FAYE GLENN ABDELLAH'S THEORY TWENTY ONE NURSING PROBLEMS ---------------------------------------------------------------INTRODUCTION y Faye Glenn Abdellah, pioneer nursing researcher

, helped transform nursing theory, nursing care and nursing education y Birth:1919 y Dr Abdellah worked as Deputy Surgeon General y Former Chief Nurse Officer for the US Public Health Service , Department of Health and human services, Washington, D.C. y She has been a leader in nursing research and has over one hundred publications related to nursing care, education for advanced practice in nursing and nursing research. y In 1960, influenced by the desire to promote client-centred comprehensive nursing care, Abdellah described nursing as a service to individuals, to families, and, therefore to, to society. y According to her, nursing is based on an art and science that mould the attitudes, intellectual competencies, and technical skills of the individual nurse into the desire and ability to help people , sick or well, cope with their health needs. y As a comprehensive service ,nursing includes; o Recognizing the nursing problems of the patient o Deciding the appropriate course of action to take in terms of relevant nursing principles o Providing continuous care of the individuals total needs o Providing continuous care to relieve pain and discomfort and provide immediate security for the individual o Adjusting the total nursing care plan to meet the patient¶s individual needs o Helping the individual to become more self directing in attaining or maintaining a healthy state of mind & body o Instructing nursing personnel and family to help the individual do for himself that which he can within his limitations o 8)Helping the individual to adjust to his limitations and emotional problems o 9) Working with allied health professions in planning for optimum health on local, state, national and international levels o 10) Carrying out continuous evaluation and research to improve nursing techniques and to develop new techniques to meet the health needs of people o These original premises have undergone an evolutionary process. As result, in 1973, the item 3, - ³providing continuous care of the individual¶s total health needs´ was eliminated. o From these premises, Abdellah¶s theory was derived. PHILOSOPHICAL UNDERPINNINGS OF THE THEORY y Abdellah¶s patient-centred approach to nursing was developed inductively from her practice and is considered a human needs theory. y The theory was created to assist with nursing education and is most applicable to the education of nurses. y Although it was intended to guide care of those in the hospital, it also has relevance for nursing care in community settings.

CONCEPTS & RELATIONSHIPS y The language of Abdellah¶s framework is readable and clear. µhe¶ for doctors and patients. o The need to appreciate the interconnectedness of social enterprises and social problems. 5. 2. education. 7. Observation of health status Skills of communication Application of knowledge Teaching of patients and families Planning and organization of work Use of resource materials Use of personnel resources Problem-solving Direction of work of others Learn to know the patient Sort out relevant and significant data Make generalizations about available data in relation to similar nursing problems presented by other patients Identify the therapeutic plan Test generalizations with the patient and make additional generalizations Validate the patient¶s conclusions about his nursing problems Continue to observe and evaluate the patient over a period of time to identify any attitudes and clues affecting his behavior Explore the patient¶s and family¶s reaction to the therapeutic plan and involve them in the plan Identify how the nurses feels about the patient¶s nursing problems 10. 9. Therapeutic use of the self . y Consistent with the decade in which she was writing. 6. and refers to the object of nursing as µpatient¶ rather than client or consumer. 4. she uses the term µshe¶ for nurses. 3. o the impact of problems such as poverty. 3. 8. and so forth on health care delivery. Discuss and develop a comprehensive nursing care plan 10. y She referred to Nursing diagnosis during a time when nurses were taught that diagnosis was not a nurses¶ prerogative. 9.MAJOR ASSUMPTIONS. o changing nursing education o continuing education for professional nurses o development of nursing leaders from under reserved groups y Abdellah and colleagues developed a list of 21 nursing problems. y They also identified 10 steps to identify the client¶s problems y 11 nursing skills to be used in developing a treatment typology 10 steps to identify the client¶s problems 1. 11 nursing skills 1. 8. 7. y Assumptions were related to o change and anticipated changes that affect nursing. 4. 6. 2. racism. 5. pollution.

