BACHELOR OF SCIENCE IN NURSING

NCMA 110
(Theoretical Foundations of Nursing)
COURSE MODULE COURSE UNIT WEEK
1 5 5

• Read course and unit objectives

• Read study guide prior to class attendance
• Read required learning resources; refer to unit terminologies for jargons
• Proactively participate in classroom discussions
• Participate in weekly discussion board (Canvas)
• Answer and submit course unit tasks

1. Personal Laptop/mobile device

2. Internet connection/device
3. Reading materials
4. Paper and Pen for writing
 1. At the end of the course unit (CM), learners will be able to:

Cognitive:

1. Define and explain Environmental Theory by Florence Nightingale, 21 Nursing

Problems by Faye Abdellah and 14 Basic needs by Virginia Henderson

Affective:

1. Inculcate the importance Environmental Theory, 21 Nursing Problems and 14 Basic

needs in our clinical practice.
2. Listen attentively during class discussions.
3. Demonstrate tact and respect when challenging other people’s opinions and ideas.
4. Accept comments and reactions of classmates on one’s opinions openly and graciously.

Psychomotor:

1. Apply the principles of Nursing theories during class discussion.

2. Participate actively during class discussions.
3. Confidently express personal opinion and thoughts in front of the class.

Environmental Theory - Nursing as “the act of utilizing the environment of the patient to
assist him in his recovery.”

21 Nursing Problems - “Nursing is based on an art and science that molds the attitudes,
intellectual competencies, and technical skills of the individual nurse into the desire and ability to
help people, sick or well, cope with their health needs.”

Nursing Need Theory - Emphasizes the basic human needs and how nurses can assist in
meeting those needs.
Florence Nightingale (12 May 1820 – 13 August 1910) was a nurse who contributed in developing
and shaping the modern nursing practice and has set examples for nurses which are standards for
today’s profession. Nightingale is the first nurse theorist well-known for developing the
Environmental Theory that revolutionized nursing practices to create sanitary conditions for
patients to get care. She is recognized as the founder of modern nursing. During the Crimean War,
she tended to wounded soldiers at night and was known as “The Lady with the Lamp.”

Early Life
Florence Nightingale was born on May 12, 1820, in Nightingale, Italy. She was the younger of two
children. Her British family belonged to elite social circles. Her father, William Shore Nightingale, a
wealthy landowner who had inherited two estates—one at Lea Hurst, Derbyshire, and the other in
Hampshire, Embley Park—when Nightingale was 5 years old.

Her mother, Frances Nightingale, hailed from a family of merchants and took pride in socializing
with people of prominent social standing. Despite her mother’s interest in social climbing,
Nightingale herself was reportedly awkward in social situations. She preferred to avoid being the
center of attention whenever possible. Strong-willed, Nightingale often butted heads with her
mother, whom she viewed as overly controlling. Still, like many daughters, she was eager to please
her mother. “I think I am got something more good-natured and complying,” Nightingale wrote in
her own defense, concerning the mother-daughter relationship.

Education
Florence Nightingale was raised on the family estate at Lea Hurst, where her father provided her
with a classical education, including studies in German, French and Italian. As for being home
schooled by her parents and tutors, Nightingale gained excellence in Mathematics.

From a very young age, Nightingale was active in philanthropy, ministering to the ill and poor
people in the village neighboring her family’s estate. At seventeen, she made the decision to
dedicate her life to medical care for the sick resulting in a lifetime commitment to speak out,
educate, overhaul and sanitize the appalling health care conditions in England.

Despite the objections of her parents, Nightingale enrolled as a nursing student in 1844 at the
Lutheran Hospital of Pastor Fliedner in Kaiserswerth, Germany.
Environmental Theory
Florence Nightingale’s Environmental Theory defined Nursing as “the act of utilizing the
environment of the patient to assist him in his recovery.”

It involves the nurse’s initiative to configure environmental settings appropriate for the gradual
restoration of the patient’s health, and that external factors associated with the patient’s
surroundings affect life or biologic and physiologic processes, and his development.

She identified 5 environmental factors: fresh air, pure water, efficient drainage, cleanliness or
sanitation and light or direct sunlight.

