Nursing Leadership: Applying Henderson's Need Theory in Quality and Risk Management

Analysis, Critique and Application of Theory

Applying the principles of Henderson’s need theory to the leadership concentration, specifically the quality and risk management roles, occurs routinely however the relationship to the need theory is not often mentioned. When reviewing cases for quality and risk management, one can typically reduce the issue to failure in communication or in meeting a patient’s needs which are part of the fourteen basic human needs of Henderson’s need theory. When one fails to meet those needs, one will typically find an issue that is reportable via a variance, complaint, grievance, or to a governing and accrediting body. The goal as nurse leaders is to provide care that is consistent with the needs of the patient

while working within the parameters of the physician orders.
Caring for potential organ donor patients is challenging emotionally and physically for all involved in the care of the patient including the family. Organ donation and procurement is a process that must be followed explicitly in order to avoid legal and ethical issues. Nicely and DeLario (2011) applied Henderson’s fourteen basic human needs to the management of an organ donor patient. Each basic human need was carefully considered and applied in the care of the organ donor and demonstrated that Henderson’s need theory is applicable to the care of all patients including those awaiting a physical death.
The nurse must ensure that the organ donor’s posture is maintained in order to prevent skin breakdown and accumulation of fluid on the lungs (Nicely & DeLario, 2011). Harvesting of skin and lungs would not be possible if the nursing care did not include proper turning to avoid skin and lung complications. Additionally communication is a key component with any potential organ donor’s family. Nicely and DeLario (2011) reported that spending time listening and comforting the family is just as important as the message that is carefully delivered in terms understood by the family. Communication is typically the number one area where breakdown occurs in health care and is an important component in Henderson’s need theory. Once a family has come to terms with their loss and decided to donate their loved ones organs it would be a tragedy to inform them the organs are not viable due to an error by the health care team in maintaining the patient. Application of Henderson’s need theory to the donor patient is important to ensure maintenance of the patient until harvesting occurs and is relevant to the leadership role as application of theory assists in avoiding legal or ethical dilemmas.
Another example in which Henderson’s need theory was applied is in childbirth education.

Leaders within organizations must ensure staff provide evidence-based knowledge to the patients and families in order for them to function independently at home. Waller-Wise (2013) reported on the application of Henderson’s principles to help well persons maintain their health during pregnancy. During childbirth classes the pregnant mother and her family are educated on the importance of eating and drinking to ensure adequate nutrition of the mother and baby (Waller-Wise, 2013). These childbirth classes afford the soon to be parents opportunities to ask questions and make choices regarding the birthing process (Waller-Wise,

2013).
Having a birthing plan that was constructed with the parents is vital in order to ensure the nursing staff meets the needs of the family.

This birthing plan is often documented in the patient’s medical record which aids the health care staff during the birthing event. Documentation and discussion of these events is often necessary to ensure all the needs of the family are met. Too often all the potential needs are not discussed and the opportunity to meet the needs of the new family is missed. These missed opportunities can result in emotional and religious conflicts within the family unit and toward the health care staff. For the nurse leader these missed opportunities in care could result in unfavorable patient satisfaction scores and reports within and outside the institution which necessitates follow up. The most important missed opportunity is how this affects the family unit itself. Depending on the missed opportunity the family unit may be affected for years based on questions not asked or decisions made with poor information. Some cultures must bury the placenta after birth and if this was not discussed and the placenta discarded the religious implications could be devastating for this family. Application of Henderson’s need theory guides the nurse in the educational plan for the patient-family unit to ensure all basic needs are covered and questions related to those needs are posed in advanced of the birthing

event.
The organ donor and childbirth education scenarios are examples of how Henderson’s need theory is applied in the clinical arena. All nurses especially those in leadership roles should be concerned with quality outcomes for the safety of the patient and family. Utilizing Henderson’s basic human needs helps to ensure all components necessary to meet the whole needs of the patient and family are included in the care provided by nursing staff. Nurse leaders should monitor patient outcomes and when necessary review cases with potentially negative or negative outcomes. In reviewing these cases the nurse leader should evaluate not only what occurred but why it occurred in order to get to the root cause and prevent a reoccurrence in the future. Once information is obtained regarding the review of a negative case this should be shared with other nurse leaders via forums to ensure this does not occur in another area. Henderson’s need theory provides a framework for nursing care which ensures all needs of the patient and family are included to promote a positive experience and outcome.