FAY ABDELLAH

PATIENT-CENTERED APPROACHES TO NURSING

"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."
Biography
Born on March 13, 11 New !ork "ity.
the #rst nurse o$cer to earn the ranking of a two%star rear admiral. &he was
the #rst nurse and the #rst woman to serve as a 'eputy &urgeon (eneral.
)er work changed the focus of nursing from disease%centered to patient%
centered, and began to include the care of families and the elderly in nursing
care.
)er publications include Better Nursing "are *hrough Nursing
+esearch and Patient-Centered Approaches to Nursing.
&he was inducted into the National ,omen-s )all of .ame in /000.
1bdellah2s Ma3or "oncepts
1. Nursing
1 helping profession
1 comprehensive service to meet patient2s needs
4ncreases or restores self%help ability
5ses /1 problems to guide nursing care
/. )ealth
*he purpose of nursing services.
she speaks of 6total health needs7 and 6a healthy state of mind and body.7
81bdellah et al., 190:
3. ;erson
<ne who has physical, emotional, or social needs
*he recipient of nursing care.
=. >nvironment
'id not discuss much
4ncludes room, home, and community
Society is included in 6planning for optimum health on local, state, and
international levels.7
10 &teps to 4dentify ;atient2s ;roblems
1. ?earn to know the patient
/. &ort out relevant and signi#cant data
3. Make generali@ations about available data in relation to similar nursing problems
presented by other patients
=. 4dentify the therapeutic plan
A. *est generali@ations with the patient and make additional generali@ations
9. Balidate the patient-s conclusions about his nursing problems
C. "ontinue to observe and evaluate the patient over a period of time to identify
any attitudes and clues aDecting his behavior
E. >Fplore the patient-s and family-s reaction to the therapeutic plan and involve
them in the plan
. 4dentify how the nurses feel about the patient-s nursing problems
10. 'iscuss and develop a comprehensive nursing care plan
11 Nursing &kills
1. <bservation of health status
/. &kills of communication
3. 1pplication of knowledge
=. *eaching of patients and families
A. ;lanning and organi@ation of work
9. 5se of resource materials
C. 5se of personnel materials
E. problem%solving
. direction of work of others
10. therapeutic use of the self
11. nursing procedure
/1 Nursing ;roblems
1. *o maintain good hygiene and physical comfort.
/. *o promote optimal activityG eFercise, rest, and sleep.
3. *o promote safety through the prevention of accidents, in3ury, or other
trauma and through the prevention of the spread of infection.
=. *o maintain good body mechanics and prevent and correct deformities.
A. *o facilitate the maintenance of a supply of oFygen to all body cells.
9. *o facilitate the maintenance of nutrition of all body cells.
C. *o facilitate the maintenance of elimination.
E. *o facilitate the maintenance of Huid and electrolyte balance.
. *o recogni@e the physiological responses of the body to disease conditions I
pathological, physiological, and compensatory.
10. *o facilitate the maintenance of regulatory mechanisms and functions.
11. *o facilitate the maintenance of sensory functions.
1/. *o identify and accept positive and negative eFpressions, feelings, and
reactions.
13. *o identify and accept the interrelatedness of emotions and organic illness.
1=. *o facilitate the maintenance of eDective verbal and nonverbal communication.
1A. *o promote the development of productive interpersonal relationships.
19. *o facilitate progress toward achievement of personal spiritual goals.
1C. *o create andJor maintain a therapeutic environment.
1E. *o facilitate awareness of self as an individual with varying physical, emotional,
and developmental needs.
1. *o accept the optimum possible goals in the light of limitations, physical and
emotional.
/0. *o use community resources as an aid in resolving problems arising from illness.
/1. *o understand the role of social problems as inHuencing factors in the case of
illness.
,eaknesses
?ittle emphasis on what the client is to achieve was given in terms of client
care.
1bdellah2s framework is inconsistent with the concept of holism.
&trengths
1s a logical and simple statement, 1bdellah2s problem%solving approach can
easily be used by practitioners to guide various activities within their nursing
practice.
*he problem%solving approach is readily generali@able to client with speci#c
health needs and speci#c nursing problems.
'orothy Kohnson
Behavioral &ystems Model
Background
11 Born in &avannah (eorgia
1=/ B&N Banderbilt 5niversity &chool of Nursing
1=E M;) )arvard 5niversity
;rofessional >Fperience
Mostly involved teaching
1=3 I 1== staD nurse at
"hatham% &avannah )ealth "ouncil
1= I 1CE 4nstructor and assistant professor in pediatric nursing at
Banderbilt 5niversity &chool of Nursing
;rofessor of nursing at 5niversity of "alifornia in ?1
1E0 published the B.&. model
>arly proponent of nursing as a science and an art
B& model based on Nightingale2s belief
;urpose of &ystems *heory
Nurse creates balance between client and environment to achieve an optimal level
of functioning.
Kohnson2s C &ubsystems
Attache!t% goal attainment% form relationships and social bonds
Aggre""i#e% protect oneself to respond to threats
Depe!$e!cy I attention, recognition, physical assistance
I!ge"tio!% intake of nutrients to obtain knowledge
E%ii!atio!% eliminate waste and to eFpress feelings
Se&'a%% to procreate, to have seFual relationships, to develop gender based
identity
Achie#ee!t% mastery or control of some aspect of the environment
&ystem is out of balance whenL
1. insu$ciency M does not get enough of something
/. discrepancy M not optimally working
3. incompatibility M subsystems conHict
=. dominance M one subsystem is always used