Abdellah’s theory

ABDELLAH’S THEORY

PRESENTED BY Mr. NAVJYOT SINGH ChoudharyM.SC NURSING 1st YEARDept. of Pediatric Nursing

INTRODUCTIONFaye Glenn Abdellah was

one of the most influential nursing theorist and public health scientists . It is extremely rare to find someone who has dedicated all her life to the advancement of the nursing profession and accomplish this feat with so much distinction and merit.

BIOGRAPHYFaye Glenn Abdellah was born on March 13, 1919,

in New York City.

EDUCATIONAL ACHIEVEMENTS

In 1942, Abdellah earned a nursing diploma from Fitkin Memorial Hospital's School of Nursing New Jersey (now Ann May School of Nursing). 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.

As an Educator and Researcher

Abdellah went on to become a nursing instructor and researcher and helped transform the focus of the profession from disease centered to patient centered. She expanded the role of nurses to include care of families and the elderly.

She worked in many settings. She had been a staff nurse, a head nurse, a faculty member at Yale University and at Columbia University, a public health nurse, a researcher and an author of more than 147 articles and books.

She was selected as Deputy Surgeon General in 1982. She retired in 1989.

What has influenced Faye Abdellah in the development her own model of nursing?

1937 – She wanted to be a nurse on the day she saw Hindenburg explode.

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'S TYPOLOGY OF 21 NURSING PROBLEMS

BASIC TO ALL PATIENTS1. To maintain good hygiene and physical comfort – After colonoscopy, patients are usually soiled from the procedure. It is therefore important to clean them properly. Physical comfort through proper positioning in bed.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. As a nurse, 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.

CONTD……….3. To promote safety through prevention of accident, injury, or other trauma and through the prevention of the spread of infection – Making sure the side rails are always up when leaving the patient . one way we prevent the spread of infection is through proper disinfection of the equipments . 4. To maintain good body mechanics and prevent and correct deformity – Positioning the patient properly, allowing for the normal anatomical position of body parts.

SUSTENAL CARE NEEDS5. 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 oxi meter 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.

6. To facilitate the maintenance of nutrition of all body cells – patients undergoing endoscopic procedures are on NPO. For this reason it is important to monitor the blood glucose level. When the patient's blood glucose falls from the normal value, we inject D50W to the patient or we change the patient's IVF to a dextrose containing fluid.

CONTD…….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.

CONTD………..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.

CONTD………

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.

REMEDIAL CARE NEEDS12. 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.

CONTD……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.

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.

CONTD…..16. To facilitate progress toward achievement of personal spiritual goals – nurse usually visits the patients in the unit. 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.

CONTD……..

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.

RESTORATIVE CARE NEEDS19. 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.

CONTD/……..

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.

ASSUMPTIONSCorrect identification of nursing

problems influences the judgment in selecting the next step in solving the client nursing problems.

CONCEPTS

MAN/PERSON

Abdellah describes people as having physical, emotional, and sociological needs. These needs may overt, consisting of largely physical needs, or covert, such as emotional, sociological and interpersonal needs- which are often missed and perceived incorrectly

The individuals (and families) are the recipients of nursing, and health, or achieving of it, is the purpose of nursing services.

HEALTH Emphasis should be placed upon

prevention and rehabilitation. Holistic approach must be taken by the nurse to help the client achieve state of health. However 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.

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.” However, as Abdellah further delineated her ideas, the focus of nursing service is clearly the individual.

NURSINGThese would mean a comprehensive

nursing service, this would include: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.5. Adjusting total nursing care plan to meet the patient’s individual needs.

CONTD…………

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 8. Helping the individual to adjust to his limitations and emotional problems.9. Working with allied health professional in planning for optimum health

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.

These 11 nursing skills that a nurse must possess includes the following:

1. Observation of health status2. Skills of communication3. Application of knowledge4. Teaching of patients and families5. Planning and organization of work6. Use of resource materials7. Use of personnel resources8. Problem-solving9. Direction of work of others10. Therapeutic use of the self11. Nursing procedures

METAPARADIGM OF ABDELLAH TYPOLOGY

Physical, Sociological,

emotional Needs

Interpersonal

Relationship

Common Elements Of Patient

Area

PURPOSES Nursing Practice Abdeallah’s main goal is the

improvement of the nursing education.The most important impact of Abdellah’s

theory to the nursing practice is that it helped transform the focus of the profession from being “disease-centered” to “patient-centered.”

The steps of the nursing process are assessment, diagnosis, planning, implementation and evaluation

Nursing EducationProfessors 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. It’s very strong nurse-centered orientation—is, on the other hand, it’s major contribution to nursing education.

Nursing ResearchHer 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.

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.

USE OF 21 PROBLEMS IN THE NURSING PROCESS

ASSESSMENT PHASE

Nursing problems provide guidelines for the collection of data.

A principle underlying the problem solving approach is that for each identified problem, pertinent data are collected.

The overt or covert nature of the problems necessitates a direct or indirect approach, respectively.

Cont.…NURSING DIAGNOSISThe 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

Cont.…PLANNING PHASEThe statements of nursing problems most closely resemble

goal statements. Once the problem has been diagnosed, the nursing goals have been established.

Contd………..IMPLEMENTATIONUsing the goals as the framework, a plan is developed and

appropriate nursing interventions are determined.

Contd…………..EVALUATIONThe most appropriate evaluation would be the nurse progress

or lack of progress toward the achievement of the stated goals..

Application.The case of SimarHe experienced severe chest pain. In

addition he experienced shortness of breadth, tachycardia and profuse diaphoresis.

Contd……..

Assessment reveals: cardiac damagePast History : He had gone through similar episodes since past 2

years.

MAIN PROBLEMSPAIN

IMPAIRED CARDIAC FUNCTIONING`

WORK RELATED STRESS

FAILURE TO SEEK MEDICAL ATTENTION

STAGES OF ILLNESS

Abdellah nsg problem

Nsg intervensions Nsg intervensions

Basic to care

1. To maintain good hygiene and physical comfort

1. Administer oxygen2. Elevate headrest3. Reposition of client4. Administer

analgesics as advised

Amount of pain

Susternal care needs

5 to facilitate the maintenance of supply of oxygen to body cells

1 promote rest2 Place in sitting

position3 Promote deep

breathing and coughing exercises

4 Implement exercises as tolerated

Vital signs.

Remedial care needs

13 To identify and accept the interrelatedness of emotional and organic illness

1 to find the nature of his job.2 explore his work related goal3 stress associated with jobs.

knowledge of relationship between stress and his illness

Stages of illness

Abdellah nsg problems

Nsg intervensions

Criterion measure

Restorative care needs

20 to use community resources as an aid in resolving problems arising from illness

1. Teach early signs and symptoms of cardiac distress.

2. Teach course of action .

Knowledge about the use of community resources.

CHARACTERISTICS

Abdellah’s theory has interrelated the concepts of health, nursing problems and problem solving as she attempts to create a different way of viewing nursing phenomenon.

LIMITATIONSThe major limitation of Abdellah theory and

the twenty one nursing problems is their very strong nursing centered orientation. With the orientation appropriate use might be the organization of teaching content for nursing students, the evaluation of a students, performance in the clinical area or both. But in terms of client care there is little emphasis on what the client is to achieve.

CONCLUSIONUsing 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 health needs of people. From this framework, 21 nursing problems were developed.

Abdellah’s theory provides a basis for determining and organizing nursing care. The problems also provide a basis for organizing appropriate nursing strategies.