Virginia Henderson’s Need Based Theory and 

Practice
Implications
According to Nicely and DeLario (2010) Virginia Henderson’s theory, Need Based, which
is derived from the Principles and Practice of Nursing is a grand theory that focuses on
nursing care and activities of daily living. This theory is appropriate to my future practice
setting as a Family Nurse Practitioner within the Emergency Department or Fast
Track/Urgent Care setting. This theory is applicable within this setting since “meeting
patient needs in the areas of respiration, nutrition, elimination, body mechanics, rest and
sleep, keeping clean and well groomed, controlling the environment, communication,
human relations, work, play, and worship (Masters, 2015, p. 384), as these will be
advanced nursing care areas that I will need to promote for my patients basic needs.

Henderson’s Background and Theory Development

Virginia Henderson, born in 1897, was a world renowned Nurse educator, researcher
and author of many nursing textbooks whose career spanned 60 years; considered by
many as the modern day Florence Nightingale (Masters, 2015). A profound change
occurred in her life which was around the time of WW one, during this time her nursing
experience evolved while in school which resulted in obtaining a bachelors and a
masters in nurse education (Masters, 2015). This experience was able to help her see a
vision for basic nursing care with patient focus on patient independence with activities
of daily living (ADLs), being the basis of her framework and practice. Henderson became
a professor at Yale University where she wrote many nursing textbooks that emphasized
nursing care, studies, principles and practice (Masters, 2015). She was able to define her
personal nursing theory and create the theory that focused on basic nursing care and
patients ADL’s. Encouraged by her nursing research she was able to speak around the
world and focused on an international approach for better patient care (Masters, 2015).
According to Masters (2015) Virginia Henderson received several honorary degrees
during her respectable nursing career which included the Christiane Reimann Prize from
the International Council of Nursing.

Phenomenon of Nursing and Common Problems

The common problems of Virginia Henderson’s need based theory, this theory outlines
the 14 components of fundamental nursing care and interventions that patients have or
use as part of their independence and ADLs (Masters, 2015). As a future APRN the
common problems that are resolved are 14 components that maintain the patient’s
physical functions, safety and maintaining a sense of wellbeing and finding oneself in
relation to where they see themselves in life (Masters, 2015).
Explanation, Definition and Interpretation of Concepts and the Four
Metaparadigms
Henderson made an assumption of her work that it was not a nursing theory so she did
not fully identify her concepts but researchers were able to come up with concepts from
her work that actually follow the common metaparadigm’s of nursing which she
included within her definition of nursing. According to Masters (2015), Virginia “did not
intend to develop a theory of nursing, she did not develop the interrelated theoretical
statements or operational definitions necessary to provide theory testability (p. 390)”.
Concepts include person, environment, health and nursing. Person is defined “as the
patient who is composed of biological, psychological, sociological, and spiritual
components (Masters, 2015, p. 387)”. These compositional segments are not separate
entities but help to assist the nurses towards interventions for the 14 components of
care, the person and family are not separate either but are considered a whole item
(Masters, 2015). Virginia Henderson was able to keep all concepts of theory and
definition consistent throughout since they overlapped and interrelated with each other
to include a whole person aspect.

Environment is important to a person’s perception of health and wellbeing but can also
affect a person’s physical as well as mental wellbeing. Henderson identified a person’s
environment as external elements that help to mold and shape an organisms life and
physical change; three areas of environment that are important are biological, physical
and behavioral (Masters, 2015). Biological includes anything that is living and breathing
organism, such as flora and vertebrate, physical components like basic elements for life
such as the sun, elemental chemicals and compounds. Both physical and biological
elements work harmoniously together in symbiosis, when something changes it affects
the whole ecological system and puts a strain on the symbiotic relationship of the
physical and biological environment (Masters, 2015). Behavioral health influences the
person and is the last component of environment; influencers include socioeconomic
elements, political, cultural, and spiritual aspects.

Health was not a component of Henderson concept that was clearly defined but
Henderson did imply that health was in relation to one’s independence (Masters, 2015).
Basically, the 14 components of basic needs relate to the persons health as health
relates to independence with activities of daily living.

Nursing is very clearly defined by Virginia Henderson and she has one of the best
known definitions of nursing. According to Virginia Burggraf (2012) Virginia Henderson
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 (or 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.

