What are Nursing Theories?

Nursing theories are organized bodies of knowledge to define what nursing is, what nurses do, and why
do they do it. Nursing theories provide a way to define nursing as a unique discipline that is separate
from other disciplines (e.g., medicine). It is a framework of concepts and purposes intended to guide the
practice of nursing at a more concrete and specific level.

Nursing, as a profession, is committed to recognizing its own unparalleled body of knowledge vital to
nursing practice—nursing science. To distinguish this foundation of knowledge, nurses need to identify,
develop, and understand concepts and theories in line with nursing. As a science, nursing is based on the
theory of what nursing is, what nurses do, and why. Nursing is a unique discipline and is separate from
medicine. It has its own body of knowledge on which delivery of care is based.

Defining Terms
Development of nursing theory demands an understanding of selected terminologies,
definitions, and assumptions.

 Philosophy. Beliefs and values that define a way of thinking and are generally
known and understood by a group or discipline.
 Theory. A belief, policy, or procedure proposed or followed as the basis of
action. It refers to a logical group of general propositions used as principles of
explanation. Theories are also used to describe, predict, or control phenomena.
 Concept. Concepts are often called the building blocks of theories. They are
primarily the vehicles of thought that involve images.
 Models. Models are representations of the interaction among and between the
concepts showing patterns. They present an overview of the thinking behind the
theory and may demonstrate how theory can be introduced into practice.
 Conceptual framework. A conceptual framework is a group of related ideas,
statements, or concepts. It is often used interchangeably with the conceptual
model and with grand theories.
 Proposition. Propositions are statements that describe the relationship between
the concepts.
  Domain. Domain is the perspective or territory of a profession or discipline.
 Process. Processes are a series of organized steps, changes or functions
intended to bring about the desired result.
 Paradigm. A paradigm refers to a pattern of shared understanding and
assumptions about reality and the world; worldview or widely accepted value
system.
 Metaparadigm. A metaparadigm is the most general statement of discipline
and functions as a framework in which the more restricted structures of
conceptual models develop. Much of the theoretical work in nursing focused on
articulating relationships among four major concepts: person, environment,
health, and nursing.

History of Nursing Theories

The first nursing theories appeared in the late 1800s when a strong emphasis was placed
on nursing education.

 In 1860, Florence Nightingale defined nursing in her “Environmental Theory”

as “the act of utilizing the environment of the patient to assist him in his
recovery.”
 In the 1950s, there is a consensus among nursing scholars that nursing needed
to validate itself through the production of its own scientifically tested body of
knowledge.
 In 1952, Hildegard Peplau introduced her Theory of Interpersonal
Relations that puts emphasis on the nurse-client relationship as the foundation
of nursing practice.
 In 1955, Virginia Henderson conceptualized the nurse’s role as assisting sick
or healthy individuals to gain independence in meeting 14 fundamental needs,
thus her Nursing Need Theory was developed.
  In 1960, Faye Abdellah published her work “Typology of 21 Nursing
Problems” that shifted the focus of nursing from a disease-centered approach to
a patient-centered approach.
 In 1962, Ida Jean Orlando emphasized the reciprocal relationship between
patient and nurse and viewed the professional function of nursing as finding out
and meeting the patient’s immediate need for help.
 In 1968, Dorothy Johnson pioneered the Behavioral System Model and
upheld the fostering of efficient and effective behavioral functioning in the
patient to prevent illness.
 In 1970, Martha Rogers viewed nursing as both a science and an art as it
provides a way to view the unitary human being, who is integral with the
universe.
 In 1971, Dorothea Orem states in her theory that nursing care is required if the
client is unable to fulfill biological, psychological, developmental, or social
needs.
 In 1971, Imogene King‘s Theory of Goal attainment states that the nurse is
considered part of the patient’s environment and the nurse-patient
relationship is for meeting goals towards good health.
 In 1972, Betty Neuman in her theory states that many needs exist, and each
may disrupt client balance or stability. Stress reduction is the goal of the system
model of nursing practice.
 In 1979, Sr. Callista Roy viewed the individual as a set of interrelated systems
who strives to maintain the balance between these various stimuli.
 In 1979, Jean Watson developed the philosophy of caring highlighted
humanistic aspects of nursing as they intertwine with scientific knowledge and
nursing practice.

