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(FAYE G. ABDELLAH)
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’s patient - Centered approach to nursing was developed inductively from her
practice and is considered a human needs theory. In 1955, a subcommittee of the National
League for Nursing Committee on Records was charged with developing a meaningful clinical
record for professional student nurses. Dr. Abdellah chaired this subcommittee, which soon
identified three barriers to its task: the lack of clear definition of nursing, the current philosophy
of nursing education was cherished but not practiced, and nursing education curricula were not
patient – centered. Using a typology of nursing problems developed in 1953, the original 58
problems were refined to 21 and validated with the assistance of faculty from 40 basic collegiate
schools of nursing. This resulted in the publication of Patient – Centered Approaches to Nursing
in1960 after at least three research studies over a five – year period.
In this 1960 publication, nursing is described as serving individuals, families, and thus, society.
The basis of nursing is both 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."
In her attempt to bring nursing practice to its proper relationship with restorative and preventive
measures for meeting total client needs, she seems to swing the pendulum to the opposite pole,
from the disease orientation to nursing orientation, while leaving the client somewhere in the
middle.
MAJOR CONCEPTS
A. Nursing Problems
The client’s health needs can be viewed as problems, which may be 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 perceived incorrectly. Yet, in many instances, solving the covert problems may
solve the overt problems as well. (Abdellah, et al., 1960).
The Twenty-One Nursing Problems (Abdellah, 1960), Basic to all patients, are the following:
Essential to Abdellah’s theory is the correct identification of nursing problems for which the
nursing skills included are:
-Observation of health status -Skills of communication
-Nursing procedure
B. Problem Solving
Quality professional nursing care requires that nurses be able to identify and solve overt and
covert nursing problems. These requirements can be met by the problem-solving process
involves identifying the problem, selecting pertinent data, formulating hypotheses, testing
hypotheses through the collection of data, and revising hypotheses when necessary on the basis
of conclusions obtained from the data. (Abdellah & Levine, 1986.)
ASSUMPTIONS
Abdellah’s (Abdellah, Beland, Martin, & Matheney, 1973) assumptions relate 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 and health care delivery; changing nursing education;
continuing education for professional nurses; and development of nursing leaders from
underserved groups.
According to Abdellah and coworkers (1960), nurses should do the following:
1. Learn to know the patient.
2. Sort out relevant and significant data.
3. Make generalizations about available data in relation to similar nursing problems
presented by other patients.
4. Identify the therapeutic plan.
5. Test generalizations with the patient and make additional generalizations.
6. Validate the patient’s conclusions about his nursing problems.
7. Continue to observe and evaluate the patient over a period of time to identify any
attitudes and clues affecting this behavior.
8. Explore the patient’s and family’s reaction to the therapeutic plan and involve them in the
plan.
9. Identify how the nurse feels about the patient’s nursing problems.
10. Discuss and develop a comprehensive nursing care plan.
STRENGTHS/WEAKNESSES
Strengths:
1. A major strength of Abdellah’s work is that the 21 nursing problems were developed
through extensive research.
2. As a logical and simple statement, Abdellah’s problem-solving approach can easily be
used by practitioners to guide various activities within their nursing practice.
3. The problem-solving approach is readily generalizable to client with specific health needs
and specific nursing problems.
4. Another strength can be seen in the emphasis placed on the importance of recognizing
and correctly identifying both overt and covert problems.
Weaknesses:
1. A major limitation is the lack of continued research to link the effectiveness of use of the
21 nursing problems to successful outcomes of nursing care.
2. The label of “nursing problems” is a limitation. Labeling the list of 21 problems as
nursing problems tends to lead the reader to the belief that Abdellah’s work is nursing
centered when she stated that she was seeking to move nursing to being patient centered.
It would have been helpful if she had used another terminology or explained more clearly
how this label relates to patient centered care.
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..
Progressive Patient Care :: Models of Nursing Care Delivery
APPLICATION
1. IN NURSING EDUCATION
Nursing education slowly deviated its concentration from the complex, medical concepts,
into exercising better attention to the client as the primary concern.
Its strong nurse-centered orientation is its major contribution to the nursing education.
2. IN NURSING RESEARCH
Abdellah’s theories 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.
Extensive research regarding patient’s needs and problems served as a foundation for
development of nursing diagnoses.
3. IN CLINICAL PRACTICE
Nurses use problem solving approaches to solve the identified nursing problems. It is
primarily designed for hospital setting, but can also be applied in community areas.
4. RESEARCH INPUT
Faye Abdellah Model to Banishing Social Stigma of Head Lice Among School Students
Abstract: In this study, an experimental comparative study was carried out aiming to monitor
the effect of Faye Abdellah Theory Model on banishing social stigma of head lice among school
students and monitor its effect on their health status and self-esteem. For the study purpose a
sample of convenience of 1600 school students and their mothers was recruited from 16 schools
from both countries participated in the study. Four tools used, pre/post interviewing
questionnaire, observation checklists, Faye Abdellah model format, self-esteem scale sheet and
students/mothers guidance booklet. The results showed that the total numbers of students at 8
schools in Egypt were 800/16700, with prevalence ratio 20.8% and 800/14300 from Kingdom of
Saudia Arabia with the prevalence ratio 17.8%. The study documented that there is highly
significant effects of the model on students’ health status and banishing the social stigma and
there is a highly positive association between selfesteem and assurance to the health behavior. It
concluded that highly self-esteem had excellent health status and completely confident in coping
with self-care management. And it is recommended that knowledge is power and teaching
mothers and students about head lice myths and facts is key to demystifying the stigma.
CASE SCENARIO
Mr. Simar experienced severe chest pain. In addition he experienced shortness of breath,
tachycardia and profuse diaphoresis.
Nursing Assessment
Assessment reveals: cardiac damage, acute pain and lack of oxygenation to the body cells.
Past history reveals he had earlier experienced similar episodes in last two years.
Major Problems
• Pain
• Impaired cardiac functioning
• Work related stress and Failure to seek medical attention
CONCLUSION
Abdellah’s theory provides a basis for determining and organizing nursing care. The
problems also provide a basis for organizing appropriate nursing strategies.
As a whole, the theory is intended to guide care not just in the hospital setting, but can
also be applied to community nursing, as well.
This theory is mainly focused on the clientsand nurses role in identification and solving
these problems.
Her theory has changed the entire nursing focus from disease to patient centered
approach.
REFERENCES