Works
Based on her observations in the Crimea, Florence Nightingale wrote Notes on Matters Affecting
the Health, Efficiency and Hospital Administration of the British Army, an 830-page report analyzing
her experience and proposing reforms for other military hospitals operating under poor
conditions. The book would spark a total restructuring of the War Office’s administrative
department, including the establishment of a Royal Commission for the Health of the Army in
1857.

In 1860, her best authored works was published, “Notes on Nursing,” outlining principles of
nursing. It is still in print today with translation in many foreign languages. In all, she had
published some 200 books, reports and pamphlets. Using the money she got from the British
government, she funded the establishment of St. Thomas’ Hospital, and within it, the Nightingale
Training School for Nurses.

In the 1870s, Nightingale mentored Linda Richards, “America’s first trained nurse”, and enabled
her to return to the USA with adequate training and knowledge to establish high-quality nursing
schools. Linda Richards went on to become a great nursing pioneer in the USA and Japan.

In the early 1880s Nightingale wrote an article for a textbook in which she advocated strict
precautions designed, she said, to kill germs. Nightingale’s work served as an inspiration for
nurses in the American Civil War. The Union government approached her for advice in organising
field medicine. Although her ideas met official resistance, they inspired the volunteer body of the
United States Sanitary Commission.
In 1854, Britain was involved in the war against the Russians (Crimean War). British battlefield
medical facilities were deplorable prompting Minister at War, Sidney Herbert, to appoint
Nightingale to oversee the care of the wounded. She arrived in Constantinople, Turkey with a
company of 38 nurses. The introduction of female nurses in the military hospitals was a major
success. Sanitary conditions were improved while nurses worked as capable assistants
to physicians and raised the morale of the British soldier by acting as bankers, sending the injured
man’s wages home, wrote letters to their families and read to the wounded.

Crimean War
The Crimean War began and soon reports in the newspapers were describing the desperate lack of
proper medical facilities for wounded British soldiers at the front. Sidney Herbert, the war
minister, already knew Nightingale, and asked her to oversee a team of nurses in the military
hospitals in Turkey. In 1854 she led an expedition of 38 women to take over the management of
the barrack hospital at Scutari where she observed the disastrous sanitary conditions.

Faye Glenn Abdellah 21 Nursing Problems

Faye Glenn Abdellah (March 13, 1919 – present) is a pioneer in nursing research who developed
the “Twenty-One Nursing Problems.” Her model of nursing was progressive for the time in that it
refers to a nursing diagnosis during a time in which nurses were taught that diagnoses were not
part of their role in health care.

She was the first nurse officer to earn the ranking of a two-star rear admiral and the first nurse
and the first woman to serve as a Deputy Surgeon General.

Early Life of Faye Abdellah

Faye Abdellah was born on March 13, 1919 in New York to a father of Algerian heritage and
Scottish mother. Her family subsequently moved to New Jersey where she attended high school.

Years later, on May 6, 1937, the German hydrogen-fueled airship Hindenburg exploded over
Lakehurst.

Abdellah and her brother witnessed the explosion, destruction and the fire subsequent to the
ignited hydrogen that killed many people. That incident became the turning point in Abdellah’s
life. It was that time when she realized that she would never again be powerless to assist when
people were in so dire need for assistance. It was at that moment she vowed that she would learn
nursing and become a professional nurse.
Education

Faye Abdellah earned a nursing diploma from Fitkin Memorial Hospital’s School of Nursing, now
known as Ann May School of Nursing.

t was sufficient to practice nursing during her time in the 1940s, but she believed that nursing care
should be based on research, not hours of care.

Abdellah went on to earn three degrees from Columbia University: a bachelor of science degree in
nursing in 1945, a master of arts degree in physiology in 1947 and a doctor of education degree in
1955.

With her advanced education, Abdellah could have chosen to become a doctor. However, as she
explained in one of her interviews that she wanted to be an M.D. because she could do all she
wanted to do in nursing, which is a caring profession.

