FAYE
GLENN ABDELLAH'S THEORY
TWENTY ONE NURSING
PROBLEMS
This page was
last updated on
16-03-09
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Faye Glenn Abdellah, pioneer nursing researcher,
helped transform nursing theory, nursing care and
nursing education
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Birth:1919
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Dr Abdellah worked as Deputy Surgeon General
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Former Chief Nurse Officer for the
US Public
Health Service , Department of Health and human
services, Washington, D.C.
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She has been a leader in nursing research and has
over one hundred publications related to nursing
care, education for advanced practice in nursing
and nursing research.
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In 1960, influenced by the desire to promote
client-centred comprehensive nursing care,
Abdellah described nursing as a service to
individuals, to families, and, therefore to, to
society.
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According to her, 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.
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As a comprehensive service ,nursing includes;
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Recognizing the nursing problems of the patient
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Deciding the appropriate course of action to
take in terms of relevant nursing principles
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Providing continuous care of the individuals
total needs
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Providing continuous care to relieve pain and
discomfort and provide immediate security for
the individual
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Adjusting the total nursing care plan to meet
the patient’s individual needs
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Helping the individual to become more self
directing in attaining or maintaining a healthy
state of mind & body
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Instructing nursing personnel and family to help
the individual do for himself that which he can
within his limitations
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8)Helping the individual to adjust to his
limitations and emotional problems
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9) Working with allied health professions in
planning for optimum health on local, state,
national and international levels
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10) Carrying out continuous evaluation and
research to improve nursing techniques and to
develop new techniques to meet the health needs
of people
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These original premises have undergone an
evolutionary process. As result, in 1973, the
item 3, - “providing continuous care of the
individual’s total health needs” was eliminated.
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From these premises, Abdellah’s theory was
derived.
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Abdellah’s patient-centred approach to nursing was
developed inductively from her practice and is
considered a human needs theory.
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The theory was created to assist with nursing
education and is most applicable to the education
of nurses.
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Although it was intended to guide care of those in
the hospital, it also has relevance for nursing
care in community settings.
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The language of Abdellah’s framework is readable
and clear.
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Consistent with the decade in which she was
writing, she uses the term ‘she’ for nurses, ‘he’
for doctors and patients, and refers to the object
of nursing as ‘patient’ rather than client or
consumer.
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She referred to Nursing diagnosis during a time
when nurses were taught that diagnosis was not a
nurses’ prerogative.
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Assumptions were related to
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change and anticipated changes that affect
nursing;
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The need to appreciate the interconnectedness of
social enterprises and social problems;
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the impact of problems such as poverty, racism,
pollution, education, and so forth on health
care delivery;
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changing nursing education
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continuing education for professional nurses
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development of nursing leaders from under
reserved groups
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Abdellah and colleagues developed a list of 21
nursing problems.
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They also identified 10 steps to identify the
client’s problems
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11 nursing skills to be used in developing a
treatment typology
10 steps to
identify the client’s problems
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Learn to know the patient
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Sort out relevant and significant data
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Make generalizations about available data in
relation to similar nursing problems presented by
other patients
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Identify the therapeutic plan
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Test generalizations with the patient and make
additional generalizations
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Validate the patient’s conclusions about his
nursing problems
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Continue to observe and evaluate the patient over
a period of time to identify any attitudes and
clues affecting his behavior
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Explore the patient’s and family’s reaction to the
therapeutic plan and involve them in the plan
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Identify how the nurses feels about the patient’s
nursing problems
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Discuss and develop a comprehensive nursing care
plan
11 nursing skills
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Observation of health status
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Skills of communication
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Application of knowledge
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Teaching of patients and families
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Planning and organization of work
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Use of resource materials
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Use of personnel resources
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Problem-solving
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Direction of work of others
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Therapeutic use of the self
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Nursing procedures
The twenty one
nursing problems
Three major categories
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Physical, sociological, and emotional needs of
clients
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Types of interpersonal relationships between the
nurse and patient
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Common elements of client care
BASIC TO ALL
PATIENTS
To promote optimal activity: exercise, rest and sleep
To promote safety through the prevention of
accidents, injury, or other trauma and through the
prevention of the spread of infection
To maintain good body mechanics and prevent
and correct deformities
SUSTENAL CARE
NEEDS
REMEDIAL CARE
NEEDS
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To identify and accept positive and negative
expressions, feelings, and reactions
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To identify and accept the interrelatedness
of emotions and organic illness
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To facilitate the maintenance of effective
verbal and non verbal communication
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To promote the development of productive
interpersonal relationships
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To facilitate progress toward achievement of
personal spiritual goals
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To create and / or maintain a therapeutic
environment
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To facilitate awareness of self as an
individual with varying physical , emotional, and
developmental needs
RESTORATIVE CARE
NEEDS
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To accept the optimum possible goals in the
light of limitations, physical and emotional
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To use community resources as an aid in
resolving problems arising from illness
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To understand the role of social problems as
influencing factors in the case of illness
Abdellah's 21 problems are actually a model
describing the "arenas" or concerns of nursing,
rather than a theory describing relationships among
phenomena. In this way, the theory distinguished the
practice of nursing, with a focus on the 21 nursing
problems, from the practice of medicine, with a
focus on disease and cure.