emotional. or other trauma and through the prevention of the spread of infection To maintain good body mechanics and prevent and correct deformities To facilitate the maintenance of a supply of oxygen to all body cells To facilitate the maintenance of nutrition of all body cells To facilitate the maintenance of elimination To facilitate the maintenance of fluid and electrolyte balance To recognize the physiological responses of the body to disease conditions To facilitate the maintenance of regulatory mechanisms and functions To facilitate the maintenance of sensory function To identify and accept positive and negative expressions. 2. Physical. and developmental needs To accept the optimum possible goals in the light of limitations. 3. rest and sleep To promote safety through the prevention of accidents. and emotional needs of clients Types of interpersonal relationships between the nurse and patient Common elements of client care 21 NURSING PROBLEMS BASIC TO ALL PATIENTS y y y y To maintain good hygiene and physical comfort To promote optimal activity: exercise. and reactions To identify and accept the interrelatedness of emotions and organic illness To facilitate the maintenance of effective verbal and non verbal communication To promote the development of productive interpersonal relationships To facilitate progress toward achievement of personal spiritual goals To create and / or maintain a therapeutic environment To facilitate awareness of self as an individual with varying physical . Nursing procedures The twenty one nursing problems Three major categories 1.11. feelings. physical and emotional To use community resources as an aid in resolving problems arising from illness SUSTENAL CARE NEEDS y y y y y y y REMEDIAL CARE NEEDS y y y y y y y RESTORATIVE CARE NEEDS y y . injury. sociological.

sick or well. and problem solving. testing hypothesis through the collection of data. . intellectual competencies. and revising hypothesis where necessary on the basis of conclusions obtained from the data. The problem can be either an overt or covert nursing problem. formulating hypothesis. from the practice of medicine. ABDELLAH¶S THEORY AND NURSING y Although Abdellah¶s writings are not specific as to a theoretical statement. she seems to swing the pendulum to the opposite pole. the theory distinguished the practice of nursing. In this way. selecting pertinent data. which the nurse can assist him or them to meet through the performance of her professional functions y In her attempt to bring nursing practice into its proper relationship with restorative and preventive measures for meeting total client needs. nursing is based on an art and science that mould the attitudes. and technical skills of the individual nurse into the desire and ability to help people. by the patient or family. with a focus on disease and cure. Such a statement maintains problem solving as the vehicle for the nursing problems as the client is moved toward health ± the outcome NURSING y Acc to her. rather than a theory describing relationships among phenomena. y The covert nursing problem is a concealed or hidden condition faced. with a focus on the 21 nursing problems. Abdellah¶s theory would state that nursing is the use of the problem solving approach with key nursing problems related to health needs of people. PROBLEM SOLVING y The problem solving process involves identifying the problem. such a statement can be derived by using her three major concepts of health.y To understand the role of social problems as influencing factors in the case of illness Abdellah's 21 problems are actually a model describing the "arenas" or concerns of nursing. which the nurse can assist him or them to meet through the performance of her professional functions. cope with their health needs. y An overt nursing problem is an apparent condition faced by the patient or family. nursing problems. while leaving the client somewhere in the middle. from the disease orientation to nursing orientation. HEALTH y Health is a dynamic pattern of functioning whereby there is a continued interaction with internal and external forces that results in the optimum use of necessary resources that serve to minimize vulnerabilities NURSING PROBLEMS y Nursing problem presented by a client is a condition faced by the client or client¶s family that the nurse through the performance of professional functions can assist them to meet .

To facilitate the maintenance of effective verbal and non verbal communication 12. To facilitate the maintenance of sensory function Belongingness & love needs 10. To facilitate the maintenance of nutrition of all body cells 3. To facilitate the maintenance of fluid and electrolyte balance 4. Keep body clean and well groomed & protect the integument ABDELLAH 1. To facilitate the maintenance of a supply of oxygen to all body cells 2. Communicate with others 11. To facilitate progress toward achievement of personal spiritual goals . Maintain body temperature 8. To promote safety through the prevention of accidents. injury. or other trauma and through the prevention of the spread of infection 10. Move & maintain desirable posture 5. To maintain good body mechanics and prevent and correct deformities 6. Avoid environmental dangers & avoid injuring others 9. Eliminate by all avenues of elimination 4. To facilitate the maintenance of elimination 5. Sleep & rest 6. Breathe normally 2. Select suitable clothing 7. Eat and drink adequately 3. To maintain good hygiene and physical comfort Physiological needs Safety needs 9. rest and sleep 7. To promote the development of productive interpersonal relationships 13. To facilitate the maintenance of regulatory mechanisms and functions 8. Worship according to faith 11. To promote optimal activity: exercise .COMPARISON WITH OTHER THEORIES MASLOW HENDERSON 1.