As an Educator
At her early twenties, Faye Abdellah worked as a health nurse at a private school and her first
administrative position was on the faculty of Yale University from 1945-1949. At that time she
was required to teach a class called “120 Principles of Nursing Practice,” using a standard nursing
textbook published by the National League for Nursing. The book included guidelines that had no
scientific basis which challenged Abdellah to explain everything to what she called the “brilliant”
students.

After a year Abdellah became so frustrated that she gathered her colleagues in the Yale courtyard
and burned the textbooks. The next morning the school’s dean told her she would have to pay for
the destroyed texts. It took a year for Abdellah to settle the debt, but she never regretted her
actions because it started her on the long road in pursuit of the scientific basis of the nursing
practice.

As a Researcher
In 1949, she met Lucile Petry Leone who was the first Nurse Officer and decided to join the Public
Health Service. Her first assignment was with the division of nursing that focused on research and
studies. They performed studies with numerous hospitals to improve nursing practice.
Abdellah was an advocate of degree programs for nursing. Diploma programs, she believes, were
never meant to prepare nurses at the professional level. Nursing education, she argued, should be
based on research; she herself became among the first in her role as an educator to focus on
theory and research. Her first studies were qualitative; they simply described situations. As her
career progressed, her research evolved to include physiology, chemistry, and behavioral sciences.

In 1957, Abdellah spearheaded a research team in Manchester, Connecticut, that established the
groundwork for what became known as progressive patient care. In this framework, critical care
patients were treated in an intensive care unit, followed by a transition to immediate care, and
then home care. The first two segments of the care program proved very popular within the
caregiver profession. Abdellah is also credited with developing the first nationally tested coronary
care unit as an outgrowth of her work in Manchester.

The home care, which is the third phase of the progressive patient care equation, was not widely
accepted in the mid-twentieth century. Abdellah explained that people at the time kept saying
home care would mean having a maid or a nurse in everyone’s home. They could not figure out
that home care with nurses teaching self care would be a way of helping patients regain
independent function. Forty years later home care had become an essential part of long-term
health care.

Established Nursing Standards

In another innovation within her field, Abdellah developed the Patient Assessment of Care
Evaluation (PACE), a system of standards used to measure the relative quality of individual health-
care facilities that was still used in the healthcare industry into the 21st century. She was also one
of the first people in the healthcare industry to develop a classification system for patient care and
patient-oriented records.

Classification systems have evolved in different ways within in the health-care industry, and
Abdellah’s work was foundational in the development of the most widely used form: Diagnostic
related groups, or DRGs. DRGs, which became the standard coding system used by Medicare,
categorize patients according to particular primary and secondary diagnoses. This system keeps
health-care costs down because each DRG code includes the maximum amount Medicare will pay
out for a specific diagnosis or procedure, while also taking into account patient age and length of
stay in a healthcare facility. Providers are given an incentive to keep costs down because they only
realize a profit if costs are less than the amount specified by the relevant DRG category.

Military Nursing Service

During her 40-year career as a Commissioned Officer in the U.S. Public Health Service from 1949
to 1989, Abdellah was assigned to work with the Korean people during the Korean War. As a
senior officer, she was alternatively assigned to Japan, China, Russia, Australia, and the
Scandinavian countries to identify the role of the Public Health Service in dealing with various
health problems. She was able to assist and initiate, in an advisory role, numerous studies in those
countries.

Abdellah’s Typology of 21 Nursing Problems

Faye Abdellah is well known for her development of the “Twenty-One Nursing Problems
Theory” that has interrelated the concepts of health, nursing problems, and problem-solving.

She views nursing as an art and a science that mold the attitude, intellectual competencies, and
technical skills of the individual nurse into the desire and ability to help individuals cope with
their health needs, whether they are ill or well.

She used Henderson’s 14 basic human needs and nursing research to establish the classification of
nursing problems.

Works
As a consultant and educator, Faye Abdellah shared her nursing theories with caregivers around
the world. She led seminars in France, Portugal, Israel, Japan, China, New Zealand, Australia, and
the former Soviet Union. She also served as a research consultant to the World Health
Organization. From her global perspective, Abdellah learned to appreciate non traditional and
complementary medical treatments and developed the belief such non-Western treatments
deserved scientific research.

