GROUP 1 FAYE ABDELLAH

Theory: 21 Nursing Problems

a. Short introduction about the theorist - BAUTISTA, MORIAH

b. Presentation of Concepts, Relationships, Models, and Nursing Paradigms. -LADAGA,
IVANA
c. Application of the Theory in the fields of Practice, Academe, and Research - DIEGO,
MICHAEL

FAYE GLENN ABDELLAH

Getting to know the Theorist

Faye Glenn Abdellah, the woman who

pioneered the 21 Nursing Problem Theory, was
born on March 13, 1919, in New York City. It was
during the year 1942 that she finished her basic
nursing education with flying colors in Fitkin
Memorial Hospital School of Nursing. In addition,
Abdellah obtained a Bachelor of Science degree in
Nursing in 1945, Master of Arts in Physiology in
1947, and Doctor of Education in 1955. Such
achievements equipped her in becoming the first
nurse and first woman to serve as a Deputy
Surgeon General in the United States. Moreover,
with her contributions in the field of Education and
Nursing Research, it is quite apparent that
Abdellah has made a huge impact in the medical
field. Abdellah was known to be a prolific author
that had more than 150 publications. Furthermore,
in the 1960s, she was “profoundly influenced by
the desire to promote client-centered all-inclusive nursing care, thus making the idea of Nursing
as a true humanitarian service to individuals, to families, and therefore to society.” (Octaviano &
Balita, 2008). This led to the birth of the Nursing Problem theory.

All of Abdellah’s hard work paid off in the end since she garnered a spot in the US National
Women’s Hall of Fame in the year 2000, was called a “living legend” by the American Academy
of Nursing in 1994, and all of her extraordinary accomplishments were used globally.

Presentation of Concepts, Relationships, Model, and Nursing Paradigms

 Faye Glenn Abdellah – 21 Nursing Problems

Faye Glenn Abdellah has been a recognized leader in developing nursing research and
nursing within the Public Health Services (Alligood, 2014). She views nursing as an art and
science that molds the attitude, 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. Abdellah
developed the typology of 21 nursing problems that interrelated the concepts of health, nursing
problems, and problem-solving. These problems are the basis for Abdellah’s Patient-Centered
Approaches Theory (Johnson & Webber, 2015). Her theory proposes the utilization of problem-
solving techniques with chief nursing problems related to the health requirements of the patients.
Her theory has been a model to guide care in hospital institutions and community health nursing
(Octaviano & Balita, 2008). Additional to these 21 nursing problems, Abdellah also identified 11
nursing skills to assist in developing a treatment typology:

A. Observation of Status
B. Skills of Communication
C. Application of Knowledge
D. Teaching of patients and families
E. Planning and organization of work
F. Use of resource materials
G. Use of personnel resources
H. Problem-solving
I. Direction of work of others
J. Therapeutic use of the self
K. Nursing procedures

Abdellah viewed the 21 nursing problems and 11 skills as a unique body of nursing
knowledge which was an idea that was crucial as nursing sought to move from a medical to a
nursing model (Johnson & Webber, 2015). Since Abdellah’s work was based on the problem-
solving method, it is an instrument to define nursing problems as the patient moves toward a
healthy outcome. Abdellah, along with her colleagues, developed ten steps to identify a patient’s
pain that are also vital in her theory. The ten steps are:

A. Learn to know the patient.

B. Sort out relevant and significant data.
C. Make generalizations about available data concerning similar nursing problems presented
by other patients.
D. Identify the therapeutic plan.
E. Test generalizations with the patient to and make additional generalizations.
F. Validate the patient’s conclusions about his nursing problems.
G. Continue to observe and evaluate the patient over a period of time to identify any attitudes
and clues affecting his or her behavior.
H. Explore the patient and their family’s reactions to the therapeutic plan and involve them in
the plan.
I. Identify how the nurses feel about the patient’s nursing problems.
J. Discuss and develop a comprehensive nursing care plan.
Nursing Metaparadigms

Person

Faye Glenn Abdellah classified the care recipients as individuals (and families). However,
she does not set a limit on the nature of human beings. The 21 nursing problems relate to the
biological, psychological, and social aspects of individuals (George, 2014). It can also be said to
correspond to concepts of importance.

Health

In her theory, health is defined as the purpose of nursing services. Although Faye Glenn
Abdellah did not provide a concrete definition of health, she speaks of it as “total health needs”
and a “healthy state of mind and body” in her description of nursing as a comprehensive service
(George, 2014). Health is considered a dynamic pattern of functioning with continued interaction
with internal and external forces that results in the optimal use of resources (Johnson & Webber,
2015).

Environment

In Abdellah’s Theory, society or environment is addressed and included in “planning for

optimum health on local, state, national, and international levels.” On the contrary, Abdellah
expounds her ideas, clearing out that the core of nursing services is in the individual. In her theory,
the society is served through attending the individual’s needs (George, 2014).

