Running head: DISCOVERY OF NURSING

The Discovery of Nursing Research via Nursing Problems

Diana Pulido
Old Dominion University
School of Nursing

Running head: DISCOVERY OF NURSING

Theory Assessment
NURS 306 - Theoretical Foundations of Professional Nursing Practice
Purpose of Assignment
This assignment is designed to allow the student an opportunity to complete an in-depth analysis
of a nursing theory/model. Analysis of the theory coupled with application to a clinical scenario
is intended to demonstrate the relevance of nursing theories to professional practice.
Approach to Assignment
This assignment was approach by analyzing the theory and its purpose, observing the meaning
from different perspectives to prevent becoming bias, using my perspective to identify
agreements and disagreements, and developing my own theory. Also by researching previous and
current practices to including statistical results and its overall outcome, by identifying areas of
the studies that used my perspective as evidence in order to reflect the accuracy of my developed
theory. The disagreeable areas of the study were considered for practice but there was not strong
data that changed my perspective.
Reason for Inclusion
I provided an overview of the history of nursing and its contribution to the healthcare system.
This assignment represents the importance of self-reflection, efficiency, and determination of
own practice. It also remarks the importance of outcome analysis of traditional and modern care
via accountability to improve safety measures, and how these have evolved in healthcare over
time.
Critical Thinking

Using nursing and other appropriate theories and models to guide professional practice

Used the appropriate nursing leadership styles such as quantum, transactional, transformational
and shared presented in the reading as guidance to analyze and perceive the intended meaning of
the interviewed leaders theory and style.

Evaluates nursing care outcomes through the acquisition of data and the questioning of
inconsistency

Evaluated the outcome of the leaders vision goal and consistency in the application of his
subjective data by observing his units structure and the efficiency of his subordinates during the
department tour after an interaction.

Uses nursing and other appropriate theories and models to guide professional practice

Running head: DISCOVERY OF NURSING

I used this model to guide my professional practice by showing me how important is to selfreflect and be self-aware as I identified I need to "meet my own needs first before meeting
others" I learned "this reduces the development of "burn out" which could be perceived by
patients", I also identified I need to work on my listening skills "another area this theory can
guide my actions is in becoming an active listener.

Uses decision-making skills in making clinical or professional judgments

I used my decision-making skills to make my clinical judgments as I stated: "Certain points of

the list have been performed, but there is still more I need to review to put into practice".

Revises actions and goals based on evidence rather than conjecture

I revised the actions, evaluate the goals and the outcomes of a research study with the purpose of
validating patient-center care as the key element in providing provide quality care "509 new
patients who were monitored statistically and observationally for a period of a year via
physician-patient meetings with videotaped sections, diagnostic test, hospitalizations, physicians
visit and specialty referrals", suddenly, "it was perceived researchers were more concern on
health care cost rather than patient safety and quality" as I stated.

Engages in creative problem-solving

I engaged a creative problem solving by suggesting "there should be more studies done using
other tools to see if similar results are obtained and also that addresses patient's benefit rather
than budget", and by providing a solution by stating " a benefit noted was participants of this
study established a well-funded trusting relationship with their health care provider, perhaps their
anxiety level decreased after understanding illness and plan of care which provides motivation to
stay compliant".
Research

Shares research findings with colleagues

The next day after reading both studies, I shared Dr. Abdellah's theory model with my co-worker
Christy Boyd, RN who also believed all nurses should implement this model as it is well
organized.
Professionalism

Demonstrates accountability for ones own professional practice.

I demonstrated accountability for my own clinical practice by maintaining current on evidence

base practice as I explored two research studies known as the Putting Patients First: PatientCentered Care: More Than the Sum of its Parts and Patient-Centered Care is Associated with
Decreased Health Care Utilization.

