Introduction
Every year more people
have coronary artery bypass graft (CABG) surgery procedures
due to the increased chance of survival, enhanced health, and the potential for
decreased angina. Despite its benefits, patients are radically affected by
the surgery, feeling pain and powerless, especially in the days immediately
following the procedure. Members of their family encounter feelings such as
outrage and depression due to the patients’ dependence upon them. A few
patients become too reliant on their family which can delay their healing, by
becoming inactive with low self-esteem. Patients need to cooperate with the
change in their condition without discouragement and dependence. This is one of
many ways they can help to manage their healing process. Nurses have an
important role in this process due to their interaction with the patients’
regaining independence. Virginia Henderson believed that the nursing process is
the use of the rational approach to solving a problem. This is why I have
chosen to analyze her need theory. She says nurses should follow a logical
approach in order to help patients avoid their feelings of powerlessness after
a procedure like a CABG. Additionally, this theory
focuses on the importance of patients’ independence so that the patients
recover quickly after leaving the hospital (Ahtisham & Jacoline, 2015).
According to Virginia
Henderson, nursing care is different from physician care. Nurses
spend more time with patients that have had a CABG, helping them
to recover, regain their health and good quality of life. The
theory explains the need of care for the patient until the patient is
ready to be independent and take care of himself/ herself. The main idea
of this theory is about encouraging and increasing a patient’s
independence. Immediately following a CABG procedure,
patients are on bed rest for an average of 6-12
hours. A nurse is needed, not only for support but to encourage
them by giving them the confidence to do their movements themselves. So,
Henderson has divided nursing activities into 14 parts, whereas nurses’ role is
divided into three parts: as substitutive, complementary, and supplementary
having the goal to help the patient become as independent as possible at the
earliest. This theory can be used by nurses to help patients successfully overcome
their needs and to make them do activities independently. Henderson’s need
theory can effectively be applied individually for every CABG patients care.
Method
Because of some
advantageous features over other models, Gibb’s reflection model has been used
in order to analyze this theory. Gibb’s model involves a cycle of 6 steps that
help improve reflective practice. The steps include 1) action plan, 2)
description, 3) feelings, 4) Evaluation, 5) Analysis, and 6) Conclusion. These
steps can be applied repeatedly in a cyclic order. The most important feature
of this model is that it considers the sphere of emotions and feelings that
play roles in a given event. Besides, this model integrates
all foundation skills of reflection. Although it focuses on reflection on
action, it can be applied to focus on reflection in and before action (Vaughan, 2013).
The reason
behind selecting Gibb’s reflective model is that I wanted to demonstrate the
reflection on my feelings and knowledge that I gained by/from reading about
this theory. I have reflected on this theory in relation to the patients that
have had coronary artery bypass surgery and their present-day needs. “Formal reflection draws on research and theory and provides guidance and
frameworks for practice” (Vaughan, 2013). Critical reflection is thought to be a prerequisite to
change learning that may make transformations in individual understandings and potential
actions. Nurses can especially utilize critical reflection practices for
keeping themselves busy in metacognition for the benefits of their patients
(Eames & Coll, 2010). The critical reflection offers several learning
outcomes such as enhanced learning thinking, and evaluation of self and
communal methods (Smith, 2011).
General Overview
Henderson’s Need theory was derived from
her practice and education in order to define the focus of nursing care towards
the needs of a patient until the patient can care for him or herself (Petiprin,
2016). Patients’ needs were the primary
concern, hence it is called the Need Theory. The Need Theory revolves around
four metaparadigms, such as nursing, health, patient (individual), and
environment (Tourville and Ingalls, 2003). Henderson believed
that there were 14 key components that were necessary for caring patients
whether they were sick or healed. The components covered a wide variety
of aspects including physiological, psychological, spiritual, and social needs.
In order to be healthy, one must be able to perform all of these components. This,
therefore, shows her to have a holistic approach to caring for the needs of
patients (Vera, 2014). An individual needs knowledge and vigor to carry out activities of
daily life and possess the basics for survival. And, an ill person needs help
to recover, become independent, or die calmly and there is a link between body
and mind. As Petiprin (2016) shows, the fourteen components that
it entails are all basic human needs. Without these components, an
individual will not be able to survive physically or will be unable to cope
mentally.
