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FAYE GLENN ABDELLAH'S THEORY

TWENTY ONE NURSING PROBLEMS


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INTRODUCTION
Faye Glenn Abdellah, pioneer nursing researcher, helped
transform nursing theory, nursing care and nursing education
Birth:1919
Dr Abdellah worked as Deputy Surgeon General
Former Chief Nurse Officer for the US Public Health Service ,
Department of Health and human services, Washington, D.C.
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.
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.
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.
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 patients
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 Helping the individual to adjust to his limitations and
emotional problems
o Working with allied health professions in planning for
optimum health on local, state, national and international
levels
o 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, - providing
continuous care of the individuals total health needs
was eliminated.
o From these premises, Abdellahs theory was derived.
PHILOSOPHICAL UNDERPINNINGS OF THE THEORY
Abdellahs patient-centred approach to nursing was developed
inductively from her practice and is considered a human needs
theory.
The theory was created to assist with nursing education and is
most applicable to the education of nurses.
Although it was intended to guide care of those in the hospital,
it also has relevance for nursing care in community settings.
MAJOR ASSUMPTIONS, CONCEPTS & RELATIONSHIPS
The language of Abdellahs framework is readable and clear.
Consistent with the decade in which she was writing, she uses
the term she for nurses, he for doctors and patients, and
refers to the object of nursing as patient rather than client or
consumer.
She referred to Nursing diagnosis during a time when nurses
were taught that diagnosis was not a nurses prerogative.
Assumptions were related to
o change and anticipated changes that affect nursing;
o The need to appreciate the interconnectedness of social
enterprises and social problems;
o the impact of problems such as poverty, racism, pollution,
education, and so forth on health care delivery;
o changing nursing education
o continuing education for professional nurses
o development of nursing leaders from under reserved
groups
Abdellah and colleagues developed a list of 21 nursing
problems.
They also identified 10 steps to identify the clients problems
11 nursing skills to be used in developing a treatment typology
10 steps to identify the clients problems
1. Learn to know the patient
2. Sort out relevant and significant data
3. Make generalizations about available data in
relation to similar nursing problems presented by
other patients
4. Identify the therapeutic plan
5. Test generalizations with the patient and make
additional generalizations
6. Validate the patients conclusions about his nursing
problems
7. Continue to observe and evaluate the patient over a
period of time to identify any attitudes and clues
affecting his behavior
8. Explore the patients and familys reaction to the
therapeutic plan and involve them in the plan
9. Identify how the nurses feels about the patients
nursing problems
10. Discuss and develop a comprehensive nursing
care plan
11 nursing skills
1. Observation of health status
2. Skills of communication
3. Application of knowledge
4. Teaching of patients and families
5. Planning and organization of work
6. Use of resource materials
7. Use of personnel resources
8. Problem-solving
9. Direction of work of others
10. Therapeutic use of the self
11. Nursing procedures
The twenty one nursing problems
Three major categories
1. Physical, sociological, and emotional needs of
clients
2. Types of interpersonal relationships between the
nurse and patient
3. Common elements of client care
21 NURSING PROBLEMS
BASIC TO ALL PATIENTS
To maintain good hygiene and physical
comfort
To promote optimal activity: exercise,
rest and sleep
To promote safety through the
prevention of accidents, injury, or other
trauma and through the prevention of the
spread of infection
To maintain good body mechanics and
prevent and correct deformities
SUSTENAL CARE NEEDS
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
REMEDIAL CARE NEEDS
To identify and accept positive and
negative expressions, feelings, 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 ,
emotional, and developmental needs

