Figure this out. Forty years ago, if you want to be a registered nurse, you have to set up a trolley in preparation for a medical procedure as one of central items in the final examination (Mc Mahon & Pearson, 1998).
Virginia Avenel Henderson,
dissatisfied with the blurring definitions of nursing, revolutionized
the image of a nurse as a distinct independent practitioner in her
pioneering theory, “Definition of Nursing”.
In her seminal work, Nature of Nursing (1964), she called for “an
occupation or especially a profession whose services affect human life
to define its functions.”
The
“concept of nursing” as Henderson described it has multidimensional
facets. In her paper entitled “Concept of Nursing” which was presented
during the Third Battersea Memorial Lecture sponsored by the Association
of Integrated and Degree Courses in Nursing (AIDCN) at the historical
Nightingale School, St. Thomas’ Hospital London on November 7, 1977, she
discussed the different definitions of nursing as affected by forces of
socio-political phenomena, the evolving health services, academic
preparation of a nurse, how the profession of medicine views nursing,
and ultimately, the perceptions of patients as primarily driven by their
stature in society (i.e. socioeconomic, educational attainment,
cultural health practices and beliefs.)
The different definitions of nursing ad infinitum,
coupled with the different functions of a professional nurse across the
globe, served as impetus for Henderson to define a universal concept of
nursing. She encouraged, however, that every nurse should have her on
concept of nursing because nursing per se is a naturally evolving profession.
Henderson’s
view on nursing offers pragmatic values on nursing practice, education
and research. This article presents feasible instances on how to
utilize Henderson’s concept in dealing with patients, ethico-legal
implications of nursing practice, nursing curriculum development and
academic preparation of a nurse and clinical nursing research within the
perspectives of Philippine setting.
Henderson on Nursing Practice
The
reason why Henderson is hailed as “Teacher of Nurses” because nurses
are indebted to her on the scope of nursing practice. Role disparities
among nurses are evident during the time of Henderson. With the birth of
her theory, it guided the nurses to remain faithful to his functional
roles and professional boundaries. Doing this, the public, being the
consumers of care, and the nurse are mutually protected and their best
interests are served.This
gave way to the aspect of legal jurisprudence of nursing. Henderson
believed that nursing must be explicitly defined in Nurse Practice Acts
that would provide the legal parameters for the nurse’s functions in
caring for consumers and safeguard the public for unprepared and
incompetent practitioners. She further advocated for national nursing
organizations and geopolitical units to enact legislation to control the
preparation, function and licensing of nursing personnel. During her
time, Henderson was so alarmed that many states had no provision for
nursing licensure to ensure safe and competent care for the consumers
(George, 1995).
The
practice of regulating nursing practice through licensure is evident
today. In the Philippines, the Board of Nursing which is the “ultimate
authority in regulating the nursing profession in the country” through
the Professional Regulation Commission, has expressed its mission to
“lead nursing development to its highest level of excellence for the
health and safety of the public.”
The
legal definition of nursing, as within the context on the language of
constitution, directs the roles of a nurse in a society. This unifying
force guides both the nurse and the patient on the activities in the
health care setting.
Let me illustrate.
We often encounter individuals with cough and colds asking us nurses
for prescription of drugs. Being fully aware with our scope of practice
as stipulated in the Nursing Law (RA 9173), we are not authorized to
prescribe drugs. Instead, we tailor health teachings as our independent and interdependent roles (e.g., increase fluid intake, rest, intake of vitamin C rich foods, consult doctor if symptoms still persist).
In
Republic Act No. 9173, otherwise known as the Philippine Nursing Act of
2002, the scope of nursing in the country is defined in functional
concepts like how Henderson constructed her theory.
This
passage is the barometer on what the society should expect from a
Filipino Nars. Do you still know this passage by heart and soul?
ARTICLE VI
Nursing Practice
Section 28. Scope of Nursing.
- A person shall be deemed to be practicing nursing within the meaning
of this Act when he/she singly or in collaboration with another,
initiates and performs nursing services to individuals, families and
communities in any health care setting. It includes, but not limited to,
nursing care during conception, labor, delivery, infancy, childhood,
toddler, preschool, school age, adolescence, adulthood, and old age. As
independent practitioners, nurses are primarily responsible for the
promotion of health and prevention of illness. A members of the health
team, nurses shall collaborate with other health care providers for the
curative, preventive, and rehabilitative aspects of care, restoration of
health, alleviation of suffering, and when recovery is not possible,
towards a peaceful death. It shall be the duty of the nurse to:
(a)
Provide nursing care through the utilization of the nursing process.