To facilitate awareness of self as an individual with varying physical. emotional. Person y Abdellah describes people as having physical. such as emotional and social needs. increasing or restoring self-help ability. To understand the role of social problems as influencing factors in the case of illness Self actualization needs ABDELLAH¶S THEORY AND THE FOUR MAJOR CONCEPTS Nursing y Nursing is a helping profession. and developmental needs 20. cope with their health needs. To create and / or maintain a therapeutic environment 19. y Although Abdellah does not give a definition of health. she speaks to ³total health needs´ and ³a healthy state of mind and body´ in her description of nursing as a comprehensive service. Abdellah describes health as a state mutually exclusive of illness. These needs may overt. or achieving of it. y Individuals (and families) are the recipients of nursing y Health. To identify and accept positive and negative expressions. or satisfy curiosity 14. is the purpose of nursing services. y She considers nursing to be comprehensive service that is based on art and science and aims to help people. feelings. Health y In Patient ±Centered Approaches to Nursing. Play or participate in various forms of recreation 14. emotional. To use community resources as an aid in resolving problems arising from illness 21. Learn. sick or well. or covert. or alleviating impairment. . y Nursing is broadly grouped into the 21 problem areas to guide care and promote use of nursing judgment. To identify and accept the interrelatedness of emotions and organic illness 18. y Patient is described as the only justification for the existence of nursing. To recognize the physiological responses of the body to disease conditions 16. consisting of largely physical needs. nursing care is doing something to or for the person or providing information to the person with the goals of meeting needs. In Abdellah¶s model. discover. physical and emotional 15. and reactions 17. Work at something providing a sense of accomplishment 13. and sociological needs. To accept the optimum possible goals in the light of limitations.Esteem needs 12.

ABDELLAH¶S WORK AND CHARACTERISTICS OF A THEORY Characteristic1 y Abdellah¶s theory has interrelated the concepts of health. the focus of nursing service is clearly the individual. However. This is true when considering nursing practice that deals with clients who have specific needs and specific nursing problems Characteristic7 y Although consistency with other theories exist. respectively. The results of data collection would determine the client¶s specific overt or covert problems. national. nursing problems.Society/Environment y Society is included in ³planning for optimum health on local. The overt or covert nature of the problems necessitates a direct or indirect approach. and problem solving as she attempts to create a different way of viewing nursing phenomenon y The result was the statement that nursing is the use of problem solving approach with key nursing problems related to health needs of people. and international levels´. Characteristic2 y Problem solving is an activity that is inherently logical in nature Characteristic 3 y Framework seems to focus quite heavily on nursing practice and individuals. This somewhat limit the ability to generalize although the problem solving approach is readily generalizable to clients with specific health needs and specific nursing problems Characteristic4 y One of the most important questions that arise when considering her work is the role of client within the framework. These specific problems would be grouped under one or more of the broader nursing problems. pertinent data are collected. This step is consistent with that involved in nursing diagnosis NURSING DIAGNOSIS y y y . state. many questions remain unanswered USE OF 21 PROBLEMS IN THE NURSING PROCESS ASSESSMENT PHASE y y y Nursing problems provide guidelines for the collection of data. as she further delineated her ideas. y The environment is the home or community from which patient comes. A principle underlying the problem solving approach is that for each identified problem. This question could generate hypothesis for testing and thus demonstrates the ability of Abdellah¶s work to generate hypothesis for testing Characteristic5 y The results of testing such hypothesis would contribute to the general body of nursing knowledge Characteristic6 y Abdellah¶s problem solving approach can easily be used by practitioners to guide various activities within their practice.

