Saturday, July 18, 2009

Changing The World... One Step At A Time (Faye G. Abdellah)

Faye Glenn Abdellah was one of the most influential nursing theorist and public health scientist in our era. It is extremely rare to find someone who has dedicated all her life to the advancement of the nursing profession and accomplish this feat with so much distinction and merit. In fact, when she was inducted into the National Women's Hall of Fame in 2000, Abdellah said, "We cannot wait for the world to change.… Those of us with intelligence, purpose, and vision must take the lead and change the world. Let us move forward together! … I promise never to rest until my work has been completed!"

And she couldn’t have said it any better. Let us get to know this extraordinary theorist by understanding her theory, appreciating how her life story influenced her scientific pursuit, and discerning how her theory can be applied in the ever-dynamic field of nursing.

BIOGRAPHY

Faye Glenn Abdellah was born on March 13, 1919, in New York City. Years later, on May 6, 1937, the German hydrogen-fueled airship Hindenburg exploded over Lakehurst, New Jersey, where 18-year-old Abdellah and her family then lived, and Abdellah and her brother ran to the scene to help. In an interview with a writer for Advance for Nurses, Abdellah recalled: "I could see people jumping from the zeppelin and I didn't know how to take care of them, so it was then that I vowed that I would learn nursing."


Educational Achievements

In 1942, Abdellah earned a nursing diploma and is magna cum laude from Fitkin Memorial Hospital's School of Nursing New Jersey (now Ann May School of Nursing).

She received her Bachelor of Science Degree in 1945, a Master of Arts degree in 1947 and Doctor of Education in Teacher’s College, Columbia University. In 1947 she also took Master of Arts Degree in Physiology. With her advanced education, Abdellah could have chosen to become a doctor. However, as she explained in her Advance for Nurses interview, "I never wanted to be an M.D. because I could do all I wanted to do in nursing, which is a caring profession.

As an Educator and Researcher

Abdellah went on to become a nursing instructor and researcher and helped transform the focus of the profession from disease centered to patient centered. She expanded the role of nurses to include care of families and the elderly.

In 1957 Abdellah headed a research team in Manchester, Connecticut, that established the groundwork for what became known as progressive patient care. In this framework, critical care patients were treated in an intensive care unit, followed by a transition to immediate care, and then home care. Abdellah is credited with developing the first nationally tested coronary care unit as an outgrowth of her work in Manchester.

Abdellah's first teaching job was at Yale University School of Nursing. At that time she was required to teach a class called "120 Principles of Nursing Practice," using a standard nursing textbook published by the National League for Nursing that included guidelines that had no scientific basis. After a year Abdellah became so frustrated that she gathered her colleagues in the Yale courtyard and burned the textbooks. As she told Image: "Of the 120 principles I was required to teach, I really spent the rest of my life undoing that teaching, because it started me on the long road in pursuit of the scientific basis of our practice."

Established Nursing Standards

In another innovation within her field, Abdellah developed the Patient Assessment of Care Evaluation (PACE), a system of standards used to measure the relative quality of individual health-care facilities that was still used in the health care industry into the 21st century. She was also one of the first people in the health care industry to develop a classification system for patient care and patient-oriented records.


Military Nursing Service

Abdellah served for 40 years in the U.S. Public Health Service (PHS) Commissioned Corps, a branch of the military. In 1981 she was named deputy surgeon general, making her the first nurse and the first woman to hold the position and hold the position for eight years. As deputy surgeon general, it was Abdellah's responsibility to educate Americans about public-health issues, and she worked diligently in the areas of AIDS, hospice care, smoking, alcohol and drug addiction, the mentally handicapped, and violence.

She was also the former Chief Nurse Officer for the U.S. Public Health Service, Department of Health and Human Services, Washington D.C. She was one of the first to talk about gerontological nursing, to conduct research in that area, and to influence public policy regarding nursing homes. She was responsible for establishing nursing-home standards in the United States.

Abdellah has frequently stated that she believes nurses should be more involved in public-policy discussions. In her government position, Abdellah also continued her efforts to improve the health and safety of America's elderly.

What has influenced Faye Abdellah in the development her own model of nursing?

1937 – She wanted to be a nurse on the day she saw Hindenburg explode. In this time she was 18 years old on an outing with her family in New Jersey. The fire and injuries that resulted from this horrific event inspired in her wish to never again be helpless when people needed assistance.