The Nursing Metaparadigm

There are four major concepts that are frequently interrelated and fundamental to nursing
theory: person, environment, health, and nursing. These four are collectively referred to
as metaparadigm for nursing.

Person, Nursing, Environment, and Health – the four main concepts that make up the nursing
metaparadigm.

Person

Person (also referred to as Client or Human Beings) is the recipient of nursing care and
may include individuals, patients, groups, families, and communities.

Environment

Environment (or situation) is defined as the internal and external surrounds that affect the
client. It includes all positive or negative conditions that affect the patient, the physical
environment, such as families, friends, and significant others, and the setting for where
they go for their healthcare.
Health

Health is defined as the degree of wellness or well-being that the client experiences. It
may have different meanings for each patient, the clinical setting, and the health care
provider.

Nursing

The attributes, characteristics, and actions of the nurse providing care on behalf of or in
conjunction with, the client. There are numerous definitions of nursing, though nursing
scholars may have difficulty agreeing on its exact definition, the ultimate goal of nursing
theories is to improve patient care.

You’ll find that these four concepts are used frequently and defined differently
throughout different nursing theories. Each nurse theorist’s definition varies in
accordance with their orientation, nursing experience, and different factors that affect the
theorist’s view of nursing. The person is the main focus but how each theorist defines the
nursing metaparadigm gives a unique take specific to a particular theory. To give you an
example, below are the different definitions of various theorists on the nursing
metaparadigm:
Components of Nursing Theories
For a theory to be a theory it has to contain a set of concepts, definitions, relational
statements, and assumptions that explain a phenomenon. It should also explain how these
components relate to each other.

Phenomenon

A term given to describe an idea or responses about an event, a situation, a process, a

group of events, or a group of situations. Phenomena may be temporary or permanent.
Nursing theories focus on the phenomena of nursing.

Concepts

Interrelated concepts define a theory. Concepts are used to help describe or label a
phenomenon. They are words or phrases that identify, define, and establish structure and
boundaries for ideas generated about a particular phenomenon. Concepts may be abstract
or concrete.

 Abstract Concepts. Defined as mentally constructed independent of a specific

time or place.
 Concrete Concepts. Are directly experienced and related to a particular time
or place.

Definitions

Definitions are used to convey the general meaning of the concepts of the theory.
Definitions can be theoretical or operational.

 Theoretical Definitions. Define a particular concept based on the theorist’s

perspective.
 Operational Definitions. States how concepts are measured.
Relational Statements

Relational statements define the relationships between two or more concepts. They are
the chains that link concepts to one another.

Assumptions

Assumptions are accepted as truths and are based on values and beliefs. These are
statements that explain the nature of concepts, definitions, purpose, relationships, and
structure of a theory.

Why are Nursing Theories Important?

Nursing theories are the basis of nursing practice today. In many cases, nursing theory
guides knowledge development and directs education, research, and practice.
Historically, nursing was not recognized as an academic discipline or as a profession we
view it today. Before nursing theories were developed, nursing was considered to be a
task-oriented occupation. The training and function of nurses were under the direction
and control of the medical profession. Let’s take a look at the importance of nursing
theory and its significance to nursing practice:

 Nursing theories help recognize what should set the foundation of practice by
explicitly describing nursing.
 By providing a definition of nursing, nursing theory also helps nurses to
understand their purpose and role in the healthcare setting.
 Theories serve as a rationale or scientific reasons for nursing interventions and
give nurses the knowledge base necessary for acting and responding
appropriately in nursing care situations.
 Nursing theories provide the foundations of nursing practice, helps generate
further knowledge, and indicate in which direction nursing should develop in
the future (Brown, 1964).
  By providing nurses a sense of identity, nursing theory can help patients,
managers, and other healthcare professionals to acknowledge and understand
the unique contribution that nurses make to the healthcare service (Draper,
1990).
 Nursing theories prepare the nurses to reflect on the assumptions and question
the values in nursing, thus further defining nursing and increasing knowledge
base.
 Nursing theories aim to define, predict, and demonstrate the phenomenon of
nursing (Chinn and Jacobs, 1978).
 It can be regarded as an attempt by the nursing profession to maintain and
preserve its professional limits and boundaries.
 In many cases, nursing theories guide knowledge development and directs
education, research, and practice although each influence the others.
(Fitzpatrick and Whall, 2005).

