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FAYE GLENN ABDELLAH’S 21 NURSING PROBLEMS THEORY

“Nursing is based on an art and science that molds 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.”

Life Story: (March 13, 1919 3 present)

● Born March 13, 1919, in New York, with Algerian and Scottish heritage; later moved to
New Jersey for high school.
● A pioneering nursing researcher who developed the "Twenty-One Nursing Problems,"
which included a nursing diagnosis when such diagnoses were uncommon.
● First nurse officer to achieve a two-star rear admiral rank and first nurse and woman to
serve as Deputy Surgeon General.
● Developed a theory connecting health, nursing problems, and problem-solving.
● Views nursing as both art and science, shaping nurses' attitudes, skills, and desire to
help individuals with their health needs.
● Used Henderson’s 14 basic human needs and nursing research to classify nursing
problems.
Education:
✔ Faye Abdellah earned a nursing diploma from Fitkin Memorial Hospital’s School of
Nursing,
now known as Ann May School of Nursing.
✔ It was sufficient to practice nursing during her time in the 1940s, but she believed
that nursing
care should be based on research, not hours of care.
✔ Abdellah went on to earn three degrees from Columbia University: a bachelor of
science
degree in nursing in 1945, a master of arts degree in physiology in 1947 and a doctor of
education degree in 1955.
✔ With her advanced education, Abdellah could have chosen to become a doctor.
However, as
she explained in one of her interviews that she wanted to be an M.D. because she could
do all she wanted to do in nursing, which is a caring profession

As an Education:
✔ In her early twenties, she worked as a health nurse at a private school and
her first
administrative position was on the faculty of Yale University from 1945-1949.
✔ At that time, she was required to teach a class called “120 Principles of
Nursing
Practice” using a standard nursing textbook published by the National League
for Nursing. The book included guidelines that had no scientific basis which
challenged her to explain everything to what she called the “brilliant” students.

As a Researcher:
✔ In 1949, she met Lucile Petry Leone who was the first Nurse Officer and
decided to
join the Public Health Service. Her first assignment was with the division of nursing that
focused on research and studies. They performed studies with numerous hospitals to
improve nursing practice.

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✔ She was an advocate of degree programs for nursing. Diploma programs,
she
believes, were never meant to prepare nurses at the professional level. Nursing
education, she argued, should be based on research; she herself became among the
first in her role as an educator to focus on theory and research. Her first studies were
qualitative; they simply described situations. As her career progressed, her research
evolved to include physiology, chemistry, and behavioral sciences.

Theory Description:
✔ The patient-centered approach to nursing was developed from her practice, and
the theory is considered a human needs theory. It was formulated to be an
instrument for nursing education, so it is most suitable & useful in that field.
✔ The nursing model is intended to guide care in hospital institutions, but can also
be applied to community health nursing, as well.

Theory Assumption:
- Emphasizes the need to address changes impacting nursing, including social issues like
poverty, racism, pollution, and education, which affect health and healthcare delivery.
- Highlights the importance of adapting nursing education, promoting ongoing education for
professional nurses, and fostering

Major Concepts & Definitions:

▪ Individual
→ She describes nursing recipients as individuals (and families), although she does
not delineate her beliefs or assumptions about the nature of human beings.
▪ Health
→ The achieving of it is the purpose of nursing services. Although Abdellah does not
define health, she speaks to “total health needs” and “a healthy state of mind and
body.” → Health may be defined as the dynamic pattern of functioning whereby
there is a continued interaction with internal and external forces that results in the
optimal use of necessary resources to minimize vulnerabilities.
▪ Society
→ It is included in “planning for optimum health on local, state, and international
levels.” However, as Abdellah further delineates her ideas, the focus of nursing
service is clearly the individual.
▪ Nursing Problems
→ The client's health needs can be viewed as problems, overt as an apparent
condition, or covert as a hidden or concealed one.
→ Because covert problems can be emotional, sociological, and interpersonal in
nature, they are often missed or misunderstood. Yet, in many instances, solving the
covert problems may solve the overt problems as well.
▪ Problem Solving
→ Quality professional nursing care requires that nurses be able to identify and
solve overt and covert nursing problems.
→ The problem-solving process can meet these requirements by identifying the
problem, selecting pertinent data, formulating hypotheses, testing hypotheses
through collecting data, and revising hypotheses when necessary based on
conclusions obtained from the data.

