Essay on Nursing Research
Virginia Henderson's nursing philosophy is known for its simplicity and inclusiveness. It centers around the patient with the nurse making him whole or complete. She says that the nurse is "a substitute for what the patient lacks" (1966, p. 21). In other words, the nurse is eyes for the blind and legs for the amputee. Her famous summary encapsulates well nursing's breadth of function.
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 a 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. (p.21)
Henderson delineated 14 patient activities that contribute to health or its recovery by which she felt the nurse could even evaluate her progress towards making the patient independent. These points include such things as number one, "Breath normally," number three, "Eliminate body wastes," and number five, "Sleep and rest" (1991, p. 22) (see Appendix for complete list). These points could also be viewed as patient needs; for example, the patient needs good air, sleep, and rest. To discover the patient's real needs the nurse must first "get inside his skin" (Henderson, 1991), by imagining herself in the patient's position and thinking about what she would need. Next, she should fill the patient's needs while at the same time not doing for the patient that which he can doing for himself (National League of Nursing [NLN], 1989). The nurse must check her interpretation of the patient's needs with the patient. (Henderson, 1964).
Henderson viewed the nurse as an "independent practitioner" as long as he, or she, is not diagnosing, prescribing treatment for disease, or making a prognosis, for these are the physicians functions" (1991, p. 22). She saw the nurse's domain as being the authority in basic nursing care. She made these statements in her 1966 edition of The Nature of Nursing, and when she wrote addendums to each chapter of the book republished in 1991 she revised her understanding of the nurse's role as "givers of "primary health care," as those who diagnose and treat when a doctor is unavailable" (p. 33). She only intimates in this 1991 writing that nurses have an opportunity to serve by diagnosing and treating persons in underserved areas where physician care is lacking, but in a video interview in 1989 she is quite adamant that nurses should educate the public to view them as primary care givers. She buttresses her argument by referencing the World Health Organization's opinion that nurses have the number and qualifications to be the primary care givers who can, and often do, meet the underserved health needs of the world's ill people. Henderson defines a primary care giver as one who is the first to hear the patient's complaint and either treat or refer him to someone else. (NLN, 1989). This definition qualifies nurses, and especially mid-wives, as some of the first primary care givers.
Henderson's ways of knowing are clearly from nursing's well-known four ways of knowing: empirics, aesthetics, personal knowledge, and ethics (Carper, 1978). Her empirical mentality beams forth when she wrote, "In this country nurses are now trying to base their practice on the same sort of scientific knowledge that guides other providers of health careЕ. health care must change daily in response to research findings" (Henderson, 1991, p. 56).
She also uses aesthetics, which is the art of nursing seen in empathetic perception, creative expression, and the designing and delivering of efficient nursing care (Carper, 1978). Henderson's insistence that the nurse discover the patient's needs by getting "inside his skin" is a prime example of trying to perceive the patient's needs through empathy. Her 14 points allow the nurse to give efficient nursing care, another aspect of aesthetics. Gaining nursing knowledge through personal knowledge is done by knowing one's self, accepting others, and actively pursuing a process of growth (Carper, 1978). Henderson (1991) exhorts the nurse to know herself in order to better concentrate on learning the patient's needs and fulfilling his. Her emphasis on a nurse who is a continual student relates to the concept of ever growing. Building knowledge through ethics is based on one having a sense of responsibility, a moral code for his conduct and a sense of obligation (Carper, 1978). Henderson (1969) believes that nurses should have a social conscience, civic interest, personal integrity and abide by a code of ethics.
I find Henderson's philosophy of nursing a welcome framework into which to place my own nursing practice. I want to make her theory my starting point rather than the ending. Fulton (1987) rightly sees Henderson's philosophy as giving nursing a unique role in health care and providing a rationale for nursing activities, the two aspects of nursing that I have longed to find. Her balance of the nurse assisting the patient while trying to bring him to a state of full independence fits nicely with the balance I hope to achieve when caring for post-surgery patients that have to be weaned from the ventilator, high oxygen concentration, and multiple medications. This is an art and science. Like she recommends, I want to be a life-long student, continually updating my concepts and practice based on the best and latest research.
Henderson's concepts provide a good outline from which a nurse educator can teach her students basic patient care. The summarization statement about the unique function of the nurse provides an overarching motto for how the nurse is to relate to the patient. The 14 points of basic nursing care provide an outline on which the nurse educator can elaborate. Henderson emphasized that the nurse should have a liberal education, grounded in the physical, biological, and social sciences (1991). She felt that the nurse should be educated, and not just trained.
Henderson believed that nurses should perform research not only within the discipline but along side the physician as a team. This advice is a good starting point for using her philosophy in research. One can find innumerable research topics within each of her 14 activities that promote patient health. A researcher could compare the recovery speed of patients who spent the hospital stay within the hospital to those who spent considerable time outdoors in the fresh air.