Awards and Honors

Faye Abdellah is recognized as a leader in the development of nursing research and nursing as a
profession within the Public Health Service (PHS) and as an international expert on health
problems. She was named a “living legend” by the American Academy of Nursing in 1994 and was
inducted into the National Women’s Hall of Fame in 2000 for a lifetime spent establishing and
leading essential health care programs for the United States. In 2012, Abdellah was inducted into
the American Nurses Association Hall of Fame for a lifetime of contributions to nursing.
er contributions to nursing and public health have been recognized with almost 90 professional
and academic honors, such as the Allied Signal Achievement Award for pioneering research in
aging and Sigma Theta Tau’s Lifetime Achievement Award.

Abdellah’s leadership, her publications, and her lifelong contributions have set a new standard for
nursing and for health care. Her legacy of more than 60 years of extraordinary accomplishments
lives on nationally and globally.

Aside from being the first nurse and the first woman to serve as a Deputy Surgeon General, Faye
Glenn Abdellah also made a name in the nursing profession with the formulation of her “21
Nursing Problems Theory.” Her theory changed the focus of nursing from disease-centered to
patient-centered and began to include the care of families and the elderly in nursing care. The
Patient Assessment of Care Evaluation developed by Abdellah is now the standard used in the
United States.

Abdellah’s 21 Nursing Problems Theory

According to Faye Glenn Abdellah’s theory, “Nursing is based on an art and science that moulds the
attitudes, intellectual competencies, and technical skills of the individual nurse into the desire and
ability to help people, sick or well, cope with their health needs.”

The patient-centered approach to nursing was developed from Abdellah’s practice, and the theory
is considered a human needs theory. It was formulated to be an instrument for nursing education,
so it most suitable and useful in that field. The nursing model is intended to guide care in hospital
institutions, but can also be applied to community health nursing, as well.

Assumptions
The assumptions Abdellah’s “21 Nursing Problems Theory” relate to change and anticipated
changes that affect nursing; the need to appreciate the interconnectedness of social enterprises
and social problems; the impact of problems such as poverty, racism, pollution, education, and so
forth on health and health care delivery; changing nursing education; continuing education for
professional nurses; and development of nursing leaders from underserved groups.

1. Learn to know the patient.

2. Sort out relevant and significant data.
3. Make generalizations about available data in relation to similar nursing problems
presented by other patients.
4. Identify the therapeutic plan.
 5. Test generalizations with the patient and make additional generalizations.
6. Validate the patient’s conclusions about his nursing problems.
7. Continue to observe and evaluate the patient over a period of time to identify any
attitudes and clues affecting this behavior.
8. Explore the patient’s and family’s reaction to the therapeutic plan and involve them in
the plan.
9. Identify how the nurse feels about the patient’s nursing problems.
10. Discuss and develop a comprehensive nursing care plan.

Major Concepts of 21 Nursing Problems Theory

The model has interrelated concepts of health and nursing problems, as well as problem-solving,
which is an activity inherently logical in nature.

Individual
She describes the recipients of nursing as individuals (and families), although she does not
delineate her beliefs or assumptions about the nature of human beings.

Health
Health, or the achieving of it, is the purpose of nursing services. Although Abdellah does not give a
definition of health, she speaks to “total health needs” and “a healthy state of mind and body.”

Health may be defined as the dynamic pattern of functioning whereby there is a continued
interaction with internal and external forces that results in the optimal use of necessary resources
to minimize vulnerabilities.

Society
Society is included in “planning for optimum health on local, state, and international levels.”
However, as Abdellah further delineates her ideas, the focus of nursing service is clearly the
individual.

Nursing Problems
The client’s health needs can be viewed as problems, which may be overt as an apparent
condition, or covert as a hidden or concealed one.
Because covert problems can be emotional, sociological, and interpersonal in nature, they are
often missed or perceived incorrectly. Yet, in many instances, solving the covert problems may
solve the overt problems as well.

Problem Solving
Quality professional nursing care requires that nurses be able to identify and solve overt and
covert nursing problems. These requirements can be met by the problem-solving process involves
identifying the problem, selecting pertinent data, formulating hypotheses, testing hypotheses
through the collection of data, and revising hypotheses when necessary on the basis of conclusions
obtained from the data.

