Theoretical Foundations in Nursing

Ganancial, Janis Fay Dorotea V., BSN 1 – D

ABDELLAH’S 21 NURSING PROBLEMS

I. ABOUT THE THEORIST

• Born in New York City, March 13, 1919
• Graduated basic nursing education in Fitkin Memorial Hospital School in Neptune,
New Jersey as magna cum laude in 1942
• Obtained Bachelor of Science (1945), Master of Arts (1947), and Doctor of Education
(1955) from the Teaches College at Columbia University
• The first nurse and first woman to serve as Deputy Surgeon General of the United
States
• A Fellow in the American Academy of Nursing
• Was also named a “living legend” by the American Academy of Nursing (1994)
• Included into the US National Women’s Hall of Fame in 2000 due to her
contributions in the Field of Education and Nursing Research
• Inducted into the ANA Hall of Fame for a lifetime of contributions to nursing and to
honor her legacy of more than 60 years of accomplishments.
• Written and discussed more than 150 publications (Alligood), 100 (Balita) related to
nursing care, education for advance practice in nursing, and nursing research
• During her40-year career: Chief Nurse Officer (1970-1987), first nurse to achieve the
rank of a two-star Flag Officer, and was the first woman and Nurse Deputy Surgeon
General (1982-1989)
• Founded and served as the first dean in the Graduate School of Nursing (GSN) at the
Uniformed Services University of the Health Sciences (USUHS)
• Abdellah never wanted to become a doctor because she could do all that she wants
to do in nursing, which is a caring profession.
• She considers her greatest accomplishment being able to “play a role in establishing
a foundation for nursing research as a science”.
• Her book, Patient-Centered Approaches to Nursing, emphasizes the science of
nursing and has elicited changes throughout nursing curricula. It is based on the
problem-solving method and it serves as a vehicle for delineating nursing (patient)
problems as the patient moves toward a healthy outcome.
II. CONTENT OF THE THEORY
BASIS
• 1960 – Abdellah was influenced by the desire to promote client-centered all-
inclusive nursing care, giving birth to the idea of Nursing as a true humanitarian
service to individuals and families, or the society in general.
• Used Henderson’s 14 basic human needs and nursing research in establishing the
classification of her 21 nursing problems.

MAJOR CONCEPTS
This theory proposes that nursing is the utilization of the problem-solving techniques
with chief nursing problems related to health requirements of clients.

NURSING PROBLEMS
Health Needs are often seen as problems, which may be:
OVERT - obvious or can-be-seen condition.
COVERT - unseen or masked one.
- can be in times with emotions and relationships in nature, they are
often seen incorrectly.
- Yet, in many instances, solving the covert problems may solve the
overt problems as well (Abdellah, et. al, 1960).

Such analysis points to a client-centered orientation. However, Abdellah offers a

different view of things stating that a nursing problem given by a client is a state faced by
the client or the support system that the nurse, by doing her job professionally, can assist
them.
The term "Nursing Problems" is more in tune with "nursing goals" and "nursing
functions" than client-centered problems, in terms of Abdellah's usage. Given that, the
focus of the theory is more nursing-centered than client-centered (Nicholls and Wessells,
1977).
In her work to place nursing in the center of restorative and preventive measures to
render the needs of the client, she refocused the role of the nurse from disease orientation
to nursing orientation.
 PROBLEM-SOLVING
The practice of competent nursing care in the future is for the nursing student to
realize that identifying and answering overt and covert nursing problems is the core
of Nursing. These conditions can be satisfied by the Problem-Solving Approach.

The Problem-Solving Process:

1. Identifying the problem.
2. Selecting relevant data.
3. Devising hypotheses.
4. Testing hypotheses through the assortment of data.
5. Revising hypotheses when necessary on the basis of conclusions obtained
from the data.

These steps resemble the pace of the Nursing Process of Assessment, Diagnosis,
Planning, Implementation, and Evaluation. The problem-solving approach was
chosen because of the belief that the best recognition of nursing problems will
greatly persuade the nurse's judgement in selecting the next steps in solving the
client's nursing problems.

HEALTH
The theory gives much importance to problem-solving as medium for the
nursing problems as the client is geared in the direction of health, which is the outcome.
 IMPORTANT PRINCIPLES
• Nursing is a true humanitarian service to individuals and families, or the society in
general.
• As a complete humanitarian service, Nursing includes the following:
1. Be acquainted with the nursing problems of the client.
2. Choose the definite courses of action to make in the scope of relevant
nursing principles.
3. Make available continuous care of the individual’s entire health needs.
4. Give continuous care to relieve pain and discomfort and provide immediate
security for the individual.
5. Regulate the total nursing care plan to meet the client’s tailored needs.
6. Serving the individual to become more self-determining in achieving
maintaining a healthy state of mind and body.
7. Informing nursing personnel, family, and support-system to provide the
individual act for oneself within perceived limitations.
8. Facilitate the individual to adapt to limits and emotional problems.
9. Team up with different allied health professions in working with the diagram
for optimum health on local, state, national, and international levels.
10. Engaging in non-stop evaluation and research to develop nursing techniques
and to create new techniques to serve the health needs of different people.

• focus of the theory is more nursing-centered - treating of client rather than disease
(Balita)
• Her work is a problem-centered approach or philosophy of nursing. (Alligood)

III. METAPARADIGM OF THE THEORY

Abdellah considers nursing as “an art and science that mold the attitude, intellectual
competencies, and technical skills of the individual nurse into the desire and ability to help individuals
cope with their health needs, whether sick or well”.