RESTORATIVE CARE NEEDS


To accept the optimum possible goals in
the light of limitations, physical and
emotional
To use community resources as an aid in
resolving problems arising from illness
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, rather than a theory describing
relationships among phenomena. In this
way, the theory distinguished the practice of
nursing, with a focus on the 21 nursing
problems, from the practice of medicine, with
a focus on disease and cure.
ABDELLAHS THEORY AND NURSING
Although Abdellahs writings are not specific as to a theoretical
statement, such a statement can be derived by using her three
major concepts of health, nursing problems, and problem
solving. Abdellahs theory would state that nursing is the use
of the problem solving approach with key nursing problems
related to health needs of people. Such a statement maintains
problem solving as the vehicle for the nursing problems as the
client is moved toward health the outcome
NURSING
Acc 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.
HEALTH
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
Nursing problem presented by a client is a condition faced by
the client or clients family that the nurse through the
performance of professional functions can assist them to meet
. The problem can be either an overt or covert nursing
problem.
An overt nursing problem is an apparent condition faced by the
patient or family, which the nurse can assist him or them to
meet through the performance of her professional functions.
The covert nursing problem is a concealed or hidden condition
faced, by the patient or family, which the nurse can assist him
or them to meet through the performance of her professional
functions
In her attempt to bring nursing practice into its proper
relationship with restorative and preventive measures for
meeting total client needs, she seems to swing the pendulum
to the opposite pole, from the disease orientation to nursing
orientation, while leaving the client somewhere in the middle.
PROBLEM SOLVING
The problem solving process involves identifying the problem,
selecting pertinent data, formulating hypothesis, testing
hypothesis through the collection of data, and revising
hypothesis where necessary on the basis of conclusions
obtained from the data.
ABDELLAHS THEORY AND THE FOUR MAJOR CONCEPTS
Nursing
Nursing is a helping profession. In Abdellahs model, nursing
care is doing something to or for the person or providing
information to the person with the goals of meeting needs,
increasing or restoring self-help ability, or alleviating
impairment.
Nursing is broadly grouped into the 21 problem areas to guide
care and promote use of nursing judgment.
She considers nursing to be comprehensive service that is
based on art and science and aims to help people, sick or well,
cope with their health needs.
Person
Abdellah describes people as having physical, emotional, and
sociological needs. These needs may overt, consisting of
largely physical needs, or covert, such as emotional and social
needs.
Patient is described as the only justification for the existence of
nursing.
Individuals (and families) are the recipients of nursing
Health, or achieving of it, is the purpose of nursing services.
Health
In Patient Centered Approaches to Nursing, Abdellah describes
health as a state mutually exclusive of illness.
Although Abdellah does not give a definition of health, she
speaks to total health needs and a healthy state of mind and
body in her description of nursing as a comprehensive
service.
Society/Environment
Society is included in planning for optimum health on local,
state, national, and international levels. However, as she
further delineated her ideas, the focus of nursing service is
clearly the individual.
The environment is the home or community from which patient
comes.
ABDELLAHS WORK AND CHARACTERISTICS OF A THEORY
Characteristic1
Abdellahs theory has interrelated the concepts of health,
nursing problems, and problem solving as she attempts to
create a different way of viewing nursing phenomenon
The result was the statement that nursing is the use of problem
solving approach with key nursing problems related to health
needs of people.
Characteristic2
Problem solving is an activity that is inherently logical in nature
Characteristic 3
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
One of the most important questions that arise when
considering her work is the role of client within the framework.
This question could generate hypothesis for testing and thus
demonstrates the ability of Abdellahs work to generate
hypothesis for testing
Characteristic5
The results of testing such hypothesis would contribute to the
general body of nursing knowledge
Characteristic6
Abdellahs problem solving approach can easily be used by
practitioners to guide various activities within their practice.
This is true when considering nursing practice that deals with
clients who have specific needs and specific nursing problems
Characteristic7
Although consistency with other theories exist, many questions
remain unanswered
USE OF 21 PROBLEMS IN THE NURSING PROCESS
ASSESSMENT PHASE
Nursing problems provide guidelines for the
collection of data.
A principle underlying the problem solving approach
is that for each identified problem, pertinent data
are collected.
The overt or covert nature of the problems
necessitates a direct or indirect approach,
respectively.
NURSING DIAGNOSIS
The results of data collection would determine the
clients specific overt or covert problems.
These specific problems would be grouped under
one or more of the broader nursing problems.
This step is consistent with that involved in nursing
diagnosis
PLANNING PHASE
The statements of nursing problems most closely
resemble goal statements. Therefore, once the
problem has been diagnosed, the goals have been
established.
Given that these problems are called nursing
problems, then it becomes reasonable to conclude
that these goals are basically nursing goals.
IMPLEMENTATION
Using the goals as the framework, a plan is
developed and appropriate nursing interventions are
determined.
EVALUATION
According to the American Nurses Association
Standards of Nursing Practice, the plan is evaluated
in terms of the clients progress or lack of progress
toward the achievement of the stated goals.
This would be extremely difficult if not impossible
to do for Abdellahs nursing problem approach since
it has been determined that the goals are nursing
goals, not the client goals.
Thus, the most appropriate evaluation would be the
nurse progress or lack of progress toward the
achievement of the stated goals.
AN illustration of the implementation of Abdellahs framework in
Ryans care
Consider a case of Ryan who experienced severe
crushing chest pain shortness of breath, tachycardia and
profuse diaphoresis
Stage of illness is basic to care
Selected Abdellah nursing problem
To maintain good hygiene and personal comfort
Classification and approach
Overt problem of pain; Direct and indirect method
Selected Nursing Interventions
administer oxygen
elevate headrest
reposition client
administer prescribed analgesic
remain with client
Criterion measure- Amount of pain
CONCEPT OF PROGRESSIVE PATIENT CARE
PPC is defined as better patient care through the organization of
hospital facilities, services and staff around the changing
medical and nursing needs of the patient
PPC is tailoring of hospital services to meet patients needs
PPC is caring for the right patient in the right bed with the right
services at the right time
PPC is systematic classification of patients based on their
medical needs
Elements of PPC
1. Intensive care
Critically and seriously ill patients requiring highly skilled
nursing care, close and frequent if not constant, nursing
observation are assigned to the ICU. One patient in an
ICU requires at least three nurses to observe him in 24
hrs
2. Intermediate care
Patients assigned to this unit are both the moderately ill
and those for whom the treatment can only be palliative
3. Self care
Ambulatory patients who are convalescencing or require
diagnosis or therapy may be cared for in this unit
4. Long term care unit
This unit will provide services to certain patients now
cared for in the general hospital, in nursing homes, or in
their own homes and who would benefit by care in a
hospital environment to achieve its maximum potential
5. Home care
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
PATIENT
better attention
better adjustment
minimized problems
life saving care
constant medical and nursing care
PHYSICIAN
assuring best nursing care
drugs and equipments at hand
orders carried out effectively
better clinical an team service
HOSPITAL
effective and efficient use of staff
improved public image
NURSING PERSONNEL
individual skills can be used
more time with patient
helping pt. and family to solve problems
job satisfaction
in-service education
COMMUNITY
continuity with hospital services
minimize the need of hospitalization
Implications of PPC for nursing education
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.
The three month assignment of professional nurses may no
longer be realistic in such a setting.
Organization of hospital and community services based on patients
needs
In the intensive care unit, the critically ill patients are
concentrated regardless of diagnosis.
These patients are under the constant audio-visual observation
of the nurse, with life saving techniques and equipment
immediately available
In the intermediate care unit are concentrated patients
requiring a moderate amount of nursing care, not of an
emergency nature, who are ambulatory for short periods, and
who are beginning to participate in he planning of their own
care
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.
In the long-term care unit are concentrated patients requiring
prolonged care. The grouping of such patients will permit
staffing patterns that are less costly
Home care, the fifth element of progressive patient care,
extends hospital services into the home to assist the physician
in the care of his patients

