Running head: APPLICATION OF VIRGINIA HENDERSONS PHILOSOPHIES

The Application of Virginia Hendersons Philosophies

Salena Barnes
Georgia College and State University

Running head: APPLICATION OF VIRGINIA HENDERSONS PHILOSOPHIES

Abstract
Nursing practice has been influenced by many theorists and philosophers alike. Virginia
Henderson was one of the noteworthy contributors to the nursing profession. Henderson had an
extensive career in clinical practice, education, and research. Her philosophy of nursing began
with the clarification that nursing practice is independent of medical practice (Alligood, 2014).
Henderson asserted fourteen basic human needs that continue to be generalizable to all nursing
practice today. The purpose of this paper is to explore Virginia Hendersons life, influences, and
philosophies. Henderson facilitated the change of how nurses were viewed, raised the bar for
nursing education, and advocated for resources for nursing research. She defined what she
considered nursing and created fourteen basic human needs that have stood the test of time. Her
philosophies are applicable in todays nursing practice and have raised standards in healthcare.
Keywords: Virginia Henderson, definition of nursing, nursing theory, Hendersons
nursing model, childbirth education, brain death

Running head: APPLICATION OF VIRGINIA HENDERSONS PHILOSOPHIES

The Application of Virginia Hendersons Philosophies

Lucy Minor Abbot gave birth to a baby girl in Kansas City, Missouri on November 30, 1897,
which she named Virginia Henderson (Halloran, 2010). Due to her brothers experiences in the
First World War, Virginia was motivated to become a nurse. With a high sense of patriotism, she
enlisted into the Army School of Nursing. She was stationed at Walter Reed Army Medical
Center in Washington, DC. This program consisted of a four month preclinical block followed
by three years of training on the ward. The curriculum entailed psychiatric and public health
nursing, which was not common. She graduated in 1921with a diploma of nursing and began her
work as a nurse at the Henry Settlement in New York City (Halloran, 2010; Van Betten &
Moriarty, 2004). In 1924, Henderson switched gears and began her career as an educator at
Norfolk Protestant Hospital in Virginia. She was the first and only nurse educator at Norfolk
Protestant Hospital. Library resources and funding was so scarce that Henderson was forced to
use free government publications received from Washington as educational materials. She
utilized Bertha Harmers Principles and Practice of Nursing, the initial educational resource to
engage physiology as the groundwork for instructing nurses. After approximately five years,
went on to continue her formal studies in nursing at Teachers College of Columbia University.
Henderson was granted her bachelors degree in nursing from Teachers College in 1932
(Halloran, 2010; Van Betten & Moriarty, 2004). She received a Rockefeller Scholarship for
academic excellence and obtained her Masters Degree in 1934 from the same university. Her
masters thesis dealt with medical and surgical asepsis. Henderson devised an experiment using
animals to determine if pathogens were eliminated more effectively by boiling or steam under
pressure. She remained a faculty member at Teachers College and encouraged the teaching of
clinical nursing. For sixteen years, Henderson taught and practiced nursing in leading New York

Running head: APPLICATION OF VIRGINIA HENDERSONS PHILOSOPHIES

hospital. She remained a member of the Columbia faculty until 1948 and left due to a dispute
over the necessity of incorporating research into nursing education (Halloran, 2010; Henderson,
1991).
Henderson began working on the Nursing Index in 1953, which was an index of all the
nursing literature in the United States (Halloran, 2010). At this time, her career in research began
when she joined Yale School of Nursing as a research associate. She took the next five years to
totally revise the Textbook of the Principles and Practice of Nursing for publication in 1955. The
new edition contained a different outlook of nursing and developed her definition of nursing
(Boschma, Davidson, & Bonifacio, 2009; Halloran, 2010).
Further, the International Council of Nurses (ICN) commissioned Henderson to compose
Basic Principles of Nursing Care in 1960 for disadvantage nurses who did not have access to
technology nor medical proficiency required to diagnose disease (Van Betten & Moriarty, 2004).
The ICNs publication of Basic Principles of Nursing Care has been translated into thirty
languages and remains in use throughout the world (Halloran, 2010; Van Betten & Moriarty,
2004).
While serving as director of the Yale Project, Henderson continued to work on the
Nursing Studies Index due to the lack of organized research material for nurses (Halloran, 2010;
Henderson, 1978). In 1972 she completed the four-volume guide Nursing Studies Index, the first
annotated index for nursing, which contained studies, research in progress, research methods,
and historical nursing materials. The Interagency Council on Library Resources for Nursing was
also founded by Henderson and continues today. Moreover, due to her influence, nursing
literature was placed in the National Library of Medicine. She worked diligently to obtain
library resources and facilities that could be utilized by nurses. She believed nursing is not

