Faye G. Abdellah’s 21 Nursing Problems Theory

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.

Description


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.

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.

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


Abdellah’s Typology of 21 Nursing Problems

Faye Abdellah's Typology of 21 Nursing Problems. Click to enlarge.
Faye Abdellah‘s Typology of 21 Nursing Problems. Click to get full size.

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
  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

Moreover, the 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.

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.

Faye Abdellah's 10 Steps to Identify the Patient's Problem. Click to enlarge.
Faye Abdellah’s 10 Steps to Identify
the Patient’s Problem. Click to enlarge.

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

Abdellah also explained nursing as a comprehensive service, which includes:

  1. Recognizing the nursing problems of the patient
  2. Deciding the appropriate course of action to take in terms of relevant nursing principles
  3. Providing continuous care of the individual’s total needs
  4. Providing continuous care to relieve pain and discomfort and provide immediate security for the individual
  5. Adjusting the total nursing care plan to meet the patient’s individual needs
  6. Helping the individual to become more self-directing in attaining or maintaining a healthy state of body and mind
  7. Instructing nursing personnel and family to help the individual do for himself that which he can within his limitations
  8. Helping the individual to adjust to his limitations and emotional problems
  9. Working with allied health professions in planning for optimum health on local, state, national, and international levels
  10. Carrying out continuous evaluation and research to improve nursing techniques and to develop new techniques to meet people’s health needs

Patient-Centered Approaches to Nursing


Focus of Care Pendulum
Focus of Care Pendulum

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. 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.

In the assessment phase, the nursing problems implement standard procedure for data collection. A principle underlying the problem-solving approach is that for each identified problem, pertinent data is collected. The overt or covert nature of problems necessitates a direct or indirect approach, respectively.

The outcome of the collection of data in the first phase conclude the possible problems of the patient, which can be grouped under one or more of the broader nursing problems. This will further lead to the nursing diagnosis.

After formulating the diagnosis, nursing care plan is developed and appropriate nursing interventions are determined. The nurse now set those interventions in action which complete the implementation phase of the nursing process.

The evaluation takes place after the interventions have been carried out. The most convenient evaluation would be the nurses progress or lack of progress toward the achievement of the goals established in the planning phase.

Strengths


The problem-solving approach is readily generalizable to 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 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 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 limit 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.

Conclusion


Abdellah ‘s typology of 21 nursing problems is a conceptual model mainly concerned with patient’s needs and the role of nurses in problem identification using a problem analysis approach.

According to the model, patients are described as having physical, emotional, and sociological needs. People are also the only justification for the existence of nursing. That is, without people, nursing would not be a profession since they are the recipients of nursing.

Patient-centered approaches to nursing health are described as a state mutually exclusive of illness. Abdellah does not provide a definition of health, but speaks to “total health needs” and “a healthy state of mind and body” in her description of nursing.

However, Abdellah rather conceptualized nurses’ actions in nursing care which is contrary to her aim of formulating a clear categorization of patient’s problems as health needs. Nurses roles were defined to alleviate the problems assessed through the proposed problem-solving approach.

As a whole, the theory is intended to guide care not just in the hospital setting, but can also be applied to community nursing, as well. The model has interrelated concepts of health and nursing problems, as well as problem-solving, which is an activity inherently logical in nature.

Furthermore, the 21 nursing problems progressed to a second-generation development referred to as patient problems and patient outcomes. Abdellah educated the public on AIDS, drug addiction, violence, smoking, and alcoholism. Her work is a problem centered approach or philosophy of nursing.

See Also


References


  • Abdellah, F.G. The federal role in nursing education. Nursing outlook. 1987, 35(5),224-225.
  • Abdellah, F.G. Public policy impacting on nursing care of older adults .In E.M. Baines (Ed.), perspectives on gerontological nursing. Newbury, CA: Sage publications. 1991.
  • Abdellah, F.G., & Levine, E. Preparing nursing research for the 21st century. New York: Springer. 1994.
  • Abdellah, F.G., Beland, I.L., Martin, A., & Matheney, R.V. Patient-centered approaches to nursing (2nd ed.). New York: Mac Millan. 1968.
  • Abdellah, F.G. Evolution of nursing as a profession: perspective on manpower development. International Nursing Review, 1972); 19, 3..
  • Abdellah, F.G.). The nature of nursing science. In L.H. Nicholl (Ed.), perspectives on nursing theory. Boston: Little, Brown, 1986.

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