As for advanced practice nursing fields Virginia Henderson was a proponent for nurses
to be independent practitioners she may have not wanted full practice independence as
she was not for nurses taking on what she perceived as physician duties such as
diagnosis, treatment, and making judgment calls (Masters, 2015).

Proposition of Concepts
Masters (2015) suggest that nurses are viewed as a helper, assistant and companion to a
patient’s health role and wellbeing. The relationship aspect is that when a patient is sick
the nurse helps the patient to get better and recover, while the patient is in
rehabilitation role the nurse assists the patients in achieving independence. Lastly the
nurse is a companion during planning of care, goal setting, and preventive maintenance
initiatives.

Assumptions of Needs Theory

According to Masters (2015) there are seventeen assumptions of the Needs theory that
were implicated from Henderson’s theory they include: Nurses must assist people with
illnesses; nurses must collaborate within an interdisciplinary team and become
independent professionally from the physician; 14 concepts of nursing describe patient
needs and complete nursing functions; goals are achieved with a symbiotic relationship
between patient and nurse with health promotion as the nurses main goal; patient and
family are one with mind and body being one within the person; assist patient with
independence while the patient controls their physiological and psychological harmony;
people function in health at all times and must maintain independence and
relationships; people maintain health status with knowledge and awareness; illness
effects environment conditions and nurses should maintain a safe environment; nurses
must be culturally competent and must maintain best practice methods while relying on
evidence-based research methods.

As explained above the four major concepts were defined by Virginia Henderson that
also describes the four metaparadigm’s as Henderson theory is the foundation of
nursing practice. Henderson theory does include sub-concepts which will be explained.
These 14 sub-concepts are: normal respiration, proper nutrition and hydration, waste
elimination and management, mobility for posture maintenance, sleep and relaxation,
proper appearance and grooming, thermoregulation through external factors, safe
environment and preventive injury, communicate emotional concerns and distress,
spiritual worship, career leading to achievement, recreational activities, and utilization of
health resources and using healthcare facilities (Vera, 2014b). These are all relevant
elements to an APRN as these can be used within assessment towards finding the
patient’s independence level and to assess patient’s assistance in obtaining or
maintaining activities of daily living for basic needs (Masters, 2015).

Theory Sub-concepts in Practice and Guidance of Nursing Actions

Utilizing Virginia Henderson’s basic needs theory and its 14 concepts will be beneficial in
my practice as a new Family Nurse Practitioner. As I would like to work within the
emergency department, putting into action clinical provider interventions would lead to
examples such as: concept of breathing normally would lead me to administer my
patient oxygen with an Albuterol treatment and treat with intravenous Solu-Medrol.

Eating and drinking appropriately, proper nutrition is vital for diabetes management,
weight management, heart health, wound healing, autoimmune disease, and patients
overall health.

Body waste removal, imbalanced removal of body waste can indicate if there is an
organism illness such as C. difficile, being aware of normal elimination methods and
treating with antifungals and antibiotics with probiotic treatment for maintenance for
good gut health.

Movement and mobility, it is important to maintain my patients independence so

splinting fractures from sports injuries, or advising low impact exercise and flexibility
exercises to arthritic and osteoporosis patients are crucial to my practice development.

Sleep and relaxation is important sub-concept of Henderson theory, maintaining my

patients sleep rhythm and patterns by decreasing external stimuli while my patient is in
the ED at night, and providing privacy and comfort during the day and more importantly
at night will allow a calmer and more enhanced patient experience.

NursingAnswers.net can help you!

References

Burggraf, V. (2012). Overview and summary: The new millennium: Evolving and
emerging nursing roles. OJIN: The Online Journal of Issues in Nursing, 17(2).
doi:10.3912/OJIN.Vol17No02ManOS

Masters, K. (2015). Models and theories focused on nursing goals and functions. In J. B.
Butts, & K. L. Rich (Eds.), Philosophies and theories for advanced nursing practice (2nd ed.,
pp. 377-407). Burlington, MA: Jones & Bartlett Learning.
Nicely, B., & DeLario, G. T. (2011). Virginia henderson’s principles and practice of nursing
applied to organ donation after brain death. Progress in transplantation, 21(1), 72-77.

