The Nursing Theories of Faye Abdellah and Virginia Henderson: Concept

The Nursing Theories of Faye Abdellah and Virginia Henderson: Concept Comparison and Analysis

Introduction

Nursing theories pivot on the nursing metaparadigm, which is based on the four core concepts of person, environment, health,
and nursing (Keefe, n.d.). As a nurse thinks about and delivers nursing care to patients, she incorporates core concepts that represent how
she views the practice of nursing and that are “designed to lead a nurse to actions that guide her practice” (Keefe, n.d.). Since core concepts
are the building blocks of nursing theory, they are common to multiple nursing theories. This paper will examine the core concept of nursing
as it is expressed in both Faye Abdellah’s and Virginia Henderson’s nursing theories.

Comparison and Analysis of Concept Definitions

The core concept of nursing is viewed very similarly in Abdellah’s and Henderson’s theories. Both Abdellah and Henderson see
the practice of nursing as a problem-solving activity that revolves around the patient’s needs, prompting Meleis to identify both theorists as
“needs theorists” (Kim & Kollak, 1999, pp. 17, 20). While Abdellah focuses her nursing theory more on “humans’ need-related problems,”
Henderson “emphasizes the nurse’s role in complementing and supplementing individual’s needs to maintain independence” (Kim &
Kollak, 1999, p. 17). Abdellah views health from a self-help perspective in which the patient is able to meet his own needs without anyone’s
help, while Henderson focuses more on how the nurse can help the patient meet his needs (Kim & Kollak, 1999, p. 17, 20). Although
Abdellah did not organize the needs she identified into a hierarchy of needs, she noted that necessities such as air, water, food, and so forth
needed to remain at the optimum level; otherwise the patient was said to be in a state of need (Kim & Kollak, 1999, p. 20). Thus, for both
nursing theorists, the meeting of the patient’s needs is at the heart of nursing practice.

Henderson identified 14 basic needs that nursing care is based on (Marriner-Tomey & Alligood, 2005, p. 56). These included
“respiration, nutrition, elimination, body mechanics, rest and sleep, keeping clean and well groomed, controlling the environment,
communication, human relations, work, play, and worship” (Butts & Rich, 2010, p. 391). Henderson defined each of these 14 basic patient
needs in much greater detail, including, for example, pulmonary ventilation, diffusion and transport of gases, regulation of respiration, and
factors that affect normal respiration, such as smoking, age, and obesity as all being components of the respiration need (Butts & Rich,
2010, p. 391). Likewise, she expanded upon the patient’s need for nutrition by explaining that the nurse’s caregiving to the patient included
not only nutrition but also quality of life, dietary essentials, fluid balance, food selection and the optimal diet, conditions that favor digestion
and assimilation, the diet to be used in sickness, and nursing measures related to oral feedings (Butts & Rich, 2010, p. 391). Underlying
Henderson’s set of 14 basic needs was her own definition of nursing, which 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 to do this in such a way as to help him gain independence as rapidly as possible” (Butts & Rich, 2010, p. 395). She did
not contend that the 14 basic needs were the only focus of nursing, however, but rather, she emphasized that “the nurse must get inside the
skin” of each patient in order to understand what that patient needed and then must validate those identified needs with the patient (Butts &
Rich, 2010, p. 397). Thus, for her, the 14 basic needs were primarily categories of needs for the nurse’s reference, so that she could make
sure that no needs were left unaccounted for and addressed. She saw the nurse’s role as one of partnering with the patient to develop a plan
of care, so nursing was far from a mere checklist in her estimation (Butts & Rich, 2010, p. 397).

Abdellah leveraged Henderson’s 14 basic human needs and nursing research to come up with her own list of 21 basic nursing
problems (Marriner-Tomey & Alligood, 2005, p. 56). The 21 problems included the nurse’s providing or facilitating such processes as
hygiene, comfort, the optimal levels of activity and sleep, accident and injury prevention, good body mechanics, oxygenation of all body
cells, maintenance of nutrition and elimination, fluid/electrolyte balance, recognition of physiological responses to disease conditions,
maintenance of regulatory mechanisms and sensory function, identification of positive and negative expressions as well as feelings and
reactions, acknowledgment and understanding of the connection between physical and emotional health, and the maintenance of effective
communication in both verbal and non-verbal modes (Kim & Kollak, 1999, pp. 18-19). Marriner-Tomey and Alligood (2005, p. 57) point
out that Abdellah’s work differs from Henderson’s in that she formulates her problems “in terms of nursing-centered services, which are
used to determine the patient’s needs” and that “her contribution to nursing theory development consists of a systematic analysis of research
reports to formulate the 21 nursing problems that served as an early guide for comprehensive nursing care.” There is room in both of these
theorists’ concepts to include such concepts as civility (Sigma Theta Tau International, 2010) and the use of music as a distractor to reduce
patient anxiety and pain (Joanna Briggs Institute, 2009, p. 13).