The nurse¶s philosophical frame of reference would determine whether this theory and the 21 nursing problems could be implemented in practice. nursing problems. 21 nursing problems were developed CONCLUSIONS y Abdellah¶s theory provides a basis for determining and organizing nursing care. Therefore. the client would be moved toward health. According to the American Nurses¶ Association Standards of Nursing Practice. Thus. once the problem has been diagnosed. the theoretical statement of nursing that can be derived is the use of the problem solving approach with key nursing problems related to health needs of people. the most appropriate evaluation would be the nurse progress or lack of progress toward the achievement of the stated goals. y It is anticipated that by solving the nursing problems.PLANNING PHASE y y The statements of nursing problems most closely resemble goal statements. the plan is evaluated in terms of the client¶s progress or lack of progress toward the achievement of the stated goals. a plan is developed and appropriate nursing interventions are determined. y From this framework. This would be extremely difficult if not impossible to do for Abdellah¶s nursing problem approach since it has been determined that the goals are nursing goals. IMPLEMENTATION y EVALUATION y y y SUMMARY y Using Abdellah¶s concepts of health. The problems also provide a basis for organizing appropriate nursing strategies. . Given that these problems are called nursing problems. the goals have been established. Using the goals as the framework. not the client goals. then it becomes reasonable to conclude that these goals are basically nursing goals. and problem solving.

Home care y This programme makes it possible to extend needed services to the patient after he leaves the hospital and returns to his home in the community Benefits of PPC PATIENT y better attention . services and staff around the changing medical and nursing needs of the patient y PPC is tailoring of hospital services to meet patients needs y PPC is caring for the right patient in the right bed with the right services at the right time y PPC is systematic classification of patients based on their medical needs Elements of PPC 1. Direct and indirect method y Selected Nursing Interventions y administer oxygen y elevate headrest y reposition client y administer prescribed analgesic y remain with client y Criterion measure. nursing observation are assigned to the ICU. tachycardia and profuse diaphoresis y Stage of illness is basic to care y Selected Abdellah nursing problem y To maintain good hygiene and personal comfort y Classification and approach y Overt problem of pain. Long term care unit y This unit will provide services to certain patients now cared for in the general hospital. close and frequent if not constant. One patient in an ICU requires at least three nurses to observe him in 24 hrs 2. Self care y Ambulatory patients who are convalescencing or require diagnosis or therapy may be cared for in this unit 4. Intensive care y Critically and seriously ill patients requiring highly skilled nursing care. Intermediate care y Patients assigned to this unit are both the moderately ill and those for whom the treatment can only be palliative 3.AN illustration of the implementation of Abdellah¶s framework in Ryan¶s care Consider a case of Ryan who experienced severe crushing chest pain µshortness of breath. or in their own homes and who would benefit by care in a hospital environment to achieve its maximum potential 5. in nursing homes.Amount of pain CONCEPT OF PROGRESSIVE PATIENT CARE y PPC is defined as better patient care through the organization of hospital facilities.

The grouping of such patients will permit staffing patterns that are less costly y Home care. and family to solve problems y job satisfaction y in-service education COMMUNITY y continuity with hospital services y minimize the need of hospitalization Implications of PPC for nursing education y Many nurse educators feel that the PPC hospital where all five phases of care are available can provide clinical experience in which the nurse can learn to solve basic nursing problems in meeting patients¶ needs. with life saving techniques and equipment immediately available y In the intermediate care unit are concentrated patients requiring a moderate amount of nursing care. and who are beginning to participate in he planning of their own care y The self-care unit provides for patients who are physically self-sufficient and require diagnostic and convalescent care in hotel-type accommodations. This unit serves as a link between the hospital and the home. y In the long-term care unit are concentrated patients requiring prolonged care. y The three month assignment of professional nurses may no longer be realistic in such a setting. y These patients are under the constant audio-visual observation of the nurse.y better adjustment y minimized problems y life saving care y constant medical and nursing care PHYSICIAN y assuring best nursing care y drugs and equipments at hand y orders carried out effectively y better clinical an team service HOSPITAL y effective and efficient use of staff y improved public image NURSING PERSONNEL y individual skills can be used y more time with patient y helping pt. the critically ill patients are concentrated regardless of diagnosis. who are ambulatory for short periods. Organization of hospital and community services based on patients needs y In the intensive care unit. the fifth element of progressive patient care. extends hospital services into the home to assist the physician in the care of his patients . not of an emergency nature.

and public policy related to nursing in several international publications. nursing research. y Cont« y Abdellah has also published on nursing. y Abdellah¶s publications on nursing education began with her dissertation.USEFULNESS y The patient centered approach was constructed to be useful to nursing practice. her interest in education for nurses continues into the present. with impetus for it being nursing education. She has been a strong advocate for improving nursing practice through nursing research .

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