Running head: APPLICATION OF VIRGINIA HENDERSONS PHILOSOPHIES

unlike other health science professionals in terms of the need for resources for research. Due to
her contribution the Sigma Theta Tau International library was named in her honor. Henderson
was a member to Sigma Theta Tau, American Academy of Nursing and obtained honorary
membership in eight other professional organizations. She is also a member of the American
Association of Nurses Hall of Fame and has received many awards, as well as honorary degrees
in her time (Halloran, 2010; Henderson, 1991; Van Betten & Moriarty, 2004).
Influences
Virginia Henderson was born at the start of the Progressive Era, when America was
plagued with political corruption, exploitation of the working class, child labor in factories,
increased immigration, growing slums and crowded cities overrun with disease (Bunce, 2014;
Prigge, 2012). This was the negative impact of the Industrial Revolution, in which the rich got
richer and the poor were poorer. Henderson graduated nursing school in 1921, as the Progressive
Era was coming to an end. Women had just received the write to vote through Nineteenth
Amendment and now could influence changes in the United States (Bunce, 2014; Flesher,
Previts, & Sharp, 2008).
Henderson experienced different influences throughout her journey. Her first influence
was as a student of Annie W. Goodrich, Dean of the Army School of Nursing (Halloran, 2010;
Henderson, 1991). Goodrich was an experienced nurse whom had worked in hospitals, public
health agencies, and educational institutions. Goodrich instilled in her the ethical significance of
nursing and viewed nursing as a global society. Goodrich had a compassion for humanity and
lifted her students sights above techniques and routines. Henderson attributes Goodrich her
early discontent with task oriented patient care and the concept of nursing as merely ancillary to
medicine. As she moved forward with her career she met Caroline Stackpole. Stackpole based

Running head: APPLICATION OF VIRGINIA HENDERSONS PHILOSOPHIES

her teaching on physiology and at Columbia University, through experimentation in the

physiology course for medical students, Henderson acquired a more analytical approach to all
aspects of care and treatment. Henderson believed that a definition of nursing should imply an
appreciation of the principle of physiological balance. It was then that the mind and body
became inseparable to Henderson. The study of physiology open the doors for psychosomatic
medicine and its implications for nursing (Halloran, 2010; Henderson, 1991).
Another influential individual for Henderson was Dr. Edward Thorndike (Henderson,
1991). Thorndikes work in psychology involved scrutinizing the fundamental needs of man and
researching on how people spent their money as well as their time. This made Henderson realize
that illness is more than a state of illness and/or threat to life. Through her observations,
Henderson concluded that fundamental needs were not being met in hospitals during that time.
She believed that if an individual was deprived of what he valued and needed, then this condition
of deprivation is worse than the disease being treated (Henderson, 1991).
Shortly afterwards, Henderson explored the works of Dr. George G. Deaver and the
physical therapists at the Institute for the Crippled and Disabled and Bellevue Hospital in New
York City (Henderson, 1991). She noted that rehabilitation was based upon building the
patients independence, which was not the case in hospital settings. Furthermore, it was here that
Henderson realized that through the rehabilitation team, a patients programs needed to be
individualized and receive constant evaluation of patients needs, with progression towards
independence being the goal (Henderson, 1991).
Ida Jean Orlando influenced her view on the nurse-patient relationship (Henderson,
1991). Orlando emphasized that in order for nurses to meet a patients needs, the needs must be

Running head: APPLICATION OF VIRGINIA HENDERSONS PHILOSOPHIES

validated by the patient. Henderson reported having several influences on her thinking and these
are only a few (Henderson, 1991).
Overview
Henderson coauthored Nursing Research: Survey and Assessment in 1964 and in her
writing highlighted that most nursing research discussed nurses and not nursing care (Halloran,
2010; Henderson, 1991). She focused on restructuring nursing research to have more of a
clinical focus (Halloran, 2010). In 1966, Virginia Henderson published her first book The Nature
of Nursing, which expressed her beliefs about nursing, including the definition. She reflects on
the changes in nursing, the implications, research, and education (Halloran, 2010).
Henderson Need Theory
Virginia Hendersons work has been referred to by an assortment of names including the
Nursing Need Theory, Definition of Nursing, and The Principles and Practice of
Nursing(Halloran, 2010). Hendersons ideas came as a result of her discontent with the
education nurses received and nursing being viewed as ancillary to medicine (Halloran, 2010;
Henderson, 1991). She developed this theory to define nursing practice and its areas of focus.
Moreover, she explained three levels of nurse-patient relationships, which are substitutive,
supplementary, and complementary. It is the nurses duty to assist the patient into the most
independent role in which they are capable of. At the substitutive level the nurse is engaging in
activities for the patient in which they cannot perform for themselves. In the supplementary
level the nurse assists or performs as a helper, in order for the patients needs to be met. In the
complimentary level the nurse is working as a partner with the patient. The nurse serves as a
source of knowledge, motivator, and mentor to the patient in the decisions concerning their