A. NURSING
The concept of nursing in this theory is generally grouped into 21 problem areas for
nurses to work out their judgement and appropriate care. Abdellah considers nursing to be an
all-inclusive service that is based on the disciplines of art and science that serves individuals, sick
or well, cope with their health needs.
B. PERSON
Abdellah classifies the beneficiary of care as individuals. However, she does not set
standard limits on the nature and essence of human beings. The 21 nursing problems relate with
biological, physiological, and social aspects of individuals and can be said to correspond to
concepts of importance.
C. HEALTH
In this theory, the concept of health is defined as the center and purpose of nursing
services. Although Abdellah does not give a definition of health, she speaks to a "total health
 needs" and a "healthy state of mind and body" in her description of nursing as a comprehensive
service.
D. ENVIRONMENT
The idea of Environment is addressed by Abdellah and is included in "planning for
optimum health on local, state, national, and international levels." However, as Abdellah
elaborates her ideas, the apex (core) of nursing service is the individual.
E. CONCEPTUAL MODEL

IV. ACCEPTANCE BY NURSING COMMUNITY

A. PRACTICE
Abdellah's Typology of Twenty-One Nursing Problems helps nurses and nursing students
perform in a scientific and 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
Twenty-One Nursing Problems technique, the clinical practitioner could assess the patient, make
a nursing diagnosis and plan interventions. With the Problem-solving process, the nurse and
nursing student will now attempt to make the welfare of the client as the essential goal or
objective rather than his or her medical condition. Using the typology in the clinical setting,
nurses will now give their work an empirical basis.
B. EDUCATION
Abdella's Typology of Twenty-One 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 of 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.
C. RESEARCH
The Typology of Twenty-One 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 nurse spent with the client. 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 client's identified needs and,
as Abdellah foresaw, they comprise of: (1) Intensive care, (2) Intermediate care, (3) Long-term
care, (4) Self-care, and (5) Home-care units.
Arranging clients by similar needs than by diagnoses, the nursing service could give the
optimum staffing patterns to acknowledge client's needs. Abdellah and Levine released in 1965
the first major text book in nursing research entitled Better Patient Care through Nursing
Research.

V. APPLICATION OF THE THEORY

Vignette

Aling Teresa, 67-years old and a retired elementary school teacher was brought to the
emergency room of a provincial hospital in Nueva Ecija, during the evening of their town's
fiesta. She complained of a stomachache, dizziness, and joint pains. After some minutes, a
provincial ambulance came and several jeepneys, bringing people with apparent burns and
injuries. The ER nurses asked what happened, and one man carrying his ten-year-old son
said that there was a fire at the town plaza. "The unlighted fireworks blew up suddenly", the
man said between gasping breaths.
The other ER nurses began to give immediate intervention on the burn clients, utilizing
the principle of triage (classification of patients based on extent of injury) and applying
emergency aid. The physicians were busy too, but remarked that it was still fortunate that no
clients received third-degree burns, only slight first-degree and second-degree bums. Aling
Teresa was moved to the medical-surgical ward for observation pending her lab tests, and a
few minutes later some burn clients followed.

Assessment

The physician's initial impression was a beginning Peptic Ulcer. After requesting tests
showed that Aling Teresa's blood pressure was elevated at 140/90 mmHg; temperature was
at 37.1°C, heart rate at 90 beats per minute and respiratory rate at 18 cycles per minute.
Careful analysis of the data and signs suggested to the nurse that most likely the dizziness
was due to a case of high blood pressure. The nurse asked the client about doing any
strenuous activity, and she said yes, having cooking and serving food all day, even dropping
some cooking utensils in haste and serving guests because it is Fiesta time in their town. The
joint pains, the client remarked, is due to her Rheumatic Arthritis that worsened starting that
morning.
 Diagnosis

• Pain related to stimulation of pain receptors and damage on mucosal lining of the
stomach.
• Impaired skin integrity related to heat damage to epidermis and dermis.

Implementation

1. Assess the clients for different nursing concerns based on Abdellah's Typology of Nursing.
Using the Typology, nurses can then coordinate and focus nursing actions based from the
observed problems of the clients. Nursing care can then be grouped and prioritized according to
the problems that need most attention.

2. Assist Aling Teresa in her nursing problem of maintaining good hygiene and physical comfort
and promoting optimal activity specifically exercise, rest, and sleep which is included in the
typology. Give health teaching, telling her that her arthritis was due to excessive physical activity,
recommending a regular intake of her medications and adequate rest.

3. Create a staff rotation among nurses in the burn unit, prioritizing clients and perceived health
problems, and then performing clinical interventions that targets the nursing needs of each burn
client based on the Typology of Nursing Problems.

Evaluation

After nursing intervention, Aling Teresa and the burn clients would be able to resolve
their nursing problems as stated in Abdellah's Twenty-one Typology of Nursing Problems.

VI. REFERENCES

Abdellah, F. G. (2004). Interview with Rear Admiral Faye Glenn Abdellah. Interview by Captain
Melvin Lessing. Military Medicine, 169(11), iii–xi.

Abdellah, F. G., Beland, I. L., Martin, A., & Matheney, R. V. (1960). Patient-centered approaches
to nursing. New York: Macmillan.

Abdellah, F. G., & Levine, E. (1994). Preparing for nursing research in the 21st century: Evolution,
methodologies, challenges. New York: Springer.

Balita, C. and Octaviano, E. (2020), 2020Ed. Theoretical Foundations of Nursing: The Philippine
Perspective.