The environment can be a clinic, hospital, or house
where communication is taken place. According to Henderson, the environment influences
a person's bond with family and society. Besides, a healthy individual can
become ill due to some factors, such as air pollution prevalent in the
environment. Within 14 components of Henderson, it is expressed that
a supportive environment is needed in order to avoid dangers, develop normally,
and achieve sleep and rest (Vera, 2014). She defines health as the basic need requiring an
individual to work effectively. Therefore, this theory emphasizes the
significance of maintaining health and preventing illness since the best
possible health may be problematic for some individuals. It also explains how factors
like ethnic, age, ability of mind and emotional control affect the health and
requirements of an individual. The three
major aspects of her model include: 1)
the nurse caring for the patient will care for them until the patient
can care for him or herself; 2)
a nurse will devote themselves to the patient day and night; and 3) the nurse
should be educated at the college level in both science and art (Petiprin,
2016).
Analysis
Description
Virginia
Henderson’s need theory exclusively offers a set of definitions, schemes and
interconnected ideas that provide a systematic mean to look for events by
recognizing reciprocity among them (Mensik, Martin, Scott, & Horton, 2011).
Henderson provided a nursing definition since there were noted differences in
the nursing definitions used by the nurses themselves and the society. This conceptual model follows
the humanistic paradigm, in which it underlines the caring of the ill and the
helpless together with the dying ones. It emphasizes more on what every nurse
have to perform and who must they deal with. Consequently, it involves inter-communication.
Feelings
Henderson defined nursing as having the
function to assist the patient with the performance of the activities that
contribute to good health. She stated that the patient would be able to perform
all 14 components unaided if they were in good health. Henderson’s theory
also entailed the ideas that a nurse is an independent practitioner that is
able to make an independent judgment (Vera, 2014). With regard to patients who have had CABG surgery
procedures are expected to be able to
express the ability to move independently and request for help when required;
show knack to resolve issues and take part in the social activities; avoid negative
thinking about themselves or others. Taking all these factors into account,
Virginia Henderson’s theory meets the criteria and shows useful ways to achieve
the expected goals.
Evaluation
According to
Geroge (2011), the basic concepts put forward by Henderson, such as basic human
needs, interaction, communication, culture, and biophysiology facilitate the
theory to provide a dynamic coverage concerning patients’ need. Despite having
a number of benefits, this theory does not provide a theoretical connection
between physiological and other characteristics of human beings. No
further theory has been derived from the Henderson Need Theory, although extensive research performed on it. This in itself creates doubt regarding
this theory as to whether a testable hypothesis can be formulated from it
(Fawcett & Desanto-Madeya, 2014). This
theory although emphasizes nursing care but lacks to demonstrate the influence
that occurs during nursing care. In other words, it lacks the explanation of
relation among the fourteen components. It also does not include the holistic
approach that not only includes emotional and physical needs of a person but
also spiritual and religious needs of a person (Tourville and Ingalls, 2003). Moreover,
there is no guaranty that there will be further requirements beyond the
requirements specified through the fourteen components of this theory. Actually,
with the changes in the lifestyle and advancement of medical technology, there
must be additional nursing care.
The
holistic approach is one of such needs that is particularly necessary in the case
of CABG patients since this approach supports patients
further than their physical requirements. Moreover, some patients are spiritual and they may use their respective
faiths and principles in dealing with dependence, helplessness, pain, and
illness. Researchers have shown that spiritual people are more optimistic and
healthier. In today’s world, healthcare providers also focus on balancing their
patients’ care by retrieving more spiritual basis of medicine. However,
according to Petiprin (2016),
the theory does not specify a specific religion and
therefore can be applied to each person individually in how they relate to the
world on a spiritual level.
Action
In the modern age,
the holistic approach is an important component of health care. Thus, the lack
of this important part makes the need theory by Henderson outdated and does not
fit aptly in relation to CABG
patients. Overall, Henderson’s need theory is relatively simple nevertheless
generalizable and requires further embellishment. Moreover, modern nursing
facilities and medical technologies should be integrated into this theory.