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.

1960 – She was influenced by the desire to promote client-centered comprehensive nursing care. Abdellah described nursing as a service to individuals, to families and therefore to, to society. Acknowledging the influence of Henderson, expanded Henderson's 14 needs into 21 problems that she believed would serve as a knowledge base for nursing. Throughout her career, she strongly supported the idea that nursing research would be the key factor in helping nursing to emerge as a true profession. The research done regarding these common needs and problems has served as a foundation for the development of what is now known as nursing diagnosis.

Now that we have learned her influences, let’s get to know her concepts on the nursing concepts of man, health, environment, and nursing:

MAN/PERSON


Abdellah describes people as having physical, emotional, and sociological needs. These needs may overt, consisting of largely physical needs, or covert, such as emotional, sociological and interpersonal needs- which are often missed and perceived incorrectly. The patient is described as the only justification for the existence of nursing. The individuals (and families) are the recipients of nursing, and health, or achieving of it, is the purpose of nursing services


HEALTH


Abdellah’s concept of health maybe 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 that serve to minimize vulnerabilities (George, 1990).

In Patient–Centered Approaches to Nursing, Abdellah describes health as a state mutually exclusive of illness. Emphasis should be placed upon prevention and rehabilitation with wellness as a lifetime goal. Holistic approach must be taken by the nurse to help the client achieve state of health (George, 1990). However in order to effectively perform these services, the nurse must accurately identify the lacks or deficits regarding health that the client is experiencing. These lacks or deficits are the client’s health needs.

Although Abdellah does not give a definition of health, she speaks to “total health needs” and “a healthy state of mind and body” in her description of nursing as a comprehensive service.

ENVIRONMENT/SOCIETY



The environment is implicitly defined by Abdellah as the home or community from which patient comes. Society is included in “planning for optimum health on local, state, national and international levels.” However, as Abdellah further delineated her ideas, the focus of nursing service is clearly the individual. Society is integrated when she discusses the implementation.




NURSING

GOAL OF NURSING:


To Abdellah, nursing is a service to individuals, to families and therefore to society. The goal of nursing according to Abdellah is the fullest physical, emotional, intellectual, social and spiritual functioning of the client which pertains to holistic care.

She stated that nursing is based on an art and science that molds 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 (George, 1990). These would mean a comprehensive nursing service, this would include:

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

Nursing care for Abdellah is doing something to or for the person or providing information to the person with the goals of meeting needs, increase or restoring self-help ability or alleviating impairment.


Her theory also stated that the nurse needs knowledge on basic science and specific nursing skills, as well as knowledge skills in the communication, psychology, sociology, growth and development and interpersonal relations. These 11 nursing skills that a nurse must possess includes the following:


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 use of the self
11. Nursing procedures



Nursing is broadly grouped into the 21 problem areas to guide care and promote use of nursing judgment. These deals with biological, psychological, and social areas of individuals.


KEY CONCEPTS AND MODEL

Faye Abdellah proposed a classificatory framework for identifying nursing problems, based on her idea that nursing is basically oriented to meeting an individual client’s total health needs. Her major effort was to differentiate nursing from medicine and disease orientation.

Abdellah’s patient-centred approach to nursing was developed inductively from her practice and is considered a human needs theory. Although it was intended to guide care of those in the hospital, it also has relevance for nursing care in community settings. Abdellah was clearly promoting the image of the nurse who was not only kind and caring, but also intelligent, competent, and technically well prepared to provide service to the patient.

ABDELLAH'S TYPOLOGY OF 21 NURSING PROBLEMS

1. To maintain good hygiene and physical comfort.
2. To promote optimal activity: exercise, rest, and 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.
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 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 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 cause of illness.


Abdellah's typology was divided into three areas:


1. Physical, sociological,and emotional needs of the patients;
2. Types of interpersonal relationship between the nurse and the patient;
3. Common elements of patient care.


Theoretical Assertions

Several assertions were repeatedly stated by Abdellah although they were not labeled as such. These assertions are:

1. The nursing problem and nursing treatment typologies are the principles of nursing practice and constitute the unique body of knowledge that is nursing.
2. Correct identification of the nursing problem influences the nurse's judgment in selecting steps in solving the patient's problem.
3. The core of nursing is patient/client problems that focus on the patient and his/her problems.