Nursing

The concept of nursing in this theory is the application of intellectual competencies and
technical skills along with the attitude, desire, and ability to help people cope with their needs
(Johnson & Webber, 2015). It is grouped into twenty-one problem areas for nurses to work out
their judgment and appropriate care. Faye Glenn Abdellah reflects nursing as a wide-ranging
service that caters to individuals, ill or healthy, coping with their healthcare needs (Octaviano &
Balita, 2008). Nursing is also described as serving individuals, families, and the society (George,
2014).

Concepts

Nursing Problems

Nursing Problems are considered a health condition that the nurse assists a patient or family
to resolve through the performance of professional functions (Johnson & Webber, 2015).
According to Octaviano and Balita (2008), health needs are taken as problems. They are
subdivided into overt, which is obvious or physical needs, or the can-be-seen conditions, and the
covert, an unseen or masked condition (George, 2014). In contrast, covert problems can be
emotional, sociological, and interpersonal, so they are often perceived mistakenly. However, in
many occurrences, solving the covert problems may resolve overt problems as well.
Problem-Solving

Efficient nursing care necessitates nurses to be able to recognize and solve overt and covert
nursing problems. The Problem-solving process includes (a) identifying the problem, (b) selecting
relevant data, (c) devising hypotheses, (d) testing hypotheses through the assortment of data, and
(e) revising beliefs when necessary based on conclusions obtained from data (George, 2014). The
problem-solving steps were chosen since they are believed to be the best way to recognize nursing
problems. These will drastically influence the nurse’s assumptions in selecting the next steps in
selecting the appropriate actions to solve the issues (Octaviano & Balita, 2008).

Models

Typology of 21 Nursing Problems

Abdellah’s typology of 21 nursing problems is a conceptual model regarding the patient’s
needs and the role of nurses in classifying the patient’s problems using a problem-solving
approach. This typology is crucial within her theory to classify nursing problems. Abdellah’s
Typology of 21 nursing problems is categorized according to needs: (a) basic to all patients, (b)
sustenal care needs, (c) remedial care needs, and (d) restorative care needs. She based this on
Henderson’s 14 basic needs to build a foundation for classifying nursing problems.

The Typology of Twenty-one Nursing Problems (Abdellah et al., 1960, pp. 16-17):

Basic to All Patients

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 the
prevention of the spread of infection.
4. To maintain good body mechanics and prevent and correct deformity.

Sustenal Care Needs

5. To facilitate the maintenance of a supply of oxygen to all body cells.

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 disease conditions – pathological,
physiological, and compensatory.
10. To facilitate the maintenance of the regulatory mechanism 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 non-verbal communications.
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 arising from illness.
21. To understand the role of social problems as influencing factors in the cause of illness.

Focus of Care Pendulum

Faye Abdellah's work is a set of problems formulated regarding nursing-centered services

used to determine patients' needs. Her usage of the Nursing Problems is more inclined to be
"nursing goals" and "nursing functions" than client-centered problems (Octaviano & Balita, 2008).
Therefore, the focus of her theory is nursing-centered rather than client-centered. This focus
contradicts what Abdellah supports, which is client-centered care. This can be observed by her
desire to move away from disease-centered orientation (treating illnesses rather than the patient).
In her attempt to restore nursing to its proper relationship with the restorative and preventive
measures to render the client's needs, she re-focused nursing from the disease-orientation to
nursing-orientation but leaving the client-orientation in the middle since it is the primary concern.
The Focus of Care Pendulum portrays this situation.
Analysis of the Theory

Strengths

The theory of the 21 nursing problems by Faye Abdellah is comprehensive and

understandable by the client with specific healthcare needs and concerns. Healthcare providers can
also utilize it, specifically by nurses, to proceed by health-allied activities within any setting. One
of the theory’s strengths was formulated under extensive research (George, 2014). Another
strength of this theory is the initiative behind the development of the 21 nursing problems.
According to George (2014), Abdellah wanted to move nursing care from medical diagnosis and
procedures to a patient-centered base. In addition, another strength can be seen through the
emphasis on the importance of recognizing and correctly identifying both overt and covert
problems. Abdellah reminded us to look beyond what’s on the surface – to figure out the covert
problems since they are often the cause of the overt problems.

Limitations

The theory has its limitations as well. Its main limitation is its nurse-centered orientation.
Labeling the 21 nursing problems tends to mislead the readers that Abdellah’s work is nursing-
centered instead of patient-centered. It would have been helpful if she used other terminologies or
elaborated more clearly on how the nursing problems relate to patient-centered care (George,
2014). Furthermore, the theory also lacks emphasis on what the patient is supposed to achieve after
receiving the healthcare he needs. The approach is solely focused on nursing practice and
individuals. Hence, it lacks the flexibility to adjust to particular settings and situations. The patient
may be diagnosed with several different issues based on what the typology indicates. Therefore,
using the 21 nursing problems could further fractionalize care since the nurse will focus on the
problems rather than looking at the patient as a whole.