Purposes of Nursing Theories

The primary purpose of theory in the profession of nursing is to improve practice by
positively influence the health and quality of life of patients. Nursing theories are also
developed to define and describe nursing care, guide nursing practice, and provide a basis
for clinical decision making. The accomplishments of nursing in the past led to the
recognition of nursing in academic discipline, research, and profession.

In Academic Discipline

Much of the earlier nursing programs identified the major concepts in one or two nursing
models, organized the concepts and build an entire nursing curriculum around the created
framework. The unique language in these models was typically introduced into program
objectives, course objectives, course descriptions, and clinical performance criteria. The
purpose was to explain the fundamental implications of the profession and to enhance the
status of the profession.
In Research

Development of theory is fundamental to the research process where it is necessary to use

theory as a framework to provide perspective and guidance to the research study. Theory
can also be used to guide the research process by creating and testing phenomena of
interest. To improve the nursing profession’s ability to meet the societal duties and
responsibilities, there need to be a continuous reciprocal and cyclical connection with
theory, practice, and research. This will help connect the perceived “gap” between theory
and practice and promote the theory-guided practice.

In Profession

Clinical practice generates research questions and knowledge for theory. In a clinical
setting, its primary contribution has been the facilitation of reflecting, questioning, and
thinking about what nurses do. Because nurses and nursing practice are often subordinate
to powerful institutional forces and traditions, the introduction of any framework that
encourages nurses to reflect on, question, and think about what they do provide an
invaluable service.

Classification of Nursing Theories

There are different ways to categorize nursing theories. They are classified depending on
their function, levels of abstraction, or goal orientation.

By Abstraction

There are three major categories when classifying nursing theories based on their level of
abstraction: grand theory, middle-range theory, and practice-level theory.
 Levels of Nursing
Theory According to Abstraction

Grand Nursing Theories

 Grand theories are abstract, broad in scope, and complex, therefore requiring
further research for clarification.
 Grand nursing theories do not provide guidance for specific nursing
interventions but rather provide a general framework and ideas about nursing.
 Grand nursing theorists develop their works based on their own experiences
and the time they were living explaining why there is so much variation among
theories.
 Address the nursing metaparadigm components of person, nursing, health, and
environment.
Middle-Range Nursing Theories

 More limited in scope (as compared to grand theories) and present concepts and
propositions at a lower level of abstraction. They address a specific
phenomenon in nursing.
 Due to the difficulty of testing grand theories, nursing scholars proposed using
this level of theory.
 Most middle-range theories are based on the works of a grand theorist but they
can be conceived from research, nursing practice, or the theories of other
disciplines.

Practice-Level Nursing Theories

 Practice nursing theories are situation specific theories that are narrow in scope
and focuses on a specific patient population at a specific time.
 Practice-level nursing theories provide frameworks for nursing interventions
and suggest outcomes or the effect of nursing practice.
 Theories developed at this level have a more direct effect on nursing practice as
compared to more abstract theories.
 These theories are interrelated with concepts from middle-range theories or
grand theories.

By Goal Orientation

Theories can also be classified based on their goals, they can

be descriptive or prescriptive.

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Descriptive Theories

 Descriptive theories are the first level of theory development. They describe the
phenomena and identify its properties and components in which it occurs.
  Descriptive theories are not action oriented or attempt to produce or change a
situation.
 There are two types of descriptive theories: factor-isolating
theory and explanatory theory.

Factor-Isolating Theory

 Also known as category-formulating or labeling theory.

 Theories under this category describe the properties and dimensions of
phenomena.

Explanatory Theory

 Explanatory theories describe and explain the nature of relationships of certain

phenomena to other phenomena.

Prescriptive Theories

 Address the nursing interventions for a phenomenon, guide practice change,

and predict consequences.
 Includes propositions that call for change.
 In nursing, prescriptive theories are used to anticipate the outcomes of nursing
interventions.