With this knowledge, how, then, can we apply Abdellah’s theory in our field of practice?


Nursing Practice

First and foremost, Abdellah’s main goal is the improvement of the nursing education. She believed that as the education of nurses improves, nursing practice improves as well.

The most important impact of Abdellah’s theory to the nursing practice is that it helped transform the focus of the profession from being “disease-centered” to “patient-centered.” The patient-centered approach was constructed to be useful to nursing practice as it helped bring structure and organization to what was often been a disorganized collection of nursing care experiences. She categorized nursing problems based on the individual’s needs and developed a typology of nursing treatment and nursing goals which served as a basis for determining and organizing nursing care.

Her twenty one nursing problems made nurses look at patients’ problems and come up with nursing plan of care in a thorough and organized way. Abdellah’s identification of health needs as overt and covert assists nurses in exploring unmasked conditions about the client and plan appropriate interventions to address them. Client centered care emphasizes the principle that every nursing goal should be geared towards treating the patient and not just the mere illness. It has been viewed that if all 21 problems are investigated, the patient would be likely to be thoroughly assessed and thus will aid the nurse organize appropriate nursing strategies. Currently, the 21 nursing problems have been updated to focus on the patient and nursing diagnosis. It has ultimately helped nurses develop their individual critical-thinking skills leading to increase in job satisfaction and more productive nurse-patient and nurse-family interaction.

The application of Abdellah’s theory in nursing practice is greatly attributed to its strong influence to a patient-centered nurse-focused problem-solving approach. Abdellah’s problem-solving process of identifying the problem, selecting pertinent data, formulating hypotheses through collection of data, and revising hypotheses on the basis of conclusions obtained from the data parallels the steps of the nursing process of assessment, diagnosis, planning, implementation and evaluation (Abdellah and Levine, 1986; George, 1995). Because of the strong nurse-centered orientation in the 21 nursing problems, their use in the nursing process is primarily to direct the nurse; indirectly, the client benefits (George, 1995). If the nurse assists the client in meeting the goals states in the nursing problems, then the client will be moved toward good, optimum health.

In the end, Abdellah’s theory helps the practicing nurse organize the administration of care, nursing strategies and provides a scientific base for making decisions. As a theorist who was actively involved on nursing and health care internationally, Abdellah gave credence to the use of the model and is an advocate of applying new knowledge to improve practice.

Nursing Education

Abdellah’s theories and concepts were developed in the 1950’s to present a comprehensive clinical record for nursing students, thus, providing structure to the nursing curriculum. The patient-centered approach that was based from her concepts supported and facilitated the move from the medical model that was used at the time to a nursing model. The major focus of her book, Patient-Centered Approaches (Abdellah, et al., 1960), was on the implementation of the model in baccalaureate, associate degree and diploma nursing programs. Abdellah’s extraordinary researches, publications and other works and her worldwide reputation have been instrumental in disseminating the patient-centered approach to educational programs around the world.

Abdellah’s typology of twenty one nursing problems was an awakening call for revisions and amendments of the nursing educational system in her era. Professors and educators realized the importance of client centered care rather than focusing on medical interventions. Nursing education then slowly deviated its concentration from the complex, medical concepts, into exercising better attention to the client as the primary concern.

One of Abdellah’s theory’s major limitation—it’s very strong nurse-centered orientation—is, on the other hand, it’s major contribution to nursing education. With this orientation, the theory can be used to organize teaching contents for nursing students, to evaluate a student’s performance in a clinical area, or both (George, 1995).

Nursing Research

Research played a great part in the selection of the 21 problem classifications. Her researches were actually the major strengths of her works. In fact, her framework continues to stimulate research about the role and responsibilities of the nurse. The broad nature of the concepts in her framework offers opportunities to identify directional relationships in nursing interventions. Her theories continue to guide researchers to focus on the body of nursing knowledge itself, the identification of patient problems, the organization of nursing interventions, the improvement of nursing education, and the structure of the curriculum.

Abdellah strongly believed the idea that nursing research would be the key factor in helping nursing emerge as a true profession. The extensive research done regarding the patient’s needs and problems has served as a foundation for the development of what is now known as nursing diagnoses.