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Although Abdellah’s writings are not specific as to
a theoretical statement, such a statement can be
derived by using her three major concepts of health,
nursing problems, and problem solving. Abdellah’s
theory would state that nursing is the use of the
problem solving approach with key nursing
problems related to health needs of people. Such a
statement maintains problem solving as the vehicle
for the nursing problems as the client is moved
toward health – the outcome
NURSING
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Acc to her, 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.
HEALTH
NURSING PROBLEMS
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Nursing problem presented by a client is a condition
faced by the client or client’s family that the
nurse through the performance of professional
functions can assist them to meet . The problem can
be either an overt or covert nursing problem.
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An overt nursing problem is an apparent condition
faced by the patient or family, which the nurse
can assist him or them to meet through the
performance of her professional functions.
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The covert nursing problem is a concealed or
hidden condition faced, by the patient or family,
which the nurse can assist him or them to meet
through the performance of her professional
functions
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In her attempt to bring nursing practice into 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.
PROBLEM SOLVING
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The problem solving process involves identifying the
problem, selecting pertinent data, formulating
hypothesis, testing hypothesis through the
collection of data, and revising hypothesis where
necessary on the basis of conclusions obtained from
the data.
MASLOW
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HENDERSON
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ABDELLAH
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Physiological needs |
1.
Breathe normally
2.
Eat and drink adequately
3.
Eliminate by all avenues of elimination
4.
Move & maintain desirable posture
5.
Sleep & rest
6.
Select suitable clothing
7.
Maintain body temperature
8.
Keep body clean and well groomed &
protect the integument
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1.
To facilitate the maintenance of a
supply of oxygen to all body cells
2.
To facilitate the maintenance of
nutrition of all body cells
3.
To facilitate the maintenance of fluid
and electrolyte balance
4.
To facilitate the maintenance of
elimination
5.
To maintain good body mechanics and
prevent and correct deformities
6.
To promote optimal activity: exercise ,
rest and sleep
7.
To facilitate the maintenance of
regulatory mechanisms and functions
8.
To maintain good hygiene and physical
comfort |
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Safety needs |
9.
Avoid environmental dangers & avoid
injuring others |
9.
To promote safety through the
prevention of accidents, injury, or other
trauma and through the prevention of the
spread of infection
10.
To facilitate the maintenance of
sensory function |
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Belongingness & love needs
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10.
Communicate with others
11.
Worship according to faith
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11.To facilitate the maintenance of
effective verbal and non verbal communication
12.
To promote the development of
productive interpersonal relationships
13.
To facilitate progress toward
achievement of personal spiritual goals |
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Esteem needs
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12.
Work at something providing a sense of
accomplishment
13.
Play or participate in various forms of
recreation
14.
Learn, discover, or satisfy curiosity
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14.
To accept the optimum possible goals in
the light of limitations, physical and
emotional
15.
To recognize the physiological
responses of the body to disease conditions
16.
To identify and accept positive and
negative expressions, feelings, and reactions
17.
To identify and accept the
interrelatedness of emotions and organic
illness
18.
To create and / or maintain a
therapeutic environment
19.
To facilitate awareness of self as an
individual with varying physical, emotional,
and developmental needs
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 case of
illness |
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Self actualization needs |
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ABDELLAH’S THEORY AND THE FOUR
MAJOR CONCEPTS
Nursing
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Nursing is a helping profession. In Abdellah’s
model, nursing care is doing something to or for
the person or providing information to the person
with the goals of meeting needs, increasing or
restoring self-help ability, or alleviating
impairment.
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Nursing is broadly grouped into the 21 problem
areas to guide care and promote use of nursing
judgment.
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She considers nursing to be comprehensive service
that is based on art and science and aims to help
people, sick or well, cope with their health
needs.
