Faye Abdellah: 21 Nursing

Problems Theory

Biography of Faye Glenn Abdellah

 Born on March 13, 1919 in New York City.
 She graduated magna cum laude from Fitkin Memorial Hospital School of Nursing in Neptune,
New Jersey in 1942 (now Ann May School of Nursing).
 She obtained her Bachelor of Science in 1945, her Master of Arts in 1947, and her Doctor of
Education in 1955 from the Teachers Colleges at Columbia.
 She was appointed Chief Nurse Officer of the U.S Public Health Service (USPHS) in 1970 and
serves that position in 17 years.
 First woman to serve as Deputy Surgeon General of the United States.
 She was inducted into the US National Women’s Hall of Fame in 2000 due to her contributions
in the field of Education and Nursing Research
 She has been a staff nurse, a head nurse, a faculty member at Yale University and Columbia
University.
 A public health nurse and an author of more than 150 articles and books.
 She has been a research consultant to the World Health Organization.
 She is a recipient of more than 79 academic honors and professional awards in her excellence in
Nursing.

WHAT HAS INFLUENCED FAYE ANDELLAH IN THE DEVELOPMENT HER OWN

MODEL OF NURSING:-
 1937:- She wanted to be a nurse on the day she saw Hindenburg explode.
 1949:- She spent 40 years in Public Health Service where she first became involved in research,
being assigned to perform studies to improve nursing practices.
 1960:- she was influenced by the desire to promote client – centered comprehensive nursing
care.

Abdellah’s 21 Nursing Problems Theory

According to Faye Glenn Abdellah’s theory, “Nursing is based on an art and science that moulds 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.”

Assumptions
The assumptions Abdellah’s “21 Nursing Problems Theory” relate to change and
anticipated changes that affect nursing; the need to appreciate the
interconnectedness of social enterprises and social problems; the impact of
problems such as poverty, racism, pollution, education, and so forth on health and
health care delivery; changing nursing education; continuing education for
professional nurses; and development of nursing leaders from underserved
groups.

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 this behavior.
8. Explore the patient’s and family’s reaction to the therapeutic plan and
involve them in the plan.
9. Identify how the nurse feels about the patient’s nursing problems.
10.Discuss and develop a comprehensive nursing care plan.

Theoretical Assertions:
 Better nursing care after evidence-based researches
 Nursing is patient centered which focuses on the health needs of the individual
 21 Nursing problems as the guidelines in nursing care
 To include family of the patient in the nursing care plan

Major Concepts of 21 Nursing Problems

Theory

Metaparadigms:

MAN/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, sociological and
interpersonal needs – which are often missed and perceived incorrectly
 The individuals (and families) are the recipients of nursing, and 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 comprehensive services.

ENVIRONMENT/SOCIETY:-

 The environment is implicitly defined by Abdellah as the home or community from which
patient comes.
 Society in included in “planning for optimum health”.
 However, as Abdellah further delineated her ideas, the focus of nursing service is clearly the
individual.

NURSING:-

 Nursing is a helping profession.

 These would mean a comprehensive nursing service, this would include:
1. Recognizing the nursing problems of the patient.
2. Deciding the appropriate actions 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.
5. Adjusting total nursing care plan to meet the patient’s individual needs.

Sub concepts
The following are the sub concepts of Faye Abdellah’s “21 Nursing Problems” theory
and their definitions.

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
 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:

Basic to all patients

1. To maintain good hygiene and physical comfort
2. To promote optimal activity: exercise, rest, and sleep
3. To promote safety through prevention of accident, injury, or other trauma
and through the prevention of the spread of infection
4. To maintain good mechanics and prevent and correct deformity.
Sustenal Care Needs
5. Facilitate the maintenance of a supply of oxygen to all body cell
6. To facilitate the maintenance of nutrition of all body cells
7. To facilitate the maintenance of elimination.
8. To facilitate the maintenance of fluid and electrolyte balance
9. To recognize the physiological responses of the body to dieses condition-
pathological, physiological, and compensatory.
10.To facilitate the maintenance of regulatory mechanisms and functions
11.To facilitate the maintenance of sensory function.

.Remedial Care Needs

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
.

Restorative Care 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
Abdellah’s work, which is based on the problem-solving method, serves as a vehicle
for delineating nursing (patient) problems as the patient moves toward a healthy
outcome. The theory identifies ten steps to identify the patient’s problem and 11
nursing skills used to develop a treatment typology.