Running head: DISCOVERY OF NURSING

Applies an ethical decision-making framework and legal guidelines to clinical situations

that incorporate moral concepts, professional ethics, and advocacy for patient well-being
and preferences

I continue to use legal guidelines such as the policy and procedures as well as the standard of
practice from my state when performing bedside care but I am also applying Dr. Abdellahs
model as my personal framework to ensure I fully meet my patients needs as I still believe this
prevents nurses from forgetting certain interventions, it expands nurses critical thinking,
promotes safe and quality care, and increase positive outcomes.

Running head: DISCOVERY OF NURSING

Abstract
Recognized as the leader in the development of nursing research (Alligood, 46), Dr. Faye
Gleen Abdellah made a great impact in U.S. history. She not only became the first nurse in
receiving the rank of two-star admiral but, separated disease-centered care approach and patientcentered care. This stimulation in the medical field allowed the occupation of nursing to become
a profession and it provided a new definition of what is to be a nurse; caring, professional, role
model, competent, and educationally prepared. Dr. Abdellah developed a system as a guide for
safe practice and to cover all aspects of each patients needs. Research articles were reviewed
and discussed for better understanding of theory.

Running head: DISCOVERY OF NURSING

The Discovery of Nursing Research via Nursing Problems

Known as the Twenty-One Nursing Problems, it is a typology created by Dr. Abdellah as
a way to problem-solving and as the framework for nursing care. Its purpose is to assess,
promote, maintain and facilitate patients recovery via an individualized holistic approach. This
approach was divided by Dr. Abdellah into three aspects as stated by Cardinal Stritch University
Physical, sociological, and emotional needs of the patients Types of interpersonal relationship
between the nurse and the patient Common elements of patient care (Faye, n.d.). Via this
twenty-one nursing problem statements, she expresses how important is for all nurses to maintain
competency and to be aware of her/his own needs and beliefs as nursing field exposes nurses to a
diverse population and cultures. Dr. Abdellah believed nursing is an ongoing learning process
requiring continuous education for a safe and professional performance perhaps is what made her
create Twenty-one nursing problems list model. This prevents nurses from forgetting certain
interventions, it expands nurses critical thinking, promotes safe and quality care, and increase
possibilities of positive outcomes. As stated by the Cardinal Stritch University, these are:
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 a 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 conditionspathological, 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.

It is clear that by using this nursing problem model, it will benefit the patient as well as
the provider. In patients, this will provide and maintain his/her dignity by meeting humans basic
needs (food, elimination, sleep, etc.,), it prevents new injuries, illnesses, and deterioration in
patients by promoting early detection and timely intervention according to based on objective
and subjective data. It assists in developing a well-funded patient-nurse relationship by
constantly maintaining patients and family members up to date with the treatment plan.
Addresses patients spiritual needs and reminds nurses to provide a healing environment. It
assesses and warns the patient of the modifiable factor that could be contributing to
hospitalization, reduces patients stress by providing a smooth transition home via community
resources and follows ups appointments for an optimal rehabilitation. From nurses perspective,
this stimulates nurses to increase their competency by continuing with education; it facilitates the
identification of physiological findings, its compensatory mechanisms, and the appropriate
treatment. It also increases job opportunities, remains the nurse to coordinate care with other
interdisciplinary team members such as palliative care, physical, occupational, speech and
respiratory therapy, aware nurses of own strengths and limitations to provide nonbiased care.
This Typology also reminds nurses of an importance of knowledge of expectations in diverse
culture and their beliefs; how patients of other cultures practices and react to situations, their
facial expressions, who is the decision maker, what rituals are practiced for a culturally
competent nursing care. Lastly, how maintain diplomacy and harmony in the patients
environment for a better healing. This model can also benefit as its readily available, can assist
in focusing on specific issues, as guidance on research studies, and it is well organized for an
easy understanding. On the other hand, this model also has some limitations; it is very nurseoriented, novice nurses could literally use this model's enumeration to prioritize care instead of