Nursing care includes, but not limited to, traditional and innovative
approaches, therapeutic use of self, executing health care techniques
and procedures, essential primary health care, comfort measures, health
teachings, and administration of written prescription for treatment,
therapies, oral topical and parenteral medications, internal examination
during labor in the absence of antenatal bleeding and delivery. In case
of suturing of perineal laceration, special training shall be provided
according to protocol established;
(b) establish linkages with community resources and coordination with the health team;
(c) Provide health education to individuals, families and communities;
(d)
Teach, guide and supervise students in nursing education programs
including the administration of nursing services in varied settings such
as hospitals and clinics; undertake consultation services; engage in
such activities that require the utilization of knowledge and
decision-making skills of a registered nurse; and
(e)
Undertake nursing and health human resource development training and
research, which shall include, but not limited to, the development of
advance nursing practice.
Comparing the Philippine legal definition of nursing with Henderson’s theory, we can view distinct commonalities.
“Nursing
is primarily assisting 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. And to do this in such a way as to help him
gain independence as rapidly as possible (Henderson, 1966 as cited by
Anonuevo et al, 2000).”
The
theme on the concept of nursing by Henderson is universal. It is
encompassing that it was adopted by World Health Organization Expert
Committee on Nursing Practice in 1995 (Kim, 2010).
Henderson’s
definition of nursing is revolutionary and visionary. Revolutionary, in
the sense, that it radically elevated the status of nursing as a
profession with its own scientific knowledge and practice base,
autonomy, authority and responsibility to its clients. Visionary because
it paves the way of nursing to grow and assume various expanded roles
nowadays. Advanced practice nursing and post graduate academic degrees
of nurses today trace its roots to this theory.
The
principles and practices of nursing must be built upon and derived from
the definition of the profession. Nurses functional roles are
explicitly elaborated in the theory, and can be viewed in three spheres:
in relationship with the patient/client, the physician and the health
care team.
In
relationship with the patient (including the family), the nurse can act
as a substitute (doing for), supplement (helping) and complementary
(working with) in meeting fundamental basic needs geared towards the
ultimate goal of healthy independence. I will peruse the concept of
independence in the proceeding text.
Henderson
asserted that nurse is distinct from medicine. She clearly pinpointed
that nurses do not follow doctor’s orders, but rather they follow in a
philosophy which allows physician to give orders to patients (Octaviano
and Balita, 2008). However, she underscored that the primary function of
a nurse must be performed in such a way that it promotes the
physician’s therapeutic plan (George, 1995). I must say, therefore, that
nurses are not handmaids of physician and being adjunct to medicine.
Nurses have their own identity!
Nurses,
according to Henderson (1977), though act interdependently with other
health workers must be masters of their unique roles. In situation
where other members of the health care team are unavailable, the nurse
is the person best prepared to supply the help for such specialists. We
can assess symptomatology and create nursing diagnoses, interpret
laboratory findings, know therapeutics and diagnostics, understand drug
dynamics, tailor heath education and diet planning.
Meeting the 14 Basic human needs as equated to healthy independence
The
concept of nurse’s unique function demands that nurses understand the
fundamental needs of human. These needs are operationalized into “14
basic human needs” which the nurse should address in the process of
providing “basic nursing care to promote human welfare” (Henderson,
1980). (See previous pages on 14 Basic Human Needs)
A
recurring theme among nursing theories is the concept of independence.
This has been referred to by Henderson as healthy independence, which
she stressed out as the goal of nursing.
Self-determination
or self-reliance is an indispensable ultimate goal of any health
models. The “person” mentioned in theory of the “Mother of Modern
Nursing” is both in the disease and wellness state, though wellness
isn’t explained explicitly in the theory. Instead, the person is largely
seen on the passive, dependent state in the disease continuum.
For example.
There are still incidences of tuberculosis in the government hospital
where I work amidst the short course chemotherapy campaign of the
Department of Health. Rural farmers with history of chronic smoking
rushed to hospital presenting dyspnea and hemoptysis . History further
revealed failure to complete the therapy. CXR result shows pulmonary
tuberculosis, hematology results reveal anemia, leukocytosis with
predominance of lymphocytes, decreased serum albumin. Utilizing
Henderson’s theory, I will respond by maintaining airway, promoting rest
and adequate nutrition, preventing further infection, placing the
patient on isolation, initiating peripheral IV and administering
antibiotic and antifibrinolytic as ordered.
