Virginia Henderson's Need Theory

This page was last updated on February 4, 2012

“Nursing theories mirror different realities, throughout their development;

they reflected the interests of nurses of that time.”

Introduction

 “The Nightingale of Modern Nursing”

 “Modern-Day Mother of Nursing.”
 "The 20th century Florence Nightingale."
 Born in Kansas City, Missouri, in 1897.
 Diploma in Nursing from the Army School of Nursing at Walter
Reed Hospital, Washington, D.C. in 1921.
 Worked at the Henry Street Visiting Nurse Service for 2 years
after graduation.
 In 1923, started teaching nursing at the Norfolk Protestant
Hospital in Virginia
 In 1929, entered Teachers College at Columbia University
for Bachelor’s Degree in 1932, Master’s Degree in 1934.
 Joined Columbia as a member of the faculty, remained until
1948.
 Since 1953, a research associate at Yale University School of
Nursing.
 Recipient of numerous recognitions.
 Honorary doctoral degrees from the Catholic University of
America, Pace University, University of Rochester, University of
Western Ontario, Yale University
 In 1985, honored at the Annual Meeting of the Nursing and
Allied Health Section of the Medical Library Association.
 Died: March 19, 1996.
 In 1939, she revised: Harmer’s classic textbook of nursing for
its 4th edition, and later wrote the 5th; edition, incorporating her
personal definition of nursing (Henderson,1991)

Theory Background

 She called her definition of nursing her “concept”

(Henderson1991)
 She emphasized the importance of increasing the patient’s
independence so that progress after hospitalization would not
be delayed (Henderson,1991)
  "assisting individuals to gain independence in relation to the
performance of activities contributing to health or its
recovery" (Henderson, 1966).
 She categorized nursing activities into 14 components, based
on human needs.
 She described the nurse's role as substitutive (doing for the
person), supplementary (helping the person), complementary
(working with the person), with the goal of helping the person
become as independent as possible.
 Her definition of nursing was:

"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. And to do this in such a way as to
help him gain independence as rapidly as possible" (Henderson, 1966).

The 14 components

 Breathe normally. Eat and drink adequately.

 Eliminate body wastes.
 Move and maintain desirable postures.
 Sleep and rest.
 Select suitable clothes-dress and undress.
 Maintain body temperature within normal range by adjusting clothing and modifying environment
 Keep the body clean and well groomed and protect the integument
 Avoid dangers in the environment and avoid injuring others.
 Communicate with others in expressing emotions, needs, fears, or opinions.
 Worship according to one’s faith.
 Work in such a way that there is a sense of accomplishment.
 Play or participate in various forms of recreation.
 Learn, discover, or satisfy the curiosity that leads to normal development and health and use the available health
facilities.

The first 9 components are physiological. The tenth and fourteenth are psychological aspects of communicating and learning
The eleventh component is spiritual and moral The twelfth and thirteenth components are sociologically oriented to occupation
and recreation

Assumption

The major assumptions of the theory are:

 "Nurses care for patients until patient can care for themselves once again. Patients desire to return to health, but
this assumption is not explicitly stated.
 Nurses are willing to serve and that “nurses will devote themselves to the patient day and night” A final assumption
is that nurses should be educated at the university level in both arts and sciences.

Henderson’s theory and the four major concepts

1. Individual

 Have basic needs that are component of health.

 Requiring assistance to achieve health and independence or a peaceful death.
 Mind and body are inseparable and interrelated.
 Considers the biological, psychological, sociological, and spiritual components.
 The theory presents the patient as a sum of parts with biopsychosocial needs.

2. E n v i r o n m e n t

 Settings in which an individual learns unique pattern for living.

 All external conditions and influences that affect life and development.
 Individuals in relation to families
 Minimally discusses the impact of the community on the individual and family.
 Basic nursing care involves providing conditions under which the patient can perform the 14 activities unaided

3. H e a l t h

 Definition based on individual’s ability to function independently as outlined in the 14 components.

 Nurses need to stress promotion of health and prevention and cure of disease.
 Good health is a challenge -affected by age, cultural background, physical, and intellectual capacities, and emotional
balance Is the individual’s ability to meet these needs independently.

