Nursing Model/Theory Application

A nurse’s role, according to Virginia Henderson’s Nursing Theory, which she wrote prior to the development of theoretical nursing, is to help a person, whether he/she is sick or well, to complete activities, contributing to his/her recovery process (or peaceful death). As the quote introducing this paper notes, the activities a nurse helps an individual perform include those he/she would complete if he/she possessed the required will, strength, or knowledge – in a way to help him/her gain or regain his/her independence. (Resuggan, 2008) Prior to Henderson (1966), Florence Nightingale (1856/1969) stressed the value of self-care in nursing. (Singleton, 2000, ¶s 5-7) Complementing Henderson’s and Nightingale’s work, more than three decades ago, Orem’s self-care deficit theory (Orem 1971, 1980, 1985, 1991, 1995; cited by Singleton, 2000, ¶s 5-7) evolved as the prominent model in the self-care area, focusing on an individual’s physical nature identifying deficits within the physical realm. In addition, according to self-care deficit theory denotes “the nurse will diagnose clients” self-care deficits and prescribe how those deficits will be met.” (Singleton, 2000, ¶s 5-7) in determining how deficits will be met, Henderson stressed the value of helping a person become as independent as possible. Her “theory” contends that nursing includes helping individuals gain independence in relation to performing activities which contribute to their health or the recovery of health. “She described the nurse’s role as substitutive (doing for the person), supplementary (helping the person), or complementary (working with the person), with the goal of helping the person become as independent as possible.” (Henderson, 1966, p. 15; cited by Virginia Henderson, 2000-2007) the following 14 components, based on human needs, according to Henderson, characterize nursing activities.

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. (“Virginia Henderson’s Need…,” 2004-2008)

Application

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.”

Virginia Avernal Henderson (1897-1996) (Henderson, 1966, p. 15; cited by Resuggan, 2008)

Aroskar (1980, p. 658; cited by Trail Ross, 1993, p. 235) explains that a dilemma consists of a choice between equally unsatisfactory alternatives or a challenging problem with no apparent satisfactory solution. As nurses regularly face ethical dilemmas that occur in clinical practice, they often must make difficult choices. Having ethical principles as tools to utilize to reflect on and analyze the issues, Trail Ross (1993, p. 233) purports, however, may help abate the task and decrease anxiety regarding whether he/she made the correct decision. The American Nurses’ Association (ANA) Committee on Ethics (1986) reports that a person finds the delineation between benefiting one person as a moral duty vs. A moral option whenever the four following fundamental criteria exist:

the patient is at significant risk of harm, loss, or damage if the nurse does not assist;

the nurse’s intervention or care is directly relevant to preventing harm;

the nurse’s care will probably prevent harm, loss, or damage to the patient; and/or the benefit the patient will gain outweighs any harm the nurse might incur and does not present more than minimal risk to the health care provider. (Trail Ross, 1993, p. 236)

The theory of obligation utilizes two philosophies: “the principle of beneficence and the principle of justice,” according to Frankena (1973; cited by Trail Ross, 1993, p. 235). Frankena contends a nurse ought to help a person because he/she possesses a moral obligation to assist them. The beneficence principle includes four “oughts”:

to prevent harm, not to inflict evil or harm, to remove evil, and to do and promote good (Frankena, 1973 cited by Trail Ross, 1993, p. 235)

Keri’s case study depicts the dilemma this researcher examines to ascertain how Henderson would have cared for her.

Keri’s Case

Keri, an active, bright, and attractive 13-year-old female, presents at the outpatient clinic for a sports physical as mandated to qualify to play on her school’s championship basketball team. While performing the initial assessment of Keri, the clinic liaison notes numerous indications of possible physical abuse, which include:

bruises on Keri’s back and upper legs, and laceration in her earlobe, from an earring being ripped out.

The nurse asks Keri, “Is someone hurting you?.”

After a long pause, during which she starts to cry, Keri relates an incident that occurred two nights before. Her biological father, Keri reports, who has a short temper, slapped her in the face, accidentally ripping out the earring, when she came home from a party two hours late. He also spanked her with a leather strap. Following additional prompting by the nurse, Keri admits that her parents divorced five years earlier and that until recently; she had been living with her mother and her mother’s live-in boyfriend in a nearby town. Her mother’s boyfriend, however, Keri states, had been sexually abusing her while her mother worked. Keri states that her mother’s boyfriend warned her not to tell anyone or he would kill her. As Keri sincerely believes her mother’s boyfriend is capable of carrying out his threat, she chose to move in with her biological dad.

Please don’t tell anyone,” Keri begs the nurse. Keri feels it is much better for her to remain with her biological father, even though he does have a bad temper. Keri fears that if JC the nurse reports the incidents, she will either, be forced to return to her mother and the mother’s sexually abusive boyfriend, of whom she is terrified.