Running head: APPLICATION OF VIRGINIA HENDERSONS PHILOSOPHIES

healthcare (Henderson, 1978, 1991). The nurse is a substitute for what the patient lacks to
make him complete, whole, or independent, by the lack of physical strength or will (Henderson,
1991, pp 27).
Hendersons need theory focuses on the importance of increasing the patients
independence and their fourteen basic human needs (Henderson, 1991). The theory consists of
four major concepts: person, environment (society), health, and nursing. The first major
component was the person or individual. Henderson defines the patient that requires nursing
care but does not limit it to an illness. She believed the mind and body are inseparable and
interrelated. In caring for the patient she advocates that biological, sociological, and spiritual
components should be considered. The second major component was the environment or
society. The patient was presented as a sum of parts with biophysical needs. Henderson failed to
define the environment, however maintaining a supportive environment is one of the fourteen
components or basic human needs. She recognizes the individual in relation to the family, but
minimally discusses the influence of the community on the family and individual. She was a
firm supporter of the private and public health agencies intervening with regards to an
individuals health. Henderson also believed society wants, and expects nurses to assist when an
individual is unable to care for themselves independently. She hypothesized individuals learn a
specific pattern of living in their setting. The third major component is health, which Henderson
did not define. However, it is inferred to mean a balance in all aspects of the individuals life.
She equated health with the ability of the individual to function independently. An individuals
health can be altered by factors such as age, cultural background, physical and mental capacity,
as well as emotional state of mind. The fourth component was nursing. The nurse should
possess knowledge to perform individualized patient care, possess nursing skills, perform

Running head: APPLICATION OF VIRGINIA HENDERSONS PHILOSOPHIES

scientific research and work interdependently with other healthcare professionals. Henderson
believed that the unique function of the nurse is to assist the individual, sick or well, in the
performance of activities contributing to health or its recovery (or to peaceful death) that they
would perform unaided if they had the necessary strength, will or knowledge. And to do this in
such a way as to help them gain independence as rapidly as possible (Henderson, 1991, p. 21).
Henderson felt the nurse should supply the individual with what they need along the lines of
knowledge, will, or assistance in performing their daily activities of living, as well as carrying
out prescribed treatments. Henderson believed the nurse is temporarily the consciousness of the
unconscious, the love of 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 for the young mother, the
mouthpiece for those to weak or withdrawn to speak and so on (Henderson, 1991, p. 21). She
believed nurses should be able to assess not only the patients need, but also conditions or factors
that may precipitate a change. Nurses should strive to keep the patients day as normal as
possible and alter the environment as necessary. Henderson also believed nurses should enable
patients to increase control over and improve their own health. Her view was that nurses should
be able to legally come up with a basic nursing plan of care or care plan as long as it did not
involve diagnosing, prescribing treatment for a disease or prognosis, thus producing
individualized patient care (Henderson, 1978, 1991).
Henderson developed fourteen components based on human needs that make up nursing
activities (Halloran, 2010; Henderson, 1978). The first nine components are physiological. The
tenth and fourteen are psychological aspects of communicating and learning. The eleventh
component spiritual and moral. The twelfth and thirteen components are sociologically oriented

Running head: APPLICATION OF VIRGINIA HENDERSONS PHILOSOPHIES

10

to occupation and recreation (Henderson, 1991). The fourteen activities for the individuals
assistance are as follows:
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.
8. Keep the body clean and well groomed and protect the integument.
9. Avoid dangers in the environment and avoid injuring others.
10. Communicate with others in expressing emotions, needs, fears, or opinions.
11. Worship according to ones faith.
12. Work in such a way that there is a sense of accomplishment.
13. Play or participate in various forms of recreation.
14. Lean, discover, or satisfy the curiosity that leads to normal development and health, and use
the available health facilities.
(Henderson, 1978; Pokorny, 2010)
Hendersons Need Theory Clinical Practice

