
And she couldn’t have said it any better. Let us get to know this extraordinary theorist by understanding her theory, appreciating how her life story influenced her scientific pursuit, and discerning how her theory can be applied in the ever-dynamic field of nursing.
BIOGRAPHY
Faye Glenn Abdellah was born on March 13, 1919, in New York City. Years later, on May 6, 1937, the German hydrogen-fueled airship Hindenburg exploded over Lakehurst, New Jersey, where 18-year-old Abdellah and her family then lived, and Abdellah and her brother ran to the scene to help. In an interview with a writer for Advance for Nurses, Abdellah recalled: "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."
Educational Achievements

She received her Bachelor of Science Degree in 1945, a Master of Arts degree in 1947 and Doctor of Education in Teacher’s College, Columbia University. In 1947 she also took Master of Arts Degree in Physiology. With her advanced education, Abdellah could have chosen to become a doctor. However, as she explained in her Advance for Nurses interview, "I never wanted to be an M.D. because I could do all I wanted to do in nursing, which is a caring profession.”
As an Educator and Researcher

In 1957 Abdellah headed a research team in Manchester, Connecticut, that established the groundwork for what became known as progressive patient care. In this framework, critical care patients were treated in an intensive care unit, followed by a transition to immediate care, and then home care. Abdellah is credited with developing the first nationally tested coronary care unit as an outgrowth of her work in Manchester.

Established Nursing Standards
In another innovation within her field, Abdellah developed the Patient Assessment of Care Evaluation (PACE), a system of standards used to measure the relative quality of individual health-care facilities that was still used in the health care industry into the 21st century. She was also one of the first people in the health care industry to develop a classification system for patient care and patient-oriented records.
Military Nursing Service

She was also the former Chief Nurse Officer for the U.S. Public Health Service, Department of Health and Human Services, Washington D.C. She was one of the first t

Abdellah has frequently stated that she believes nurses should be more involved in public-policy discussions. In her government position, Abdellah also continued her efforts to improve the health and safety of America's elderly.
What has influenced Faye Abdellah in the development her own model of nursing?

1949 – She spent 40 years in Public Health Service where she first became involved in research, being assigned to perform studies to improve nursing practices.
1960 – She was influenced by the desire to promote client-centered comprehensive nursing care. Abdellah described nursing as a service to individuals, to families and therefore to, to society. Acknowledging the influence of Henderson, expanded Henderson's 14 needs into 21 problems that she believed would serve as a knowledge base for nursing. Throughout her career, she strongly supported the idea that nursing research would be the key factor in helping nursing to emerge as a true profession. The research done regarding these common needs and problems has served as a foundation for the development of what is now known as nursing diagnosis.
Now that we have learned her influences, let’s get to know her concepts on the nursing concepts of man, health, environment, and nursing:
MAN/PERSON

HEALTH
Abdellah’s concept of health maybe 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 that serve to minimize vulnerabilities (George, 1990).
In Patient–Centered Approaches to Nursing, 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 (George, 1990). However in order to effectively perform these services, 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.
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.
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.” However, as Abdellah further delineated her ideas, the focus of nursing service is clearly the individual. Society is integrated when she discusses the implementation.
NURSING
GOAL OF NURSING:
To Abdellah, nursing is a service to individuals, to families and therefore to society. The goal of nursing according to Abdellah is the fullest physical, emotional, intellectual, social and spiritual functioning of the client which pertains to holistic care.

1. Recognizing the nursing problems of the patient.
2. Deciding the appropriate actions to take in terms of relevant nursing principles.
3. Providing continuous care of the individual’s total health needs.
4. Providing continuous care to relieve pain and discomfort and provide immediate security for the individual.
5. Adjusting total nursing care plan to meet the patient’s individual needs.
6. Helping the individual to become more self directing in attaining or maintaining a healthy state of mind and body.
7. Instructing nursing personnel and family to help the individual do for himself that which he can with his limitations.
8. Helping the individual to adjust to his limitations and emotional problems.
9. Working with allied health professional in planning for optimum health on local, state, national and international needs.
10. Carrying out continuous evaluation and research to improve nursing techniques and to develop new techniques to meet all the health needs of the people.
Nursing care for Abdellah is doing something to or for the person or providing information to the person with the goals of meeting needs, increase or restoring self-help ability or alleviating impairment.
Her theory also stated that the nurse needs knowledge on basic science and specific nursing skills, as well as knowledge skills in the communication, psychology, sociology, growth and development and interpersonal relations. These 11 nursing skills that a nurse must possess includes the following:

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
Nursing is broadly grouped into the 21 problem areas to guide care and promote use of nursing judgment. These deals with biological, psychological, and social areas of individuals.
KEY CONCEPTS AND MODEL
Faye Abdellah proposed a classificatory framework for identifying nursing problems, based on her idea that nursing is basically oriented to meeting an individual client’s total health needs. Her major effort was to differentiate nursing from medicine and disease orientation.
Abdellah’s patient-centred approach to nursing was developed inductively from her practice and is considered a human needs theory. Although it was intended to guide care of those in the hospital, it also has relevance for nursing care in community settings. Abdellah was clearly promoting the image of the nurse who was not only kind and caring, but also intelligent, competent, and technically well prepared to provide service to the patient.
ABDELLAH'S TYPOLOGY OF 21 NURSING PROBLEMS
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.
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.
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.
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.

Abdellah's typology was divided into three areas:
1. Physical, sociological,and emotional needs of the patients;
2. Types of interpersonal relationship between the nurse and the patient;
3. Common elements of patient care.
Theoretical Assertions
Several assertions were repeatedly stated by Abdellah although they were not labeled as such. These assertions are:
1. The nursing problem and nursing treatment typologies are the principles of nursing practice and constitute the unique body of knowledge that is nursing.
2. Correct identification of the nursing problem influences the nurse's judgment in selecting steps in solving the patient's problem.
3. The core of nursing is patient/client problems that focus on the patient and his/her problems.
With this knowledge, how, then, can we apply Abdellah’s theory in our field of practice?
Nursing Practice
First and foremost, Abdellah’s main goal is the improvement of the nursing education. She believed that as the education of nurses improves, nursing practice improves as well.

Her twenty one nursing problems made nurses look at patients’ problems and come up with nursing plan of care in a thorough and organized way. Abdellah’s identification of health needs as overt and covert assists nurses in exploring unmasked conditions about the client and plan appropriate interventions to address them. Client centered care emphasizes the principle that every nursing goal should be geared towards treating the patient and not just the mere illness. It has been viewed that if all 21 problems are investigated, the patient would be likely to be thoroughly assessed and thus will aid the nurse organize appropriate nursing strategies. Currently, the 21 nursing problems have been updated to focus on the patient and nursing diagnosis. It has ultimately helped nurses develop their individual critical-thinking skills leading to increase in job satisfaction and more productive nurse-patient and nurse-family interaction.

In the end, Abdellah’s theory helps the practicing nurse organize the administration of care, nursing strategies and provides a scientific base for making decisions. As a theorist who was actively involved on nursing and health care internationally, Abdellah gave credence to the use of the model and is an advocate of applying new knowledge to improve practice.
Nursing Education

Abdellah’s typology of twenty one nursing problems was an awakening call for revisions and amendments of the nursing educational system in her era. Professors and educators realized the importance of client centered care rather than focusing on medical interventions. Nursing education then slowly deviated its concentration from the complex, medical concepts, into exercising better attention to the client as the primary concern.
One of Abdellah’s theory’s major limitation—it’s very strong nurse-centered orientation—is, on the other hand, it’s major contribution to nursing education. With this orientation, the theory can be used to organize teaching contents for nursing students, to evaluate a student’s performance in a clinical area, or both (George, 1995).
Nursing Research
Research played a great part in the selection of the 21 problem classifications. Her researches were actually the major strengths of her works. In fact, her framework continues to stimulate research about the role and responsibilities of the nurse. The broad nature of the concepts in her framework offers opportunities to identify directional relationships in nursing interventions. Her theories continue to guide researchers to focus on the body of nursing knowledge itself, the identification of patient problems, the organization of nursing interventions, the improvement of nursing education, and the structure of the curriculum.
Abdellah strongly believed the idea that nursing research would be the key factor in helping nursing emerge as a true profession. The extensive research done regarding the patient’s needs and problems has served as a foundation for the development of what is now known as nursing diagnoses.
Her Typology gave birth to more nursing research and studies. The concepts are very precise and straight forward, making it simple and applicable, thus, stimulating similar disciplines and researches. Her typology was also utilized by some clinical institutions in establishing their staffing outline, namely, the intensive care, intermediate care, long term care, self care and home care units. These were identified according to how Abdellah ideates patient’s needs in her concept of care. Now patients in varied medical institutions are categorized with similar client needs, than by their medical diagnosis and diseases. Also it helped nurses provide better patient care and improve critical thinking skills.
Let us see how nurses in various settings can use Abdellah’s Typology of Needs Theory in their own work settings.
From an ICU nurse:
Ruff Joseph Cajanding, RN