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Abdellah’s Typology of 21 Nursing Problems: these fall into three categories: (1) physical,
sociological, and emotional needs of patients; (2) types of interpersonal relationships between
the patient and nurse; and (3) common elements of patient care

1. To maintain good hygiene and physical comfort.

2. To promote optimal activity: exercise, rest, sleep
3. To promote safety by preventing accidents, injuries, or other trauma and preventing the
spread of infection.
4. To maintain good body mechanics and prevent and correct the deformity.
5. To facilitate the maintenance of a supply of oxygen to all body cells.
6. To facilitate the maintenance of nutrition for all body cells.
7. To facilitate the maintenance of elimination.
8. To facilitate the maintenance of fluid and electrolyte balance.
9. To recognize the physiologic responses of the body to disease conditions-pathologic,
physiologic, 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 and personal spiritual goals.
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17. To create 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 that arise from an illness.
21. To understand the role of social problems as influencing factors in the cause of illness.

10 Steps to Identify the Patient”s Problems:

▪ Learn to know the patient.
▪ Sort out relevant and significant data.
▪ Make generalizations about available data concerning 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 or her behavior.
▪ Explore the patient and their family”s reactions to the therapeutic plan and involve them in the
plan.
▪ Identify how the nurses feel about the patient's nursing problems.
▪ Discuss and develop a comprehensive nursing care plan

11 Nursing Skills to Develop a Treatment Typology:

✔ observation of health status ✔ use of personnel resources
✔ skills of communication ✔ problem-solving
✔ application of knowledge ✔ the direction of work of others
✔ the teaching of patients and families ✔ therapeutic uses of the self
✔ planning and organization of work ✔ nursing procedure
✔ use of resource materials

Abdellah also 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 individual’s 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 obtaining or maintaining a healthy state
of body and mind
▪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,
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and international levels
▪ Carrying out continuous evaluation and research to improve nursing techniques and to
develop new techniques to meet people”s health needs

Patient-Centered Approaches to Nursing:

- Abdellah’s framework is based on nursing-centered services to address patient needs, which
seems contradictory to her advocacy for a client-centered approach.
-Although she supports client-centered care, her emphasis on nursing-centered methods
reflects a shift from disease-focused to nursing-focused care, potentially overlooking the client in
favor of a non-disease-centered orientation.
-Her focus on integrating nursing with preventive and restorative care represents a move away
from disease orientation, sometimes placing the client between these two approaches.
.

Theory Analysis
Faye Abdellah aimed to categorize patient problems based on health needs but instead focused
on defining nursing actions. Her problem-solving approach, designed to address patient issues
and alleviate suffering, enhances nurses' critical thinking and analytical skills, fostering a
structured, effective approach to patient care.

Strengths:
- Abdellah’s problem-solving approach is easily applicable to clients with specific health needs
and nursing problems.
- Healthcare providers can use this model to guide activities in clinical settings, particularly for
clients with defined needs.
- The language of Abdellah’s framework is simple and easy to understand.
- The framework emphasizes problem-solving, a logically structured activity.
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Weaknesses:
- A major limitation of Abdellah's theory is its strong nurse-centered focus, which contradicts her
aim of addressing patient needs.
- The theory lacks emphasis on client goals and outcomes in care.
- While the problem-solving approach is useful for specific health needs, the framework’s focus
on nursing practice and individual roles limits its generalizability.
- Abdellah’s framework is inconsistent with holism, as it may lead to fragmented care and
overlook potential problems by categorizing clients based on specific problems rather
than considering the whole person.

Conclusion:

- Abdellah's typology of 21 nursing problems is a conceptual model focused on patient needs

and the role of nurses in identifying and analyzing these problems.
- The model highlights that patients have physical, emotional, and sociological needs,
positioning people as the core justification for the nursing profession.
- However, Abdellah’s framework, which emphasizes nursing actions, diverges from her goal of
categorizing patient problems as health needs, defining nurses' roles around alleviating
these problems.
- The theory is applicable not only in hospital settings but also in community nursing, with its
interrelated concepts of health, nursing problems, and problem-solving.
- The 21 nursing problems evolved into a second-generation model focusing on patient
problems and outcomes, with Abdellah contributing to public health education on issues
like AIDS, drug addiction, violence, smoking, and alcoholism. Her work reflects a
problem-centered philosophy of nursing.

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