Nurses nowadays are so astute in meeting the physiologic needs of patients. We assist them to have the physiologic “strength”.
We fail to meet the psychological/emotional, learning, spiritual and
social/recreation needs of our clients (i.e. these need s constitute the
#10-#14th basic needs according to Henderson). Basing from
my example, I may explore the reasons why adherence to treatment regimen
is low. Doing so may serve as my basis in conducting health education
to provide “knowledge” and motivate my clients to have the “will”
to be responsible on their own health. This clearly pinpoints how
Henderson organized nursing problems rather than medical diagnosis. By
having the necessary strength, knowledge and will, independence is
attainable, as posited by Henderson.
The
assumption on the Activities of Daily Living (ADL), also known as basic
needs, still remains true and valid today. Though in Henderson’s
theory, almost more than half of the activities focuses on physiologic
needs, she advocated “holism” to include the psychosocial and spiritual
dimensions of a person.
In
delivery of nursing care, the nurse is guided with a scientific problem
solving process and with the recognition of nursing process nowadays,
it can also be employed. Quality of care rendered by a competent nurse
should be evaluated in terms of the “speed” to which the patient regains
independence (George, 1995). All nursing care done should be translated
into writing, a written nursing care plan. This has valuable
implication in terms of legal aspects, outcome evaluation and research.
Henderson
further questioned the “nursing process” reminding us all that problem
solving is not exclusive to any profession (McBride, nd). The nursing
process according to her highlights only the science of nursing,
excluding the art of nursing. However, the problem solving approach can
be used in her thesis.
In summary, Henderson’s theory:
- Assists nurses, whose primary function is being the direct caregiver to the patient, in finding an immediate reward in patient’s progress from dependence to independence.
- Helps nurses make every effort to understand the patient when he or she lacks will, knowledge, or strength.
- Henderson’s approach to patient care was deliberative and involved decision making.
- Utilizes nursing process (assessment, planning, implementation, & evaluation) as the problem-solving process and is not peculiar to nursing.
Henderson on Nursing Education
Her
advocacy, alongside with her proposal on the three phases of curriculum
design, dramatically changed the nursing education and is prevalent in
the baccalaureate programs in our county today.
She
analyzed the curricula of the usual 4 year nursing program in USA and
categorized the courses into (1) the humanities, (2) the biological and
physical sciences, (3) the social sciences, and (4) the medical and
nursing arts and sciences. The growing variation among programs offered
by schools of nursing results to different roles of a nurse assumed in
health care setting. This is the reason why Henderson (1977) proposed a
basic nursing program.
Henderson
(1977) gave emphasis on interdisciplinary education and fostering a
humanistic concept of health care. The basic nursing curriculum which
includes social and bio-physical sciences has three natural stages of
learning. The first stage is devoted in assisting patient to meet his
activities of daily living, the second stage focuses on symptomatic
nursing or common physical and emotional dysfunctions and third stage
integrates care to the different developmental stages and whole life
span of an individual.
In
the Philippine setting, the basic nursing curriculum as proposed by
Henderson is evident in the four year nursing programs today. The 1st year is devoted on studying physical, biological and social sciences and effective communication skills. The 2nd
year focuses on normal physiologic functioning, primary health care,
basic nursing care and fundamental concepts of nursing. The 3rd
year and senior year integrate multidimensional care to varied clients
(ie. Individual, family, groups, community) across life span with
physiologic and psychosocial alterations supported by
scientifically-driven research. The product of the program is a nurse
generalist.
Student
nurses should develop clinical judgments, direct individualized patient
care, a habit of inquiry, and be lifelong students.
Henderson’s
immortal contributions to nursing education is encapsulated in her
definition of nursing, her proposed nursing program and the nursing
books she authored like the Textbook of the Principles and Practice of Nursing, Basic Principles of Nursing Care and Nature of Nursing, which served as nursing classics and the guiding light on the practice of nursing.
Henderson developed three phases of curriculum that students should progress through their learning.
- Fundamental needs of the patient, the planning of the nursing care, and the unique function of the nurse helping the patient perform his activities of daily living.
- Helping patients meet their needs during marked body disturbances or pathological states that demand modifications in the nurse’s plan of care.
- Patient and family-centered, wherein students become involved in the complete study of the patient and its needs.
