Faye Abdellah

21 NURSING PROBLEMS
Background
• Born -March13.1919
• Nursing Diploma from Fitkin Memorial
Hospital
Columbia University
• Bachelors Degree in Nursing 1945
• Masters Degree in Physiology 1947
• Doctorate in Education 1955
May 6, 1937
• German hydrogen-fueled
airship Hindenburg
exploded in Lakehurst, New
Jersey

• "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."
 Accomplishments
• U.S. Public Health Service (Branch of Military)
• Chief Nurse Officer
• First Deputy U.S. Surgeon General
• Uniformed Services University of Health
Sciences
• Founder and First Dean, Graduate School of
Nursing
• Yale University School of Nursing
• Nursing Instructor
• Nursing researcher and
theorist

• “First woman to
become a surgeon
general as a nurse”

• Originated from nursing practice & desire to

promote patient-centered comprehensive
care
 Faye G. Abdellah’s Theory
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.”
METAPARADIGM
 Person
• Having physical, emotional, and sociological
needs.
• Needs may be OVERT largely physical
needs
• COVERT  emotional, sociological and
interpersonal needs- which are often missed
and perceived incorrectly.
 Nursing Responsibilities
Effective communication between patient and caregiver. Information is
accurate, timely and appropriate.

Do everything possible to alleviate patients’ pain and make them feel
comfortable.

We provide emotional support and alleviate fears and anxiety.

We involve family and friends in every phase of our patients’ care.
• Patient is
described as the
only justification
for the existence of
nursing.
 Health
• Does not give a definition of health
• “Total health needs” and “a healthy state
of mind and body” in her description of
nursing as a comprehensive service.
 Environment
• Home or community from which patient comes.

• Society is included in “planning for optimum

health on local, state, national and international
levels.”
 Nursing
• “Nursing is based on an art and science that mold
the attitudes, intellectual competencies, and
technical skills of the individual nurse into the
desire and ability to help people, sick or well,
cope with their health needs”
• Comprehensive nursing service
 Nursing
• Service to individuals, to families and therefore
to society.
• Goal of nursing is the fullest physical,
emotional, intellectual, social and spiritual
functioning of the client which pertains to
holistic care.
 11 Nursing Skills
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
 Abdellah’s Theory and Nursing
Influence

Physiologic

Psychological
PATIENT Sociologic
four categories of patient needs
• Basic to all patients
• Sustenal care needs
• Remedial care needs
• Restorative care
needs.
Twenty-One Nursing
Problems
Serve as a knowledge base for nursing
( Categorized according to needs)
 BASIC TO ALL PATIENTS
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. Physical comfort through proper
positioning in bed.
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. As a nurse,
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 – one way we prevent the spread
of infection is through proper disinfection
of the equipments . Bed alarm , call light at
all times
4. To maintain good body mechanics and
prevent and correct deformity – Positioning
the patient properly, allowing for the
normal anatomical position of body parts.
 SUSTENAL CARE NEEDS
5. facilitate the maintenance of a supply of oxygen to all
body cells – when patients manifest breathing problems,
oxygen is attached to them. Sedated patients are attached
to cardiac monitor and pulse oxi meter 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. 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 .
9. To recognize the physiological responses of the
body to disease conditions—pathological,
physiological, and compensatory – ex. Pt. with
DENGUE-it is important to check the patients for
signs of bleeding by monitoring the BP, capillary
refill

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 –
When a patient is admitted who is already deaf
and mute, we communicate to them by body
language to maintain their basic need despite of
inadequacy to the sensory function.

Communicate to comatose patient

12. 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.
13. 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.
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.
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 – nurse usually visits
the patients in the unit. 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.
 RESTORATIVE CARE 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.
- support groups for depressed patients
- Shelter homes for victims of abuse
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.
 10 Ways to Identify a Client’s
Problem
 Learn to know the patient
 Continue to observe and evaluate
 Sort out relevant and significant data the patient over time to identify any
attitudes and clues affecting his
behavior
 Analyze and make generalizations
about available data
 Explore the patient’s and family’s
reaction to the therapeutic plan and
 Identify the therapeutic plan involve them in the plan

 Test generalizations with the patient  Identify how the nurse feels about
and make additional generalizations the patient’s nursing problems

 Validate the patient’s conclusion about  Discuss and develop a

his nursing problems comprehensive nursing care plan
 CHARACTERISTICS

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.
 LIMITATIONS
The major limitation of Abdellah theory and the
twenty one nursing problems is their very strong
nursing centered orientation. With the
orientation appropriate use might be the
organization of teaching content for nursing
students, the evaluation of a students,
performance in the clinical area or both. But in
terms of client care there is little emphasis on
what the client is to achieve.
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
health needs of people. From this framework, 21
nursing problems were developed.

Abdellah’s theory provides a basis for determining and

organizing nursing care. The problems also provide a
basis for organizing appropriate nursing strategies.