using patients acuity, it can be costly for patients due to having multiple inpatients medical
diagnoses, and it could cause potential illnesses to be missed due to inability to identify patients
current level of illness (Wayne, n.d).
A research article called Patient-Centered Care is Associated with Decreased Health
Care Utilization focus on a study that was performed with the purpose of finding an association
between patient-centered care, reduction of health care usage and lower medical annual cost as
this article researchers believed patient-centered care increases cost due to the necessity of
covering specific patient's needs with the assistance of other interdisciplinary members (Bertakis,
n.d.). Previous research results found that patients who felt their care were received based on
their unique needs and the communication with all interdisciplinary team were well established,
had the fewer diagnostic test and fewer referrals, causing a reduction in annual medical charges
(Bertakis, n.d.).
After the Institute of Medicine identified "patient-centeredness" as one of "the six key
components in achieving quality health care (Bertakis, n.d.), a research study was conducted to
measure the reliability of this finding. Some of the behaviors tested include respecting and
valuing patients views and perspectives, understanding of patients social interactions, validation
of patients understanding regarding a problem, treatment, and patients participation. This
research was a random selection of 509 new patients who were monitored statistically and
observationally for a period of a year via physician-patient meetings with videotaped sections,
diagnostic test, hospitalizations, physicians visit and specialty referrals. After analyzing the
results and to include the statistical data, it was concluded that Patient-centered care using this
instrument was to be significantly related to lower subsequent medical expenses without
significantly adding to the length of the medical encounter (Bertakis, n.d.).

From this study, it was perceived researchers were more concern on health care cost
rather than patient safety and quality as the Dr. Abdellahs theory emphasizes. Even though there
is a great debate on this subject at the federal level, there should be more studies done using
other tools to see if similar results are obtained and also that addresses patients benefit rather
than budget. A benefit noted was participants of this study established a well-funded trusting
relationship with their health care provider, perhaps their anxiety level decreased after
understanding illness and plan of care which provides motivation to stay compliant.
Another article found, called Putting Patients First: Patient-Centered Care: More Than
the Sum of its Parts focus on presenting the different results when performing patient-centered
care vs. medical routine care is performed. This article addresses patients opinion and thoughts
when these two types of care are provided, how the nurse plays an important role in this matter
and how organizations can assist to make patient-centered care part of its culture. It also explains
about a program known as Planetrees Patient-Centered Hospital Designation Program, a
nationwide hospital recognition obtained when patient-centered care approach is reflected. One
of the ways this program obtain hospitals compliance with this type of care approach is through
a patient survey called The Hospital Consumer Assessment of Healthcare Providers and Systems
(HCAHPS), this is a category survey that covers all areas of the patients hospital care
experience; pain management, nurse-patient communication, Physician-patient communication,
and others. Currently, there are only ten hospitals in the U.S. and part of Canada that have been
rewarded this recognition. The ultimate goal of this programs is to make all worldwide hospital a
patient-centered culture (Frampton, 2010). This article does address the importance of using Dr.
Abdhellas theory such as miscommunication leading to system dysfunction. For instance, the

case presented of a patient who decided not to express his needs because he perceived his nurse
was burned out due to her facial and verbal expressions she presented while providing care.
According to this article, organizations gets compensated when patient-centered care
approach is adopted, therefore, it is important to recognize nurses as they are the first ones in
promoting patient-centered care. These organizations should use part of their compensation to
purchase new equipment, reduce nurse-patient ratio by hiring extra staff which it will allow extra
time at the bedside that way Dr. Abdellahs theory of promoting interpersonal relationship can
realistically be accomplished. A local hospital in the state of Virginia is constantly working to
reach Magnet Recognition Program described as an affiliate of the American Nurses
Association, to hospitals that satisfy a set of criteria designed to measure the strength and quality
of their nursing (Magnet, n.d.) this is a way the organization wants to change its culture as it is
believed by the time this is achieved, all staff will be delivering patient-centered care. This
hospital currently uses CAPS survey as a tool to assess patient's overall satisfaction. It seems this
hospital is still focused on prevention and illness-treatment care as nosocomial diseases have
greatly been reduced, but there is still no change in patient's satisfaction according to last results.
There is till has not been any changes yet; telemetry department has 18 beds, 6:1 nurse-patient
ratio, the great shortage of nurses assistance for day shift and no unit coordinator.
It is clear that providing patient-centered care benefits the patient, the nurse, and the
organization. After been expose to dynamic situations as a nurse, it was noticed humans overall
just want to feel valued, respected and heard. It is obvious that practicing a task on a daily basis
becomes a routine, and once this monotony is established, it is hard to step outside of this zone,
regardless of how knowledgeable the health care provider is; changes are missed, motivation
decreases and the overall environment becomes negative causing no progress. Dr. Abdellahs