Running head: APPLICATION OF VIRGINIA HENDERSONS PHILOSOPHIES

11

Evolution of nursing process

Hendersons fourteen basic principles are incorporated into the nursing process utilized
today (Henderson, 1982; Henderson, 1991). The five components of the nursing process are
assessment, nursing diagnosis, planning, implementation, and evaluation. The first phase of the
nursing process is assessment and a patient can be assessed on the fourteen component of
nursing care. The nurse can gather information through interviewing, observation, and
examination. Nurses have the ability to differentiate what is considered normal vs abnormal.
The second phase, establishing a nursing diagnosis is made by the nurse after analyzing the
information obtained. Henderson felt the nurse should use her knowledge base of the disease
process to analyze the data. In the third phase of the nursing process, Hendersons theory can be
applied because she believed the nurse is responsible for identifying the patients needs. The
nurse is charged with updating the plan of care as needed, even with regard to physicians orders.
Henderson wanted nurses to assess the individuals independence level and take into account
their strength, motivation, and knowledge. During the implementation phase, Hendersons
theory is applicable as well. Henderson encouraged the nurse to document how they assist the
individual, whether well or sick, in meeting the basic human needs to maintain health, recovering
from an illness, or aiding in a peaceful death. The implementation consists of individualized
interventions based on factors. Hendersons concepts are valid in the evaluation phase because
this occurs when the nurse reflects upon the fourteen basic concepts and evaluates the degree in
which the patient can perform them independently (Henderson, 1982; Henderson, 1991).
Furthermore, Henderson impacted the type education nurses received. She believed
nurses needed college or university educations to practice as experts and should take an evidence
based approach to the nursing practice (Henderson, 1991). She felt nurses needed to recognize

Running head: APPLICATION OF VIRGINIA HENDERSONS PHILOSOPHIES

12

the fundamental needs of individuals, create plans of nursing care, and assist with activities of
daily living. Nurses should have the capacity to change nursing care plans as the patients status
changes and nursing should be patient, as well as family centered (Henderson, 1991).
Moreover, Henderson was a stern believer in research. She believed that research was
required to evaluate and improve nursing practices (Henderson, 1991). She recommended
library research and created the first library of nursing literature. In 1964, she released the
Survey and Assessment of Nursing Research, which identified several explanations for the lack of
research in nursing. The majority of efforts were being put forth to maintain nursing staff and
recruiting students, with minimal effort supporting nursing research. In addition, there was a
lack of support for nursing research from physicians as well as facility administrators.
Henderson shed light on these areas, in much need of improvement (Halloran, 2010; Henderson,
1991).
Pros and Cons
A major deficiency in Hendersons work is the absence of conceptual connection between
physiological and other human characteristics. Although the relationship among her fourteen
basic components are not clearly defined, this element makes them generalizable. Each of the
fourteen activities can be formed into research questions, however they are not written in testable
terms. Due to the absence of a conceptual diagram, interconnections between the concepts of
Hendersons principle are not clearly delineated. However, the fourteen basic needs are
applicable to the health of individuals of all ages and can be used as guide by most nurses. Her
definition of nursing and the fourteen components of basic human needs are simple and selfexplanatory.

Running head: APPLICATION OF VIRGINIA HENDERSONS PHILOSOPHIES

13

Application to Research
Hendersons theory is applicable, not only to the sick, but the well, and the unconscious
(Henderson, 1991). Her definition of nursing, as well as her fourteen basic human needs can be
applied to individuals in different stages of their life. Furthermore, the theory provides an
applicable basis for the most general to specialized areas of care within an organization. The
following discussion includes Hendersons theory and how it is applicable to childbirth
education, as well as organ donation.
The American Nurses Credentialing Center (ANCC) has a Magnet recognition program
for healthcare organizations for nursing excellence. The program is designed to recognize
hospitals that provide quality patient care and improvements in professional nursing practice
within the organization. These standards of nursing excellence must be evident in every unit
which provides nursing care, thus fostering high-quality nursing and a positive work
environment (Lundmark & Hickey, 2006; Wolf & Greenhouse, 2006). For hospitals to attain
Magnet Status, the facility must provide evidence that a nursing conceptual framework on a
theory is used as the basis of care. A facility seeking Magnet status utilized Virginia Hendersons
theory Definition of Nursing in childbirth education (Waller-Wise, 2013). Utilizing any theory
in childbirth education is not an easy task considering that the patient comes to a setting
undergoing what is considered a normal life event such as pregnancy and childbirth (Mensik,
Martin, Scott, & Horton, 2011). However, Hendersons theory provides a definition of nursing
care, as well as outlines areas in which nursing care is required (Pokorny, 2010).
Hendersons theory is applicable to childbirth education because it acknowledges that
nursing care includes serving as an educator to young mother and that a well person may need to
gain knowledge to maintain health and function independently (Henderson, 1978; Waller-Wise,