4. Nursing

 Temporarily assisting an individual who lacks the necessary strength, will and knowledge to satisfy 1 or more of 14
basic needs.
 Assists and supports the individual in life activities and the attainment of independence.
 Nurse serves to make patient “complete” “whole", or "independent."
 The nurse is expected to carry out physician’s therapeutic plan Individualized care is the result of the nurse’s
creativity in planning for care.
 “Nurse should have knowledge to practice individualized and human care and should be a scientific problem solver.”
 In the Nature of Nursing Nurse role is,” to get inside the patient’s skin and supplement his strength will or knowledge
according to his needs.”

Henderson’s and Nursing Process

”Summarization of the stages of the nursing process as applied to Henderson’s definition of nursing and to the 14
components of basic nursing care.

Nursing Process Henderson’s 14 components and definition of nursing

Nursing Henderson’s 14 components

Assessment

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.

Nursing Document how the nurse can assist the individual, sick or well.
implementation
Nursing Assist the sick or well individual in to performance of activities in meeting human needs to maintain
implementation 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

Comparison with Maslow's Hierarchy of Need

Maslow's Henderson
Breathe normally

Physiological Eat and drink adequately Eliminate by all avenues of elimination

needs Move and maintain desirable posture Sleep and rest Select suitable
clothing Maintain body temperature Keep body clean and well
groomed and protect the integument

Safety Needs Avoid environmental dangers and avoid injuring other

Communicate with others

Belongingness
and love needs
worship according to one's faith
Work at something providing a sense of accomplishment

Esteem needs Play or participate in various forms of recreation

Learn, discover, or satisfy curiosity

Characteristic of Henderson’s theory

 There is interrelation of concepts.

 Concepts of fundamental human needs, biophysiology, culture, and interaction, communication are borrowed from
other discipline.Eg.. Maslow’s theory.
  Her definition and components are logical and the 14 components are a guide for the individual and nurse in reaching
the chosen goal.
 Relatively simple yet generalizable.
 Applicable to the health of individuals of all ages.
 can be the bases for hypotheses that can be tested.
 assist in increasing the general body of knowledge within the discipline.
 Her ideas of nursing practice are well accepted.
 can be utilized by practitioners to guide and improve their practice.

Limitations

 Lack of conceptual linkage between physiological and other human characteristics.

 No concept of the holistic nature of human being.
 If the assumption is made that the 14 components prioritized, the relationship among the components is unclear.
 Lacks inter-relate of factors and the influence of nursing care.
 Assisting the individual in the dying process she contends that the nurse helps, but there is little explanation of what
the nurse does.
 “Peaceful death” is curious and significant nursing role.

Conclusion

 Henderson provides the essence of what she believes is a definition of nursing.

 Her emphasis on basic human needs as the central focus of nursing practice has led to further theory development
regarding the needs of the person and how nursing can assist in meeting those needs.
 Her definition of nursing and the 14 components of basic nursing care are uncomplicated and self-explanatory.

References

1. Timber BK. Fundamental skills and concepts in Patient Care, 7th edition, LWW, N
2. George B. Julia , Nursing Theories- The base for professional Nursing Practice , 3rd ed. Norwalk, Appleton & Lange.
3. Wills M.Evelyn, McEwen Melanie (2002). Theoretical Basis for Nursing Philadelphia. Lippincott Williams& wilkins.
4. Meleis Ibrahim Afaf (1997) , Theoretical Nursing : Development & Progress 3rd ed. Philadelphia, Lippincott.
5. Taylor Carol,Lillis Carol (2001)The Art & Science Of Nursing Care 4th ed. Philadelphia, Lippincott.
6. Potter A Patricia, Perry G Anne (1992) Fundamentals Of Nursing –Concepts Process & Practice 3rd ed. London
Mosby Year Book.
7. Vandemark L.M. Awareness of self & expanding consciousness: using Nursing theories to prepare nurse –therapists
Ment Health Nurs. 2006 Jul; 27(6) : 605-15
8. Reed PG, The force of nursing theory guided- practice. Nurs Sci Q. 2006 Jul;19(3):225
9. Delaune SC,. Ladner PK, Fundamental of nursing, standard and practice, 2nd edition, Thomson, NY, 2002