In choosing one of these two theories—that of Faye Abdellah—and where and how it may best be applied to nursing practice, it
is notable that Abdellah is the nurse theorist at El Camino Hospital and that her progressive patient care (PPC) approach is applicable to
chronic outpatient dialysis patients. PPC promotes the tailoring of the hospital’s services to ensure that they meet the patient’s needs and has
been described as “caring for the right patient in the right bed with the right services at the right time” (“Faye Glenn Abdellah’s Theory,”
2011). Abdellah’s conceptual model lends itself not only to specialties such as dialysis but also to big-picture issues that cut across
specialties, such as the problem of medical errors and patient-centered care. This makes it adaptable for use in a variety of nursing settings.
However, the model might best be applied in areas where drastic improvement in basic, patient-centered care is needed. An example would
be hospitals’ emergency waiting rooms, where patients may sit without being seen for hours, or even days, at a time and where several
people in recent years have even died before being seen or treated at all. Similarly, Abdellah’s model would be excellent for use in nursing
homes, where care often does not meet her standard of care; since the elderly are not usually in a position to alert anyone to improper or
inadequate care, nursing homes have in large part become rife with workers that do not address the 21 problems that Abdellah’s theory
identifies. The flexibility of Abdellah’s model to stretch to fit such disparate venues of nursing care is attributable to the fact that her 21
problems actually describe “‘arenas’ or concerns of nursing, rather than…relationships among phenomena,” so she distinguishes the practice
of nursing from the practice of medicine, with the former focusing on her 21 nursing problems and the latter emphasizing diseases and their
cures (“Faye Abdellah,” n.d.).

The analysis of Faye Abdellah’s theory in conjunction with Virginia Henderson’s, which preceded it, demonstrates the
importance of considering patients’ needs as problems that must be solved by the nurse. Abdellah’s theory defines the 21 nursing problems
that must be addressed, but it is not confined merely to those; it also takes into consideration the individual patient and his or her unique
needs. Thus, Abdellah’s theory is a good one for helping the whole person, as it encompasses not only physical needs but also emotional
ones, recognizing the link between the two. It even includes the necessity for good communication between the patient and the nurse, which
enables the nurse to understand and verify the patient’s true needs so that she can meet them. In the last analysis, Abdellah’s theory is an
adaptable one that considers the patient not only on the basis of what he needs from a physical standpoint but also for partnering with the
nurse to ensure that his care is tailored to his needs and meets his emotional and other needs.

Virginia Henderson
Definition of nursing
Virginia Henderson viewed the patient as an individual who requires help toward achieving independence and completeness or wholeness of
mind and body. She clarified the practice of nursing as independent from the practice of physicians and acknowledged her interpretation of
the nurse’s role as a synthesis of many influences. Her work is based on (1) Thorndike, an American psychologist, (2) her experiences with
the Henry House Visiting Nurse Agency, (3) experience in rehabilitation nursing, and (4) Orlando’s conceptualization of deliberate nursing
action (Henderson, 1964; Orlando, 1961).
Henderson emphasized the art of nursing and proposed 14 basic human needs on which nursing care is based. Her contributions include
defining nursing, delineating autonomous nursing functions, stressing goals of interdependence for the patient, and creating self-help
concepts. Her self-help concepts influenced the works of Abdellah and Adam (Abdellah, Beland, Martin, & Matheney, 1960; Adam,
1980, 1991).
Henderson made extraordinary contributions to nursing during her 60 years of service as a nurse, teacher, author, and researcher, and she
published extensively throughout those years. Henderson wrote three books that have become nursing classics: Textbook of the Principles
and Practice of Nursing (1955), Basic Principles of Nursing Care (1960), and The Nature of Nursing (1966). Her major contribution to
nursing research was an 11-year Yale-sponsored Nursing Studies Index Project published as a four-volume-annotated index of nursing’s
biographical, analytical, and historical literature from 1900 to 1959.
In 1958, the nursing service committee of the International Council of Nurses (ICN) asked Henderson to describe her concept of nursing.
This now historical definition, published by ICN in 1961, represented her final crystallization on the subject:
“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”
Henderson’s definition of nursing was adopted subsequently by the ICN and disseminated widely; it continues to be used worldwide.
In The Nature of Nursing: A Definition and Its Implications for Practice, Research, and Education, Henderson (1966) proposed 14 basic
needs upon which nursing care is based (Box 5-1).