Vera, M. (2014). Virginia henderson – 

Virginia Henderson’s Need Theory

Virginia Henderson developed the Nursing Need Theory 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 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 to apply the physical, biological, and social sciences and the
development of skills based on them.” (Henderson, 1960)

Assumptions of the Need Theory

Virginia Henderson’s Need Theory assumptions 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 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 in keeping the people healthy. She believes that society wants and expects
the nurse’s acting 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 any aid in the 14 components or basic human needs.

On the other hand, nurses are key persons in promoting health, preventing 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 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 has the responsibility to assess the patient’s needs, 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 nursing
approach covering the physiological, psychological, spiritual, and
1. eleis Ibrahim Afaf (1997). Theoretical Nursing: Development & Progress 3rd
ed. Philadelphia, Lippincott.
2. Henderson, V. (1966). The nature of nursing. In George, J. (Ed.). Nursing
theories: the base for professional nursing practice. Norwalk, Connecticut:
Appleton & Lange.
3. Henderson, V. (1991). The nature of nursing: Reflections after 25 years. In
McEwen, M. and Wills, E. (Ed.). The theoretical basis for nursing. USA:
Lippincott Williams & Wilkins.
An evaluation of Henderson's nursing needs model and how it
can be adapted for use in veterinary nursing
Anarosa Wallace, Marie Jones
Friday, October 2, 2020
Henderson's nursing needs model is a nursing model of care that is used in human
nursing. It is based on 14 fundamental needs that are said to involve every aspect of
the patient. Henderson believes that if nursing interventions use these 14
fundamental needs as a framework, this will aid the patient in becoming independent
again, which is the overall aim. However, as Henderson's model was intended for
human use, there are aspects that are not appropriate for use in veterinary patients.
Therefore, this article illustrates how it can be adapted for use in animals, using the
nursing process as a structure.

Figure 1 The nursing process (Orpet, 2011).

A nursing model is a description of how to plan, systematically implement and evaluate

nursing care (Jeffery, 2006). They are increasingly being introduced allowing veterinary
nurses to develop their skills (Wager and Welsh, 2013) in implementing nursing care for
veterinary patients, providing a more holistic approach, to ensure aspects of care are less
likely to be overlooked. Nursing models ensure that nursing care is patient-orientated, rather
than primarily focusing on their presenting problem (Jeffery, 2006). For example, the
patient-orientated approach of a feline patient in heart failure would take into account their
stress levels, which could have a negative impact on their condition compared with just
focusing on their heart rate, pulse quality and respiratory rate. Care plans allow nurses to
work towards clear goals, but also enable different healthcare professionals, such as
veterinary surgeons and physiotherapists, to have a better understanding of how the patient
is coping in the hospital as they can clearly see what nursing interventions are being carried
out (Bowes, 2015).

It is important to distinguish between a nursing model and the nursing process: the nursing
process uses five steps in a cyclical manner to outline how nursing care is structured. This
allows veterinary nurses to continuously evaluate the patient and create a framework for
how the nursing care is approached (Figure 1). Nursing models guide nurses in the
decision-making associated with the steps of the nursing process; when used in conjunction
with the nursing process they can enable nurses to deliver a high standard of individualised
patient care, as a nursing model incorporates aspects that are missing from the nursing
process (Lock, 2011). Nurses must consider numerous, potentially competing factors, when
making decisions to meet patient needs (Tanner, 2006). For instance, the nurse caring for a
patient with a fractured femur would have to consider their need to urinate and defecate
alongside their anorexia as a result of the pain from the fracture.
Figure 1 The nursing process (Orpet, 2011).

There is only one nursing model made specifically for application in animals compared with
those used in human nursing (Nelson and Welsh, 2015). This model, designed by Orpet
and Jeffery, is The Ability Model; it focuses on 10 abilities that the patient should be able do,
including the ability to eat, drink and urinate (Nelson and Welsh, 2015). This article will
focus on Henderson's nursing needs model and how this can be adapted for use in
veterinary patients, using the nursing process as a framework.