Running head: APPLICATION OF VIRGINIA HENDERSONS PHILOSOPHIES

14

2013). Hendersons fourteen basic human needs must be able to assess in order to care for the
patients needs (Henderson, 2006; Waller-Wise, 2013).
Furthermore, Hendersons theory is broad enough to be applied to the organ donation
process (Nicely & DeLario, 2011). She felt the nurse is temporarily the consciousness of the
unconscious, the love of the suicidal, the leg of the amputee, the eyes of the newly blind, a means
of locomotion for the newborn, knowledge and confidence for the young mother, a voice for
those too weak to speak (Henderson, 1991, p. 22). The organ donors discussed were brain dead
candidates for solid-organ donation transplants. Brain death is irreversible loss of brain and three
findings in brain death are coma, absence of brainstem reflexes, and apnea (Lustbader, 2014).
An individual can be a candidate for potential organ donation if a serious brain injury has
occurred and when death is imminent. Once a set of criteria are met the hospital will contact the
affiliated organ procurement organization (Shafer et al., 2006). The nurses involved in the care
of the brain dead donors are those practicing as organ procurement professionals or those caring
for the patient in a clinical setting.
In the nursing process, Henderson emphasized patient-focused and family focused care.
Through the utilization of her concept of nursing, as well as the fourteen basic principles the end
outcome becomes beneficial for the donor, the recipient, and their families (Nicely & DeLario,
2011). The following section provides examples of Hendersons basic human needs as
applicable in childbirth education and organ donation after brain death.
Normal Breathing
Breathing is an automatic response that conscious individuals can control. In childbirth
education, women are taught to focus on breathing, as well as how to control their breathing to

Running head: APPLICATION OF VIRGINIA HENDERSONS PHILOSOPHIES

15

relax, decrease stress, improve oxygenation, and decrease their perception of pain. It is vital that
the mother maintains control of her breathing due to the possibility of inadequate oxygenation
for her and the baby (Waller-Wise, 2013). Furthermore, to maintain the organs viability, it is
essential to provide adequate oxygenation of the donor, which is done through intubation and
ventilation in brain-dead patients (Nicely & DeLario, 2011).
Eat and Drink Adequately
In order to be prepared for labor it is necessary for women to be adequately hydrated and
have enough energy to perform the process of labor (Waller-Wise, 2013). A woman should have
a reservoir of energy prepared just in case she is not capable of consuming food due to possible
operable procedures (Waller-Wise, 2013). However, in a brain dead organ donor they are no
longer capable of taking in adequate nutrition, therefore it is up to the nurse to provide
essentially everything the donor requires to maintain the function of the donor organs. Various
nutrients are placed in preservation solutions upon extraction and transport of the organs to
maintain function. Hendersons concept of assisting the individual to maintain proper nutrition
has been expanded to include maintain hydration and essential nutrients to maintain support of
organ function (Nicely & DeLario, 2011).
Elimination of Body Wastes
While in the later stages of labor the woman may have to pass stool and empty their
bladder to prevent discomfort (Waller-Wise, 2013). Donors with inadequate brain functions
require nurses to monitor multiple indicators that may include laboratory results, hemodynamic
monitoring, inadequate or excess urine output (Nicely & DeLario, 2011). Nurses can monitor

Running head: APPLICATION OF VIRGINIA HENDERSONS PHILOSOPHIES

16

unconscious improper elimination of body wastes and educate pregnant women on the
importance of elimination to prevent complication as well as discomfort.
Move and Maintain Desirable Postures
The womans ability to move freely during labor strengthens contractions which allows a
better position for comfort decreasing the need for pain medication and could assist with the
decent of the baby (Waller-Wise, 2013). An unconscious donor does not possess the ability to
move freely, therefore nurses must reposition donors to prevent skin breakdown, pulmonary
infiltrates, and pneumonia (Arbour, 2005). The donors lungs may present a challenge and are
difficult to maintain for organ transplant. As a result, it has been recognized that the same care is
necessary to prevent deterioration of the lungs in the donor as it would be for an immobile
patient (Nicely & DeLario, 2011). Nurses can provide care by assisting both with mobility to
prevent medical complications or discomfort.
Sleep and Rest
Sleep disturbances can present late in pregnancy and during labor, thus leading to fatigue.
Pregnant women are provided education by nurses such as bedtime relaxation and therapy
techniques, aiding in an increase in quality of sleep (Beebe & Lee, 2007; Waller-Wise, 2013). In
an unconscious donor, their body still requires rest, which may be compromised by
complications from brain death. Nurses must closely monitor the unconscious for any signs of
stress from the body to ensure optimal organs for transplantation for prevention of complications
to the recipient (Nicely & DeLario, 2011).
Select suitable clothes; Dress and Undress

