Virginia Henderson: A contemporary nurse 1897-1996
Kathryn L Roberts
Professor of Nursing, Flinders University, SA
The biographical details and definition of nursing in this editorial are taken from Virginia Henderson, the First Ninety Years by James P Smith (1989), Scutari Press, Harrow Middlesex, UK.
The original definition of nursing was taken from Virginia Henderson's textbook, The Principles and Practice of Nursing.
PP: 090 - 092
Virginia Henderson passed away in April 1996, having lived for ninety-nine years. She has been described as being to 20th century nursing what Florence Nightingale was to the 19th century. Her contribution cannot be over-estimated and her passing will leave a gap that will be hard to fill.
Virginia Henderson was born in Kansas City, United States in 1897, one of eight children and the daughter of a lawyer who represented the Indians. Her mother was the head of domestic affairs in the house and had some education although it was not customary for women to be educated. When Virginia was three-years old the family moved back to the state of Virginia. Her early years were spent at home, where she was educated at her grandfather's school which was conducted on the estate where she lived.
Virginia was motivated to become a nurse because of her brothers' experiences in the First World War. She entered the Army School of Nursing in Washington DC, just before the Armistice of 1918. The program was a 4-month preclinical block followed by training in the wards for the rest of the three years. The curriculum was ahead of its time and included psychiatric nursing and public health nursing. The latter took place in some of the tougher areas of New York City. Following her training she worked as a community nurse for a year. She then went back to the state of Virginia where she was the first nurse educator and worked for five years trying to improve the education program. In 1932, she went to Teacher's College, Columbia University where many of the best American nurse-academics of the post-Second World War period were produced. There, she completed her bachelor's and master's degrees, even electing to do a thesis. Following completion of her master's degree, she remained on the faculty of Teacher's College and tried to promote the teaching of clinical nursing. She then spent five years revising a nursing textbook and developing her definition of nursing. In 1953 she started working on the Nursing Index, an index of all of the nursing literature in the United States. When she finished she was seventy-five years old. Virginia then joined the faculty at Yale University School of Nursing and started a gruelling schedule of consultancies and appearances at professional meetings. Her international reputation flourished and she visited over a dozen countries, including Australia. Numerous awards and accolades have been bestowed on her, including honorary doctorates.
Virginia Henderson's major contributions to nursing were four-fold. Firstly, she revised the Harmer textbook which became first the Harmer and Henderson and then the Henderson and Nite text. It was one of the most successful basic nursing texts ever published. Henderson's second achievement was the development of the Nursing Index, which classified and indexed all nursing literature for the first time. This was a major project that took many years and required a team of people to complete. It was the forerunner of today's nursing indexes such as CINAHL. Virginia's third major contribution was her philosophy of nursing which was adopted by the International Council of Nursing in 1966:
The unique function of the nurse is to assist the individual, sick or well, in the performance of those activities contributing to health or its recovery (or to a peaceful death) that he would perform unaided if he had the necessary strength, will, or knowledge. And to do this in such a way as to help him gain independence as rapidly as possible. This aspect of her work, this part of her function, she initiates and controls; of this she is master. In addition, she helps the patient to carry out the therapeutic plan as initiated by the physician. She also, as a member of a medical team, helps other members, as they in turn help her, to plan and carry out the total program whether it be for the improvement of health, or the recovery from illness, or support in death.
This philosophy was in my opinion very pertinent in that it addressed the need for clients to have a peaceful death rather than to be kept alive at all costs. It acknowledged death as the end of life rather than a failure of the medical profession. This philosophy is especially relevant at this time in the Northern Territory where we are the first part of the English-speaking world to establish a Rights of the Terminally Ill Act. According to Virginia's biographer, James P Smith, she thought that a person ought to be able to practise euthanasia because forcing someone to live who wants to die is wrong. She told Smith that lengthening a life that had no longer any 'meaning, purpose of enjoyment is wrong and that life has no useful purpose when the person says so and when the family agrees that it will be a relief to them when he is dead'. She was obviously open-minded about euthanasia.
Virginia Henderson's fourth major contribution was the development of the fourteen human needs model. This has been a framework for nurses to assess clients, and plan, implement and evaluate care. I have the privilege of teaching a course on nursing and health models and theories for which I often set a model-based care plan as an assignment. Students frequently choose Henderson's fourteen needs model because it is easy to understand and apply.
I had the pleasure of meeting Virginia Henderson when she visited Royal Prince Alfred Hospital in Sydney in 1982, at the age of eighty-five. The School of Nursing under the direction of Joyce Edwards, the principal nurse educator, developed a curriculum for the midwifery course. I had the job of facilitating that development and writing the curriculum. We used Henderson's fourteen needs as a conceptual framework. This was a very unusual approach, as nursing models were not commonly used in Australian nursing curricula.
The hospital was approaching its centenary and a conference and oration were being planned by the Nursing division to celebrate the event. Because of Virginia's involvement in the curriculum through her model, Yvonne Winter, the Director of Nursing and Ms Edwards invited Miss Henderson to give the Centenary Nursing Oration at the Great Hall, University of Sydney. It was a momentous occasion. I will never forget that figure, short of stature, who commanded the whole audience as she gave her oration in her Southern accent. Even my husband, who is not easily impressed, was spellbound. The night after the oration, the organising committee and Miss Henderson went out to dinner together, during which she further captured the hearts of all present. She was a great storyteller. However, like all truly great people, she was very modest about her own achievements.
James P Smith in his book Virginia Henderson, the First Ninety Years tells of Virginia's impressions of Australia during that trip. She thought that Australia was 'a very vital society that was making very rapid changes and had accomplished much'. She considered that she had been given great hospitality during that visit and she enjoyed the workshop that she took part in. She was impressed with the male nurses and that nursing by males was 'well-received and encouraged'. She was also impressed with our National Health Insurance scheme and felt that it was far ahead of anything that the United States had achieved. However, Virginia apparently thought it was unfortunate that the college-based nursing education programs were not very well-attended, and attributed that to the good pay given to student nurses in hospital schools of nursing. She thought that she was probably in on the beginnings of the transfer to the tertiary sector, and remembered talking with 'young politicians who were ready to discuss... the possibility of radical changes in nursing education'. She considered that there was at that time very little nursing research in Australia.
Virginia Henderson was a nurse who was ahead of her time. When nursing was just starting its long battle to become a profession, she was a leader of the struggle. According to Smith, Virginia recognised that in order to be a discipline, nursing must encourage more research and have its own body of knowledge, although she did not believe in over-intellectualising nursing. Yet, she cautioned us never to forget our true function - caring for the patient/client. She insisted on nursing being centred and not losing track of its meaning through obscure terminology. She believed that what nursing needs is 'some measurement of the effect of what nurses are doing and the effect on the receiver of that care'.
Virginia Henderson was unique. She was a scholar and researcher who promoted the value of clinical practice and the importance of clinical teaching. She was also beloved by many friends. She was skilled with her hands not only in nursing but in her personal life; as a skilful and artistic cook, dressmaker and interior decorator. Virginia Henderson will never be forgotten while nurses remember her philosophy of the unique role of the nurse.