USEFULNESS
The patient centered approach was constructed to be useful to
nursing practice, with impetus for it being nursing education.
Abdellahs publications on nursing education began with her
dissertation; her interest in education for nurses continues into
the present.
Cont
Abdellah has also published on nursing, nursing research, and
public policy related to nursing in several international
publications. She has been a strong advocate for improving
nursing practice through nursing research
VALUE IN EXTENDING NURSING SCIENCE
It helped to bring structure and organization to what was often
a disorganized collection of lectures and experiences.
She categorized nursing problems based on the individuals
needs and developed developed a typology of nursing
treatment and nursing skills..
NURSING RESEARCH
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.
LIMITATIONS
Very strong nursing centered orientation
Little emphasis on what the client is to achieve
Her framework is inconsistent with the concept of holism
Potential problems might be overlooked
SUMMARY
Using Abdellahs concepts of health, nursing problems, and
problem solving, 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.
From this framework, 21 nursing problems were developed

CONCLUSIONS
Abdellahs theory provides a basis for determining and
organizing nursing care. The problems also provide a basis for
organizing appropriate nursing strategies.
It is anticipated that by solving the nursing problems, the client
would be moved toward health. The nurses philosophical
frame of reference would determine whether this theory and
the 21 nursing problems could be implemented in practice.