Republic of the Philippines

PAMANTASAN NG LUNGSOD NG MAYNILA

(University of the City of Manila)
Intramuros, Manila, Philippines

COLLEGE OF NURSING
(Dalubhasaan ng Narsing)

Written report for the subject of

Theoretical Foundation of Nursing

Faye Glenn Abdellah

Submitted by:
BINAYUG, Mhyca Glishele F.
GONZAGA, Rebecca Francine G.
MAMISAY, Karyll Ann M.

Submitted to:
Dr. Marilyn R. Coladilla
FAYE GLENN ABDELLAH

“Faye Glenn Abdellah (born 1919) dedicated her life

to nursing and, as a researcher and educator, helped
change the profession's focus from a disease-
centered approach to a patient-centered approach.
She served as a public health nurse for 40 years,
helping to educate Americans about the needs of the
elderly and the dangers posed by AIDS, addiction,
smoking, and violence. As a nursing professor, she
developed teaching methods based on scientific
research. Abdellah continued to work as a leader in
the nursing profession into her eighties.”

Abdellah was born on March 13, 1919, in New York City. Years later, on May 6, 1937,
the German hydrogen-fueled airship Hindenburg exploded over Lakehurst, New Jersey, where 18-
year-old Abdellah and her family then lived, and Abdellah and her brother ran to the scene to help.
In an interview with a writer for Advance for Nurses, Abdellah recalled: "I could see people
jumping from the zeppelin and I didn't know how to take care of them, so it was then that I vowed
that I would learn nursing."
Abdellah earned a nursing diploma from Fitkin Memorial Hospital's School of Nursing
(now Ann May School of Nursing). In the 1940s, this was sufficient for practicing nursing, but
Abdellah believed that nursing care should be based on research, not hours of care. She went on
to earn three degrees from Columbia University: a bachelor of science degree in nursing in 1945,
a master of arts degree in physiology in 1947 and a doctor of education degree in 1955.
With her advanced education, Abdellah could have chosen to become a doctor. However,
as she explained in her Advance for Nurses interview, "I never wanted to be an M.D. because I
could do all I wanted to do in nursing, which is a caring profession”.
Abdellah was an advocate of degree programs for nursing. Diploma programs, she
believes, were never meant to prepare nurses at the professional level. Nursing education, she
argued, should be based on research; she herself became among the first in her role as an educator
to focus on theory and research. Her first studies were qualitative; they simply described situations.
As her career progressed, her research evolved to include physiology, chemistry, and behavioral
sciences.
In 1957 Abdellah headed a research team in Manchester, Connecticut, that established the
groundwork for what became known as progressive patient care. In this framework, critical care
patients were treated in an intensive care unit, followed by a transition to immediate care, and then
home care. The first two segments of the care program proved very popular within the caregiver
profession. Abdellah is also credited with developing the first nationally tested coronary care unit
as an outgrowth of her work in Manchester.
In another innovation within her field, Abdellah developed the Patient Assessment of Care
Evaluation (PACE), a system of standards used to measure the relative quality of individual health-
care facilities that was still used in the health care industry into the 21st century. She was also one
of the first people in the health care industry to develop a classification system for patient care and
patient-oriented records. Classification systems have evolved in different ways within in the
health-care industry, and Abdellah's work was foundational in the development of the most widely
used form: Diagnostic related groups, or DRGs. DRGs, which became the standard coding system
used by Medicare, categorize patients according to particular primary and secondary diagnoses.
This system keeps health-care costs down because each DRG code includes the maximum amount
Medicare will pay out for a specific diagnosis or procedure, while also taking into account patient
age and length of stay in a health care facility. Providers are given an incentive to keep costs down
because they only realize a profit if costs are less than the amount specified by the relevant DRG
category.
Abdellah served for 40 years in the U.S. Public Health Service (PHS) Commissioned
Corps, a branch of the military. She served on active duty during the Korean War and was the first
nurse officer to achieve the rank of two-star rear admiral. Outside her wartime work, as a public
health nurse, she focused much of her attention on care of the elderly. She was one of the first to
talk about gerontological nursing, to conduct research in that area, and to influence public policy
regarding nursing homes. During the 1970s she was responsible for establishing nursing-home
standards in the United States. Abdellah checked on nursing homes by making unannounced visits
and wandering throughout the facility checking areas visitors rarely saw. She found many fire
hazards and also discovered that it was often hard to trace ownership of nursing homes. Abdellah's
scrutiny was not welcomed, even by the licensing boards charged with looking out for their elderly
patients, and some states prohibited Abdellah and others from making unannounced visits.
In 1981 U.S. Surgeon General C. Everett Koop named Abdellah deputy surgeon general,
making her the first nurse and the first woman to hold the position. She served under the U.S.
surgeon general for eight years and retired from the military in 1989. As deputy surgeon general,
it was Abdellah's responsibility to educate Americans about public-health issues, and she worked
diligently in the areas of AIDS, hospice care, smoking, alcohol and drug addiction, the mentally
handicapped, and violence.
In her government position, Abdellah also continued her efforts to improve the health and
safety of America's elderly. She prepared and distributed a series of leaflets designed to inform
people about Alzheimer's disease, arthritis, the safe use of medicines, influenza, high blood
pressure, and other threats to elderly health. Under her guidance, the PHS also worked with
physicians to make them aware of the latest research on health issues regarding older patients. For
instance, physicians were warned that ordinary drug dosages may not be appropriate for elderly
patients.
 Abdellah has written many articles in professional journals as well as several books,
including Effect of Nurse Staffing on Satisfactions with Nursing Care (1959), Patient-centered
Approaches to Nursing (1960), Better Patient Care through Nursing Research (1965; revised
1986), and Intensive Care, Concepts and Practices for Clinical Nurse Specialists (1969). She is the
recipient of over 70 awards and honorary degrees and is a fellow of the American Academy of
Nursing. Abdellah was named to the Nursing Hall of Fame at Columbia University in 1999.
In 2000 Abdellah was inducted into the National Women's Hall of Fame in Seneca, New
York. During her Hall of Fame induction speech, Abdellah said, "We cannot wait for the world to
change.… Those of us with intelligence, purpose, and vision must take the lead and change the
world. Let us move forward together! … I promise never to rest until my work has been
completed!"