Her Typology gave birth to more nursing research and studies. The concepts are very precise and straight forward, making it simple and applicable, thus, stimulating similar disciplines and researches. Her typology was also utilized by some clinical institutions in establishing their staffing outline, namely, the intensive care, intermediate care, long term care, self care and home care units. These were identified according to how Abdellah ideates patient’s needs in her concept of care. Now patients in varied medical institutions are categorized with similar client needs, than by their medical diagnosis and diseases. Also it helped nurses provide better patient care and improve critical thinking skills.

Let us see how nurses in various settings can use Abdellah’s Typology of Needs Theory in their own work settings.

From an ICU nurse:
Ruff Joseph Cajanding, RN

As an ICU nurse, Abdellah's model of nursing care equips me with specific guidelines as to how I can better manage various patient conditions with adeptness and grace. The spectrum of cases I have and will handle in the ICU is diverse and multidimensional, ranging from the extremely common myocardial infarction, up until the most devastating Stevens-Johnson Syndrome, or porphyria, and their management could not get any more complicated. However, in planning for their care, I could utilize the principles underlying Abdellah's Typology inasmuch as it is synonymous to Maslow's hierarchy of needs. I will be guided by the fact that the basic needs should be met first (oxygenation, hydration, nutrition, etc.) before proceeding to higher level needs. Moreover, I will utilize the principle of treating patients in holistic manner, minding their psychosocio-spiritual needs inasmuch as I cater to their physical needs. Ultimately, Abdellah's typology provides nurses a framework as to how we can better organize our work in order to deliver quality nursing care to our clientele—the individual, the family, and the community in general.

From an OR nurse:
Francis Lloyd Borcelas, RN

“As an OR suite nurse, my responsibilities are not only confined on being a scrub, circulating, or anesthetist nurse in the PACU. Managing the OR is a big responsibility, and we do function similarly to the bedside nurses in the ward. Once the patient is scheduled for a procedure, an hour should be rendered for pre-operative preparation including giving of pre-operative medications, performing physical as well as emotional, psychological and spiritual assessment, and reviewing the patient’s history and laboratory results, referrals and co-management needed. In this manner, we learn more about the patient through our review of relevant data and consequently uncover nursing problems presented by the patient. Through this, we will be able to identify the therapeutic plan of care that needs to be delivered pre-operative, intra-operative and post-operatively. The applicability of Abdellah’s nursing theory is of valuable to patient care and management, and this allows nurses to manage patients in a holistic manner.

From a medical-surgical nurse:
Mae Claire N. Cabatania, RN

I would like to cite a case of my client (a stroke patient) in the medical-surgical ward. He is 45 year old male patient diagnosed with CVA and was a trans-out from ICU. He is receiving oxygen therapy via nasal cannula and hooked to NGT for feeding, and there are times when the client would be restless. Upon receiving the client during endorsement I have identified the possible nursing problems of my client. First thing on the line is the performance of self care needs and safety. Self care needs such as personal hygiene is very important for client to maintain their integrity and enhance their recovery. Another nursing problem identified is the risk for injury. At times the patient is restless, raising of side rails is very important to prevent falls and injuries. Stroke patients are at risk for falls due to altered level of consciousness. To maintain my client’s nutrition to support his recovery, he is fed via nasogastric tube as prescribed by physician. Also, my patient is at risk for aspiration that is why before feeding it is a must to check for the placement of nasogastric tube to avoid aspiration during feeding.