Henderson’s 14 Needs
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 a normal range by adjusting clothing and modifying the environment.
8. Keep the body clean and well groomed and protect the integument.
9. Avoid dangers in the environment and avoid injuring others.
10. Communicate with others in expressing emotions, needs, fears, or opinions.
11. Worship according to one’s faith.
12. Work in such a way that there is a sense of accomplishment.
13. Play or participate in various forms of recreation.
14. Learn, discover, or satisfy the curiosity that leads to normal development and health, and use the available health facilities.
From Henderson, V. A. (1991). The nature of nursing: Reflections after 25 years (pp. 22–23). New York: National League for Nursing
Press.
Henderson identified three levels of nurse-patient relationships in which the nurse acts as: (1) a substitute for the patient, (2) a helper to
the patient, and (3) a partner with the patient. Through the interpersonal process, the nurse must get “inside the skin” of each of her patients
in order to know what help is needed (Harmer and Henderson, 1955, p. 5). Although she believed that the functions of nurses and physicians
overlap, Henderson asserted that the nurse works in interdependence with other health care professionals and with the patient. She illustrated
the relative contributions of the health care team in a pie graph.
In The Nature of Nursing: Reflections after 25 Years, Henderson (1991) added addenda to each chapter of the 1966 edition with changes
in her views and opinions. Henderson said of her theory that “the complexity and quality of the service is limited only by the imagination
and the competence of the nurse who interprets it” (Henderson, 2006). Her theory has been applied to research in the specialized area of
organ donation (Nicely & DeLario, 2011) and framed a discussion of remembering the art of nursing in a technological age ( Henderson,
1980; Timmins 2011). Henderson’s work is viewed as a nursing philosophy of purpose and function.

Major Concepts of the Nursing Need Theory

Individual
Henderson states that individuals have basic health needs 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
to health is one of her 14 activities for client assistance.
Henderson’s theory supports the private and public health sector’s tasks or agencies to keep people healthy. She believes that society wants
and expects the nurse’s act for individuals who cannot 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 aid in the 14 components or basic human needs.
On the other hand, nurses are key persons in promoting health, preventing illness, and curing. 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 them as soon as possible.”
Her definition of nursing distinguished a nurse’s role in health care: The nurse is expected to carry out a physician’s therapeutic plan, but
individualized care results from 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 is
responsible for assessing the patient’s needs, helping them meet health needs, and providing an environment in which the patient can
perform activity unaided.

Faye Glenn Abdellah

Twenty-one nursing problems
Faye Glenn Abdellah is recognized as a leader in the development of nursing research and nursing as a profession within the Public Health
Service (PHS) and as an international expert on health problems. She was named a “living legend” by the American Academy of Nursing in
1994 and was inducted into the National Women’s Hall of Fame in 2000 for a lifetime spent establishing and leading essential health care
programs for the United States. In 2012, Abdellah was inducted into the American Nurses Association Hall of Fame for a lifetime of
contributions to nursing (ANA News Release, 2012).
Abdellah has been active in professional nursing associations and is a prolific author, with more than 150 publications. During her 40-
year career as a Commissioned Officer in the U.S. Public Health Service (1949 to 1989), she served as Chief Nurse Officer (1970 to 1987)
and was the first nurse to achieve the rank of a two-star Flag Officer (Abdellah, 2004) and the first woman and nurse Deputy Surgeon
General (1982 to 1989). After retirement, Abdellah founded and served as the first dean in the Graduate School of Nursing, GSN,
Uniformed Services University of the Health Sciences (USUHS).
Abdellah considers her greatest accomplishment being able to “play a role in establishing a foundation for nursing research as a science”
(p. iii). Her book, Patient-Centered Approaches to Nursing, emphasizes the science of nursing and has elicited changes throughout nursing
curricula. Her work, which is based on the problem-solving method, serves as a vehicle for delineating nursing (patient) problems as the
patient moves toward a healthy outcome.
Abdellah views nursing as an art and a science that mold the attitude, intellectual competencies, and technical skills of the individual
nurse into the desire and ability to help individuals cope with their health needs, whether they are ill or well. She formulated 21 nursing
problems based on a review of nursing research studies (Box 5-2). She used Henderson’s 14 basic human needs (see Box 5-1) and
nursing research to establish the classification of nursing problems.