Other Ways of Classifying Nursing Theories

Classification According to Meleis

Afaf Ibrahim Meleis (2011), in her book Theoretical Nursing: Development and
Progress, organizes the major nurse theories and models using the following headings:
needs theories, interaction theories, and outcome theories. These categories indicate the
basic philosophical underpinnings of the theories.
  Needs-Based Theories. The needs theorists were the first group of nurses who
thought of giving nursing care a conceptual order. Theories under this group are
based on helping individuals to fulfill their physical and mental needs. Theories
of Orem, Henderson, and Abdella are categorized under this group. Need
theories are criticized for relying too much on the medical model of health and
placing the patient in an overtly dependent position.
 Interaction Theories. These theories placed the emphasis of nursing on the
establishment and maintenance of relationships and highlight the impact of
nursing on patients and how they interact with the environment, people, and
situations. Theories of King, Orlando, and Travelbee are grouped under this
category.
 Outcome Theories. These theories describe the nurse as controlling and
directing patient care by using their knowledge of the human physiological and
behavioral systems. Nursing theories of Johnson, Levine, Rogers, and Roy
belong to this group.

Classification According to Alligood

In her book, Nursing Theorists and Their Work, Raile Alligood (2017) categorized
nursing theories into four headings: nursing philosophy, nursing conceptual models,
nursing theories and grand theories, and middle-range nursing theories.

 Nursing Philosophy. Is the most abstract type and sets forth the meaning of
nursing phenomena through analysis, reasoning, and logical presentation.
Works of Nightingale, Watson, Ray, and Benner are categorized under this
group.
 Nursing Conceptual Models. Are comprehensive nursing theories that are
regarded by some as pioneers in nursing. These theories address the nursing
metaparadigm and explain the relationship between them. Conceptual models
of Levine, Rogers, Roy, King, and Orem are under this group.
 Grand Nursing Theories. Are works derived from nursing philosophies,
conceptual models, and other grand theories that are generally not as specific as
 middle-range theories. Works of Levine, Rogers, Orem, and King are some of
the theories under this category.
 Middle-Range Theories. Are precise and answer specific nursing practice
questions. They address the specifics of nursing situations within the
perspective of the model or theory from which they are derived. Examples of
Middle-Range theories are that of Mercer, Reed, Mishel, and Barker.

Biography of Florence Nightingale

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.

Personal Life
Nightingale, circa 1858
Only announcing her decision to enter the field in 1844, following her desire to be a
nurse was not easy for Florence Nightingale. Her mother and sister were against her
chosen career, but Nightingale stood strong and worked hard to learn more about her
craft despite the society’s expectation that she become a wife and mother.

As a woman, Nightingale was very attractive and charming that made every man like her.
However, she rejected a suitor, Richard Monckton Milnes, 1st Baron Houghton, because
she feared that entertaining men would interfere the process. The income given to her by
her father during this time allowed her to pursue her career and still live comfortably.
Though Nightingale had several important friendships with women, including a
correspondence with an Irish nun named Sister Mary Clare Moore, she had little respect
for women in general, and preferred friendships with powerful men.

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.”

Nightingale providing care to wounded and ill soldiers during the Crimean War
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
Nightingale Statue, London Road, Derby
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.

A letter dated 1896 from Nightingale to the Duke of Westminster about the importance of nurses.
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.

Appointments

In 1853, Florence Nightingale accepted the position of superintendent at the Institute for
the Care of Sick Gentlewomen in Upper Harley Street, London. She held this position
until October 1854.

Nightingale and Her Nurses Depart for the Crimea, October 1854
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.

Nightingale and some of the 38 “handmaidens of the Lord” (as she called them) to nurse
wounded British soldiers in the Crimean War
She returned to England in 1856. In 1860, she established the Nightingale Training
School for nurses at St Thomas’ Hospital in London. Once the nurses were trained, they
were sent to hospitals all over Britain, where they introduced the ideas they had learned,
and established nursing training on the Nightingale model.

Awards and Honors

Crimean War Memorial located facing Waterkloo Place at the junction of Lower Regent Street
and Pall Mall, London.
England has given Florence Nightingale numerous awards and honors.

Nightingale became known as “The Lady with the Lamp.” During the Crimean War, she
initially made her rounds on horseback and at night used an oil lamp to light her way,
then reverted to a mule cart and finally a carriage with a hood and curtains. Nightingale
remained at Scutari for a year and a half. She left in the summer of 1856, once the
Crimean conflict was resolved, and returned to her childhood home at Lea Hurst. To her
surprise she was met with a hero‘s welcome, which the humble nurse did her best to
avoid.

