This page presents the various scholarly researches and articles done by people who used Virginia Henderson's Theory as their inspiration. These works have served as guides for the enhancement of our profession. Furthermore, more studies are being made incorporating Henderson's model various aspects. Also in this page, the UPOU-MAN contributors have summarized a few articles and how it can be applied in our day-to-day interaction with our clients.
Virginia Henderson's Principles and Practice of Nursing Applied to Organ Donation after Brain Death
by Nicely, Bruce, DeLario, Ginger T
Registered nurses were some of the first non-physician organ transplant and donation specialists in the field, both in procurement and clinical arenas. Nursing theories are abundant in the literature and in nursing curricula, but none have been applied to the donation process. Noted nursing theorist Virginia Henderson (1897-1996), often referred to as the "first lady of nursing," developed a nursing model based on activities of living. Henderson had the pioneering view that nursing stands separately from medicine and that nursing consists of more than simply following physicians' orders. Henderson's Principles and Practice of Nursing is a grand theory that can be applied to many types of nursing. In this article, Henderson's theory is applied to the intensely focused and specialized area of organ donation for transplantation. Although organ donation coordinators may have backgrounds as physicians' assistants, paramedics, or other allied health professions, most are registered nurses. By virtue of the inherent necessity for involvement of the family and friends of the potential donor, Henderson's concepts are applied to the care and management of the organ donor, to the donor's family and friends, and in some instances, to the caregivers themselves. (Progress in Transplantation. 2011;21:72-77)
The nurse is temporarily the consciousness of the unconscious, the love of life of the suicidal, the leg of the amputee, the eyes of the newly blind, a means of locomotion for the newborn, knowledge and confidence for the young mother, a voice for those too weak to speak.1
Nursing theorist Virginia Henderson (1897-1996), often referred to as the "first lady of nursing," penned these words in "The Concept of Nursing,"1 in a section titled "Nursing's Unique Function." Of the 4 categories of nursing theory (metatheory, grand theory, middle range theory, and practice theory), Henderson's grand theory of activities of living provides a range of ideas that is broad enough for the theory to be applied to the donation process.2
For clarity, organ donor in this work is defined as an individual who is brain dead and is a candidate for solid-organ donation for transplantation. Although it is possible for living patients to donate some organs (eg, a kidney, a liver segment, the lobe of a lung),3 this article is limited to deceased donors. (Note: Donation after cardiac death is another possibility for organ donation but is not discussed here either.) Nurse herein refers to both registered nurses practicing as organ procurement professionals or nurses practicing in the clinical setting, caring for a patient who has or may become an organ donor.
Although most organ procurement organizations do not include nutritional supplementation in organ donor management, some evidence suggests that the potential organ donor would benefit from supplementation of dextrose, amino and fatty acids, and glutamine.'7 Nutrients such as dextrose, glutathione, adenosine, and raffinose are included in the various preservation solutions delivered directly to the organs during recovery and transport.18 For the potential organ donor, Henderson's concept of assisting a client to "eat and drink adequately" is expanded to establishing and maintaining hydration and normovolemia to support adequate organ function.
Elimination of Body Waste
Henderson lists "elimination of body waste"13 as the third activity. When brain function is impaired, production of antidiuretic hormone often decreases and halts completely with brain death. Kidneys are often highly sensitive to this injury and frequently respond by decreased urine output, diabetes insipidus, or other anomalies. The nurse, who understands the delicate balance between kidney function and many other body systems, will know that monitoring organ function through laboratory testing at regular intervals is essential and will suggest interventions as needed. Insightful nurses who are working with potential organ donors also understand that fluid overload is often an unfortunate side effect of trauma care- although it may not be evident for several hours- so the nurses will monitor multiple indicators (eg, arterial and/or central catheters) and suggest interventions to maintain stability.
It can also be challenging for nurses to reconcile the visible with the invisible. Nurses may need to review the fact that without the ventilator there would be no breathing and may need to allow the patient's family to be present during apnea testing. The nurse may need to review the legal and ethical definitions of brain death and review the criteria under which brain death is determined. The nurse's understanding of, and comfort with, brain death is essential. If a patient's family perceives uncertainty from the nurse, they may be hesitant to trust a brain death declaration, which may adversely affect organ donation.21 The situation can cause fragile emotions, which left unchecked, can lead to a difficult environment.
Maintain Body Temperature Within Normal Range by Adjusting Clothing/Modifying Environment
"Maintain body temperature within normal range by adjusting clothing and modifying environment" is Henderson's next activity.13 Along with loss of voluntary nervous control, neurological devastation also compromises the hypothalamus, weakening the body's ability to regulate temperature. It is not uncommon for a brain-injured patient to experience body temperatures ranging from hypothermic to hyperthermic. Hyperthermia increases the metabolic and oxygen consumption rates. Hypotension causes a left shift in the oxyhemoglobin dissociation curve, impairing oxygen delivery to the tissue and decreasing the ability of the kidneys to concentrate urine. External adjustments are required to prevent further damage.16 Additionally, some patients who become donors have succumbed to meningitis, either bacterial or viral, which causes even more temperature fluctuation. Warming- or cooling- the patient should be a routine part of trauma care, and, as Henderson implies, the nurse provides this care when the patient cannot. The nurse must respond to temperature extremes with cooling blankets, heating lamps, or other technological interventions.
