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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 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,
- “providing 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
 Abdellah’s 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 Abdellah’s 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 client’s problems
 11 nursing skills to be used in developing a treatment typology
10 steps to identify the client’s 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 patient’s 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 patient’s and family’s reaction to the therapeutic plan and involve them in
the plan
9. Identify how the nurses feels about the patient’s 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.
ABDELLAH’S THEORY AND NURSING
 Although Abdellah’s 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. 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. 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 client’s 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.
COMPARISON WITH OTHER THEORIES

MASLOW HENDERSON ABDELLAH

1. Breathe normally 1. To facilitate the maintenance of


a supply of oxygen to all body cells

2. Eat and drink 2. To facilitate the maintenance of


adequately nutrition of all body cells
Physiological
needs 3. Eliminate by all 3. To facilitate the maintenance of
avenues of elimination fluid and electrolyte balance

4. Move & maintain 4. To facilitate the maintenance of


desirable posture elimination

5. Sleep & rest 5. To maintain good body


mechanics and prevent and correct
6. Select suitable deformities
clothing
6. To promote optimal activity:
7. Maintain body exercise , rest and sleep
temperature
7. To facilitate the maintenance of
8. Keep body clean and regulatory mechanisms and
well groomed & protect functions
the integument
8. To maintain good hygiene and
physical comfort

9. Avoid environmental 9. To promote safety through the


Safety needs dangers & avoid injuring prevention of accidents, injury, or
others other trauma and through the
prevention of the spread of
infection
10. To facilitate the maintenance of
sensory function

Belongingness & 10. Communicate with 11.To facilitate the maintenance of


love needs others effective verbal and non verbal
11. Worship according to communication
faith 12. To promote the development of
productive interpersonal
relationships
13. To facilitate progress toward
achievement of personal spiritual
goals
Esteem needs 12. Work at something 14. To accept the optimum
providing a sense of possible goals in the light of
accomplishment limitations, physical and emotional
13. Play or participate in 15. To recognize the physiological
various forms of responses of the body to disease
recreation conditions
14. Learn, discover, or 16. To identify and accept positive
satisfy curiosity and negative expressions, feelings,
and reactions
17. To identify and accept the
interrelatedness of emotions and
organic illness
18. To create and / or maintain a
therapeutic environment
19. To facilitate awareness of self
as an individual with varying
physical, emotional, and
developmental needs
20. To use community resources
as an aid in resolving problems
arising from illness
21. 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
 Nursing is a helping profession. In Abdellah’s 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.
ABDELLAH’S WORK AND CHARACTERISTICS OF A THEORY
Characteristic1
 Abdellah’s 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
Abdellah’s work to generate hypothesis for testing
Characteristic5
 The results of testing such hypothesis would contribute to the general body of nursing knowledge
Characteristic6
 Abdellah’s 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 client’s 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 client’s progress or lack of progress toward the
achievement of the stated goals.
 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, 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.

SUMMARY
 Using Abdellah’s 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
 Abdellah’s 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
nurse’s philosophical frame of reference would determine whether this theory and the 21 nursing
problems could be implemented in practice.
AN illustration of the implementation of Abdellah’s framework in Ryan’s 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
Benefits of PPC
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.
 Abdellah’s 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