From a medical-surgical nurse ward:
Patricia Cornejo, RN

In this setting where clients receive direct nursing care, nurses provide a variety of measures to maintain good hygiene and physical comfort. For clients who are totally dependent and require total hygiene care such as clients with alteration in level of sensorium, a complete bed bath is rendered. While bathing the client, exposing only the areas being bathed, closing the door or pulling room curtains around the bathing area promote physical comfort. Clients in a hospital setting have their normal rest and sleep routine disrupted, which generally leads to sleep problems. The nurse can control the hospital environment in several ways. As an example, the nurse can close the curtains between clients in semiprivate rooms. Lights on the nurse’s station and client’s room can be dimmed at night. To reduce noise, nurses can conduct conversations and reports in a private area away from the client’s rooms and keep necessary conversations to a minimum, especially at night. Keeping bed clean and dry and in a comfortable position may help clients relax. Some clients suffer painful illnesses requiring special comfort measures such as application of dry or moist heat, use of supportive dressings or sprints, and proper positioning before retiring. In the rehabilitation unit, the nurse, in collaboration with other health care professionals such as physical therapists, promotes activity and exercise by teaching the use of canes, walkers, or crutches, depending on the assistive device most appropriate for the client’s condition. Nursing interventions to facilitate supply of oxygen to all body cells include positioning and coughing techniques. Initially placing a dyspneic client in high-fowlers position can relieve dyspnea whereas deep breathing and coughing techniques for postoperative client prevent further complications such as pneumonia. To create and/or maintain a therapeutic environment, a nurse can allow relatives to remain at client’s bedside during hospitalization. To facilitate the maintenance of sensory function in the older adult clients, it helps to reduce any background noise by turning off or lowering the volume of any TV, appliance, or radio during a conversation. Since bedridden clients are at risk for sensory deprivation, a nurse routinely stimulates them through range-of-motion exercises, positioning, and self-care activities (as appropriate). To prevent the spread of infection, nurses can teach aseptic practices. Medical asepsis, which includes hand hygiene and environmental cleanliness, reduces the transfer of microorganisms. Proper disposal of body secretions such as sputum should be taught as well. Safety bars on toilets, locks on beds and wheelchairs, and call lights are examples of safety features found in the hospital to prevent accident, injury, or other trauma.

To further examine how Abdellah’s Typology of 21 Nursing Problems can individually be applied in a specific nursing area, the following scenario is presented:

In my experience as a staff nurse in the endoscopy unit, Faye Abdellah's 21 nursing problems were applied in the following ways:
Katherine D, RN

1. To maintain good hygiene and physical comfort – After colonoscopy, patients are usually soiled from the procedure. It is therefore important to clean them properly and change their diapers if applicable. Physical comfort through proper positioning in bed, adjusting the air-conditioning unit, as well as proper lighting are also provided to the patient, especially if they were sedated and have to stay in the unit.

2. To promote optimal activity: exercise, rest, and sleep – Patients who were sedated during the procedure stay in the unit until the effect of the sedation has decreased to a safe level. During this time, patients are allowed to stay in the room and rest. As a nurse, I make sure the patients are able to rest and sleep well by providing a conducive environment for rest, such as decreasing environmental noise and dimming the light if necessary.

3. To promote safety through prevention of accident, injury, or other trauma and through the prevention of the spread of infection – Making sure the siderails are always up when leaving the patient keeps them from fall accidents. In our unit, one way we prevent the spread of infection is through proper disinfection of the equipments we use. We use products such as Cidezime to disinfect the instruments.


4. To maintain good body mechanics and prevent and correct deformity – Positioning the patient properly, allowing for the normal anatomical position of body parts.


5. To facilitate the maintenance of a supply of oxygen to all body cells – when patients manifest breathing problems, oxygen is attached to them, usually via nasal cannula. Sedated patients are attached to cardiac monitor and pulse oximeter while having the oxygen delivered. When the oxygen saturation falls below the normal levels, the rate of oxygen is increased accordingly, as per physician's order.

6. To facilitate the maintenance of nutrition of all body cells – patients undergoing endoscopic procedures are on NPO. For this reason it is important to monitor the blood glucose level through HGT. When the patient's blood glucose falls from the normal value, we inject D50W to the patient or we change the patient's IVF to a dextrose containing fluid.

7. To facilitate the maintenance of elimination – Providing bedpans or urinals to patients and at times, insertion of foley catheter when the patient is not able to void


8. To facilitate the maintenance of fluid and electrolyte balance – Proper regulation of the intravenous solutions as well as proper incorporations it may have. An example is when patients have low serum potassium, KCl is incorporated in the solution


9. To recognize the physiological responses of the body to disease conditions—pathological, physiological, and compensatory – it is important to check the patients for signs of internal gastrointestinal bleeding by monitoring the blood pressure and cardiac rate.


10. To facilitate the maintenance of regulatory mechanisms and functions – When a patient has a difficulty in breathing and is showing an increase respiratory rate, elevating the head part of the bed is done to facilitate the respiratory function.


