INTRODUCTION.
- "Nursing is based on an art and science that mould 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." - Abdellah
Abdellah explained nursing as a comprehensive service, which includes:
- Recognizing the nursing problems of the patient
- Deciding the appropriate course of action to take in terms of relevant nursing principles
- Providing continuous care of the individuals total needs
- Providing continuous care to relieve pain and discomfort and provide immediate security for the individual
- Adjusting the total nursing care plan to meet the patient’s individual needs
- Helping the individual to become more self directing in attaining or maintaining a healthy state of mind & body
- Instructing nursing personnel and family to help the individual do for himself that which he can within his limitations
- Helping the individual to adjust to his limitations and emotional problems
- Working with allied health professions in planning for optimum health on local, state, national and international levels
- Carrying out continuous evaluation and research to improve nursing techniques and to develop new techniques to meet the health needs of people
(In 1973, the item 3, - “providing continuous care of the individual’s total health needs” was eliminated.)
ABOUT THE THEORIST AND THEORETICAL SOURCES
- Birth:1919
- 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
- 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
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
- Continue to observe and evaluate the patient over a period of time to identify any attitudes and clues affecting his behavior
- 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 organization of work
- Use of resource materials
- Use of personnel resources
- Problem-solving
- Direction of work of others
- Therapeutic use of the self
- Nursing procedure
21 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
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 deformity
SUSTENAL CARE NEEDS
- To facilitate the maintenance of a supply of oxygen to all body cells
- To facilitate the maintenance of nutrition of all body cells
- To facilitate the maintenance of elimination
- To facilitate the maintenance of fluid and electrolyte balance
- To recognize the physiological responses of the body to disease conditions
- To facilitate the maintenance of regulatory mechanisms and functions
- 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
ABDELLAH’S THEORY AND THE FOUR MAJOR CONCEPTS
NURSING
- Nursing is a helping profession.
- 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.
- Nursing to be comprehensive service.
PERSON
- Abdellah describes people as having physical, emotional, and sociological 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.
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 AND 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.
CHARACTERISTICS OF THE THEORY
- Abdellah’s theory has interrelated the concepts of health, nursing problems, and problem solving.
- Problem solving is an activity that is inherently logical in nature.
- Framework focus on nursing practice and individuals.
- The results of testing such hypothesis would contribute to the general body of nursing knowledge
- Easy to apply in practice.
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. Once the problem has been diagnosed, the nursing goals have been established.
IMPLEMENTATION
- Using the goals as the framework, a plan is developed and appropriate nursing interventions are determined.
EVALUATION
- The most appropriate evaluation would be the nurse progress or lack of progress toward the achievement of the stated goals..
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 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.
REFERENCES
- George Julia B. Nursing theories: The base of professional nursing practice 3rd edition. Norwalk, CN: Appleton and Lange; 1990.
- Abdellah, F.G. The federal role in nursing education. Nursing outlook. 1987, 35(5),224-225.
- Abdellah, F.G. Public policy impacting on nursing care of older adults .In E.M. Baines (Ed.), perspectives on gerontological nursing. Newbury, CA: Sage publications. 1991.
- Abdellah, F.G., & Levine, E. Preparing nursing research for the 21st century. New York: Springer. 1994.
- Abdellah, F.G., Beland, I.L., Martin, A., & Matheney, R.V. Patient-centered approaches to nursing (2nd ed.). New York: Mac Millan. 1968.
- Abdellah, F.G. Evolution of nursing as a profession: perspective on manpower development. International Nursing Review, 1972); 19, 3..
- Abdellah, F.G.). The nature of nursing science. In L.H. Nicholl (Ed.), perspectives on nursing theory. Boston: Little, Brown, 1986.
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