typology can be used as a reminder to all professional to cover all areas when caring for a human
being. After learning this theory, it is well acknowledged the importance of performing a selfassessment and meet own needs first before meeting others; this reduces the development of
"burn out" which could be perceived by patients. More importance should be placed into all
patients spirituals needs as this will provide them serenity and assist with healing. Another area
this theory can guide actions is in becoming an active listener. Due to the rush of the
environment, patient ratio and family expectations; often times nurses only agree with what the
patient is stating in order to reduce the length of time in patient's room, perhaps this could cause
deterioration of patient's overall health.
This authors philosophy consist of maintaining harmony and balance in all areas of life
for a good overall health. It seems Dr. Abdellahs theorys emphasized this message but in a
detailed and well-organized manner. These discussed articles and self-analysis allows identifying
nursing theory as an important tool to use especially when researching for an evidence base
practice. The research part of this paper demanded to self-assess this authors own philosophy; it
promoted understanding in how others can view expression of any sort, how practicing the list
can benefit, the limitations it could bring, and finally it allowed this author to explore nursing
theorists with similar views that be related causing expansion of critical thinking for a better
bedside practice. Certain points of the list have been performed, but there is still more to that
need to be placed into practice decided as the ultimate goal is to continue making a change
within, the patients, the current and future organizations.

References
Alligood, M. R. (2014). Nursing theorists and their work (8th ed.) Faye Glenn Abdellah, 46, 47.
St. Louis, MO: Mosby, Inc.
Bertakis, K. D. (n.d.). Patient-centered care is associated with decreased health care utilization.
In Journal of the American Board of Family Medicine. Retrieved November 20, 2015, from
http://www.jabfm.org/content/24/3/229.full
Faye Glenn Abdellah - twenty-one nursing problems. (n.d.). In Cardinal Stritch University.
Retrieved November 20, 2015, from http://www.stritch.edu/Library/DoingResearch/Research-by-Subject/Health-Sciences-Nursing-Theorists/Faye-Glenn-Abdellah--Twenty-One-Nursing-Problems/
Frampton, S. B. (2010, September). Putting patients first: patient-centered care: more than the
sum of its parts. American Journal of Nursing, 110(9), 49-53. Retrieved November 20,
2015, from
http://journals.lww.com/ajnonline/Abstract/2010/09000/Putting_Patients_First__Patient_C
entered_Care_.25.aspx
Magnet status: what it is, what it is not, and what it could be. (n.d.). In The Truth About Nursing.
Retrieved April 10, 2012, from
http://www.truthaboutnursing.org/faq/magnet.html#ixzz3slYQ0lMc
Wayne, G. (n.d.). Faye g. Abdullah's 21 nursing problems theory. In Nurseslabs. Retrieved
November 20, 2015, from http://nurseslabs.com/faye-g-abdellahs-21-nursing-problemstheory/

Honor Code:
This statement will be included on all work handed in for credit and signed. The Honor Pledge
states:
"I pledge to support the Honor System of Old Dominion University. I will refrain from any form
of academic dishonesty or deception, such as cheating or plagiarism. I am aware that as a
member of the academic community it is the responsibility to turn in all suspected violators of
the Honor Code. I will report to a hearing if summoned."

Name: Diana Pulido

Signature: DianaCPulido
Date: November 20, 2015