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. (Abdellah & Levine, 1986)

FAYE GLENN ABDELLAH CONCEPTS OF THE

NURSING CONCEPTS OF MAN, HEALTH,
ENVIRONMENT & NURSING
Nursing is broadly group into twenty-one problem areas to guide care and promote use of
nursing judgment. These deal with biological, psychological, and social areas of individuals.

Faye Abdellah proposed a classificatory framework for identifying nursing problems, based
on her idea that nursing is basically oriented to meeting an individual total health needs. Her
major effort was to differentiate nursing from medicine and disease orientation. Her patient-
centred approach to nursing was developed inductively from her practice and is considered a
human needs theory; with its relevance for nursing care in community settings. She promotes
the image of the nurse not only as kind and caring, but also intelligent, competent, and
technically well prepared to provide service to the patient.

Typology of 21 Nursing Problems

Basic to all patient needs
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.

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—pathological,
physiological, and compensatory.

10. To facilitate the maintenance of regulatory mechanisms and functions.

11. To facilitate the maintenance of sensory function.

REMEDIAL CARE NEEDS

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.

RESTORATIVE CARE 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.

Theoretical Assertions
The nursing problem and nursing treatment typologies are the principles of nursing practice
and constitute the unique body of knowledge that is nursing.

Correct identification of the nursing problem influences the nurse’s judgment in selecting
steps in solving the patients’ problem.

The core of nursing is patient/client problems that focus on the patient and their problems

Abdellah’s main goal was the advancement of education for nurses; she believed that as the
education of nurses improves, nursing practice improves as well. 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 came up with
nursing plan of care in a through and organized way. He client centered care emphasizes the
principle that the nurses’ goal should be geared towards treating the patient and not just the
illness. Her problem-solving process of identifying the problem, selecting pertinent data,
formulate hypotheses through collection of data, and revising hypotheses on the basis of
conclusions obtained from the data that parallels the steps of the nursing process of
assessment, diagnosis, planning, implementation and evaluation ( Abdellah and Levine, 1986;
George, 1995). If the nurse assists the client in meeting the goals stated in the nursing
problem, then the client will be moved toward good, optimum health. The theory helps the
practicing nurse organize the administration of care, nursing strategies and provides a
scientific basis for making decisions.

Her Typology gave birth to more nursing research and studies. The concepts are precise and
straight forward, making it simple and applicable. Patient are categorized with similar client
needs, than by their medical diagnosis and diseases, it helped the nurse to provide better
patient care and improved critical thinking skills.

ABDELLAH’S TYPOLOGY AND THE FOUR

CONCEPTS OF THE NURSING METAPARADIGM
MAN/PERSON

Abdellah describes people as having physical, emotional and sociology needs.

These needs may overt, consisting of largely physical needs, or convert, such as emotional,
sociology and interpersonal needs – which often missed and perceived incorrectly.

The patient is describes 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.

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.

Abdellah further delineated her ideas; the focus of nursing service is clearly the individual.
Society is integrated when she discusses the implementation.

HEALTH

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.
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.

NURSING

Abdellah view nursing as a helping profession.

Is a comprehensive service that combines art and science.

Does something to or for a client or provides information that helps meet the client’s needs,
increase or restores self-help ability, or alleviates impairment.

Uses the nursing process, a problem-solving approach.

Can use the 21 nursing problems as a guide for nursing care.

Nancy Roper
The model is based upon activities of living, which evolved from the work of Virginia
Henderson in 1966. The activities of daily living are the key to the model, which seeks to
define "what living means." The discoveries about what living means are categorized into the
activities of living to promote maximum independence through complete assessment, which
leads to interventions that further support independence in areas that may be difficult or
impossible for the patient on his or her own. The model assesses the patient's level of
independence in relation to the activities of living, which then helps the nurse and health care
team to develop a nursing care plan based on the patient's individual abilities and levels of
independence. To be most effective, the patient should be assessed upon admission, as well
as evaluated throughout care. That way, changes can be made to the care plan, if needed. The
activities of living listed in the model are:

• Maintaining a safe environment

• Communication

• Breathing

• Eating and drinking

• Elimination

• Washing and dressing

• Temperature control

• Mobilization

• Working and playing

• Expressing sexuality
• Sleeping

• Death and dying

Factors that sway activities of living are biological, psychological, sociocultural,

environmental, and politico economic. These factors create the model holistic, and if they are
not involved in assessment, it will be both unfinished and flawed. The biological factor is the
impact of the overall health; the psychological factor is the impact of emotion, cognition,
spiritual beliefs, and the ability to understand; the sociocultural factor is the impact of society
and culture experienced by the individual; the environmental factor considers the impact of
the environment on the patient, as well as the patient's impact on the environment; and the
politico economic factor is the impact of the government, politics, and economy on the
activities of daily living.

NANCY ROPERS METAPARADIGM IS CONSIDERED

AS ACTIVITIES OF LIVING
The Roper-Logan-Tierney Model for Nursing is a theory of nursing care based on activities
of daily living, which are often abbreviated ADLs or ALs.