Application of the Theory in the fields of Practice, Academe, and Research Practice
Practice

Dr. Abdellah's typology of 21 nursing problems has aided nursing professionals in dealing
with patient care in a more ordered and systematic manner in our nursing practice. With the
problem-solving method, a nursing practitioner can identify a patient's problems, plan for his care,
and implement nursing interventions for the recognized problem in a scientific manner utilizing
this typology (Aligood, 2014). This problem-solving strategy has changed our practice since we
are attempting to focus our attention on the client himself rather than the client's medical condition,
which is the medical profession's primary goal.

The nurse will be able to provide meaning to each nursing action he or she performs by
using the scientific foundation of the theory. The clinical practitioner could assess the patient,
make a nursing diagnosis, and arrange interventions using the 21 nursing problems technique.
Abdellah's major objective is to improve nursing education. She believed that as nurses' education
improves, so will their nursing practice. It shifted the profession's emphasis from "disease-
centered" to "patient-centered.". The patient-centered approach was created to aid nursing practice
by providing structure and organization to what was frequently a chaotic environment. The patient-
centered approach was designed to be effective in nursing practice since it helps to organize and
structure what was frequently a disorderly collection of nursing care experiences. The nursing
problem was based on the needs of the individual, and a typology of nursing treatment and nursing
goals were developed as a basis for determining and arranging nursing care. Client-centered care
highlights the idea that every nursing focus should be to treat the patient rather than just the
condition. (Octaviano & Balita, 2008)

Education (Academe)

Abdellah's idea was formed and expanded during the 1950s, providing structure to the
nursing curriculum. Abdellah's outstanding research, publications, and other activities, as well as
her international reputation, have helped to spread the patient-centered approach to educational
programs all over the world. The most persuasive effect on the educational system was Abdellah's
classification of 21 nursing problems. Educators realized that if nurses are to become self-
governing, they must make significant adjustments. They recognized that the profession's most
serious defect was the lack of or limited base of a scientific body of knowledge specific to nursing.
This hole was filled by typology, which provided the most critical and urgent opportunity to break
away from the medical model of cultivating nurses. Instead of focusing on medical interventions,
professors and educators acknowledged the necessity of client-centered care. Nursing education
gradually shifted its focus away from sophisticated medical principles and toward a greater
emphasis on the client as the major concern. (Octaviano & Balita, 2008)

Research

Dr. Abdellah's work has made major contributions to the field of ever-advancing nursing
research, as her work is primarily based on research. This typology is thought to have influenced
the present nursing diagnosis classification system. This nursing concept is still a preferred basis
for nursing studies today. (Sigma Theta Tau International Honor Society of Nursing, 1998).

Abdellah's theories continue to direct researchers to concentrate on the body of nursing

knowledge, the identification of patient problems, the organization of nursing interventions, the
enhancement of nursing education, and the curriculum structure. The 21 problem classes were
chosen based on extensive research. Her research was undoubtedly one of the most impressive
aspects of her work. Her framework continues to stoke interest in the role and responsibilities of
nurses. Her framework's ideas have a broad breadth, allowing for the identification of guided
linkages in nursing treatments. Her theories continue to direct scholars to focus on the body of
nursing knowledge itself, patient issue identification, nurse intervention organization, nursing
education enhancement, and curriculum design. The considerable investigation into the patient's
requirements and difficulties laid the groundwork for the establishment of what is now known as
nursing diagnoses. Abdellah's typology established the foundation for developing the nursing care
 model, which was subsequently used to establish the staffing outline in clinical settings.
(Octaviano & Balita, 2008)

REFERENCES

Book Reference:
Alligood, M. R. (2014). Nursing theorists and their works (8th ed.). Elsevier Mosby.
George, J. B. (2014). Nursing Theories: The Base for Professional Nursing Practice (6th Edition ed.).
Pearson Education Limited.

Johnson, B. M., & Webber, P. B. (2015). An Introduction to Theory and Reasoning in Nursing (4th Edition
ed.). Lippincott Williams & Wilkins.

Octaviano, E. F., & Balita, C. E. (2008). Theoretical Foundations of Nursing: The Philippine Perspective.
Ultimate Learning Series.

Online Reference:

Application to Nursing Practice: Faye Abdellah’s Theory Example | GraduateWay. (2016, December 8).
GraduateWay. https://graduateway.com/application-to-nursing-practice-faye-abdellahs-theory/

Faye Abdellah: 21 Nursing Problems Theory. (2014). Retrieved from https://nurseslabs.com/faye-g-

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