Literature Review
According to Parker (2001), Henderson’s Need Theory values
self-reliance of a patient. The nursing care helps patients to do their tasks
themselves and take control of their needs unaided. Nursing care does so by
giving and encouraging patients’ strength, supplementing their level of
understanding, and enhancing their willpower. If a patient is still dependent,
it means the basic aim has not been achieved. Henderson emphasizes that nurses
should have the intention to understand their patients properly by learning
about their needs (Marriner-Tomey and Alligood 2006). According to Timber (2001), the Need Theory is
ideally complementary and adaptable for care and its practices are associated
with nursing in a variety of clinical environments. According to Ahtisham and
Jacoline (2015), the Need Theory works to identify caring needs, convey and
assess holistic nursing care. Furthermore, it can be related to any clinical environment.
It can also assist qualified nurses to
gather reliable and legitimate data regarding the customers’ health status,
which consecutively improves the quality of nursing care offered to the
patients. Petiprin (2016) says, “I am very pulled to her theory based on the
application to different aspects of the patient’s care as well as the relation
it has to the current position of nursing that I hold.” Petiprin (2016) further
says Henderson developed her theory from her practice and education. However,
her intention was not to put forward a theory; rather, to provide a specific definition
of nursing practice. This theory put emphasis on patients’ independence to help
them progress from hospital stay as quickly as possible and expedite their
transition to home life.
Application
Henderson's nursing
need theory is a comprehensive theory that can be applied to various types of
nursing practices. It can be applied to nursing practice as a way for nurses to
set aims and purposes on the basis of 14 components. Moreover, if the 14 types
of need are achieved in the case of patients, the performance in nursing care
can be improved a lot. Each of Henderson’s 14 basic concepts can serve as the
base for research, however, those are not written in laboratory terms (Geroge,
2011). I think if combined with the holistic approach and applied through modern
medicine and the latest medical technology, Henderson's need theory can be
great to provide nursing care for CABG patients and this is what I want to do.
Conclusion
The authenticity
of any profession is proven by its capability to create and apply assumptions
and theory. Although nurses enjoy an exquisite status in the society, this
profession has to put forth great effort to declare itself as a highly esteemed
profession. In this scenario, a lot of tough tasks pertaining to patients’ care
have to be performed besides handling patients. The patients in critical care
especially of cardiac patients not only need typical nursing help but also rehabilitation
so they can spend the rest of their life independently. Henderson’s need theory
particularly addresses the patients’ needs and explains nurses’ role
effectively. And, this is why I want to use this theory.
References
Ahtisham, Y.
& Jacoline, S. (2015). Integrating Nursing Theory and Process into
Practice; Virginia’s Henderson Need Theory, 443. International Journal of Caring Sciences.
Eames, C. & Coll, R.K. (2010). Cooperative
education: Integrating classroom and workplace learning. In S. Billett(Ed.), Learning Through Practice, Professional and
Practice-based Learning, 180-196. Dordrecht, Netherlands: Springer Science.
Fawcett, J., & Desanto-Madeya, S. (2014).
Contemporary nursing knowledge: Analysis and evaluation of nursing models and
theories (3rd ed.). Philadelphia, PA: F. A. Davis.
Geroge, J.B. (2011). Nursing theories : the base for professional nursing
practice. Upper Saddle River, N.J.: Pearson Education.
Marriner-Tomey, A. & Alligood, M. R. (2006). Nursing theorists and their work. St. Louis,
Mo.: Mosby/Elsevier, 6th edition.
Mensik, Martin, Scott, & Horton. ( 2011)
Development of a professional nursing framework: the journey toward nursing
excellence, 41(6):259-64. The Journal of
Nursing Administration.
Parker, M. E. (2001). Nursing Theories and Nursing
Practice. Philadelphia: F.A. Davis Company.
Petiprin, A. (2016). Need Theory. Nursing-Theory.org. Retrieved from
http://www.nursing-theory.org/theories-and-models/henderson-need-theory.php
Smith, E. (2011). Teaching critical reflection. Teaching in Higher Education, 16: 2, 211
— 223. London: Taylor & Francis.
Timber, B.
K. (2001).Fundamental skills and concepts in Patient Care, 7th edition, LWW, N.
Tourville, C. & Ingalls, K. (2003). The Living Tree of Nursing Theories. Nursing
Forum an Independent Voice for Nursing. 21-36. Wiley Periodicals, Inc.
Vaughan, P. (2013). The Importance of Reflection with
Improving Care and Improving Standards and The 6Cs. West Midlands: Royal
College of Nursing.
Vera,
M. (2014). Virginia hendersons nursing need theory. Nurselabs.com. Retrieved
from http://nurseslabs.com/virginia-hendersons-need-theory./
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