According to the model, there are five factors that influence the activities of living. The
incorporation of these factors into the theory of nursing makes it a holistic model. If they
aren't considered, the resulting assessment is incomplete and flawed. The factors are used to
determine the individual patient's relative independence in regards to the activities of daily
living.

They are: biological, psychological, sociocultural, environmental, and politico economic.

The biological factor addresses the impact of the overall health, of current injury and illness,
and the scope of the patient's anatomy and physiology.

The psychological factor addresses the impact of emotion, cognition, spiritual beliefs, and the
ability to understand. According to Roper, this is about "knowing, thinking, hoping, feeling
and believing."

The sociocultural factor is the impact of society and culture as experienced by the individual
patient. This includes expectations and values based on class and status, and culture within
the sociocultural factor relates to the beliefs, expectations, and values held by the individual
patient for him or herself, as well as by others pertaining to independence in and ability to
carry out the activities of daily living.

The environmental factor in Roper's theory of nursing makes it a "green" model. The theory
takes into consideration the impact of the environment on the activities of daily living, but
also examines the impact of the activities of daily living on the environment.

The politico economic factor is the impact of the government, politics, and economy on the
activities of daily living. This factor addresses issues such as funding, government policies
and programs, war or conflict, availability to benefits, political reforms, interest rates, and
availability of public and private funding, among others.
The impressions of the usefulness of each theory to the
practice of nursing.
The development and use of theories were meant to establish clear standards and boundaries
for quality nursing care within this profession as such we being with this quote;

"Theory without practice is sterile and practice without theory is blind."

-- Karl Marx

The theories of Abdellah and that of Roper are the models that bring together the one centred
on human needs. Though these theories were carved out of Virginia Henderson’s concept of
doing for another person what he or she lacks the strength, will, or knowledge to do, (George)
pg577, they also added new dimensions to the nursing practice. Besides returning that person
to independence as soon as possible, they also seek to identify the patient and not just the
disease being treated. Nursing care which is client- centred and involves or addresses the
activities of daily living could only lead to the road of personal rehabilitation once practiced.
Therefore the usefulness of both the model of nursing and the client – centred approach once
explored should lead to only that of a positive.

Abdellah believed the focus of theory should be on the delivery of nursing care to the whole
person. This holistic look included the physical, emotional, intellectual, social, and spiritual
needs of the client and of their family. The main concepts behind this holistic theme being
addressed are health, nursing problems, and problem solving. In the practice of nursing
performing preventative and rehabilitative measures with wellness being a focal goal, would
only help the nurse achieve a level of health for her client. Identifying the patient’s loop holes
or gaps in their health when they are admitted through initial assessments, and doing this
accurately would serve as guides in addressing the patient’s health needs.

In relation to nursing problems, yes they can be overt or covert in nature, but using this
holistic approach making the client the centre of the care being afforded to him these
problems can be identified and dealt with using nursing functions. Abdellah defines nursing
as, the use of the problem- solving approach with key nursing problems related to the health
needs of people. pg173. Out of this nursing diagnoses and outcomes can come into view still
remaining patient oriented. The problem solving process which when looked at is parallel to
our use of the nursing process to direct personalised nursing care to the client. Therefore it
can only add to the accuracy in identifying and dealing with a client’s state of wellness.

Looking at the Roper- Logan- Tierney model for nursing its usefulness can be seen not only
in the nursing arena but in other spheres. Ideally its use should be the thread used to link and
assess planned care during the length of a patient’s care. This model which looks at the
activities of daily living when coupled with the five factors that influence such activities;
such as the biological, psychological, sociocultural, environment and politico-economic
factors, this model would indeed benefit the one being assessed. Presently this assessment
model is used to identify changes in a patient’ life due to some form of illness basically as a
checklist which wasn’t its first modus operandi. Roper’s vision for using the Model of
Nursing just as her counterpart Abdellah’s vision, was to accurately identify problems and
solve them using this tool to plan nursing care. Roper’s stated
"The patient is the patient, they are not a different patient
because they are in a different clinical area. Their needs
are the same it’s who will meet those needs that changes."
To the question of these theories and their usefulness indeed they would aid in the practice of
nursing through their exposure of the covert and overt aspects of the patient’s life. Use of
these two tools would aid in identifying the nursing problems the client faces and hence allow
for the planned care to address these problems through the problem- solving technique. This
should ultimately lead to the achievement of the nursing goal of restoration and prevention of
good health.

Conclusion
The use of nursing theories to guide the practice of nursing is still evolving on daily basis
with the movement of nursing from intuition, guess work and trial and error to the use of
research and a more evidence based approach to the delivery and understanding of
individualized nursing care.

Nurses then need to understand that theory should provide the foundations of nursing
practice, help to generate further knowledge and indicate in which direction nursing should
develop in the future. Theory is important because it helps us to decide what we know and
what we need to know.

It helps to distinguish what should form the basis of practice by explicitly describing nursing.
The benefits of having a defined body of theory in nursing include better patient care,
enhanced professional status for nurses, improved communication between nurses, and
guidance for research and education.