Running head: APPLICATION OF VIRGINIA HENDERSONS PHILOSOPHIES

17

Labor is an appropriate situation for a woman to be educated on wear clothing that are for
her, yet provide accessibility for assessment and prognosis of labor. Nurses can educate pregnant
women on clothing that maybe inappropriate, as well as the possibility of the attire being soiled
(Waller-Wise, 2013). Furthermore, in organ donors the same respect for dignity must be
maintained and that no respect has been lost as a human being. Nurses are taught to preserve
privacy and maintain the proper clothing for the individual. This is an uncomfortable time for
families and helps preserve the worth of the individual in their eyes (Nicely & DeLario, 2011).
Maintain Body Temperature within a Normal Range by Adjusting Clothing and Modifying the
Environment
Throughout pregnancy women obtain more fat stores, the basal metabolic rate increases,
and women experience an increase in heat produced by the growing life inside of her uterus
(Waller-Wise, 2013). The work of labor causes more heat production and diaphoresis thus the
women may choose to remove items of clothing during this process or in the use of hydrotherapy
((Waller-Wise, 2013). A brain dead donor no longer possess the ability to maintain his body
temperature therefore, it is necessary for the nurse to apply the appropriate equipment (cooling or
warming blanket) to maintain the appropriate body temperature (Nicely & DeLario, 2011).
Nurses have the capability to assist both with maintaining the proper temperature.
Keep the Body Clean and Well Groomed and Protect the Integument
Taking a shower or bath is refreshing and invigorating. However, water has another use
in hydrotherapy and is utilized to promote healing and treat injuries. The use of warm water,
increases circulation, relaxes muscles, aids in pain relief, softens tissues and promotes healing
(Waller-Wise, 2013). When women change positions in water, it feels weightless and is with less

Running head: APPLICATION OF VIRGINIA HENDERSONS PHILOSOPHIES

18

friction (Mollamahmutolu et al., 2012; Papile et al., 2014; Waller-Wise, 2013). Moreover,
cleanliness and protection of the skin is required for brain dead donors. These are basic nursing
activities and could have detrimental effects on the family if the donor is seen unkempt, bloody,
unclean, and the room air filled with aromas of urine and excrement. Cleanliness must be
maintained to decrease infection and prevent skin breakdown (Nicely & DeLario, 2011). The
skin acts as a protective barrier for the body. Frequent oral care and suctioning prevents
ventilator acquired pneumonia (Arbour, 2005). After death has occurred nurses provide
postmortem care. Whether alive or dead, cleanliness must be maintained, demonstrating
compassion, as well as respect for the individual (Nicely & DeLario, 2011).
Avoid Dangers in the Environment and Avoid Injuring Others
The unborn fetus can be exposed to many environmental hazards that could interfere with
development. Therefore, it is necessary for women to receive education before or immediately
after pregnant. The education would include avoiding smoking, use of tobacco, lead, mercury,
pesticides, solvents, fumes, chlorine and other potentially dangerous environmental exposures
(Ondeck & Focareta, 2009; Waller-Wise, 2013). Dangers in the environment are monitored by
the nurse in a brain dead donor. The nurse also prevents further injury to others by ensuring that
proper testing has been done before transplanting the organ in another individual. Nurses avoid
injuring others by providing clarification to the family concerning the meaning of brain death
versus coma. This provides the family with understanding and aid in closure (Arbour, 2005;
Nicely & DeLario, 2011).
Communicating with Others in Expressing Emotions, Needs, Fears, or Opinions

Running head: APPLICATION OF VIRGINIA HENDERSONS PHILOSOPHIES

19

Pregnant women face numerous decisions and choices. Therefore, education provides
them with the basis for making informed decisions. The pregnant woman must explore their
inner thoughts, fears, emotions, and communicate them to their healthcare providers, to ensure
their needs will be met (Waller-Wise, 2013). Open lines of communication should be maintained
between healthcare professionals, families, and patients. In a brain dead donor the family may
have several questions involving their loved ones status. The nurse must allow the family to
express their emotions, needs, fear, and opinions. Verbal and nonverbal interactions with the
family should display compassion, honesty, respect, and clarity (Nicely & DeLario, 2011).
Worship According to Ones Faith
The process of labor and bringing life into the world could ensue worship of ones faith
(Waller-Wise, 2013). Death and dying also calls upon the familys spiritual beliefs and practices.
Nurses must respect the individuals or families faith, facilitate worship, or end-of-life rituals that
allow the family to express their grief (Nicely & DeLario, 2011; Yousefi, Roshani, & Nazari,
2014).
Work in Such a Way That There is a Sense of Accomplishment
The experience of motherhood is unique to every woman as they transition from
pregnancy into motherhood. Nurses can help nurture and guide the experience which can be
positive life changing event (Waller-Wise, 2013). However, in a situation where death is
involved, a sense of accomplishment may come from the nurse maintaining optimal function of
the organs, which in turns has a positive impact on the recipients life (Nicely & DeLario, 2011).
Play or Participate in Various Forms of Recreation