The nurse, albeit, knows that the state law, as well as several federal statutes, requires that suspected abuse be reported immediately.

Communicate With Others

The tenth component, noted in Henderson’s list of 14 nursing activities, “Communicate with others in expressing emotions, needs, fears, or opinions,” (“Virginia Henderson’s Need…,” 2008) depicts the focus, this writer contends, Henderson would utilize. During the process of communicating with Keri, to help her express her emotions, needs, fears and opinions, along with determining how to best communicate with child protective services and Keri’s mother, the nurse deals with ethical principles, which include confidentiality, along with the duty to report suspected child abuse. In weighing the obligations of confidentiality in regard to reporting suspected abuse, after addressing a patient’s immediate medical needs, the nurse, per legal stipulations in most states, must report the abuse. In fact, a majority of state child protection statutes specifically identify nurses as mandatory reporters. “The nurse’s statutory duty to report child abuse,” however, “conflicts with the duty to keep patient information confidential.” (Kearney, 2007) to resolve this dilemma and ensure child abuse is addressed, state legislatures statutorily rule the nurse’s duty to report child abuse must trump his/her duty of confidentiality. In Keri’s case, this writer contends, the obligation to confidentiality does not supersede the obligation to report the abuse to appropriate officials. Reporting the abuse, the action this writer would take, helps free Keri from her emotional prison, and likely helps Keri become stronger in her self-care ability and gain a semblance of independence she needs to develop.

III. ANALYSIS & CONCLUSION

She [Virginia Henderson] was one of the first nurses to point out nursing does not consist of merely following physician’s orders.”

Virginia Henderson’s Need…,” 2008)

More than Merely Following Physician’s Orders

Henderson’s principles basically depict the theory behind helping people take care of themselves. Even though Henderson did not appear to intend to develop a major nursing theory, her “theory” reflects the primary theory behind helping people take care of themselves. This writer concludes that Henderson’s uncomplicated and self-explanatory “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.”

Consequently, concepts Henderson (1966) proposed have been utilized in nursing education from the 1930s until the present. (O’Malley, 1996; cited by “Virginia Henderson’s Need…,” 2008) in addition to following physician’s orders, Henderson’s “theory” stresses in this paper, a nurse’s role includes helping a person become as independent as possible as soon as possible.

Henderson’s contributions to nursing literature, which expand from the 1930s through the 1990s, significantly impacted nursing research, strengthening and enhancing he focus on nursing practice and confirming the value of tested interventions in helping individuals regain their health. “From an historical standpoint, her concept of nursing enhanced nursing science this has been particularly important in the area of nursing education.” (“Virginia Henderson’s Need…,” 2008) Principles of Henderson’s theory, published in numerous primary nursing textbooks utilized from the 1930s through the 1960s, along with principles embodied by the 14 activities continue to prove vital in evaluating nursing care in thee21st century, not only in cases such as Keri’s, but in a myriad of others benefiting from nursing.

References

Kearney, Kathleen M., the Nurse’s Duty to Report Child Abuse vs. The Attorney’s Duty of Confidentiality: The Nurse Attorney’s Dilemma Journal of Nursing Law. Social Science Electronic Publishing, Inc.; January 25, 2007. Retrieved September 25, 2007, at http://ssrn.com/abstract=1256366.

Resuggan, Ray RN;RPN;MRN. (Last Modified: August 17, 2008). “Virginia Avernal Henderson.” Nurses.info. Retrieved September 25, 2007, from: http://www.nurses.info/nursing_theory_person_henderson_virginia_.htm.

Singleton, Joanne K. “Nurses’ perspectives of encouraging clients’ care-of-self in a short-term rehabilitation unit within a long-term care facility,” Rehabilitation Nursing, January 1, 2000. Retrieved September 25, 2007, from: http://www.highbeam.com/doc/1P348282208.html.

Trail Ross, Mary Ellen. (1993). “Linking Ethical Principles With Community Practice.” Journal of Community Health Nursing, Vol. 10. Retrieved September 25, 2007, at http://www.questia.com/read/95780716?title=Linking%20Ethical%20Principles%20W%20Community%20Practice.

Virginia Henderson. (2000-2007), NurseScribe. Retrieved September 25, 2007,from http://www.enursescribe.com/Henderson.htm.

Virginia Henderson’s Need Theory.” (2004-2008). Nursing Theories. Current Nursing. Retrieved September 25, 2007, at http://currentnursing.com/nursing_theory/Henderson.htm.

Additional Info:

Virginia Avernal Henderson

Resuggan, Ray RN;RPN;MRN. (Last Modified: August 17, 2008). “Virginia Avernal Henderson.” Nurses.info. http://www.nurses.info/nursing_theory_person_henderson_virginia_.htm.

Virginia Avernal Henderson (1897-1996)

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