Problem Solving
Quality professional nursing care requires that nurses be able to identify and solve overt
and covert nursing problems. These requirements can be met by the problem-solving process
involves identifying the problem, selecting pertinent data, formulating hypotheses, testing
hypotheses through the collection of data, and revising hypotheses when necessary on the basis of
conclusions obtained from the data.
Abdellah’s Typology of 21 Nursing Problems
The 21 nursing problems fall into three categories: physical, sociological, and emotional
needs of patients; types of interpersonal relationships between the patient and nurse; and common
elements of patient care. She used Henderson’s 14 basic human needs and nursing research to
establish the classification of nursing problems. Abdellah’s 21 Nursing Problems are the
following:

1. To maintain good hygiene and physical comfort

2. To promote optimal activity: exercise, rest, sleep
3. To promote safety through prevention of accident, injury, or other trauma and
through prevention of the spread of infection
4. To maintain good body mechanics and prevent and correct deformity
5. To facilitate the maintenance of a supply of oxygen to all body cells
6. To facilitate the maintenance of nutrition for all body cells
7. To facilitate the maintenance of elimination
8. To facilitate the maintenance of fluid and electrolyte balance
9. To recognize the physiologic responses of the body to disease conditions—
pathologic, physiologic, and compensatory
10. To facilitate the maintenance of regulatory mechanisms and functions
11. To facilitate the maintenance of sensory function
 12. To identify and accept positive and negative expressions, feelings, and reactions
13. To identify and accept interrelatedness of emotions and organic illness
14. To facilitate the maintenance of effective verbal and nonverbal communication
15. To promote the development of productive interpersonal relationships
16. To facilitate progress toward achievement and personal spiritual goals
17. To create or maintain a therapeutic environment
18. To facilitate awareness of self as an individual with varying physical, emotional,
and developmental needs
19. To accept the optimum possible goals in the light of limitations, physical and
emotional
20. To use community resources as an aid in resolving problems that arise from illness
21. To understand the role of social problems as influencing factors in the cause of
illness

In the year 1960, Dr. Faye Glenn Abdellah defined nursing as a service to individual, to
families and therefore to society as whole. This description of nursing came from her desire and
will to promote patient-centered nursing care that would shift the nursing-centered approach to
patient-centered one. Also, according to her, the whole concept of nursing is actually based on an
art and science that aims to mold the three important aspects that are vital to nurses and those are
the attitudes, intellectual competencies, and the technical skills of the individual nurse; filling the
desire and capability to help the people cope with their health needs, sick or well. Nursing may be
carried out under specific and accurate medical directions and nursing as a comprehensive service,
it includes the following:
1. Recognizing the nursing problems of the patient;
2. Deciding the appropriate courses of action to take in terms of relevant nursing
principles;
3. Providing continuous care of the individual’s total health needs;
4. Providing continuous care to relieve pain and discomfort and provide immediate
security for the individual;
5. Adjusting the total nursing care plan to meet the patient’s individual needs;
6. Helping the individual to become more self-directing in attaining or maintaining a
healthy state of mind and body;
7. Instructing nursing personnel and family to help the individual do for himself that
which he can within his limitations;
8. Helping the individual to adjust to his limitations and emotional problems;
9. Working with allied health professions in planning for optimum health on local,
state, national, and international levels; and
10. Carrying out continuous evaluation and research to improve nursing techniques
and to develop new techniques to meet the health needs of people (Abdellah,
Beland, Martin, & Matthew, 1960, pp. 24-25)
 There was an evolutionary process that these original medical directions have undergone
and because of this, the number 3 which is the ‘Providing continuous care of the individual’s total
health needs’ was removed and although there was no explanation given as to why it was removed,
it was inferred that the words continuous and total are two things that can’t be achieved wholly or
provide totally. From all these ideas and premises, Dr. Abdellah’s theory was derived.