Subconcepts
The following are the subconcepts of Faye Abdellah’s “21 Nursing Problems” theory and their
definitions.

The 21 nursing problems fall into three categories: physical, sociological, and emotional needs of
patients; types of interpersonal relationships between the patient and nurse; and common
elements of patient care. She used Henderson’s 14 basic human needs and nursing research to
establish the classification of nursing problems. Abdellah’s 21 Nursing Problems are the following:

1. To maintain good hygiene and physical comfort

2. To promote optimal activity: exercise, rest, sleep
3. To promote safety through prevention of accident, injury, or other trauma and through
prevention of the spread of infection
4. To maintain good body mechanicsand prevent and correct deformity
5. To facilitate the maintenance of a supply of oxygen to all body cells
6. To facilitate the maintenance of nutrition for all body cells
7. To facilitate the maintenance of elimination
8. To facilitate the maintenance of fluid and electrolyte balance
9. To recognize the physiologic responses of the body to disease conditions—pathologic,
physiologic, and compensatory
10. To facilitate the maintenance of regulatory mechanisms and functions
11. To facilitate the maintenance of sensory function
12. To identify and accept positive and negative expressions, feelings, and reactions
 13. To identify and accept interrelatedness of emotions and organic illness
14. To facilitate the maintenance of effective verbal and nonverbal communication
15. To promote the development of productive interpersonal relationships
16. To facilitate progress toward achievement and personal spiritual goals
17. To create or maintain a therapeutic environment
18. To facilitate awareness of self as an individual with varying physical, emotional, and
developmental needs
19. To accept the optimum possible goals in the light of limitations, physical and emotional
20. To use community resources as an aid in resolving problems that arise from illness
21. To understand the role of social problems as influencing factors in the cause of illness

Moreover, the needs of patients are further divided into four categories: basic to all
patients, sustenal care needs, remedial care needs, and restorative care needs.

Basic Needs
The basic needs of an individual patient are to maintain good hygiene and physical comfort;
promote optimal health through healthy activities, such as exercise, rest and sleep; promote safety
through the prevention of health hazards like accidents, injury or other trauma and through the
prevention of the spread of infection; and maintain good body mechanics and prevent or correct
deformity.

Sustenal Care Needs

Sustenal care needs facilitate the maintenance of a supply of oxygen to all body cells; facilitate the
maintenance of nutrition of all body cells; facilitate the maintenance of elimination; facilitate the
maintenance of fluid and electrolyte balance; recognize the physiological responses of the body to
disease conditions; facilitate the maintenance of regulatory mechanisms and functions; and
facilitate the maintenance of sensory function.

Remedial Care Needs

Remedial care needs to identify and accept positive and negative expressions, feelings, and
reactions; identify and accept the interrelatedness of emotions and organic illness; facilitate the
maintenance of effective verbal and non-verbal communication; promote the development of
productive interpersonal relationships; facilitate progress toward achievement of personal
spiritual goals; create and maintain a therapeutic environment; and facilitate awareness of the self
as an individual with varying physical, emotional, and developmental needs.
Restorative Care Needs
Restorative care needs include the acceptance of the optimum possible goals in light of limitations,
both physical and emotional; the use of community resources as an aid to resolving problems that
arise from illness; and the understanding of the role of social problems as influential factors in the
case of illness.

Abdellah’s work, which is based on the problem-solving method, serves as a vehicle for
delineating nursing (patient) problems as the patient moves toward a healthy outcome. The
theory identifies ten steps to identify the patient’s problem and 11 nursing skills used to develop a
treatment typology.