11. To facilitate the maintenance of sensory function – Sometimes there are semi-conscious patients, in these cases, it is still necessary to talk to them while performing nursing interventions to maintain their auditory sense


12. To identify and accept positive and negative expressions, feelings, and reactions – most patients feel anxious before undergoing the procedures. It is necessary to listen to the patients' expressions and allow them to ask questions. To decrease their anxiety, proper instructions are given, what they are to expect, how long the procedure will take, what they should do during and after the procedure as well as other concerns.


13. To identify and accept interrelatedness of emotions and organic illness – Encourage patients to verbalize their feelings and allow them to cry when they have the need to do so will help them emotionally. Some patients are diagnosed with malignancy after the procedure and during this time the emotional needs of the patient is a priority.


14. To facilitate the maintenance of effective verbal and nonverbal communication – when patients are not able to express themselves verbally, it is important to assess for nonverbal cues. For instance when patients are in pain, assessing for facial grimacing. Touch and eye contact are also done for a good patient care.


15. To promote the development of productive interpersonal relationships – allow the patient's significant others to stay with the patient before and after the procedure. This allows for bonding and promotes interpersonal relationship.


16. To facilitate progress toward achievement of personal spiritual goals – our supervisor is a nun and she usually visits the patients in the unit. Catholic patients may benefit from this, allowing them time to practice their faith


17. To create and/or maintain a therapeutic environment - providing proper lighting, proper room temperature, a quiet environment are done to patients staying in the unit.


18. To facilitate awareness of self as an individual with varying physical, emotional, and developmental needs – care to patients vary according to their developmental needs. Allowing the parents to stay during the procedure help the pediatric patients in their emotional and developmental needs.


19. To accept the optimum possible goals in the light of limitations, physical, and emotional – The goals for each patient vary depending on the capability of the patient. The nutritional goal for a patient with a PEG tube for instance will be different, knowing that the patient has limited feeding options.


20. To use community resources as an aid in resolving problems arising from illness – Some patients live far from the city and thus referral to health centers is sometimes done


21. To understand the role of social problems as influencing factors in the cause of illness – Some patients who are diagnosed with amoebic colitis for instance are advised to avoid buying street foods to which the preparation they are not sure of, and also avoid drinking water that are not safe.


***

In conclusion, using Abdellah’s concepts of health, nursing problems, and problem solving, the theoretical statement of nursing that can be derived is the use of the problem-solving approach with key nursing problems related to the health needs of people. From this framework, 21 nursing problems, which are comparable to Henderson’s 14 components of nursing and Maslow’s hierarchy of needs, are developed. Her theory and framework provides a basis for determining and organizing nursing care. It is anticipated that by solving the nursing problems through appropriate and organized nursing strategies, the client will be moved towards ultimate health.




















Isn’t health everything that we all aspire for?


Sources:
Abdellah, F. G. & Levine, E. (1965). Better patient care through nursing research. New York: Macmillan.
George, J. (2002). Nursing Theories: The Base for Professional Nursing Practice. Upper Saddle River, NJ: Prentice-Hall, Inc.
George, J. (1995). Nursing theories: The base for professional nursing practice, 4th ed. USA: Prentice-Hall Intl.
George, J.B. (1990). Nursing theories: The base for professional nursing practice 3rd edition. Norwalk, CN: Appleton and Lange.

_____________. (1998). Image. USA: ____________.

Johnson, B. & Webber, P. (2005). An Introduction to Theory and Reasoning in Nursing 2nd Ed. Philadelphia, PA: Lippincott Williams and Wilkins.
Octaviano, O. & Balita, C. (2000). Theoretical Foundations of Nursing: The Philippine Perspective. Philippines: ___________.
_____________. (2000). Advance for Nurses. USA: ___________.
Parascandola, J (1994). "Women in the Public Health Service". Leadership in Public Health. Chicago: Illinois Public Health Leadership Institute.

Submitted by Group B: UPOU N207 batch 2009 group B
.

9 comments:

N207 Students said...

Faye Glenn Abdellah
• A Nursing Theorist
Faye Glenn Abdellah short history
• Dr. Abdellah was born on March 13, 1919 .
• She is a pioneer in nursing research who has been recognized with 77 professional and academic honors.
• She was the first nurse officer to receive the rank of a two star rear admiral.
• She helped transform nursing theory, nursing care and nursing education and as a result was inducted into The National Women’s Hall of fame in 2000.
• She is the first nurse and the first woman to serve as Deputy Surgeon General.
• She is a former Chief Nurse Officer for the U.S. Public Health Service, Department of Health and Human Services, Washington D.C.
• she developed educational materials in many key areas of public health, including AIDS, the mentally handicap, violence, hospice care, smoking cessation, alcoholism, and drug addiction.