ABDELLAH’S THEORY

Even thou Abdellah didn’t clearly state a specific theoretical statement but through her
three major concepts of health, nursing problems, and problem solving, her whole concept of
patient-centered approach can be understood.

Abdellah’s theory revolves around the definition of nursing as the use of the problem-
solving approach with key nursing problems related to the health needs of people (Falco, 2002).
Because of her theoretical statement about nursing, the problem solving as the vehicle for nursing
problems as the patient is moved towards the outcome which is the health therefore towards health
was maintained. Her theory is continuously used for nursing practice, education, and research.

 HEALTH

Although there was no specific definition Abdellah has given for Health, but her
concept or idea of health can be inferred to be the dynamic pattern of functioning whereby
there is a continued interaction with internal and external forces that results in the optimal
use of necessary resources that serve to minimize vulnerabilities (Abdellah and Levine,
1986; Torres and Stanton, 1982). Her concept about health gives emphasis on ways to
prevent and rehabilitate with wellness and the importance of making those two a lifetime
goal. Nurses help the patients achieve a state of health by performing nursing services
through a holistic approach to their patients. However, to effectively perform those
services, a nurse knows and accurately identify the deficit that concerns the health of the
patient or the situation the patient is experiencing. The lacks stated are the patient’s health
needs.

 NURSING PROBLEMS

According to Abdellah, the patient’s health needs can be viewed as problems,

which may be ‘overt’ as an apparent condition, or ‘covert’ as a hidden or concealed one.
 Because covert problems can be emotional, sociological, and interpersonal in nature, they
are often missed or perceived incorrectly. Yet, in many instances, solving the covert
problems may also solve the overt problem.

Having such concept viewed problems as a patient-centered approach. However,

Abdellah seems to see those in a different point of view. She wanted to differentiate the
nursing problems to medical problems thus saying that nursing problem presented by a
patient is a condition faced by the patient or patient’s family that the nurse through the
performance of professional functions, can assist them to meet. Her use of the term ‘nursing
problems’ can be connected and relate to ‘nursing functions’ or ‘nursing goals’ which are
both consistent than that of patient-centered problems therefore the whole viewpoint could
turn into nursing-centered rather than patient-centered.

Because of it turning into nursing-centered orientation, it is now becoming in

contrast with her original premise which is the patient-centered approach. The changing of
approach is because of her desire to move away from a disease-centered, overt problem,
procedural orientation for nursing.

In her attempt to bring nursing practice into its proper relationship with restorative
and preventive measures for meeting total patient needs, she seems to swing the pendulum
to the opposite pole, from the disease-orientation to a nursing orientation, while leaving
the patient somewhere the middle. Although the approach of the problems is more of a
nursing-centered, it is actually clear that the problems are those that the patient experienced
that the nurse can help meet. The problems identify where nursing can help (Falco, 2002).
In Abdellah’s Typology of Basic Nursing Problems Presented by Patients, she
included three particular columns which are the basic nursing problem presented by patient,
specific problem of patient, and common conditions. For example, in the first column we
have to facilitate the maintenance of a supply of oxygen to all body cells. Then for its
second column, we ‘clear airway’ as the specific problem of a patient and the following as
the common conditions: Asthmatic, Postoperative, Chest Surgery, Foreign Bodies, and
Unconscious Patient.’ With the use of this, the focus will now go back to the patient
therefore achieving the patient-centered approach. According to Abdellah, she recognizes
the importance and the need to shift from nursing problems to patient outcomes.

ABDELLAH’S THEORY AND NURSING’S METAPARADIGM

 Individual
Faye Glenn Abdellah described nursing as a service to an individual and her twenty-
one nursing problems that deal with the biological, psychological, and social areas of
individuals.
  Health
For Faye Glenn Abdellah, achieving health is the purpose of nursing service.

 Environment
Faye Glenn Abdellah described nursing as a service to an individual, to family and
therefore to society. Also, she included society in “planning for optimum health on local, state,
national, and international levels” (Abdella et al., 1960).