Running head: APPLICATION OF VIRGINIA HENDERSONS PHILOSOPHIES

20

Nursing educators often use role-play to present real life scenarios. This gives the
pregnant woman the opportunity to ask questions, consider possibilities, and assess her own
responses (Waller-Wise, 2013). However, Hendersons play and recreation are not applicable
to the brain dead donor, but to the family (Henderson, 1978). In dealing with the tragedy of a
loved one becoming brain dead, it may be beneficial for the family to go outside, walk around,
and vent. Nurses, as well as family members need to relieve stress, which can be done through
various indoor and outdoor activities (Nicely & DeLario, 2011).
Learn, Discover, or Satisfy the Curiosity that Leads to Normal Development and Health, and Use
the Available Health Facilities
Childbirth classes provide an opportunity for families to lean, discover and satisfy their
curiosity concerning pregnancy and birth (Waller-Wise, 2013). Childbirth education provides a
clear picture of what to expect and takes some of the guess work out of it for expecting mothers.
However, this does not apply to a brain dead donor but can be utilized with their families.
Nurses can provide grief support, choose to research aspect of life and death, and educate others
with the knowledge they possess (Nicely & DeLario, 2011).
Future Implications
Within Africa there is armed conflicts, declines in aid, increase in poverty and the HIV/AIDS
epidemic (Tlou, 2001). One of the effects of this detrimental environment is that nurses start to
migrate to industrialized countries, with a stable environment as well as working conditions.
This has a devastating impact on the Africas health care system. Virginia Henderson believed
that the environment can have a positive or negative effect on an individual however, nurses have
an opportunity to alter the environment to be a more supportive one (Henderson, 1991).

Running head: APPLICATION OF VIRGINIA HENDERSONS PHILOSOPHIES

21

Considering the nursing migrating to greener pastures. What remains of the individuals who
require a nurse? Nurses can assist with healthcare reform through research, and assessing the
distribution in contexts of globalization, privatization, decentralization and deregulation. In
doing so nurses across the board have to have the same standard professional credentials and
expertise. To Henderson this meant receiving a university education, first in the liberal arts and
sciences, then a specialization at a higher education. With the lack of equitable distribution of
technological resources, nurses in underdeveloped countries remain years behind those countries
that do. Henderson would encourage all nurses in various roles to attain as much knowledge as
possible and distribute it to others. The International Classification for Nursing Practice (ICNP),
is working on describing the problems in nursing, as well as issues in primary health and
community based practices to establish an international language for nursing. (Tlou, 2001).
However, new technological advances have replaced some of the tasks nurses performed, but
cannot as Henderson described it they have their limitations. Robots cannot empathize, comfort,
mentor nor do they possess that human touch (Tlou, 2001).
Henderson encouraged research, more importantly being involved in research. In the
research with HIV pregnant women to prevent transmission of the virus to the unborn child some
of the women received a placebo in Third World countries and the nurses felt these women were
used as guinea pigs at a vulnerable state in their life (Tlou, 2001). Therefore, Henderson has
encouraged nurses to be involved in the research and more importantly she encourage health
promotion, these would be a preventive measures to keep women from acquiring the virus (Tlou,
2001). In dealing with an epidemic such as HIV/AIDS underdeveloped countries attain research
from wealthier countries which does not build upon the skills of the poorer countries and does
not address the culture and environment of the impoverished region (Tlou, 2001).

Running head: APPLICATION OF VIRGINIA HENDERSONS PHILOSOPHIES

22

Research was important to Henderson and with its utilization nurses can contribute
changing the gender-based inequalities that exist and become proactive for women. She also
envisioned nurses as being independent practitioners if physicians are unavailable, thus enabling
health care and health promotion to remote and impoverish areas. Virginia Henderson
contribution to nursing has affected the globe and still is driving change (Tlou, 2001).
Conclusion
Nursing is a complex, demanding process in which using a theoretical framework may
provide a clearer expectation for nurses (Schmieding, 1990). In her definition of nursing
Henderson, provides what she considers to be the essence of nursing. Her emphasis on the
individuals basic needs has led to the development of other theories and how nursing practice
can impact an individuals care. To this day Virginia Hendersons philosophies hold true and is
applicable in everyday current nursing practice. She encouraged nurses to be patient advocates,
educators, promoters of health, and to utilize research for best practices The modern mother of
nursing left the world on March 19, 1996 at the age of ninety-eight years, but her legacy
continues to influence, encourage, motivate, and drive change of the nursing profession today
("Virginia Avenel Henderson dies at age 98," 1996).