Of course, controlling all of the variables would be very difficult. Another example could be taken from point number eight that encourages the nurse to keep the patient clean and well-groomed. An interesting research project could compare the recovery rate of the patients who received a daily bath with those who received a bath every two days. Again, controlling other variables and providing a large enough sample population would be a major task.
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 a 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. (p.21)
Henderson delineated 14 patient activities that contribute to health or its recovery by which she felt the nurse could even evaluate her progress towards making the patient independent. These points include such things as number one, "Breath normally," number three, "Eliminate body wastes," and number five, "Sleep and rest" (1991, p. 22) (see Appendix for complete list). These points could also be viewed as patient needs; for example, the patient needs good air, sleep, and rest. To discover the patient's real needs the nurse must first "get inside his skin" (Henderson, 1991), by imagining herself in the patient's position and thinking about what she would need. Next, she should fill the patient's needs while at the same time not doing for the patient that which he can doing for himself (National League of Nursing [NLN], 1989). The nurse must check her interpretation of the patient's needs with the patient. (Henderson, 1964).
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Henderson viewed the nurse as an "independent practitioner" as long as he, or she, is not diagnosing, prescribing treatment for disease, or making a prognosis, for these are the physicians functions" (1991, p. 22). She saw the nurse's domain as being the authority in basic nursing care. She made these statements in her 1966 edition of The Nature of Nursing, and when she wrote addendums to each chapter of the book republished in 1991 she revised her understanding of the nurse's role as "givers of "primary health care," as those who diagnose and treat when a doctor is unavailable" (p. 33). She only intimates in this 1991 writing that nurses have an opportunity to serve by diagnosing and treating persons in underserved areas where physician care is lacking, but in a video interview in 1989 she is quite adamant that nurses should educate the public to view them as primary care givers. She buttresses her argument by referencing the World Health Organization's opinion that nurses have the number and qualifications to be the primary care givers who can, and often do, meet the underserved health needs of the world's ill people. Henderson defines a primary care giver as one who is the first to hear the patient's complaint and either treat or refer him to someone else. (NLN, 1989). This definition qualifies nurses, and especially mid-wives, as some of the first primary care givers.
Henderson's ways of knowing are clearly from nursing's well-known four ways of knowing: empirics, aesthetics, personal knowledge, and ethics (Carper, 1978). Her empirical mentality beams forth when she wrote, "In this country nurses are now trying to base their practice on the same sort of scientific knowledge that guides other providers of health careЕ. health care must change daily in response to research findings" (Henderson, 1991, p. 56).
She also uses aesthetics, which is the art of nursing seen in empathetic perception, creative expression, and the designing and delivering of efficient nursing care (Carper, 1978). Henderson's insistence that the nurse discover the patient's needs by getting "inside his skin" is a prime example of trying to perceive the patient's needs through empathy. Her 14 points allow the nurse to give efficient nursing care, another aspect of aesthetics. Gaining nursing knowledge through personal knowledge is done by knowing one's self, accepting others, and actively pursuing a process of growth (Carper, 1978). Henderson (1991) exhorts the nurse to know herself in order to better concentrate on learning the patient's needs and fulfilling his. Her emphasis on a nurse who is a continual student relates to the concept of ever growing. Building knowledge through ethics is based on one having a sense of responsibility, a moral code for his conduct and a sense of obligation (Carper, 1978). Henderson (1969) believes that nurses should have a social conscience, civic interest, personal integrity and abide by a code of ethics.
I find Henderson's philosophy of nursing a welcome framework into which to place my own nursing practice. I want to make her theory my starting point rather than the ending. Fulton (1987) rightly sees Henderson's philosophy as giving nursing a unique role in health care and providing a rationale for nursing activities, the two aspects of nursing that I have longed to find. Her balance of the nurse assisting the patient while trying to bring him to a state of full independence fits nicely with the balance I hope to achieve when caring for post-surgery patients that have to be weaned from the ventilator, high oxygen concentration, and multiple medications. This is an art and science. Like she recommends, I want to be a life-long student, continually updating my concepts and practice based on the best and latest research.
Henderson's concepts provide a good outline from which a nurse educator can teach her students basic patient care. The summarization statement about the unique function of the nurse provides an overarching motto for how the nurse is to relate to the patient. The 14 points of basic nursing care provide an outline on which the nurse educator can elaborate. Henderson emphasized that the nurse should have a liberal education, grounded in the physical, biological, and social sciences (1991). She felt that the nurse should be educated, and not just trained.
Henderson believed that nurses should perform research not only within the discipline but along side the physician as a team. This advice is a good starting point for using her philosophy in research. One can find innumerable research topics within each of her 14 activities that promote patient health. A researcher could compare the recovery speed of patients who spent the hospital stay within the hospital to those who spent considerable time outdoors in the fresh air.
Of course, controlling all of the variables would be very difficult. Another example could be taken from point number eight that encourages the nurse to keep the patient clean and well-groomed. An interesting research project could compare the recovery rate of the patients who received a daily bath with those who received a bath every two days. Again, controlling other variables and providing a large enough sample population would be a major task.
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