Nursing needs model

Virginia Henderson was an American theorist who believed that the patient's most important
aspect was their ability to be as independent as when they are in full health (Gonzalo,
2014). The priority of her nursing care was therefore to assist the patient in regaining their
independency (Ahtisham and Sommer, 2015). She shaped the idea that each patient has
14 fundamental needs and these provide the basis for effective nursing interventions to be
developed (Ahtisham and Sommer, 2015). The fundamental needs are shown in Table 1.
Table 1 The 14 fundamental needs
Table 1 The 14 fundamental needs

1 Physiological needs 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 Psychological needs Communicate with others in expressing emotions, needs, fears or opinions

11 Spiritual and moral Worship to one's faith

needs

12 Sociological needs Work in such a way that there is a sense of accomplishment

13 Play or participate in various forms of recreation

14 Psychological needs Learn, discover or satisfy the curiosity that leads to normal development and health, and use
the available health facilities

(Alligood, 2014)
Henderson organised the nursing needs into different categories: physiological,
psychological, spiritual and moral and sociological (Ahtisham and Sommer, 2015). They are
structured in this way because Henderson believed that these categories are different
domains of the individual (Pearson, 2012).

Nursing has a holistic approach to focus on the patient as a whole, rather than just their
presenting problem, which is the approach when using the medical model (Jeffery, 2006).
Henderson's nursing theory supports this by maintaining a holistic approach through
highlighting how nursing care should consider different components rather than just the
physiological needs. For example, how the psychological needs such as learning and
communicating should be considered when aiding the patient to become independent, as
their health is influenced by this. For example, a patient needs to communicate with the
nurse to express their need to eliminate body waste. Additionally, Henderson says the
patient's need to learn, leads to normal development (Petiprin, 2016). This holistic approach
allows the nursing care for each animal to be individualised, as the needs for each patient
will be slightly different.
Nursing assessment
The first stage of the nursing process is carrying out a nursing assessment. During this
stage, details about the patient's life and routine can be identified so nursing care can be
individualised in a way to benefit them (Orpet and Jeffery, 2006). This can be carried out
during the admission of the patient; the nurse can ask the owner a series of questions to
build a picture of the patient's normal routine and any relevant history. If the patient has
been admitted by the veterinary surgeon, once in the ward the nurse can complete the
assessment over the telephone with the owner. The assessment phase also allows the
nurse to get the basis for the physiological aspects of the fundamental needs, such as
respiratory and heart rate, from completion of a full physical examination.

Creating a relationship with the patient and client is very important as it allows the most
accurate information to be obtained to base the assessment on. Conversations with the
client allow the nurse to gain information regarding the patient's normal routine, including
their likes and dislikes. During the assessment phase, the nurse can act as a helper to the
patient by obtaining information from the owner that will benefit the patient during their
hospital stay and reduce stress. For example, asking the owner what the patient's diet is at
home, what time they like to eat and what their favourite treat is can be beneficial when
trying to tempt the patient to eat after a period of anorexia. Acting as a helper to the patient
is one form of patient-nurse relationship that Henderson outlines in her model (Alligood,
2014).

The nursing needs model provides structure to the assessment meaning certain aspects
are less likely to be missed, because it has been provided in a list form. Although it does
mean that nurses may forget to elaborate on things that are not included in the list (see
Table 2 for Henderson's nursing assessment form (Ahtisham and Sommer, 2015)). This can
lead to insufficient interventions because the information has not been provided.
Additionally, one aspect of Henderson's model that has been maintained in the veterinary
adaptation is numbering each need (Table 3), this provides more structure and makes it
easier to refer to each need than an unnumbered system. Khatiban et al (2019) found that
introducing a patient assessment form significantly improved the nurse's skill level as they
could do a more thorough assessment, which in turn led to better evaluation of patient
outcome. Therefore, this suggests the adaptation of Henderson's assessment form could
benefit both the veterinary nurses and patients.
Table 2 Henderson's patient assessment form

Nursing assessment of [insert patient name]