SOURCE: http://currentnursing.com/nursing_theory/Henderson.html
DOROTHEA OREM

Four Concepts -Nursing's Metaparadigm

1. Human Being (Humanity) - an integrated whole composed of an internal physical, psychological and social nature
with varying degrees of self care ability (chin/kramer, 2004).
-a substantial or real unity whose parts are formed and attain perfection through the differentiation of the
whole during the process of development. Has the capability to reflect, symbolize, and use symbols.
-when referring to humans, Orem uses the term individual, patient, multiperson, self care agent, dependent
care agent.
2. Health - health and healthy are terms to describe living things according to Orem, they are structurally and
funcitonally whole or sound, includes that which make a person human, she define health as "a state of physical,
mental and social sell-being, and not merely the absence of disease or infirmity (p 184, foster/bennett 2001).Orem
sees health as a state of well being, which refer to a person's condition of existence, characterized by contentment,
pleasure, happiness, movement towars self ideals. The present sociopolitical climate influenced Orem to exand her
definition of health to include the concept of preventive health care. She uses the terms health, health state, and well
being.
3. Nursing - according to Orem its an art through which the practitioner of nursing gives specialized assisstance to
persons with disabilities that needed greater than ordinary assistance to meed the daily needs for self care. It consists
of actions deliberately selected and performed by nurses to help patients under their care to maintain or change
conditions in themselves or their environment. Terms used: nursing, nursing agency.
4. Environment- the sorrounding of the patients may affect their ability to perform their selfcare activity. Includes
two dimensions a. physical, chemical, biologic features and socioeconomic features.
a. Physical,chemical and biologic features: atmosphere, pollutants, weather, pets, infectious organisms
b. Socioeconomic features: family, community, gender, gender roles, cultural roles, cultural prescription
of authority.
Terms used- environment, environment features

Biography of Dorothea E. Orem

Dorothea Elizabeth Orem (July 15, 1914 – June 22, 2007) was one of America’s foremost nursing
theorists who developed the Self-Care Deficit Nursing Theory, also known as the Orem Model of
Nursing.

Her theory defined Nursing as “The act of assisting others in the provision and management of self-care
to maintain or improve human functioning at home level of effectiveness.” It focuses on each individual’s
ability to perform self-care, defined as “the practice of activities that individuals initiate and perform on
their own behalf in maintaining life, health, and well-being.”
Early Life

Dorothea Orem was born in July 15, 1914 in Baltimore, Maryland. Her father was a construction worker
and her mother is a homemaker. She was the youngest among two daughters.

In the early 1930s, she earned her nursing diploma from the Providence Hospital School of Nursing in
Washington, D.C. She went on to complete her Bachelor of Science in Nursing in 1939 and her Master’s
of Science in Nursing in 1945, both from the Catholic University of America in Washington, D.C.

Education

Dorothea Elizabeth Orem

Dorothea Orem attended Seton High School in Baltimore, and graduated in 1931. She received a diploma
from the Providence Hospital School of Nursing in Washington, D.C. in 1934 and went on to the Catholic
University of America to earn a B.S. in Nursing Education in 1939, and an M.S. in Nursing Education in
1945.

he had a distinguished career in nursing. She earned several Honorary Doctorate degrees. She was given
Honorary Doctorates of Science from both Georgetown University in 1976 and Incarnate Word College
in 1980. She was given an Honorary Doctorate of Humane Letters from Illinois Wesleyan University in
1988, and a Doctorate Honoris Causae from the University of Missouri in Columbia in 1998.

Self-Care Theory

Dorothea Orem’s Self-Care Deficit Theory focuses on each “individual’s ability to perform self-care,
defined as ‘the practice of activities that individuals initiate and perform on their own behalf in
maintaining life, health, and well-being.'” The Self-Care or Self-Care Deficit Theory of Nursing is
composed of three interrelated theories: (1) the theory of self-care, (2) the self-care deficit theory, and
(3) the theory of nursing systems, which is further classified into wholly compensatory, partial
compensatory and supportive-educative. It is discussed further below.

Major Concepts of the Self-Care Deficit Theory

In this section are the definitions of the major concepts of Dorothea Orem’s Self-Care Deficit Theory:

Nursing

Nursing is an art through which the practitioner of nursing gives specialized assistance to persons with
disabilities which makes more than ordinary assistance necessary to meet needs for self-care. The nurse
also intelligently participates in the medical care the individual receives from the physician.

Humans

Humans are defined as “men, women, and children cared for either singly or as social units,” and are the
“material object” of nurses and others who provide direct care.

Environment

The environment has physical, chemical and biological features. It includes the family, culture, and
community.