The Queen rewarded Nightingale’s work by presenting her with an engraved brooch that
came to be known as the “Nightingale Jewel” and by granting her a prize of $250,000
from the British government.

In 1883, Nightingale was awarded the Royal Red Cross by Queen Victoria. In 1904, she
was appointed a Lady of Grace of the Order of St John (LGStJ). In 1907, she became the
first woman to be awarded the Order of Merit. In the following year she was given
the Honorary Freedom of the City of London.
Death

Despite being known as the heroine of the Crimean War, Florence Nightingale felt ill in
August 1910. She seemed to recover and was reportedly in good spirits, however, she
developed an array of troubling symptoms a week later, on the evening of Friday, August
12, 1910. She died unexpectedly at 2 pm the following day, Saturday, August 13, at her
home in London. She left a large body of work, including several hundred notes which
were previously unpublished.

Usually, well-known people with great contributions are offered national funerals, but
Nightingale had expressed the desire that her funeral be a quiet and modest affair.

The Florence Nightingale Museum

London, Greater London, England
Respecting her last wishes, her relatives turned down a national funeral and the “Lady
with the Lamp” was laid to rest in her family’s plot at St. Margaret’s Church, East
Wellow, in Hampshire, England.

In honor of the life and career of the “Angel of the Crimea,” the Florence Nightingale
Museum sits at the site of the original Nightingale Training School for Nurses, houses
more than 2,000 artifacts. And up to this day, the name “Florence Nightingale” is
universally recognized and known as the pioneer of modern nursing.

Memory

Florence Nightingale has a memorial in St. Paul’s Cathedral where a formal memorial
service was held. There is a Florence Nightingale Museum located at St. Thomas
Hospital in London where she founded the nursing school. The US Navy launched a
namesake troop transport during World War II, “USS Florence Nightingale,” which
served gallantly during the course of the war receiving four battle stars.
In addition to the continued operation of the Florence Nightingale School of Nursing and
Midwifery at King’s College London, The Nightingale Building in the School of Nursing
and Midwifery at the University of Southampton is also named after her.

Hospitals

Furthermore, four hospitals in Istanbul are named after Nightingale: F. N. Hastanesi in

Şişli (the biggest private hospital in Turkey), Metropolitan F.N. Hastanesi in Gayrettepe,
Avrupa F.N. Hastanesi in Mecidiyeköy, and Kızıltoprak F.N. Hastanesi in Kadiköy, all
belonging to the Turkish Cardiology Foundation.

A ward of the hospital at Scutari where Nightingale worked, from an 1856 lithograph

Audio

Florence Nightingale’s voice was saved in a phonograph recording from 1890 preserved
in the British Library Sound Archive. The recording is in aid of the Light Brigade Relief
Fund, and says: “When I am no longer even a memory, just a name, I hope my voice may
perpetuate the great work of my life. God bless my dear old comrades of Balaclava and
bring them safe to shore. Florence Nightingale.”

Museums

Many exhibits and artifacts are displayed as well as a bit of folklore with an exhibit
featuring the preserved owl Athena, her little pet and companion who lived in her pocket.
With America’s first female doctor, Elizabeth Blackwell, opened the Women’s Medical
College.

Nightingale’s Environmental Theory

The Environmental Theory by Florence Nightingale 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.
Nightingale discussed the Environmental Theory in her book Notes on Nursing: What it
is, What it is Not. She is considered as the first theorist in nursing and paved the way in
the foundation of the nursing profession we know today.

Major Concepts of Florence Nightingales Theory

The major concepts of Florence Nightingale’s Theory are:

Nursing

“What nursing has to do… is to put the patient in the best condition for nature to act upon
him” (Nightingale, 1859/1992)

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Nightingale stated that nursing “ought to signify the proper use of fresh air, light,
warmth, cleanliness, quiet, and the proper selection and administration of diet – all at the
least expense of vital power to the patient.” She reflected the art of nursing in her
statement that, “the art of nursing, as now practiced, seems to be expressly constituted to
unmake what God had made disease to be, viz., a reparative process.”

Human Beings

Human beings are not defined by Nightingale specifically. They are defined in relation to
their environment and the impact of the environment upon them.

