Since 1960 when the International Council of Nurses (ICN) first published Basic Principles of Nursing Care, a work their Nursing Service Committee commissioned, Virginia Henderson’s description of nursing and the unique function of the nurse has been used throughout the world to standardize nursing practice.Basic Principles of Nursing Care was written just after the 1955 publication of Harmer & Henderson’s Textbook of the Principles and Practice of Nursing, 5th edition (Henderson, 1955), which until 1975 was the most widely used nursing textbook in English and Spanish speaking worlds. A third book, The Nature of Nursing (Henderson, 1966, 1991), included implications for how nursing could provide direction for four essential functions of a profession: service, education, research, and leadership. Henderson’s model of nursing is most succinctly presented in the ICN’s Basic Principles of Nursing Care, a work available in 30 of the world’s languages. She says:
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 the person would perform unaided given the necessary strength, will or knowledge. And to do this in such a way as to help the individual gain independence as rapidly as possible. (Henderson, 2004, p. 12)
Basic nursing care means helping patients with activities such as eating and drinking adequately, eliminating body wastes, and moving and maintaining desirable postures or providing conditions under which he can perform them unaided. Henderson also described conditions in persons that always affect basic needs such as nursing care of newborn or the dying.
There are also pathological states (as contrasted with specific diseases) that modify basic need, such as marked disturbances of fluid and electrolyte balance including starvation states, pernicious vomiting, and diarrhea, acute oxygen want, and shock (including “collapse” and hemorrhage). According to Henderson’s model, 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, a “voice” for those too weak to speak, and so on. (Henderson, 1997, pp. 23–24)
That this model was first authored in 1950 when Henderson was preparing the 5th edition of her textbook is noteworthy. The era of the antibiotic made much of what Nightingale wrote in Notes on Nursing about the importance of nature obsolete. Needed was a description of nurses’ functions that built on Nightingale’s intervention-focused book and extended it into the era of science and biotechnology. Basic Principles of Nursing Care [BPNC] and Notes on Nursing [NN] are remarkably similar in content. Eat and drink adequately in BPNC became the modern version of the “Taking food” and “What food?” sections of NN, for example. Henderson continued the emphasis on interventions but shifted the ideal performer of procedures from nurses to nurse-educated and nurse-supported patients, encouraging independence, especially important in chronic illness. Neither doctors nor hospitals are required to practice nursing under this model.
Gladys Nite (Nite & Willis, 1964) explicitly tested the Henderson model of nursing in clinical experiments of effective nursing care for cardiac patients. Brooten (Brooten & Naylor, 1995) and Naylor (Naylor et al., 1999) implicitly examined this model in clinical research. The “nurse dose” which they seek to measure may indeed be some quantified measure of this unique function. Similarly, other researchers seem to be addressing the universality of this unique nurses’ function in their examination of the effectiveness of nurses in different roles and in different settings (S. Douglas et al., 1995; Landefeld, Palmer, Kresevic, Fortinsky, &Kowal, 1995; Olds et al., 1997, 2002).
Henderson went on from this work to prepare a critique of nursing research and an index of the English-language nursing literature written between 1900 and 1960. When finished, she revised the textbook which she had twice previously redone. Remarkably, the textbook incorporated countless citations from the professional literature synthesizing what was known about the nursing profession up to its 1978 publication date. Principles and Practice of Nursing, 6th edition (Henderson & Nite, 1978), organized a disparate literature around her model of nursing which had not appreciably altered in the nearly 20 years since it first appeared. Rather than changing her mind based on her close reading of the literature, Henderson synthesized the citations into a coherent reference document, an evidence-based text as it were.
Three of Henderson’s papers extend her model; two by validation, the other by contradiction. The Concept of Nursing (Henderson, 1978) specifically addressed her work as a model. Preserving the Essence of Nursing in a Technological Age (Halloran, 1995, p. 96) extended her ideas to include services nurses provide in intensive care units and was organized using the four essential professional functions first depicted in The Nature of Nursing: practice, education, research, and leadership. In Nursing Process—Is the Title Right?, Henderson (Halloran, p. 199) contradicted what had become the accepted alternative to the use of the word “nursing” by arguing that the word “process” unnecessarily constrained professional vision and precluded experience, logic, expert opinion, and research as bases for practice.
The most complete exposition of Henderson’s model of nurses’ function and nursing practice is contained in the 6th edition of Principles and Practice of Nursing. This reference text is a modern book largely unknown to the American nurses who today struggle with many of the issues of professional practice elaborated on in the documents related to the Henderson model.