Health

Health is “being structurally and functionally whole or sound.” Also, health is a state that encompasses
both the health of individuals and of groups, and human health is the ability to reflect on one’s self, to
symbolize experience, and to communicate with others.

Self-Care

Self-care is the performance or practice of activities that individuals initiate and perform on their own
behalf to maintain life, health, and well-being.

SOOURCE: https://nurseslabs.com/dorothea-orems-self-care-theory/
Dorothy Johnson: Behavioral System Model
What is Behavioral System Model?

Dorothy Johnson’s theory defined Nursing as “an external regulatory force which acts to
preserve the organization and integration of the patient’s behaviors at an optimum level
under those conditions in which the behavior constitutes a threat to the physical or social
health, or in which illness is found.”

It also states that “each individual has patterned, purposeful, repetitive ways of acting
that comprises a behavioral system specific to that individual.”

Goals

Dorothy Johnson began her work on the model with the premise that nursing was a
profession that made a distinctive contribution to the welfare of society. Thus, nursing
had an explicit goal of action in patient welfare.

The goals of nursing are fourfold, according to the Behavior System Model: (1) To assist
the patient whose behavior is proportional to social demands. (2) To assist the patient
who is able to modify his behavior in ways that it supports biological imperatives. (3) To
assist the patient who is able to benefit to the fullest extent during illness from the
physician’s knowledge and skill. And (4) To assist the patient whose behavior does not
give evidence of unnecessary trauma as a consequence of illness.

Assumptions of the Behavioral System Model

The assumptions made by Dorothy Johnson’s theory are in three categories: assumptions
about system, assumptions about structure, and assumptions about functions.

Johnson identified several assumptions that are critical to understanding the nature and
operation of the person as a behavioral system: (1) There is “organization, interaction,
interdependency and integration of the parts and elements of behaviors that go to make
up the system.” (2) A system “tends to achieve a balance among the various forces
operating within and upon it, and that man strive continually to maintain a behavioral
system balance and steady state by more or less automatic adjustments and adaptations to
the natural forces occurring on him.” (3) A behavioral system, which requires and results
in some degree of regularity and constancy in behavior, is essential to man. It is
functionally significant because it serves a useful purpose in social life as well as for the
individual. And (4) “System balance reflects adjustments and adaptations that are
successful in some way and to some degree.”

The four assumptions about structure and function are that: (1) “From the form the
behavior takes and the consequences it achieves can be inferred what ‘drive’ has been
stimulated or what ‘goal’ is being sought.” (2) Each individual person has a
“predisposition to act with reference to the goal, in certain ways rather than the other
ways.” This predisposition is called a “set.” (3) Each subsystem has a repertoire of
choices called a “scope of action.” And (4) The individual patient’s behavior produces an
outcome that can be observed.

And lastly, there are three functional requirements for the subsystems.: (1) The system
must be protected from toxic influences with which the system cannot cope. (2) Each
system has to be nurtured through the input of appropriate supplies from the environment.
And (3) The system must be stimulated for use to enhance growth and prevent stagnation.

Major Concepts

The following are the major concepts and definitions of the Johnson’s nursing model
including the definition for its nursing metaparadigm:
Human Beings

Johnson views human beings as having two major systems: the biological system and the
behavioral system. It is the role of medicine to focus on the biological system, whereas
nursing’s focus is the behavioral system.

The concept of human being was defined as a behavioral system that strives to make
continual adjustments to achieve, maintain, or regain balance to the steady-state that is
adaptation.

Environment

Environment is not directly defined, but it is implied to include all elements of the
surroundings of the human system and includes interior stressors.

Health

Health is seen as the opposite of illness, and Johnson defines it as “some degree of
regularity and constancy in behavior, the behavioral system reflects adjustments and
adaptations that are successful in some way and to some degree… adaptation is
functionally efficient and effective.”

Nursing

Nursing is seen as “an external regulatory force which acts to preserve the organization
and integration of the patient’s behavior at an optimal level under those conditions in
which the behavior constitutes a threat to physical or social health, or in which illness is
found.”

Behavioral system

Man is a system that indicates the state of the system through behaviors.
System

That which functions as a whole by virtue of organized independent interaction of its

parts.

Subsystem

A mini system maintained in relationship to the entire system when it or the environment
is not disturbed.

SOURCE: https://nurseslabs.com/dorothy-e-johnsons-behavioral-system-model/