Abdellah’s Typology of 21 Nursing Problems

1. To maintain good hygiene and physical comfort
2. To promote optimal activity: exercise, rest, sleep
3. To promote safety through prevention of accident, injury, or other trauma and through prevention of the spread of infection
4. To maintain good body mechanics and prevent and correct deformity
5. To facilitate the maintenance of a supply of oxygen to all body cells
 6. To facilitate the maintenance of nutrition for all body cells
7. To facilitate the maintenance of elimination
8. To facilitate the maintenance of fluid and electrolyte balance
9. To recognize the physiologic responses of the body to disease conditions—pathologic, physiologic, and compensatory
10. To facilitate the maintenance of regulatory mechanisms and functions
11. To facilitate the maintenance of sensory function
12. To identify and accept positive and negative expressions, feelings, and reactions
13. To identify and accept interrelatedness of emotions and organic illness
14. To facilitate the maintenance of effective verbal and nonverbal communication
15. To promote the development of productive interpersonal relationships
16. To facilitate progress toward achievement and personal spiritual goals
17. To create or maintain a therapeutic environment
18. To facilitate awareness of self as an individual with varying physical, emotional, and developmental needs
19. To accept the optimum possible goals in the light of limitations, physical and emotional
20. To use community resources as an aid in resolving problems that arise from illness
21. To understand the role of social problems as influencing factors in the cause of illness
From Abdellah, F. G., Beland, I. L., Martin, A., & Matheney, R. V. (1960). Patient-centered approaches to nursing. New York:
Macmillan. Reprinted with the permission of Scribner, a division of Simon & Schuster.
Abdellah’s work is a set of problems formulated in terms of nursing-centered services, which are used to determine the patient’s needs.
Her contribution to nursing theory development is the systematic analysis of research reports and creation of 21 nursing problems that guide
comprehensive nursing care. The typology of her 21 nursing problems first appeared in Patient-Centered Approaches to Nursing (Abdellah,
Beland, Martin, & Matheney, 1960). It evolved into Preparing for Nursing Research in the 21st Century: Evolution, Methodologies, and
Challenges (Abdellah & Levine, 1994). The 21 nursing problems progressed to a second-generation development referred to as patient
problems and patient outcomes. Abdellah educated the public on AIDS, drug addiction, violence, smoking, and alcoholism.

Major Concepts of 21 Nursing Problems Theory

The model has interrelated concepts of health and nursing problems and problem-solving, which is inherently logical in nature.
Individual
She describes nursing recipients as individuals (and families), although she does not delineate her beliefs or assumptions about the nature of
human beings.
Health
Health, or the achieving of it, is the purpose of nursing services. Although Abdellah does not define health, she speaks to “total health
needs” and “a healthy state of mind and body.”
Health may be defined as the dynamic pattern of functioning whereby there is a continued interaction with internal and external forces that
results in the optimal use of necessary resources to minimize vulnerabilities.
Society
Society is included in “planning for optimum health on local, state, and international levels.” However, as Abdellah further delineates her
ideas, the focus of nursing service is clearly the individual.
Nursing Problems
The client’s health needs can be viewed as problems, overt as an apparent condition, or covert as a hidden or concealed one.
Because covert problems can be emotional, sociological, and interpersonal in nature, they are often missed or misunderstood. Yet, in many
instances, solving the covert problems may solve the overt problems as well.
Problem Solving
Quality professional nursing care requires that nurses be able to identify and solve overt and covert nursing problems. The problem-solving
process can meet these requirements by identifying the problem, selecting pertinent data, formulating hypotheses, testing hypotheses
through collecting data, and revising hypotheses when necessary based on conclusions obtained from the data.