Henderson's 14 components Assessment findings

1 Breathing normally  

2 Eat and drink adequately  

3 Elimination of body wastes  

4 Movement and posturing  

5 Sleep and rest  

6 Select suitable clothes-dress and undress  

7 Maintain body temperature  

8 Keep the body clean and well groomed  

9 Avoid dangers in the environment  

10 Communication  

11 Worship according to one's faith  

12 Work accomplishment  

13 Play or participate in various forms of recreation  

14 Learn, discover, or satisfy the curiosity  

Table 3 The veterinary adaptation of Henderson's patient assessment form

Patient name:Sex: FNAge: 12 Weight: 4 kgBreed: DSH

Presenting problem: Heart failure

Heart rate Respiratory rate MM/CRT Pulses

260 40 Pale <2 seconds Good

Additional notes: Medications: clopidogrel, benazepril and furosemide

1 Breathe: Do they seem to not want to exercise or get Recently she doesn't go outside as much, seems to be sleeping
tired easily?Do they have any effort?Any noise?Is the moreOwner thinks she has some inspiritory effort, but a regular
pattern regular? pattern

2 Nutrition: What is their diet?How often do they eat Dry Whiskas foodAdlib — food is left out all dayShe eats out of a
during the day?Do they like to eat out of any particular small plate Favourite treat is Dreamies
type of bowl?What is their favourite treat?

3 Hydration: How often do they drink?Do they drink She will not drink out of a bowl in the house — only from
from outside sources, e.g rain butt?What type of bowl outside sources. Occasionally drinks from the sink in the house.
do they like to drink out of? Owner is unsure what bowl she likes to drink out of — she
offers shallow sided bowls in the house

4 Urination and defecation: How often do they urinate She goes to the toilet outside — owner is unsure how often Has
and defecate?Do they like to do it on any particular seen her go in the soil in the flower bed
surface, e.g grass or concrete?Do they have a
command?

5 Maintaining body temperature: What is their She likes to sleep in front of the fire/radiator and in the sun. She
temperature?Do they like to seek warmth?Do they get does get hot in the summer — her respiratory rate increases
very hot in different conditions? Temperature: 37.9°C

6 Mobilisation: Do they enjoy going for walks/going She enjoys being outside of the house, normally in the summer
out the house?Do they struggle to jump or go up the she is outside most of the dayHasn't noticed her struggling to
stairs?Do they have any medical problems such as jump onto the sofa, onto the garden fence etc
arthritis?

7 Behaviour: How do they react to strangers?How do She is nervous at first around new peopleSometimes hisses or
they react to pain?Do they have any favourite toys? tries to escape if painfulShe doesn't really play with toys —
How do they react if they are scared?Do they like to occasionally will chase string if you pull it around Likes to sleep a
sleep a lot? lot in the morning and then evening

8 Keeping the body clean: Do they like to groom She always grooms herself with no problems. She is never dirty
themselves?Do you have to groom/bath them at all?
Are they often very dirty?

To adapt Henderson's assessment form to make it more appropriate for veterinary patients,
some of the fundamental needs have been changed. Instead of having long statements like
Henderson has in her model, this has been changed to having one word regarding the area
of assessment (Table 3). For example, need 4 ‘Move and maintain desirable postures’
(Table 2) has been changed to need 6 ‘mobilisation’ (Table 3). Open questions have been
incorporated into the assessment form underneath each subtitle so that more qualitative
information can be gathered (Table 3). This is a significant amendment to Henderson's
model as it makes the model more concise and easier to understand, while maintaining the
ability to yield a sufficient amount of information.

Other changes include: need 2 being separated into two components — rather than ‘Eat
and drink adequately’ it is now ‘Nutrition’ and ‘Hydration’ (needs 2 and 3 respectively). This
means that more specific information about these aspects can be gathered. For example, it
allows information regarding the type of diet and timing of feeds as well as what sort of bowl
they like to drink out of and how often they drink to be gathered. This information means
that their hospital stay can be made as similar to their life at home as possible, making it
less stressful for the patient.

Conversely, some needs have been incorporated into one to make one need that is overall
more relevant to veterinary patients. Needs 10, 13 and 14 have been combined into one
need titled ‘Behaviour’ (need 7). This is to make it more applicable to an animal patient than
a human patient, because the way animals communicate, play and learn can be shown
through their behaviour. By having questions incorporated into this one need it means
information can be gathered about each of the original components in a concise manner.