PHILOSOPHICAL UNDERPINNINGS OF THE THEORY

• Abdellah’s patient-centred approach to nursing was developed inductively from her practice and is considered a human needs theory.
• The theory was created to assist with nursing education and is most applicable to the education of nurses.
• Although it was intended to guide care of those in the hospital, it also has relevance for nursing care in community settings.
MAJOR ASSUMPTIONS, CONCEPTS & RELATIONSHIPS

• The language of Abdellah’s framework is readable and clear.
• Consistent with the decade in which she was writing, she uses the term ‘she’ for nurses, ‘he’ for doctors and patients, and refers to the object of nursing as ‘patient’ rather than client or consumer.
• She referred to Nursing diagnosis during a time when nurses were taught that diagnosis was not a nurses’ prerogative.
• Assumptions were related 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 care delivery;
– changing nursing education.
– continuing education for professional nurses.
– development of nursing leaders from under reserved groups.
• Abdellah and colleagues developed a list of 21 nursing problems.
• They also identified 10 steps to identify the client’s problems
• 11 nursing skills to be used in developing a treatment typology

N207 Students said...

10 steps to identify the client’s problems

• Learn to know the patient.
• Sort out relevant and significant data.
• Make generalizations about available data in relation to similar nursing problems presented by other patients.
• Identify the therapeutic plan.
• Test generalizations with the patient and make additional generalizations.
• Validate the patient’s conclusions about his nursing problems
• Validate the patient’s conclusions about his nursing problems.
• Explore the patient’s and family’s reaction to the therapeutic plan and involve them in the plan.
• Identify how the nurses feels about the patient’s nursing problems.
• Discuss and develop a comprehensive nursing care plan
11 nursing skills

• Observation of health status .
• Skills of communication
• Application of knowledge.
• Teaching of patients and families.
• Planning and organizing of work.
• Use of resource materials.
• Use of personal resources.
• Problem-solving.
• Direction of work of others.
• Therapeutic use of the self.
• Nursing procedures.
The twenty one nursing problems

Three Major Categories
• Physical, sociological, and emotional needs of clients.
• Types of interpersonal relationships between the nurse and patient.
• Common elements of client care.

N207 Students said...

BASIC TO ALL PATIENTS

• To maintain good hygiene and physical comfort.
• To promote optimal activity: exercise, rest and sleep.
• To promote safety through the prevention of accidents, injury, or other trauma and through the prevention of the spread of infection.
• To maintain good body mechanics and prevent and correct deformities
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.
10. To facilitate the maintenance of regulatory mechanisms and functions.
11. To facilitate the maintenance of sensory function
REMEDIAL CARE NEEDS

• To identify and accept positive and negative expressions, feelings, and reactions.
• To identify and accept the interrelatedness of emotions and organic illness.
• To facilitate the maintenance of effective verbal and non verbal communication.
• To promote the development of productive interpersonal relationships.
• To facilitate progress toward achievement of personal spiritual goals.
• To create and or maintain a therapeutic environment.
• To facilitate awareness of self as an individual with varying physical , emotional, and developmental needs.
RESTORATIVE CARE NEEDS

• To accept the optimum possible goals in the light of limitations, physical and emotional.
• To use community resources as an aid in resolving problems arising from illness.
• To understand the role of social problems as influencing factors in the case of illness.

N207 Students said...

Person
• Abdellah describes people as having physical, emotional, and sociological needs. These needs may overt, consisting of largely physical needs, or covert, such as emotional and social needs.
• Patient is described as the only justification for the existence of nursing.
• Individuals (and families) are the recipients of nursing.
• Health, or achieving of it, is the purpose of nursing services.
Nursing
• Nursing is a helping profession. In Abdellah’s model, 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.
• 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.
Health
• In Patient –Centered Approaches to Nursing, Abdellah describes health as a state mutually exclusive of illness.
• Although Abdellah does not give a definition of health, she speaks to “total health needs” and “a healthy state of mind and body” in her description of nursing as a comprehensive service.
Society/Environment

• Society is included in “planning for optimum health on local, state, national, and international 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 patient comes.

