more fully understand their practice. During the
1960s, several studies were published that explored
nursing practice issues. These works focused on pa-
tients’ complaints of pain (Barron, 1966; Bochnak,
1963), incidence of post-operative vomiting
(Dumas & Leonard, 1963), patient admission
processes (Elms & Leonard, 1966), nurses’ re-
sponses to expressed patient needs (Gowan &
Morris, 1964), and the effects of patient assistance
with planning nursing procedure administration
(Tryson, (1963).
The most important contribution of Orlando’s
theoretical work is what it says about the values un-
derpinning the nursing practice. Inherent in this
theory is a strong statement: What transpires be-
tween the patient and the nurse is of the highest
value. The true worth of her nursing theory is that
it clearly states what nursing is or should be today.
Regardless of the changes in the health-care system,
the human transaction between the nurse and the
patient in any setting holds the greatest value, not
only for nursing, but also for society at large.
Orlando’s theory can serve as a philosophy as well
as a theory, because it is the foundation upon which
our profession has been built. With all of the bene-
fits that modern technology and modern health
care bring—and there are many—we need to pause
and ask the question “What is at risk in health care
today”? The answer to that question may lead to
reconsideration of the value of Orlando’s theory
as perhaps the critical link for enhancing relation-
ships between nursing and patient today (Rittman,
2001).
HENDERSON
Based on the assumption that nursing has a unique
function, Henderson believed that nursing inde-
pendently initiates and controls activities related to
basic nursing care. Relating the conceptualization
of basic care components with the unique func-
tions of nursing provided the initial groundwork
for introducing the concept of independent nurs-
ing practice. In her 1966 publication,The Nature of
Nursing,Henderson stated: “It is my contention
that the nurse is, and should be legally, an inde-
pendent practitioner and able to make independent
judgments as long as he, or she, is not diagnosing,
prescribing treatment for disease, or making a
prognosis, for these are the physician’s functions”
(Henderson, 1966, p. 22).
Furthermore, Henderson believed that func-
tions pertaining to patient care could be catego-
rized as nursing and non-nursing. She believed that
limiting nursing activities to “nursing care” was a
useful method of conserving professional nurse
power (Harmer & Henderson, 1955). She defined
non-nursing functions as those that are not a
service to the person (mind and body) (Harmer &
Henderson, 1955). For Henderson, examples of
non-nursing functions included ordering supplies,
cleaning and sterilizing equipment, and serving
food (Harmer & Henderson, 1955).
At the same time, Henderson was not in favor of
the practice of assigning patients to lesser trained
workers on the basis of complexity level. For
Henderson, “all ‘nursing care’... is essentially com-
plex because it involves constant adaptation of pro-
cedures to the needs of the individual” (Harmer &
Henderson, 1955, p. 9).
As the authority on basic nursing care,
Henderson believed that the nurse has the respon-
sibility to assess the needs of the individual patient,
help individuals meet their health needs, and/or
provide an environment in which the individual
can perform activities unaided. It is the nurse’s
role, according to Henderson, “to ‘get inside the
patient’s skin’ and supplement his strength, will or
knowledge according to his needs” (Harmer &
Henderson, 1955, p. 5). Conceptualizing the nurse
as a substitute for the patient’s lack of necessary
will, strength, or knowledge to attain good health
and to complete or make the patient whole, high-
lights the complexity and uniqueness of nursing.
Based on the success ofTextbook of the Principles
and Practice of Nursing(fifth edition), Henderson
was asked by the International Council of Nurses
(ICN) to prepare a short essay that could be used as
a guide for nursing in any part of the world. Despite
Henderson’s belief that it was difficult to promote a
universal definition of nursing,Basic Principles of
Nursing Care(Henderson, 1960) became an inter-
national sensation. To date, it has been published
in 29 languages and is referred to as the twentieth-
century equivalent of Florence Nightingale’s Notes
on Nursing.After visiting countries worldwide, she
concluded that nursing varied from country to
country and that rigorous attempts to define it have
been unsuccessful, leaving the “nature of nursing”
largely an unanswered question (Henderson, 1991).
Henderson’s definition of nursing has had a last-
ing influence on the way nursing is practiced76 SECTION II Evolution of Nursing Theory: Essential Influences