The ten steps are:

1. Learn to know the patient.

2. Sort out relevant and significant data.
3. Make generalizations about available data in relation to similar nursing problems
presented by other patients.
4. Identify the therapeutic plan.
5. Test generalizations with the patient and make additional generalizations.
6. Validate the patient’s conclusions about his nursing problems.
7. Continue to observe and evaluate the patient over a period of time to identify any
attitudes and clues affecting his or her behavior.
8. Explore the patient and his or her family’s reactions to the therapeutic plan and involve
them in the plan.
9. Identify how the nurses feel about the patient’s nursing problems.
10. Discuss and develop a comprehensive nursing care plan.
The 11 nursing skills are:

1. observation of health status

2. skills of communication
3. application of knowledge
4. teaching of patients and families
5. planning and organization of work
6. use of resource materials
 7. use of personnel resources
8. problem-solving
9. direction of work of others
10. therapeutic uses of the self
11. nursing procedure
Abdellah also explained nursing as a comprehensive service, which includes:

1. Recognizing the nursing problems of the patient

2. Deciding the appropriate course of action to take in terms of relevant nursing principles
3. Providing continuous care of the individual’s total needs
4. Providing continuous care to relieve pain and discomfort and provide immediate
security for the individual
5. Adjusting the total nursing care plan to meet the patient’s individual needs
6. Helping the individual to become more self-directing in attaining or maintaining a
healthy state of body and mind
7. Instructing nursing personnel and family to help the individual do for himself that which
he can within his limitations
8. Helping the individual to adjust to his limitations and emotional problems
9. Working with allied health professions in planning for optimum health on local, state,
national, and international levels
10. Carrying out continuous evaluation and research to improve nursing techniques and to
develop new techniques to meet people’s health needs

Patient-Centered Approaches to Nursing

Faye Abdellah’s work is a set of problems formulated in terms of nursing-centered services, which
are used to determine the patient’s needs. The nursing-centered orientation to client care appears
to be contradicting to the client-centered approach that Abdellah professes to support. This can be
observed by her desire to move away from a disease-centered orientation.
In her attempt to bring nursing practice to its proper relationship with restorative and preventive
measures for meeting total client needs, she seems to swing the pendulum to the opposite pole,
from the disease orientation to nursing orientation, while leaving the client somewhere in the
middle.

21 Nursing Problems and The Nursing Process

The nursing process in Abdellah’s theory includes assessment, nursing diagnosis, planning,
implementation, and evaluation.

In the assessment phase, the nursing problems implement a standard procedure for data
collection. A principle underlying the problem-solving approach is that for each identified
problem, pertinent data is collected. The overt or covert nature of problems necessitates a direct
or indirect approach, respectively.

The outcome of the collection of data in the first phase concludes the possible problems of the
patient, which can be grouped under one or more of the broader nursing problems. This will
further lead to the nursing diagnosis.
After formulating the diagnosis, nursing care plan is developed and appropriate nursing
interventions are determined. The nurse now set those interventions in action which complete the
implementation phase of the nursing process.

The evaluation takes place after the interventions have been carried out. The most convenient
evaluation would be the nurse’s progress or lack of progress toward the achievement of the goals
established in the planning phase.

Analysis
With the aim of Faye Abdellah in formulating a clear categorization of patient’s problems as health
needs, she rather conceptualized nurses’ actions in nursing care which is contrary to her aim.
Nurses roles were defined to alleviate the problems assessed through the proposed problem-
solving approach.

The problem-solving approach introduced by Abdellah has the advantage of increasing the nurse’s
critical and analytical thinking skills since the care to be provided would be based on sound
assessment and validation of findings.

Virginia 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).

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.

In 1953, she was completely rewriting the Harmer and Henderson Textbook on the Principles and
Practice of Nursingwhen 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.

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.

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.

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
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.
The following are the references and sources used for this guide:

• Florence Nightingale: Part I. Strachey, Lytton. 1918. Eminent Victorians. (n.d.). Florence
Nightingale: Part I. Strachey, Lytton. 1918. Eminent Victorians. Retrieved July 31, 2014,
from https://www.bartleby.com/189/201.html
• Florence Nightingale and Lynn McDonald (Editor) (2010). “An introduction to Vol
14”. Florence Nightingale: The Crimean War. Wilfrid Laurier University
Press.ISBN 0889204691.
• Himetop. (n.d.). Florence Nightingale Museum –. Retrieved July 31, 2014, from
https://himetop.wikidot.com/florence-nightingale-museum
• Cohen, I. B. (1984). Florence Nightingale. Scientific American, 250(3), 128-137. [Link]
• Nursing Theory and Conceptual Framework, Fundamentals of Nursing: Human Health and
Function, Ruth F. Craven and Constance J. Hirnle, 2003, pp.56
• The Nature of Nursing, Fundamentals of Nursing: Concepts, Process and Practice, Second
Edition, Barbara Kozier, Glenora Erb, Audrey Berman, Shirlee Snyder, 2004, p.38
• Nightingale, F. (1860/1957/1969). Notes on nursing: What it is and what it is not. In
McEwen, M. and Wills, E. (Ed.). Theoretical basis for nursing. USA: Lippincott Williams &
Wilkins.
• Nightingale, F. (1992). Notes on nursing: What it is and what it is not. (Com. ed.). (Original
publication 1859). In George, J. (Ed.). Nursing theories: the base for professional nursing
practice. Norwalk, Connecticut: Appleton & Lange.
•

• Abdellah, F.G. The federal role in nursing education. Nursing outlook. 1987, 35(5),224-
225.
• Abdellah, F.G. Public policy impacting on nursing care of older adults .In E.M. Baines
(Ed.), perspectives on gerontological nursing. Newbury, CA: Sage publications. 1991.
• Abdellah, F.G., & Levine, E. Preparing nursing research for the 21st century. New York:
Springer. 1994.
• Abdellah, F.G., Beland, I.L., Martin, A., & Matheney, R.V. Patient-centered approaches to
nursing (2nd ed.). New York: Mac Millan. 1968.
• Abdellah, F.G. Evolution of nursing as a profession: perspective on manpower
development. International Nursing Review, 1972); 19, 3..
• Abdellah, F.G.). The nature of nursing science. In L.H. Nicholl (Ed.), perspectives
on nursing theory. Boston: Little, Brown, 1986.
• Craddock, J. (2013). Encyclopedia of world biography supplement. Detroit, Mich.: Gale.
https://www.encyclopedia.com/doc/1G2-3435000010.html

• Christiane Reimann Prize. (n.d.). Christiane Reimann Prize. Retrieved July 27, 2014, from
https://www.icn.ch/about-icn/christiane-reimann-prize/
• Home. (n.d.). AAHN Gravesites of Prominent Nurses. Retrieved July 27, 2014, from
https://www.aahn.org/gravesites/henderson.html
• 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
• 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
• 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
• 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
 • 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
• VIRGINIA HENDERSON. (n.d.). Virginia Henderson and her Timeless Writings. Retrieved July
27, 2014, from https://www.unc.edu/~ehallora/henderson.htm
• George B. Julia (2010). Nursing Theories: The Base for Professional Nursing Practice. Pearson
Higher Ed USA.
• Meleis Ibrahim Afaf (1997). Theoretical Nursing: Development & Progress 3rd
ed. Philadelphia, Lippincott.
• Henderson, V. (1966). The nature of nursing. In George, J. (Ed.). Nursing theories: the base
for professional nursing practice. Norwalk, Connecticut: Appleton & Lange.
• 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.

• Baly, Monica and E. H. C. G. Matthew. “Nightingale, Florence (1820–1910)”, Oxford

Dictionary of National Biography Oxford University Press, 2004; online edn, Jan 2011
• Bostridge, Mark (2008). Florence Nightingale. The Woman and Her Legend. Viking (2008);
Penguin (2009). US title Florence Nightingale. The Making of an Icon. Farrar Straus (2008).
• Rees, Joan. Women on the Nile: Writings of Harriet Martineau, Florence Nightingale, and
Amelia Edwards. Rubicon Press: 1995, 2008
• Smith, James (1989). Virginia Henderson: the first ninety years. Ishiyaku Euroamerica
• The Nurse Theorists – Virginia Henderson Promo – a short interview video with Virginia
Henderson.

.
Scenario:
Nurse Patricia is caring for a patient with Pulmonary Tuberculosis in the emergency room. The
hospital doesn't have any private room for isolation. Explain your answer with the theory
provided.
1. What is the best nursing action of Nurse Patricia in line with the Environmental Theory.
2. How will you promote quality of life in PTB patient by the use of 14 basic needs and 21
nursing problems?