N207 Students said...

NURSING PROBLEMS

• Nursing problem presented by a client is a condition faced by the client or client’s family that the nurse through the performance of professional functions can assist them to meet . The problem can be either an overt or covert nursing problem.
• An overt nursing problem is an apparent condition faced by the patient or family, which the nurse can assist him or them to meet through the performance of her professional functions.
• The covert nursing problem is a concealed or hidden condition faced, by the patient or family, which the nurse can assist him or them to meet through the performance of her professional functions
• In her attempt to bring nursing practice into 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.
PROBLEM SOLVING

• The problem solving process involves identifying the problem, selecting pertinent data, formulating hypothesis, testing hypothesis through the collection of data, and revising hypothesis where necessary on the basis of conclusions obtained from the data.

N207 Students said...

Characteristic 1

• Abdellah’s theory has interrelated the concepts of health, nursing problems, and problem solving as she attempts to create a different way of viewing nursing phenomenon.
• The result was the statement that nursing is the use of problem solving approach with key nursing problems related to health needs of people.
Characteristic2

• Problem solving is an activity that is inherently logical in nature.
Characteristic 3


• 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 problems

Characteristic4

• One of the most important questions that arise when considering her work is the role of client within the framework. This question could generate hypothesis for testing and thus demonstrates the ability of Abdellah’s work to generate hypothesis for testing.
Characteristic 5


• The results of testing such hypothesis would contribute to the general body of nursing knowledge.

Characteristic 6

• Abdellah’s problem solving approach can easily be used by practitioners to guide various activities within their practice. This is true when considering nursing practice that deals with clients who have specific needs and specific nursing problems.
Characteristic 7


• Although consistency with other theories exist, many questions remain unanswered.

Acceptance by the Nursing community
• Practice
– Abdellah’s typology of 21 nursing problems helps nurses and nursing students perform in a scientific, systematic way. Using this scientific foundation will empower the nurse to give meaning to each and every nursing action that he/ she will perform. Using the 21 nursing problems technique, the clinical practitioner could asses the patient, make a nursing diagnosis and plan interventions.

N207 Students said...

• Education
– Abdellah’s typology of 21 nursing problems had the most potent effect on the educational system. Educators came to the realization that revisions are of prime importance if nurses were to become self-governing. They saw that the biggest flaw in the profession was the absence or limited base of a scientific body of knowledge unique to nursing. The typology satisfied this void and gave the most crucial and timely opportunity to move away from the medical replica of cultivating nurses.

• Research
– The typology of 21 nursing problems was produced through research; therefore it is expected that more research followed after its introduction to the academic world. Intensive research, like the function studies (a type of research) scrutinized the quantity of time the nurses spent with the patient. The typology utilized by abdellah and strachan became the root for cultivating the nursing care model and was then employed for setting up the staffing outline in clinical settings. The staffing patterns were found on the patient’s identified needs and, as Abdellah foresaw, they comprise of:
– Intensive care
– Intermediate care
– Long-term care
– Self care
– Home-care units

N207 Students said...

USE OF 21 PROBLEMS IN THE NURSING PROCESS

ASSESSMENT PHASE

• Nursing problems provide guidelines for the collection of data.
• A principle underlying the problem solving approach is that for each identified problem, pertinent data are collected.
• The overt or covert nature of the problems necessitates a direct or indirect approach, respectively.
NURSING DIAGNOSIS

• The results of data collection 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. Therefore, once the problem has been diagnosed, the goals have been established.
• Given that these problems are called nursing problems, then it becomes reasonable to conclude that these goals are basically nursing goals.
IMPLEMENTATION

• Using the goals as the framework, a plan is developed and appropriate nursing interventions are determined.
EVALUATION

• According to the American Nurses’ Association Standards of Nursing Practice, the plan is evaluated in terms of the client’s progress or lack of progress toward the achievement of the stated goals.
• This would be extremely difficult if not impossible to do for Abdellah’s nursing problem approach since it has been determined that the goals are nursing goals, not the client goals.
• Thus, the most appropriate evaluation would be the nurse progress or lack of progress toward the achievement of the stated goals.

posted by:Dianne A. Dalida

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