 Nursing
Nursing is grouped into twenty-one problem areas to guide, care and promote the use
of nursing judgement (Falco, 2002). She also defined nursing to be a comprehensive service
that is based on an art and science and aims to help people, sick or well, cope with their health
needs.

USE OF THE TWENTY-ONE PROBLEMS IN THE NURSING PROCESS

The use of the 21 nursing problems of Abdellah in the nursing process serves primarily to
direct the nurse in identifying the areas in which the patient needs the nurse’s help. If the nurse
successfully helped the patient’s goals as stated in the 21 nursing problems then the patient will be
moved toward health. There are four steps for the nurse to assist the patient reach their goal.
Assessment. Within this phase, the nursing problems provide guidelines for the collection of
data. For each of the identified nursing problem, relevant data are supposed to be collected. By
facilitating the collection of data, such a classification promotes investigating those problems
consistent with the patient’s ability to provide self-help. Multitudes of nursing problems could
exist if the patient is holistic.
Nursing Diagnoses and Outcomes: Through the data collected in the assessment, the process
of identifying overt (direct approach) and covert (indirect approach) nursing problems and
interpreting, analyzing, and selecting appropriate courses of action to solve these problems is
problem solving, the final building block of Abdellah’s writing, takes place.
Planning and Implementation: The statements of the nursing problems contain the basis for
desired outcomes and most closely resemble goal attainments. Using the goals as the framework,
a plan is developed and appropriate nursing implementations are determined.
Evaluation: If the nursing problems are seen as areas in which the nurse can assist the patient,
then the patient’s ability to provide self-help in the identified areas must be evaluated. Abdellah
postulates that criterion measures can be determined from groupings of the nursing problems, it
can be used to measure patient care. Abdellah suggested the following criteria that can be used to
determine the effectiveness of patient-centered care:
1. The patient is able to provide for the satisfaction for his own needs.
 2. The nursing care plan makes provision to meet four needs – sustenal care, remedial care,
restorative care, and preventive care.
3. The care plan extends beyond the patient’s hospitalization and makes provision for
continuation of the care at home.
4. The levels of nursing skills provided vary with the individual patient care requirements.
5. The entire care plan is directed at having the patient help himself.
6. The care plan makes provision for involvement of members of the family throughout the
hospitalization and after discharge.

GROUP REFLECTION
Description
Our professor grouped us randomly into three (3). Right after our professor gave us the
assigned Theorist to report, we decided to make a group chat so that we can start discussing our
topic. We attempt to make a plan on Wednesday but due to our busy schedule we all agreed to
make it on weekends. We divided the report into three parts, and each of us must do a PowerPoint
presentation and a written report about the given part of the report. In the end, we need to compile
it, then discuss it to the class.
Feelings
We were quite happy because we are given an ample amount of time to do our report. But
we also got frustrated for the things and responsibility we need to do in other subjects. Sometimes
the awkwardness toward each other is there, because we still don't fully know each other. In
overall, we are glad because we are given a chance to work as a group.
Evaluation
We were blessed to have this kind of experience because through this, we learned many
things that we can use later on when we become nurses. The only thing that we wish to change
was our availability when we were working with this but it couldn’t be helped, but still, we
managed to get our work done before the deadline.
Analysis
Through teamwork we successfully finished our report on time although we have busy
schedules. Another factor that really helped our group is that there is no freeloader that pulled our
group down. As Helen Keller said, "Alone we can do so little; together we can do so much." We
believe that trust and unity can help any group.
Conclusion
Through effective teamwork and well-thought of ideas about how we would present Faye
Glenn Abdellah's theory, we were able to productively finish our group report assignments that we
tasked to one another therefore making the whole duration of our group activity enjoyable and
educational in ways we could learn from it as well as how the others can also learn from us.
Action Plan
If we will be working with another group next time, we will make sure that the group will
have an initial activity among ourselves that would break the ice between us if happens that we
are all from different group of friends and have not talked with each other that often; so we could
work more effectively and productively. Also, we will have a group discussion about the topic that
has been assigned to us so we can be more familiar about it. Another is that we will gather different
refences for us to use and work with. If there are concerns that we want to raise, we won’t hesitate
to say it for the betterment of our performance and for the benefit of the group that we will be
working with in the future.

REFERENCES
Julia B. George, RN, PhD. Nursing Theories: The Base for Professional Nursing Practice. 2002
Suzanne M. Falco. Nursing Theories: The Base for Professional Nursing Practice. 2002
Gibb’s reflective cycle retrieved from “https://www.ed.ac.uk/reflection/reflectors-
toolkit/reflecting-on-experience/gibbs-reflective-cycle”