Aside from being the first nurse and the first woman to serve as a Deputy Surgeon General, Faye Glenn Abdellah also made a name in the nursing profession with the formulation of her “21 Nursing Problems Theory.” Her theory changed the focus of nursing from disease-centered to patient-centered, and began to include the care of families and the elderly in nursing care. The Patient Assessment of Care Evaluation developed by Abdellah is now the standard used in the United States.
According to 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.”The patient-centered approach to nursing was developed from Abdellah’s practice, and the theory is considered a human needs theory. It was formulated to be an instrument for nursing education, so it most suitable and useful in that field. The nursing model is intended to guide care in hospital institutions, but can also be applied to community health nursing, as well.
Major Concepts
The model has interrelated concepts of health and nursing problems, as well as problem-solving, which is an activity inherently logical in nature.
Individual
She describe the recipients of nursing as individuals (and families), although she does not delineate her beliefs or assumptions about the nature of human beings.
Health
Health, or the achieving of it, is the purpose of nursing services. Although Abdellah does not give a definition of health, she speaks to “total health needs” and “a healthy state of mind and body.” Health may be defined as 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 to minimize vulnerabilities.
Society
Society is included in “planning for optimum health on local, state, and international levels.” However, as Abdellah further delineates her ideas, the focus of nursing service is clearly the individual.
Nursing Problems
The client’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 solve the overt problems as well.
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.
Subconcepts
Twenty-one Nursing Problems (Abdellah, 1960)
1. To maintain good hygiene and physical comfort.
2. To promote optimal activity: exercise, rest, and sleep.
3. To promote safety through the prevention of accidents, injury, or other trauma and through the prevention of the spread of infection.
4. To maintain good body mechanics and prevent and correct deformities.
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 regulatory mechanisms and functions.
11. To facilitate the maintenance of sensory functions.
12. To identify and accept positive and negative expressions, feelings, and reactions.
13. To identify and accept the 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 of personal spiritual goals.
17. To create and/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 arising from illness.
21. To understand the role of social problems as influencing factors in the case of illness.
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.
Basic Needs
The basic needs of an individual patient are to maintain good hygiene and physical comfort; promote optimal health through healthy activities, such as exercise, rest and sleep; promote safety through the prevention of health hazards like accidents, injury or other trauma and through the prevention of the spread of infection; and maintain good body mechanics and prevent or correct deformity.
Sustenal Care Needs
Sustenal care needs facilitate the maintenance of a supply of oxygen to all body cells; facilitate the maintenance of nutrition of all body cells; facilitate the maintenance of elimination; facilitate the maintenance of fluid and electrolyte balance; recognize the physiological responses of the body to disease conditions; facilitate the maintenance of regulatory mechanisms and functions; and facilitate the maintenance of sensory function.
Remedial Care Needs
Remedial care needs identify and accept positive and negative expressions, feelings, and reactions; identify and accept the interrelatedness of emotions and organic illness; facilitate the maintenance of effective verbal and non-verbal communication; promote the development of productive interpersonal relationships; facilitate progress toward achievement of personal spiritual goals; create and maintain a therapeutic environment; and facilitate awareness of the self as an individual with varying physical, emotional, and developmental needs.
Restorative Care Needs
Restorative care needs include the acceptance of the optimum possible goals in light of limitations, both physical and emotional; the use of community resources as an aid to resolve problems that arise from illness; and the understanding of the role of social problems as influential factors in the case 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.
According to Abdellah and coworkers (1960), nurses should do the following:
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.
The 11 nursing skills are:
- observation of health status
- skills of communication
- application of knowledge
- teaching of patients and families
- planning and organization of work
- use of resource materials
- use of personnel resources
- problem-solving
- direction of work of others
- therapeutic uses of the self
nursing procedure
Abdellah also explained nursing as a comprehensive service, which includes:
- Recognizing the nursing problems of the patient
- Deciding the appropriate course of action to take in terms of relevant nursing principles
- Providing continuous care of the individual’s total needs
- Providing continuous care to relieve pain and discomfort and provide immediate security for the individual
- Adjusting the total nursing care plan to meet the patient’s individual needs
- Helping the individual to become more self-directing in attaining or maintaining a healthy state of body and mind
- Instructing nursing personnel and family to help the individual do for himself that which he can within his limitations
- Helping the individual to adjust to his limitations and emotional problems
- Working with allied health professions in planning for optimum health on local, state, national, and international levels
- Carrying out continuous evaluation and research to improve nursing techniques and to develop new techniques to meet people’s health needs
Strengths/Weaknesses
Strengths:
As a logical and simple statement, Abdellah’s problem-solving approach can easily be used by practitioners to guide various activities within their nursing practice.
The language of Abdellah’s framework is readable and clear.
The theoretical statement places heavy emphasis on problem solving, an activity that is inherently logical in nature.
The problem-solving approach is readily generalizable to client with specific health needs and specific nursing problems.
Weaknesses:
The major limitation to Abdellah’s theory and the 21 nursing problems is their very strong nurse-centered orientation.
Little emphasis on what the client is to achieve was given in terms of client care.
Failure of the framework to provide a perspective on humans and society in general limits the generalizability of the theory.
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.
Analysis
With the aim of Abdellah in formulating a clear categorization of patient’s problems as health needs, she rather conceptualized nurses’ actions in nursing care which is contrary to her aim. Nurses roles were defined to alleviate the problems assessed through the proposed problem-solving approach.
The problem-solving approach introduced by Abdellah has the advantage of increasing the nurse’s critical and analytical thinking skills since the care to be provided would be based on sound assessment and validation of findings.
One can identify that the framework is strongly applied to individuals as the focus of nursing care. The inclusion of an aggregate of people such as the community or society would make the theory of Abdellah more generalizable since nurses do not only provide one-person service especially now that the community healthcare level is sought to have higher importance than curative efforts in the hospital.
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