The ten steps are:

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 or her behavior.
8. Explore the patient and his or her family’s reactions to the therapeutic
plan and involve them in the plan.
9. Identify how the nurses feel about the patient’s nursing problems.
10.Discuss and develop a comprehensive nursing care plan.
The 11 nursing skills are:

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 uses of the self
11.nursing procedure
Patient-Centered Approaches to Nursing
Faye Abdellah’s work is a set of problems formulated in terms of nursing-centered
services, which are used to determine the patient’s needs. The nursing-centered
orientation to client care appears to be contradicting to the client-centered
approach that Abdellah professes to support. This can be observed by her desire to
move away from a disease-centered orientation.

Focus of Care Pendulum of Faye Abdellah’s Theory. The nursing-centered orientation to client
care seems contrary to the client-centered approach that Abdellah professes to uphold. The
apparent contradiction can be explained by her desire to move away from a disease-centered
orientation. In her attempt to bring nursing practice to 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.
In her attempt to bring nursing practice to 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.

21 Nursing Problems and The Nursing

Process
The nursing process in Abdellah’s theory includes assessment, nursing diagnosis,
planning, implementation, and evaluation.
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.
 Once the problem has been diagnosed, the nursing goals have been
established.
IMPLEMENTATION:
 Using the goals as the framework, a plan is developed and appropriate
nursing interventions are determined.
EVALUATION:
 The most appropriate evaluation would be the nurse progress or lack of
progress toward the achievement of the stated goals

Relevance of theory in nursing practice,

education and research:
NURSING PRACTICE:-

 Abdellah’s main goal is the improvement of the nursing education.

  The most important impact of Abdellah's theory to the nursing practice is
that it helped transform the focus of the profession from being ‘disease-
centered’ to ‘patient - centered’.
 The steps of the nursing process are assessment, diagnosis, planning,
implementation and evaluation.

NURSING EDUCATION:-

 Professors and educators realized the importance of client centered care

rather than focusing on medical interventions.
 Nursing education then slowly deviated its concentration from the complex,
medical concepts, into exercising better attention to the client as the primary
concern.
 It’s very strong nurse- centered orientation- is, on the other hand, it’s major
contribution to nursing education.

NURSING RESEARCH:-

 Her theories continue to guide researchers to focus on the body of nursing

knowledge itself, the identification of patient problems, the organization of
nursing interventions, the improvement of nursing education, and the
structure of the curriculum.
 The extensive research done regarding the patient’s needs and problems has
served as a foundation for the development of what is now known as nursing
diagnosis

Maslow hierarchy: Comparison of Henderson

and Abdellah’s Theory
Application example
The case of Simar
 He experienced severe chest pain. In addition he experienced shortness of
breath, tachycardia and profuse diaphoresis.
Assessment reveals:
 Cardiac damage
 Past History: He had gone through similar episodes since past 2 years.

Main problems:

 Pain
 Impaired cardiac function
 Work related stress
 Failure to seek medical attention
Strengths
The following are the strengths of Faye Abdellah’s “21 Nursing Problems” theory.

 The problem-solving approach is readily generalizable to the client with

specific health needs and specific nursing problems.
 With the model’s nature, healthcare providers and practitioners can use
Abdellah’s problem-solving approach to guide various activities within the
clinical setting. This is true when considering nursing practice that deals
with clients who have specific needs and specific nursing problems.
  The language of Faye Abdellah’s framework is simple and easy to
comprehend.
 The theoretical statement greatly focuses on problem-solving, an activity
that is inherently logical in nature.

Weaknesses
The following are the limitations of Faye Abdellah’s “21 Nursing Problems” theory.

 The major limitation to Abdellah’s theory and the 21 nursing problems is

their very strong nurse-centered orientation. She rather conceptualized
nurses’ actions in nursing care which is contrary to her aim.
 Another point is the lack of emphasis on what the client is to achieve was
given in terms of client care.
 Framework seems to focus quite heavily on nursing practice and
individuals. This somewhat limits the ability to generalize although the
problem-solving approach is readily generalizable to clients with specific
health needs and specific nursing.
 Also, Abdellah’s framework is inconsistent with the concept of holism. The
nature of the 21 nursing problems attests to this. As a result, the client
may be diagnosed as having numerous problems that would lead to
fractionalized care efforts, and potential problems might be overlooked
because the client is not deemed to be in a particular stage of illness.