Henderson on Research
Her
early ideas recognized on the importance of an outcomes orientation,
health promotion, continuity of care, patient advocacy,
multidisciplinary scholarship, integration of the arts and sciences, and
boundary spanning (McBride, nd). She encouraged on the utilization of
library for research work and inclusion of research subjects in the
baccalaureate level.
As
a proof of her dedication to inquiry, she advocated on “clinical
research”. Although, her theory is not written in testable terms, her 14
basic needs can be reformulated into research questions (Mc Ewan &
Wills, 2007).
In
an article written by Nicely, Bruce, DeLario and Ginger (2011), the
theory of Virginia Henderson was utilized creatively in the practice and
principles of nursing as applied to organ donation after brain death in
the clinical practice. This shows how the theory can be feasible in
clinical research.
Evelyn
Adam, a Canadian nurse, extended the work of Henderson, by developing
concepts integrated into a conceptual model (George, 1995). There are
six major units in the conceptual model namely goal of the profession,
beneficiary, role, source of difficulty, intervention which includes the
focus and modes and consequences. This model can be translated into
further research as it seeks to operationalize the theory of Henderson
into tangible form.
Henderson further includes the following in using her theory on research:
- Guide to evaluate and improve practice.
- Basing their practice on research findings and acquiring the habit of looking for research.
- Utilizing library resources and hoping that nurses would conduct research to improve practice rather than to merely gain academic respectability.
- Believed that nursing would not become a research-based profession until practicing nurses learn to use library resources.
The Nursing Process as Applied to Henderson’s Needs Theory
Nursing Process
|
Henderson’s 14 components and definition of nursing
|
Nursing Assessment
|
Assessment focuses on Henderson’s 14 components of health.
|
Nursing Diagnosis
|
Analysis: Compare data to knowledge base of health and disease.
|
Nursing plan
|
Identify
individual’s ability to meet own needs with or without assistance,
taking into consideration strength, will or knowledge.
Prioritization of needs are done by the nurse together with the patient.
Long term goal: optimal independence
Short term goals: successful activities as directed to the fulfillment of the long term goals.
|
Nursing implementation
|
Document how the nurse can assist the individual, sick or well.
Assist
the sick or well individual in to performance of activities in
meeting human needs to maintain health, recover from illness, or to
aid in peaceful death.
|
Nursing process
|
Implementation
based on the physiological principles, age, cultural background,
emotional balance, and physical and intellectual capacities.
Carry out treatment prescribed by the physician.
|
Nursing evaluation
|
Henderson’s 14 components and definition of nursing
Use the acceptable definition of nursing and appropriate laws related to the practice of nursing.
The
quality of care is drastically affected by the preparation and native
ability of the nursing personnel rather that the amount of hours of
care.
Successful
outcomes of nursing care are based on the speed with which or degree
to which the patient performs independently the activities of daily
living
|
Table 1. Needs Theory’s Nursing Process[i]
Henderson’s
definition of nursing and 14 components of basic nursing care can be
useful in guiding the assessment and care of patients preparing for
surgical procedures. For example, in assessing Mr. G’s preoperative
vital signs, the nurse noticed he seemed anxious. The nurse encouraged
Mr. G. to express his concerns about the surgery. Mr. G. told the nurse
that he had a fear of not being able to control his body and that he
felt general anesthesia represented the extreme limit of loss of bodily
control. The nurse recognized this concern as being directly related to
Henderson’s fourth component of basic nursing care: Move and maintain desirable postures. The
nurse explained to Mr. G. that her role was to “perform those acts he
would do for himself if he was not under the influence of anesthesia”
(Gillette, 1996, p. 267) and that she would be responsible for
maintaining his body in a comfortable and dignified position. She
explained how he would need to be positioned during the surgical
procedure, what part of his body would be exposed, and how long the
procedure was expected to take. Mr. G. also told the nurse about an
experience he had following an earlier surgical procedure in which he
experienced pain in his right shoulder. Mr. G. expressed concern that
being in one position too long during the surgery would damage his
shoulder and result in waking up with shoulder pain again. Together they
discussed positions that would be most comfortable for his shoulder
during the upcoming procedure, and she assured Mr. G. that she would be
assessing his position throughout the procedure.
- Myrene Aseron
-Paul Froilan Garma
-Raiza Justol
-Nadine Cybil Solano
-Rainer Sularte
-Rainer Sularte
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AN
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Ourselves, our body, our health….. enhancing self usage towards prevention of illnesses & promoting well-being.
ReplyDeletethat what Nurses do :)