Some of the needs from Henderson's model have been removed as they are not
appropriate to animals. This includes the needs: 6, 9, 11 and 12. Some of these needs such
as: avoiding dangers in the environment (need 9) and worship according to one's faith
(need 11) are more relevant to how the owner cares for the patient at home, which the
author does not see as applicable to the patient's hospital stay, which is why they have
been removed from the assessment form. Overall, there are now eight needs compared
with the original 14 in Henderson's model.

The adaptation also creates more structure to the physiological fundamental needs than the
original model. Space to record the vital parameters has been included, so heart rate,
respiratory rate, mucous membrane colour (MM) and capillary refill time (CRT) can be filled
in. This is a modification to Henderson's original model as she did not incorporate these
parameters. Recording these during the nursing assessment means that they can be
referred to when the patient is being evaluated to see if the patient's condition has changed.
An example of a completed patient assessment form is shown in Table 3.

Nursing diagnosis
After the assessment, the nursing diagnosis is created by deciding which nursing
interventions are needed for the patient, based on the information that has already been
gathered. The main goal of this is to identify any problems that the patient already has or
any potential problems that could arise from their stay in hospital (Welsh and Wager, 2013).
After doing an assessment using the basis of the fundamental needs, a nursing diagnosis
can focus on any problems that the patient is having with any of the needs (Welsh and
Wager, 2013). An example of a nursing diagnosis can be seen in Table 4. It is important to
note that while nurses can make a nursing diagnosis to decide which interventions are most
appropriate for the patient, they cannot legally make a clinical diagnosis under the
Veterinary Surgeons Act (1966) as this breaks the RCVS code of conduct (RCVS, 2020).
Table 4 Nursing diagnosis and planning
Table 4 Nursing diagnosis and planning
Nursing Short term goal and nursing
Nursing need diagnosis Potential problem intervention
1. Breathe Tachypnoeic (40 Decrease in oxygen Get respiratory rate within normal range.
bpm) saturationInspiratory and Reduce stress Monitor mucous
expiratory effort membrane colour Monitor respiratory
rate and effort
2. Nutrition No problems Anorexia Maintain nutrition, meet RER
with eating requirements. Offer dry food in kennel
currently
3. Hydration Hydration status Dehydration Maintain hydrationOffer water in kennel
adequate
4. Urination and Able to urinate FLUTD from stressUrine Allow opportunities to urinate and
defecation and defecate scoldingConstipation defecateProvide litter tray in kennel
5. Maintaining Normal HypothermiaHyperthermia Maintain temperature within normal
body temperature rangeRecord temperature every 4 hours
temperature
6. Mobilisation Able to mobilise Joint stiffness Do PROM if immobile for a long period
adequately of time
7. Behaviour Showing normal Stress-related behaviours Reduce stress, provide hides in the
behaviour kennel
8. Keeping body Able to groom Not grooming because of stressFur Reduce stress, groom fur if needed
clean herself becoming matted and dirty

Planning
At the planning stage, the goals of the nursing care are outlined, and the way in which these
will be met is planned (Orpet and Jeffery, 2006). It also allows the nurse to prioritise which
needs are more important (Welsh and Wager, 2013). Following on from the above example
in Table 3, which shows the patient has a respiratory rate of 40, if the patient is tachypnoeic
and their oxygen saturation is decreasing, this need would be prioritised over the patient's
need to be able to groom and keep themselves clean.

When using the nursing needs model to plan the nursing care it is important to remember
the goal of the model, which is to make the patient become independent again. Particularly
in a hospital environment, it is hard to allow the patient to be completely independent
because they have to stay in a kennel. This is why the nursing interventions are designed to
help the patient to be as independent as possible so when they leave the hospital their
recovery is not hindered at all.

When using Henderson's model to plan the nursing care that is put in place, there is
minimal structure to it. It describes the fundamental needs and outlines what interventions
will help the patient become independent; it does not prioritise them or incorporate the goals
of the care. Therefore, when adapting to veterinary patients an aspect used in the Orpet
and Jeffery Ability Model has been included. Here they incorporate a ‘short-term goal’
section in their care plan template (Welsh and Wager, 2013). This means the goals can be
written clearly (Nelson and Welsh, 2015). The added structure makes it clear to not just
veterinary nurses but other healthcare professionals what is trying to be achieved. This
means that anyone can glance at the nursing care plan and know what is being done to
benefit the patient and improve their condition. Table 4 shows the nursing diagnosis and
planning aspect of the adapted version of Henderson's nursing model.