Environment

The physical environment is stressed by Nightingale in her writing. In her theory,

Nightingale’s writings reflect a community health model in which all that surrounds
human beings is considered in relation to their state of health.
Health

Nightingale (1859/1992) did not define health specifically. She stated, “We know nothing
of health, the positive of which pathology is negative, except for the observation and
experience. Given her definition that of the art of nursing is to “unmake what God had
made disease,” then the goal of all nursing activities should be client health.

She believed that nursing should provide care to the healthy as well as the ill and
discussed health promotion as an activity in which nurses should engage.

Subconcepts of the Environmental Theory

The following are the subconcepts of Florence Nightingale’s theory:

Conceptual Framework of Nightingale’s Environmental Theory. Note that the client, the nurse,
and the major environment concepts are in balance; that is; the nurse can manipulate the
environment to compensate for the client’s response to it. The goal of the nurse is to assist the
patient in staying in balance. If the environment of a client is out of balance, the client expends
unnecessary energy.

Health of Houses

“Badly constructed houses do for the healthy what badly constructed hospitals do for the
sick. Once ensure that the air is stagnant and sickness is certain to follow.”

Ventilation and Warming

“Keep the air he breathes as pure as the external air, without chilling him.”

Nightingale believed that the person who repeatedly breathed his or her own air would
become sick or remain sick. She was very concerned about “noxious air” or “effluvia”
and foul odors that came from excrement. She also criticized “fumigations,” for she
believed that the offensive source, not the smell, must be removed.

The importance of room temperature was also stressed by Nightingale. The patient
should not be too warm or too cold. The temperature could be controlled by an
appropriate balance between burning fires and ventilation from windows.

Light

Nightingale believed that second to fresh air, the sick needed light. She noted that direct
sunlight was what patients wanted.

Noise

She stated that patients should never be “waked intentionally” or accidentally during the
first part of sleep. She asserted that whispered or long conversations about patients are
thoughtless and cruel. She viewed unnecessary noise, including noise from female dress,
as cruel and irritating to the patient.
Variety

She discussed the need for changes in color and form, including bringing the patient
brightly colored flowers or plants. She also advocated rotating 10 or 12 paintings and
engravings each day, week, or month to provide variety for the patient. Nightingale also
advocated reading, needlework, writing, and cleaning as activities to relieve the sick of
boredom.

Bed and Bedding

Nightingale noted that an adult in health exhales about three pints of moisture through
the lungs and skin in a 24-hour period. This organic matter enters the sheets and stays
there unless the bedding is changed and aired frequently.

She believed that the bed should be placed in the lightest part of the room and placed so
the patient could see out of a window. She also reminded the caregiver never to lean
against, sit upon, or unnecessarily shake the bed of the patient.

Personal Cleanliness

“Just as it is necessary to renew the air round a sick person frequently to carry off morbid
effluvia from the lungs and skin, by maintaining free ventilation, so it is necessary to
keep pores of the skin free from all obstructing excretions.”

“Every nurse ought to wash her hands very frequently during the day.”

Nutrition and Taking Food

Nightingale noted in her Environmental Theory that individuals desire different foods at
different times of the day and that frequent small servings may be more beneficial to the
patient than a large breakfast or dinner. She urged that no business be done with patients
while they are eating because this was a distraction.
Chattering Hopes and Advice

Florence Nightingale wrote in her Environmental Theory that to falsely cheer the sick by
making light of their illness and its danger is not helpful. She encouraged the nurse to
heed what is being said by visitors, believing that sick persons should hear the good news
that would assist them in becoming healthier.

Social Considerations

Nightingale supported the importance of looking beyond the individual to the social
environment in which he or she lived.

Environmental Factors

In Florence Nightingale’s Environmental Theory, she identified five (5) environmental

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

1. Pure fresh air – “to keep the air he breathes as pure as the external air without
chilling him.”
2. Pure water – “well water of a very impure kind is used for domestic purposes.
And when epidemic disease shows itself, persons using such water are almost
sure to suffer.”
3. Effective drainage – “all the while the sewer maybe nothing but a laboratory
from which epidemic disease and ill health is being installed into the house.”
4. Cleanliness – “the greater part of nursing consists in preserving cleanliness.”
5. Light (especially direct sunlight) – “the usefulness of light in treating disease is
very important.”

