TWENTY  ONE  NURSING   PROBLEMS  

FAYE  GLENN  ABDELLAH  

FAYE  GLENN  ABDELLAH  
•  Dr  Abdellah  worked  as  Deputy  Surgeon  General  in   US   and   Chief   Nurse   Officer   for   the   US   Public   Health  Service  ,  Department  of  Health  and  Human   Services,  Washington,  D.C.   •  According   to   her,   nursing   is   based   on   an   art   and   science   that   mold   the   aKtudes,   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’S  THEORY  AND  THE   FOUR  MAJOR  METAPARADIGMS  

NURSING  
•  Nursing  is  a  helping  profession.   •  In   Abdellah’s   model,   nursing   care   is   doing   something   to   or   for   the   person   or   providing   informaNon   to   the   person   with   the   goals   of   meeNng   needs,   increasing   or   restoring   self-­‐ help  ability,  or  alleviaNng  impairment.  

NURSING  
•  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,   emoNonal,   and   sociological   needs.   These   needs   may   overt,   consisNng   of   largely   physical   needs,  or  covert,  such  as  emoNonal  and  social   needs.   •  The   paNent   is   described   as   the   only   jusNficaNon  for  the  existence  of  nursing.    

PERSON  
•  Individuals  (and  families)  are  the  recipients  of   nursing.   •  Health,   or   achieving   of   it,   is   the   purpose   of   nursing  services.  

HEALTH  
•  In  PaNent–Centered  Approaches  to  Nursing,   Abdellah  describes  health  as  a  state  mutually   exclusive  of  illness.   •  Although  Abdellah  does  not  give  a  definiNon   of  health,  she  speaks  to  “total  health  needs”   and  “a  healthy  state  of  mind  and  body”  in  her   descripNon  of  nursing  as  a  comprehensive   service.  

SOCIETY  AND  ENVIRONMENT  
•  Society   is   included   in   “planning   for   opNmum   health   on   local,   state,   naNonal,   and   internaNonal   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  paNent  comes.  

USE  OF  21  PROBLEMS  IN  THE   NURSING  PROCESS  

ASSESSMENT  PHASE  
•  Nursing   problems   provide   guidelines   for   the   collecNon  of  data.   •  A   principle   underlying   the   problem   solving   approach   is   that   for   each   idenNfied   problem,   perNnent  data  are  collected.   •  The   overt   or   covert   nature   of   the   problems   necessitates   a   direct   or   indirect   approach,   respecNvely.      

NURSING  DIAGNOSIS  
•  The  results  of  data  collecNon  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  PHASE  
•  Using   the   goals   as   the   framework,   a   plan   is   d e v e l o p e d   a n d   a p p r o p r i a t e   n u r s i n g   intervenNons  are  determined.    

EVALUATION  PHASE  
•  The  most  appropriate  evaluaNon  would  be  the   nurse  progress  or  lack  of  progress  toward  the   achievement  of  the  stated  goals.  

10  STEPS  TO  IDENTIFY  THE     CLIENT’S  PROBLEMS  

1.  Learn  to  know  the  paNent.   2.  Sort  out  relevant  and  significant  data.   3.  Make  generalizaNons  about  available  data  in   relaNon   to   similar   nursing   problems   presented  by  other  paNents.   4.  IdenNfy  the  therapeuNc  plan.   5.  Test   generalizaNons   with   the   paNent   and   make  addiNonal  generalizaNons.  

6.  Validate   the   paNent’s   conclusions   about   his   nursing  problems.   7.  ConNnue  to  observe  and  evaluate  the  paNent   over  a  period  of  Nme  to  idenNfy  any  aKtudes   and  clues  affecNng  his  behavior.   8.  Explore  the  paNent’s  and  family’s  reacNon  to   the  therapeuNc  plan  and  involve  them  in  the   plan.  

9.  IdenNfy   how   the   nurses   feels   about   the   paNent’s  nursing  problems   10. D iscuss   and   develop   a   comprehensive   nursing  care  plan    

11  NURSING  SKILLS  TO  BE  USED   IN  DEVELOPING  A  TREATMENT   TYPOLOGY  

1.  2.  3.  4.  5.  6. 

ObservaNon  of  health  status     Skills  of  communicaNon   ApplicaNon  of  knowledge   Teaching  of  paNents  and  families   Planning  and  organizaNon  of  work   Use  of  resource  materials  

7.  Use  of  personnel  resources   8.  Problem-­‐solving   9.  DirecNon  of  work  of  others   10. TherapeuNc  use  of  the  self   11. Nursing  procedure  

THREE  MAJOR  CATEGORIES  
•  Physical,  sociological,  and  emoNonal  needs  of   clients.   •  Types   of   interpersonal   relaNonships   between   the  nurse  and  paNent.   •  Common  elements  of  client  care.  

21  NURSING  PROBLEMS  

1.  To   maintain   good   hygiene   and   physical   comfort.   2.  To   promote   opNmal   acNvity:   exercise,   rest  and  sleep.   3.  To   promote   safety   through   the   prevenNon   of   accidents,   injury,   or   other   trauma   and   through   the   prevenNon   of   the   spread   of   infecNon.   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   nutriNon   of   all  body  cells.   7.  To  facilitate  the  maintenance  of  eliminaNon.   8.  To   facilitate   the   maintenance   of   fluid   and   electrolyte  balance.    

9.  To   recognize   the   physiological   responses   of   the  body  to  disease  condiNons   10. To   facilitate   the   maintenance   of   regulatory   mechanisms  and  funcNons   11. To   facilitate   the   maintenance   of   sensory   funcNon.  

12. To   idenNfy   and   accept   posiNve   and   negaNve   expressions,  feelings,  and  reacNons   13. To  idenNfy  and  accept  the  interrelatedness  of   emoNons  and  organic  illness   14. To   facilitate   the   maintenance   of   effecNve   verbal  and  non  verbal  communicaNon   15. To   promote   the   development   of   producNve   interpersonal  relaNonships  

16. To  facilitate  progress  toward  achievement  of   personal  spiritual  goals   17. To   create   and   /   or   maintain   a   therapeuNc   environment   18. T o   facilitate   awareness   of   self   as   an   individual   with   varying   physical   ,   emoNonal,   and  developmental  needs  

19. To  accept  the  opNmum  possible  goals  in  the   light  of  limitaNons,  physical  and  emoNonal   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    

Think  about  this:  
•  The   purpose   of   life   is   a   life   of   purpose.     -­‐   Robert  Byrne   •  Robert   Eugene   Byrne   (born   April   20,   1928   in   N e w   Y o r k   C i t y )   i s   a   l e a d i n g   American   chess   player,   a   Grandmaster,   and   a   c h e s s   a u t h o r .   H e   w o n   t h e   U . S .   Championship  in  1972,  and  was  a  World  Chess   Championship  Candidate  in  1974.    

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