Implementation
The implementation stage is where the nursing interventions that are outlined in the care
plan are carried out. When carrying out the nursing care, it is important that the instructions
are clearly written out in the care plan with specific details (Orpet and Jeffery, 2006). This
means that anyone who implements the interventions knows exactly what to do. It is
especially important with Henderson's theory as she states how the nurse works
interdependently with other healthcare professionals (Alligood, 2014) and if instructions are
not written clearly, they may be misunderstood by colleagues, which could lead to them
being wrongly implemented. By writing the instructions clearly it means there is less room
for error in the interventions, which consequently aids the patient in regaining their
independence. The interventions can be written using SMART objectives, which are
instructions that are specific, measurable, achievable, realistic and timed (Ballantyne,
2017). An example of a SMART objective for a tachypnoeic patient is as follows: aim to get
respiratory rate within normal limits (20–28 breaths per minute (bpm)), measure respiratory
rate and effort every hour. Using this principle provides additional detail so that the nursing
intervention can be more objective (Ballantyne, 2017). A detailed SMART objective for a
tachypnoeic patient can be seen in Table 5.
Table 5 A SMART objective for a tachypnoeic patient
Table 5 A SMART objective for a tachypnoeic patient
1. Breathe — nursing intervention using SMART principles
Specific Aim to get respiratory rate back to a normal rate (20–28 bpm)
Measurable Measure and record respiratory rate and effort
Achievable 24-hour nursing care available
Realistic Patient's respiratory rate is within normal limits at home
Timed Measure and record respiratory rate and effort every hour

Evaluation
Evaluation is one of the most important stages of the nursing process. If the care is not
evaluated it would be unclear whether the nursing interventions were beneficial to the
patient (Orpet and Jeffery, 2006). The evaluation aspect requires the nurse to re-examine
the patient after the interventions have been carried out, then identify whether they have
been successful or not (Orpet and Jeffery, 2006).

One disadvantage of Henderson's Model is that it has no structured section for evaluation of
the nursing care provided; therefore, it has been adapted to incorporate a way to evaluate
the patient. By including the evaluation with the rest of the care plan it means it is less likely
to be missed. It also encourages the nurse to write more detail; then, when re-evaluating
the patient in the future this information can be referred to, which helps to make the
evaluation an ongoing process.
In order for the evaluation to be thorough, it should be structured with questions such as:

 Has the goal been achieved?

 What needs to be changed?
 Has the patient's condition improved, deteriorated, or stayed the same?

By organising the evaulation process into questions it

makes it easier to complete the evaluation, which will increase compliance (Orpet
and Jeffery, 2006). Conclusion
Henderson's nursing need theory is a good basis for a theory as it incorporates 14 fundamental
needs that are relevant to what nursing care needs to be focused on in order to help the human
patient become more independent. However, some of the needs are not applicable to veterinary
patients, like their inability to worship a faith or wear clothes. Therefore, when adapting this
model, some of the needs should be modified so that they can be used on animals.

The nursing process is a significant basis for nurses to structure their care for their patients.
However, Henderson's theory does not necessarily link closely to the process as it only mentions
the 14 fundamental needs and not the need for a nursing diagnosis, implementation, or
evaluation. Consequently, to improve this model it has been modified so that these aspects of the
nursing process are easier to do for patients.

KEY POINTS

 Henderson's nursing needs model is a nursing model of care that has been made for use in
human nursing practice; it is based on14 fundamental needs.
 Using a nursing model of care when looking after patients, provides a holistic view to
nursing.
 Henderson's model provides a good structure to the nursing assessment because of the list
of fundamental needs. However, some of the needs have been removed or changed to
make it more appropriate to animals.
 The nursing needs model does not incorporate a nursing diagnosis, therefore this has been
included in the veterinary adaptation by highlighting any problems the patient has and
what nursing interventions are needed.
 In the veterinary adaptation, the structure incorporated planning nursing care, meaning
aspects of care are less likely to be missed.
 Evaluation is a crucial aspect missing from Henderson's nursing need model. In the
adaptation, a dedicated section has been incorporated to ensure that the nursing
interventions are benefiting the patient and improving their condition.