The factors posed great significance during Nightingale’s time when health institutions
had poor sanitation, and health workers had little education and training and were
frequently incompetent and unreliable in attending to the needs of the patients.
Also emphasized in her environmental theory is the provision of a quiet or noise-free and
warm environment, attending to patient’s dietary needs by assessment, documentation of
time of food intake, and evaluating its effects on the patient.

Deficiencies in these five factors produce illness or lack of health, but with a nurturing
environment, the body could repair itself.

Analysis of the Environmental Theory

In the era that we are in today, we are faced with environmental conditions beyond what
was ought to be natural and nurturing. Some of the global environmental issues that we
have now are global warming, nuclear radiation threats, man-made environmental
calamities, and pollution. From these occurrences, Nightingale’s model seemed to be
very ideal. Her concept of providing fresh air to patients is in question with today’s
industrialization effects.

In addition to the analysis of the concept of ventilation, it is not always beneficial for all
clients to have fresh air. Natural air has its impurities which in turn may infect open
wounds and drainages such as in burns.

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With the idea of providing light, the light emitted by the sun today is proven to be
harmful already because of the destruction of the ozone layer of the Earth. Exposing the
patient constantly to direct sunlight may then be more destructive to the patient’s
betterment than being beneficial.

It is true that a healthy environment heals as what Nightingale stated but the question
now is how our environment would remain health amidst the negative effects of the
progress of technology and industrialization.

Since the applicability of some of the concepts to specific situations today is non-feasible,
development of this theory is utterly needed to accommodate the changes of the
environment that we currently have. Still, above all this, it is very much clear the
Nightingale’s Environmental Theory is superb as a starting point of the progression of
our profession and served as a catalyst for nursing’s improvement.

Assumptions of Florence Nightingale’s Theory

The assumptions of Florence Nightingale in her Environmental Theory are as follows:

 Florence Nightingale believed that five points were essential in achieving a

healthful house: “pure air, pure water, efficient drainage, cleanliness, and
light.”
 A healthy environment is essential for healing. She stated that “nature alone
cures.”
 Nurses must make accurate observations of their patients and be able to report
the state of the patient to the physician in an orderly manner.
 Nursing is an art, whereas medicine is a science. Nurses are to be loyal to the
medical plan, but not servile.

Strengths

The language Florence Nightingale used to write her books was cultured and flowing,
logical in format, and elegant in style. Nightingale’s Environmental Theory has broad
applicability to the practitioner. Her model can be applied in most complex hospital
intensive care environment, the home, a work site, or the community at large. Reading
Nightingale’s Environmental Theory raises consciousness in the nurse about how the
environment influences client outcomes.

Weaknesses

In Nightingale’s Environmental Theory, there is scant information on the psychosocial

environment when compared to the physical environment. The application of her
concepts in the twentieth century is in question.
Conclusion

The Environmental Theory of Nursing is a patient-care theory. It focuses on the alteration

of the patient’s environment in order to affect change in his or her health. Caring for the
patient is of more importance rather than the nursing process, the relationship between
patient and nurse, or the individual nurse.

In this way, the model must be adapted to fit the needs of individual patients. The
environmental factors affect different patients unique to their situations and illnesses, and
the nurse must address these factors on a case-by-case basis in order to make sure the
factors are altered in a way that best cares for an individual patient and his or her needs.

Biography of Hildegard E. Peplau

Hildegard Elizabeth Peplau (September 1, 1909 – March 17, 1999) was an American
nurse who is the only one to serve the American Nurses Association (ANA) as Executive
Director and later as President. She became the first published nursing
theorist since Florence Nightingale.

Peplau was well-known for her Theory of Interpersonal Relations, which helped to
revolutionize the scholarly work of nurses. Her achievements are valued by nurses
all over the world and became known to many as the “Mother of Psychiatric
Nursing” and the “Nurse of the Century.”

Early Life

Hildegard Peplau was born on September 1, 1909. She was raised in Reading,
Pennsylvania by her parents of German descent, Gustav and Otyllie Peplau. She was the
second daughter, having two sisters and three brothers. Though illiterate, her father was
persevering while her mother was a perfectionist and oppressive. With her young age,
Peplau’s eagerness to grow beyond traditional women’s roles was precise. She considers
nursing was one of few career choices for women during her time. In 1918, she witnessed
the devastating flu epidemic that greatly influenced her understanding of the impact of
illness and death on families.