Grooming/Protecting the Integument
Nurses should take great care in the use of specific language when communicating with the family. When a patient is declared brain dead, health care professionals commonly use terminology such as "braindead" rather than "dead" and "life-support" when referring to the ventilator. These terms can be confusing to the patient's family. Using the term "dead" sends a more definitive message to the family that their loved one is, in fact, dead.22 Terms such as "retrieval," "procurement," and "harvest" are often used to describe the surgical procedure through which organs are removed from the donor. Richardson24 argues that the word "retrieval" implies that the organs belong to someone other than the donor and we are merely taking them back while "procurement" refers to commerce and commodities and tends to focus on the recipient rather than the donor. Although one might argue that "harvest" refers to a time of plentitude and thanksgiving, harvesting of crops was traditionally done by "sickle or scythe, the same implements used by the Grim Reaper, Death."24 For these reasons, nurses should use the term recovery. Recovery implies healing, and although the donor will not be healed, it can aid in the healing of the donor family by offering some solace or comfort in their grief by looking at donation as a way to bring meaning to the death of their loved one.22 Many people encounter organ donation with misconceptions that nurses should work to correct, and nurses must do so with great finesse so as not to undermine individual belief systems or values.
Worship According to One's Faith
Henderson lists "worship according to one's faith" as the next activity.13 Most of the practice of nursing, and certainly death and dying, may prompt nurses to call upon their own spiritual beliefs. Patients and patients' families may have different beliefs, which nurses must respect. Nearly all religious groups support organ donation as long as it does not impede the life or hasten the death of the donor.25 In the case of an organ donor, clergy may be called in to support the family. When considering donation, the family may look to a faith leader for answers.25 Nurses may find opportunities not only to communicate information to the clergy, but perhaps also to facilitate worship or end-of-life rituals for the family at the bedside to outwardly express their grief.26 Additionally, repeated exposure to episodes of death may prompt nurses to further explore their own spiritual journey and give them a choice to participate in worship as grief support for themselves.
Play and Recreation
Of all health providers, nurses render the most intimate personal service. . . . Perhaps the quality people most often seek in the nurse is that of a comforting presence. If there is a universal concept of nursing it embodies the characteristics of a service that is intimate, constant and comforting.
Virginia Henderson's Activities for Client Assistance within her concept of nursing apply logically and easily to the complex process of organ donation for transplantation. Applied within the broader context of the nursing metaparadigm- person, environment, health, and nursing- Henderson's activities provide an excellent framework within which nurses can work competently. Henderson was cognizant of the need to include the patient's family, and her tenets work equally well in caring for them. Nurses must advocate for patients. Unfortunately, not all health care professionals, including physicians and nurses, understand brain death.28 It can be an ethical minefield if the health care team compromises care that could save the patient's life, fails to take appropriate actions to preserve organ function, or takes actions incongruent with the Nurse Practice Act.
Henderson said of her theory that "the complexity and quality of the service is limited only by the imagination and the competence of the nurse who interprets it.'" She also alluded to nurses' autonomy. Expanding opportunities for nurses to specialize in advanced practices, such as organ donation and transplantation, is an ideal fit for Henderson's concept of nursing. The activities she lists as crucial elements of excellent patient care extend to the patient's family, and in the case of organ donation, to the recipients of donated organs. The nurse who applies Henderson's concepts throughout the donation process will contribute significantly to transferring the gift of life from one human being to one or more patients at the next phase of the donation process.
Comments from the Contributor
The article best describes the theory of Henderson which explains the interactions and consequences of interactions that are related to assessment, diagnosis and interventions; which also explain the context of health and illness that account for human variations. A patient has his set of human basic needs and problems in dealing with daily activities.
However, ethical issues ad protocols and permissible societal boundaries should be brought into consideration regarding organ donation after brain death. In order to maintain and protect the integrity of transplantation, this practice should be based on concise scientific data and accepted principles and protocols so as to serve its purpose, and that is to bring about new hope and new life for a person. Based on Henderson’s Theory in which there is the identification of 14 basic needs, the outcome of transplantation will bring about the enhancement of a person’s life for the better.
The roles nurses play provide an image of someone who is active and helpful to the patient who is striving for independence and focused on doing a deliberate and well planned activity, that is pursuing to have a will to do daily activities; and that is complementing and supplementing knowledge for the good of the patient and of the patient’s significant others. The nurse thus assists and aides in the promotion and recovery of a patient who had just undergone transplantation, as well as educate the significant others to provide support for the recovery and wellness of the patient.
Nicely, Bruce "". Progress in Transplantation. FindArticles.com. 10 Jul, 2011. http://findarticles.com/p/articles/mi_qa4117/is_201103/ai_n57242444/
Copyright North American Transplant Coordinators Organization Mar 2011
Provided by ProQuest Information and Learning Company. All rights Reserved
1. What has happened to nursing arts and/or nursing 101?
Would we want Florence Nightingale or Virginia Henderson to know what is being passed as basic hands on nursing care today?
2. Henderson, Virginia. "Excellence in Nursing." American Journal of Nursing 100 (October 2000): 961.
3. Acceptance and Commitment Therapy (ACT) http://www.nursingplanet.com/pn/acceptance_commitment_therapy.html
4. Chest Physiotherapy http://currentnursing.com/reviews/chest_physiotherapy.html
5. Care of Dying and Dead http://currentnursing.com/reviews/care_of_dying_and_death.html
6. Use of sleep care guidelines in a surgical intensive care unit reduces noise levels and improves patient-reported sleep quality http://ebn.bmj.com/content/early/2011/06/14/ebn1172.short?q=w_ebn_ahead_tab
4. "The Virginia Henderson International Nursing Library is committed to providing knowledge resources to help advance nurses and patient care. The library is dedicated to bringing you the latest research on nursing knowledge that is important to all nurses – clinicians, researchers, educators, and students."
5. http://www.nlm.nih.gov/ --biography