From an OR nurse:
Francis Lloyd Borcelas, RN

From a medical-surgical nurse:
Mae Claire N. Cabatania, RN

From a medical-surgical nurse ward:
Patricia Cornejo, RN

To further examine how Abdellah’s Typology of 21 Nursing Problems can individually be applied in a specific nursing area, the following scenario is presented:
In my experience as a staff nurse in the endoscopy unit, Faye Abdellah's 21 nursing problems were applied in the following ways:
Katherine D, RN
1. To maintain good hygiene and physical comfort – After colonoscopy, patients are usually soiled from the procedure. It is therefore important to clean th

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. During this time, patients are allowed to stay in the room and rest. As a nurse, I 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 – Making sure the siderails are always up when leaving the patient keeps them from fall accidents. In our unit, one way we prevent the spread of infection is through proper disinfection of the equipments we use. We use products such as Cidezime to disinfect the instruments.
4. To maintain good body mechanics and prevent and correct deformity – Positioning the patient properly, allowing for the normal anatomical position of body parts.
5. To facilitate the maintenance of a supply of oxygen to all body cells – when patients manifest breathing problems, oxygen is attached to them, usually via nasal cannula. Sedated patients are attached to cardiac monitor and pulse oximeter 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.

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 as well as proper incorporations it may have. An example is when patients have low serum potassium, KCl is incorporated in the solution
9. To recognize the physiological responses of the body to disease conditions—pathological, physiological, and compensatory – it is important to check the patients for signs of internal gastrointestinal bleeding by monitoring the blood pressure and cardiac rate.
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 – Sometimes there are semi-conscious patients, in these cases, it is still necessary to talk to them while performing nursing interventions to maintain their auditory sense
12. 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, proper instructions are given, what they are to expect, how long the procedure will take, what they should do during and after the procedure as well as other concerns.
13. 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.
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. Touch and eye contact are also done for a good patient care.
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 – our supervisor is a nun and she usually visits the patients in the unit. Catholic 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.
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
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.
***
In 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 the health needs of people. From this framework, 21 nursing problems, which are comparable to Henderson’s 14 components of nursing and Maslow’s hierarchy of needs, are developed. Her theory and framework provides a basis for determining and organizing nursing care. It is anticipated that by solving the nursing problems through appropriate and organized nursing strategies, the client will be moved towards ultimate health.

Isn’t health everything that we all aspire for?
Sources:
Abdellah, F. G. & Levine, E. (1965). Better patient care through nursing research. New York: Macmillan.
George, J. (2002). Nursing Theories: The Base for Professional Nursing Practice. Upper Saddle River, NJ: Prentice-Hall, Inc.
George, J. (1995). Nursing theories: The base for professional nursing practice, 4th ed. USA: Prentice-Hall Intl.
George, J.B. (1990). Nursing theories: The base for professional nursing practice 3rd edition. Norwalk, CN: Appleton and Lange.
_____________. (1998). Image. USA: ____________.
Johnson, B. & Webber, P. (2005). An Introduction to Theory and Reasoning in Nursing 2nd Ed. Philadelphia, PA: Lippincott Williams and Wilkins.
Octaviano, O. & Balita, C. (2000). Theoretical Foundations of Nursing: The Philippine Perspective. Philippines: ___________.
_____________. (2000). Advance for Nurses. USA: ___________.
Parascandola, J (1994). "Women in the Public Health Service". Leadership in Public Health. Chicago: Illinois Public Health Leadership Institute.
Submitted by Group B: UPOU N207 batch 2009 group B.
发表评论