Education

Hildegard Elizabeth Peplau

Hildegard Elizabeth Peplau

When the autonomous, nursing-controlled, Nightingale era schools came to an end in the
early 1900s, schools then were handled by hospitals, and the so-called formal “book
learning” was put down. Hospitals and physicians considered women in nursing as a
source of free or inexpensive labor. Exploitation was very common by nurse’s employers,
physicians and educational providers.

In 1931, she graduated in Pottstown, Pennsylvania School of Nursing. Peplau earned a

Bachelor’s degree in interpersonal psychology in 1943 at Bennington College in
Vermont. She studied psychological issues together with Erich Fromm, Frieda Fromm-
Reichmann, and Harry Stack Sullivan at Chestnut Lodge, a private psychiatric hospital in
Maryland. Peplau held master’s and doctoral degrees from Teachers College, Columbia
University in 1947.

Career and Appointments of Hildegard Peplau

Hildegard Peplau - Pottstown Hospital School of Nursing Yearbook Photograph 1931

Hildegard Peplau – Pottstown Hospital School of Nursing Yearbook Photograph 1931

After graduating in Pennsylvania, Hildegard Peplau then worked as a staff nurse in her
place and in New York City. A summer position as a nurse for the New York University
summer camp led to a recommendation for Peplau to become the school nurse at
Bennington College in Vermont, where she earned a Bachelor’s degree in interpersonal
psychology. Peplau’s lifelong work was largely focused on extending Sullivan’s
interpersonal theory for use in nursing practice.

She served in the Army Nurse Corps and was assigned to the 312th Field Station Hospital
from 1943-1945 in England, where the American School of Military Psychiatry was
located. She met and worked with all the leading figures in British and American
psychiatry. After the war, Peplau was at the table with many of these same men as they
worked to reshape the mental health system in the United States through the passage of
the National Mental Health Act of 1946.

“Nursing has made great progress from being an occupation to becoming a profession in
the 20th. Century. As the 21st. Century approaches, further progress will be reported and
recorded in Cyberspace – The Internet being one conduit for that. Linking nurses and
their information and knowledge across borders – around the world – will surely advance
the profession of nursing much more rapidly in the next century”

– Hildegard Peplau

Peplau was certified in psychoanalysis by the William Alanson White Institute of New
York City. In the early 1950s, she developed and taught the first classes for graduate
psychiatric nursing students at Teachers College. Peplau was a member of the faculty of
the College of Nursing at Rutgers University from 1954 until her retirement in 1974. She
was a professor emerita at the said university.

Hildegard Peplau 2

Peplau was known for her “Interpersonal Relations Theory.”

At Rutgers University, she created the first graduate level program for the preparation of
clinical specialists in psychiatric nursing. She was a prolific writer and was equally well
known for her presentations, speeches, and clinical training workshops. Peplau
vigorously advocated that nurses should become further educated so they could provide
truly therapeutic care to patients rather than the custodial care that was prevalent in the
mental hospitals of that era.

During the 1950s and 1960s, she supervised summer workshops for nurses throughout
the United States, mostly in state psychiatric hospitals. In these seminars, she taught
interpersonal concepts and interviewing techniques, as well as individual, family, and
group therapy. Peplau was an advisor to the the World Health Organization and was a
visiting professor at universities in Africa, Latin America, Belgium, and throughout the
United States. A strong advocate for graduate education and research in nursing, Peplau
served as a consultant to the U.S. Surgeon General, the U.S. Air Force, and the National
Institute of Mental Health. She participated in many government policy making groups.
Biography of Virginia Henderson

Virginia Avenel 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.

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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).

Henderson when she was a research associate at Yale

Henderson when she was a research associate at Yale

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.

Basic Principles of Nursing Care

Book cover of Basic Principles of Nursing by Virginia Henderson

Book cover of Basic Principles of Nursing by Virginia Henderson

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

000000000000000000000000000000000000000000000000000000000000000000000000
0000000000000000000The 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.

Death

Henderson died on March 19, 1996 at a hospice in Branford, Connecticut, she was 98.
Her remains were interred in her family’s plot of the churchyard of St. Stephen’s
Church, Forest, Bedford County, Virginia.

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.
Click image to enlarge.
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.
 ADVERTISEMENTS

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.