ABDELLAH’S 21 NURSING PROBLEMS THEORY

INTRODUCTION
 Abdellah’s model describes concerns of nursing rather than a theory describing
relationships among phenomena. Her theory provides a foundation for determing
and organizing nursing care.
 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.
 Patient- centered Approaches to Nursing is A HUMAN NEEED THEORY –
human beings have universal and objective needs for health and autonomy and a
right to their optimal satisfaction.
 Focus on Nursing Education abd Nurse Practice
 The purpose is to guide patient care in the hospital and community settings.
 "Nursing is based on an art and science that mold 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." – Abdellah
 Abdellah’s model describes concerns of nursing rather than a theory describing
relationships among phenomena. Her theory provides a foundation for determing
and organizing nursing care.
 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.
 Patient- centered Approaches to Nursing is A HUMAN NEEED THEORY –
human beings have universal and objective needs for health and autonomy and a
right to their optimal satisfaction.
 Focus on Nursing Education abd Nurse Practice
 The purpose is to guide patient care in the hospital and community settings.
 Faye Glenn Abdellah is a pioneer in nursing research who developed the “Twenty-
One Nursing Problems.” Her model of nursing was progressive for the time in that
it refers to a nursing diagnosis during a time in which nurses were taught that
diagnoses were not part of their role in health care.
ABDELLAH’S 21 NURSING PROBLEMS THEORY

 She was the first nurse officer to earn the ranking of a two-star rear admiral and the
first nurse and the first woman to serve as a Deputy Surgeon General.
HISTORY AND BACKGROUND

 Was born on March 13, 1919 in New York to a father of Algerian heritage and
Scottish mother.
 Her family subsequently moved to New Jersey where she attended high
school.
 Years later, on May 6, 1937, the German hydrogen-fueled airship Hindenburg
exploded over Lakehurst.
 Abdellah and her brother witnessed the explosion, destruction and the fire
subsequent to the ignited hydrogen that killed many people. That incident
became the turning point in Abdellah’s life. It was that time when she realized
that she would never again be powerless to assist when people were in so dire
need for assistance. It was at that moment she vowed that she would learn
nursing and become a professional nurse. Deputy Surgeon General Faye G.
Abdellah, RN, MA, EdD, died on February 24, 2017, at the age of 97.
PUBLISHED BOOKS & AWARDS

 Lists of some of popular works or most widely held works by Faye G Abdellah
 Preparing Nursing Research for the 21st Century : Evolution, Methodologies,
Challenges -has 12 editions published
 New Directions in Patient-Centered Nursing; Guidelines for Systems of Service,
Education, and Research -has 9 editions published
 Patient-Centered Approaches to Nursing -has 16 editions published
 The Nursing Shortage : Dynamics and Solutions -has 1 edition published
 Effect of Nurse Staffing on Satisfactions with Nursing Care : A Study of How
Omissions in Nursing Services, as Perceived by Patients and Personnel, are
Influenced by the Number of Nursing Hours Available -has 5 editions published
INFLUENCES

 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.
ABDELLAH’S 21 NURSING PROBLEMS THEORY

 1960 - She was influenced by the desire to promote client-centered comprehensive

nursing care.

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.
PERSON

 She describes the recipients of nursing as individuals (and families), although she
does not delineate her beliefs or assumptions about the nature of human beings.
 Abdellah describes people as having physical, emotional, and sociological needs.
 Patient is described as the only justification for the existence of nursing.
HEALTH

 In Patient–Centered Approaches to Nursing, Abdellah describes health as a state

mutually exclusive of illness.
 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.”
SOCIETY AND ENVIRONMENT

 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.
 The environment is the home or community from which patient comes.

NURSING

 Nursing is a helping profession.

ABDELLAH’S 21 NURSING PROBLEMS THEORY

 Nursing care is doing something to or for the person or providing information to

the person with the goals of meeting needs, increasing or restoring self-help ability,
or alleviating impairment.
 Nursing is broadly grouped into the 21 problem areas to guide care and promote
use of nursing judgment.
 Nursing to be comprehensive service.
KEY CONCEPT
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
ABDELLAH’S 21 NURSING PROBLEMS THEORY

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

 Needs of patients are further divided into four categories: basic to all patients,
sustenal care needs, remedial care needs, and restorative care needs.
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.
ABDELLAH’S 21 NURSING PROBLEMS THEORY

REMEDIAL CARE NEEDS

 Remedial care needs to 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 resolving 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.

 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.
ABDELLAH’S 21 NURSING PROBLEMS THEORY

 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
 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.
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.
ABDELLAH’S 21 NURSING PROBLEMS THEORY

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.

STRENGTH
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.
LIMITATIONS

 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.
 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.
ABDELLAH’S 21 NURSING PROBLEMS THEORY

APPLICATION TO NURSING PRACTICE

 ABDELLAH’S “Ten way’s of Identifying a Client’s Problem” is utilized in the

clinical setting and are necessary in initiating and implementing the nursing care
plan.
 Nursing Programs encourage nusing students to utilize patient-centered approaches
in the clinical setting.
 Problem Solving approach is utilized by practioners in guiding treatment plans
within their practice. Especially within practices that deals with clients who have
specific health care needs and specific nursing problems.(Nursing Theories, 2010)
EDUCATION

 She attended her high school in New Jersey after her family have move there.
 In 1940’s she attended the Fitkin the memorial Hospital’s School now known as
Ann May School of Nursing where she earned her Nursing diploma in 1942.
 In 1945’s she attended Columbia University where she expanded her education and
choose to become a Doctor
 In 1945’s she attended the Columbia University where she earned 3 degrees which
are: bachelor degree in nursing in 1945, master of art degree in physiology in 1947,
and Doctor of education in 1955.

RESEARCH (LESSING, 2004)

 Assisted international nursing research studies during the Korean War (China,
Japan, Australia, Russia)
 Abdellah’s research findings led to the first federally-tested coronary care unit in
Connecticut Theory and research data led to establishment of the office of Long-
Term Care.