Running head: APPLICATION OF VIRGINIA HENDERSONS PHILOSOPHIES

23

References
Arbour, R. (2005). Clinical management of the organ donor. AACN Clinical Issues: Advanced
Practice in Acute & Critical Care, 16(4), 551-580.
Beebe, K. R., & Lee, K. A. (2007). Sleep disturbance in late pregnancy and early labor. Journal
of Perinatal & Neonatal Nursing, 21(2), 103-108.
Boschma, G., Davidson, L., & Bonifacio, N. (2009). Bertha Harmer's 1922 textbook -- The
Principles and Practice of Nursing: clinical nursing from an historical perspective.
Journal of Clinical Nursing, 18(19), 2684-2691. doi: 10.1111/j.1365-2702.2009.02891.x
Bunce, S. (2014). Historiography: The Progressive Era of the United States. Language in India,
14(5), 303-310.
Flesher, D. L., Previts, G. J., & Sharp, A. D. (2008). The Right to Practice Without the Right to
Vote. CPA Journal, 78(7), 6-8.
Halloran, E. (2010). Virginia Henderson: Oxford University Press.
Henderson, V. (1978). The concept of nursing. Journal of Advanced Nursing, 3(2), 113.
Henderson, V. (1982). The nursing process -- is the title right? Journal of Advanced Nursing,
7(2), 103-109. doi: 10.1111/j.1365-2648.1982.tb00217.x
Henderson, V. (1991). The nature of nursing : a definition and its implications for practice,
research, and education : reflections after 25 years / Virginia A. Henderson: New York :
National League for Nursing Press, c1991.
Henderson, V. (2006). The concept of nursing. Journal of Advanced Nursing, 53(1), 21-31. doi:
10.1111/j.1365-2648.2006.03660.x

Running head: APPLICATION OF VIRGINIA HENDERSONS PHILOSOPHIES

24

Lundmark, V. A., & Hickey, J. V. (2006). Magnet recognition: nursing excellence and quality.
The MAGNET RECOGNITION PROGRAM: understanding the appraisal process.
Journal of Nursing Care Quality, 21(4), 290-294.
Lustbader, D. (2014). ORGAN DONATION: PRACTICALITIES AND ETHICAL
CONUNDRUMS. American Journal of Critical Care, 23(1), 81-84. doi: /
10.4037/ajcc2014696
Mensik, J. S., Martin, D. M., Scott, K. A., & Horton, K. (2011). Development of a Professional
Nursing Framework: The Journey Toward Nursing Excellence. Journal of Nursing
Administration, 41(6), 259-264. doi: 10.1097/NNA.0b013e31821c460a
Mollamahmutolu, L., Moralolu, ., zyer, ., Su, F. A., Karayaln, R., Hanerliolu, N., . . .
Dilmen, U. (2012). The effects of immersion in water on labor, birth and newborn and
comparison with epidural analgesia and conventional vaginal delivery. Suda doumun,
travay, doum ve yenidoan zerine etkileri ve epidural analjezi ile normal doum ve
konvansiyonel vajinal doum ile karlatrlmas., 13(1), 45-49. doi:
10.5152/jtgga.2012.03
Nicely, B., & DeLario, G. T. (2011). Virginia Henderson's principles and practice of nursing
applied to organ donation after brain death. Progress in Transplantation, 21(1), 72-77.
Ondeck, M., & Focareta, J. (2009). Environmental hazards education for childbirth educators.
Journal of Perinatal Education, 18(4), 31-40. doi: 10.1624/105812409X474690
Papile, L.-A., Baley, J. E., Benitz, W., Carlo, W. A., Cummings, J., Kumar, P., . . . Watterberg, K.
L. (2014). Immersion in Water During Labor and Delivery. Pediatrics, 133(4), 758-761.
doi: 10.1542/peds.2013-3794

Running head: APPLICATION OF VIRGINIA HENDERSONS PHILOSOPHIES

25

Prigge, M. J. (2012). Dangers in the Dark: Motion Picture Reform in Progressive-Era

Milwaukee, 74.
Schmieding, N. J. (1990). An integrative nursing theoretical framework. Journal of Advanced
Nursing, 15(4), 463-467. doi: 10.1111/j.1365-2648.1990.tb01840.x
Shafer, T. J., Wagner, D., Chessare, J., Zampiello, F. A., McBride, V., & Perdue, J. (2006). Organ
donation breakthrough collaborative: increasing organ donation through system redesign.
Critical Care Nurse, 26(2), 33.
Tlou, S. D. (2001). Nursing: a new era for action A Virginia Henderson memorial lecture.
Nursing Inquiry, 8(4), 240-245. doi: 10.1046/j.1320-7881.2001.00113.x
Van Betten, P. T., & Moriarty, M. (2004). Nursing illuminations : a book of days / Patricia T. Van
Betten, Melisa Moriarty: St. Louis, Mo. : Mosby, c2004.
Virginia Avenel Henderson dies at age 98. (1996). Nursing News, 46(3), 3-3.
Waller-Wise, R. (2013). Utilizing Henderson's Nursing Theory in Childbirth Education.
International Journal of Childbirth Education, 28(2), 30-34.
Wolf, G. A., & Greenhouse, P. K. (2006). A road map for creating a magnet work environment.
Journal of Nursing Administration, 36(10), 458-462.
Yousefi, H., Roshani, A., & Nazari, F. (2014). Experiences of the families concerning organ
donation of a family member with brain death. Iranian Journal of Nursing & Midwifery
Research, 19(3), 323-330.