medical practice. There was a concerted effort in the 1950s to articulate implicit assumptions about nursing and to bring them together into a holistic theory that, if understood and implemented in practice, would ensure that professional nursing provided a benefit above and beyond the actions of family or lay carers.

One of the people to do this was Virginia Henderson. Henderson trained at the Army School of Nursing in Washington, D. C. and qualified in 1921. She practised clinically and as a nurse educator before she was invited to edit a new edition of a classicAmerican textbook,  Harmer's Textbook of the Principles and Practice of Nursing .Henderson five years revising it,  and the 1955 version was based on a new theory of nursing,  entirely independent of medicine in which:

"nurses assist individuals, sick or well, in the performance of those activities contributing to health, its recovery (or to a peaceful death), that they would perform unaided if they had the requisite strength, will or knowledge."

The International Council of Nurses commissioned her to write an essay entitled Basic Principles of Nursing Care (Geneva,1960) for nurses who had neither access to technology nor the medical care required to establish disease diagnoses. This demonstrated that her theory was not dependant on place of equipment.

Henderson's Needs Theory identified 14 components, based on human needs: breathing; eating and drinking; eliminating body waste; moving and maintaining posture; sleeping and rest; dressing and undressing; maintaining body temperature; keeping body clean and well groomed; avoiding dangers in the environment and avoid injuring others; communicating with others in expressing emotions, needs, fears, or opinions; worshiping according to one’s faith; working in such a way that there is a sense of accomplishment; playing or participating in various forms of recreation; learning, discovering, or satisfying the curiosity that leads to normal development and health

 She described the nurse's role in assisting people with these component in three ways:

- Substitutive (doing things on behalf of the person where they are unable to meet their own health needs),

-Supplementary (helping the person to meet their needs),

 Complementary (working with the person to develop their personal capacity to meet their needs independently)

Henderson saw nursing as a logical process, where the nurse makes a structured assessment of the individual against the fourteen needs. The assessment leads to a nursing (as opposed to a medical) diagnosis and the setting of an outcome goal. The diagnosis and goal in turn inform a plan of care, which is monitored and adapted to meet the goal. This became known as the nursing theory process, or the nursing process.

Many subsequent nursing theories have been developed, often focusing in more depth on one or more of the fourteen components and nursing theory was a key part of preregistration curriculum in the 1970s and 1980s but has fallen out of favour more recently.

Nursing theories are in essence philosophical. The conceptual frameworks are difficult to measure under the dominant positivist paradigm. Henderson herself undertook a critical review of nursing research in 1953 and found that most nursing research studied nurses, not nursing care. The move into higher education in the UK, with an increasing emphasis on empirical evidence has left many nursing theories in a no man's land and nurse researchers still study either nurses or medical treatments rather than nursing diagnoses. Few if any are studying the practice of nursing.

Increasingly this theory vacuum is leading people within and outside the profession to suggest that there is no such thing as professional nursing and that we should focus on inter-professional working; physiotherapists as ward managers, social workers to provide home care and a range of support roles to provide the support for physical needs. Without a unifying theory, perhaps they are right.

Harmer, B.  (1922) TextBook of the Principles and Practice of Nursing New York: Macmillan

Harmer, B. andHenderson, V. (1955) Textbook of thePrinciples and Practice of Nursing New York: Macmillan

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