Person
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Abdellah describes people as having physical,
emotional, and sociological needs. These needs may
overt, consisting of largely physical needs, or
covert, such as emotional and social needs.
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Patient is described as the only justification for
the existence of nursing.
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Individuals (and families) are the recipients of
nursing
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Health, or achieving of it, is the purpose of
nursing services.
Health
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In Patient –Centered Approaches to Nursing,
Abdellah describes health as a state mutually
exclusive of illness.
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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.
Society/Environment
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Society is included in “planning for optimum
health on local, state, national, and
international levels”. However, as she further
delineated her ideas, the focus of nursing service
is clearly the individual.
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The environment is the home or community from
which patient comes.
Characteristic1
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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
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The result was the statement that nursing is the
use of problem solving approach with key nursing
problems related to health needs of people.
Characteristic2
Characteristic 3
Characteristic4
Characteristic5
Characteristic6
Characteristic7
ASSESSMENT PHASE
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Nursing problems provide guidelines for the
collection of data.
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A principle underlying the problem solving
approach is that for each identified problem,
pertinent data are collected.
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The overt or covert nature of the problems
necessitates a direct or indirect approach,
respectively.
NURSING DIAGNOSIS
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The results of data collection would determine the
client’s specific overt or covert problems.
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These specific problems would be grouped under
one or more of the broader nursing problems.
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This step is consistent with that involved in
nursing diagnosis
PLANNING PHASE
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The statements of nursing problems most closely
resemble goal statements. Therefore, once the
problem has been diagnosed, the goals have been
established.
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Given that these problems are called nursing
problems, then it becomes reasonable to conclude
that these goals are basically nursing goals.
IMPLEMENTATION
EVALUATION
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According to the American Nurses’ Association
Standards of Nursing Practice, the plan is
evaluated in terms of the client’s progress or
lack of progress toward the achievement of the
stated goals.
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This would be extremely difficult if not
impossible to do for Abdellah’s nursing problem
approach since it has been determined that the
goals are nursing goals, not the client goals.
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Thus, the most appropriate evaluation would be the
nurse progress or lack of progress toward the
achievement of the stated goals.
AN illustration of
the implementation of Abdellah’s framework in Ryan’s
care
Consider a case of Ryan who experienced severe
crushing chest pain ‘shortness of breath,
tachycardia and profuse diaphoresis
Selected Abdellah nursing problem
To maintain good hygiene and personal comfort
Classification and approach
Overt problem of pain; Direct and indirect method
Selected Nursing Interventions
elevate headrest
reposition client
administer prescribed analgesic
remain with client
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PPC is defined as better patient care through the
organization of hospital facilities, services and
staff around the changing medical and nursing
needs of the patient
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PPC is tailoring of hospital services to meet
patients needs
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PPC is caring for the right patient in the right
bed with the right services at the right time
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PPC is systematic classification of patients based
on their medical needs
Elements of PPC
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Intensive care
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Critically and seriously ill patients requiring
highly skilled nursing care, close and frequent
if not constant, nursing observation are
assigned to the ICU. One patient in an ICU
requires at least three nurses to observe him in
24 hrs
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Intermediate care
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Self care
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Long term care unit
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This unit will provide services to certain
patients now cared for in the general hospital,
in nursing homes, or in their own homes and who
would benefit by care in a hospital environment
to achieve its maximum potential
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Home care
Benefits of PPC
PATIENT
better adjustment
minimized problems
life
saving care
constant medical and nursing care
PHYSICIAN
drugs and equipments at hand
orders carried out effectively
better clinical an team service
HOSPITAL
improved
public image
NURSING PERSONNEL
more
time with patient
helping pt. and family to solve problems
job
satisfaction
in-service
education
COMMUNITY
minimize the need of hospitalization
Implications of
PPC for nursing education
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Many nurse educators feel that the PPC hospital
where all five phases of care are available can
provide clinical experience in which the nurse can
learn to solve basic nursing problems in meeting
patients’ needs.
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The three month assignment of professional nurses
may no longer be realistic in such a setting.
Organization of
hospital and community services based on patients
needs
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In the intensive care unit, the critically ill
patients are concentrated regardless of diagnosis.
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These patients are under the constant audio-visual
observation of the nurse, with life saving
techniques and equipment immediately available
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In the intermediate care unit are concentrated
patients requiring a moderate amount of nursing
care, not of an emergency nature, who are
ambulatory for short periods, and who are
beginning to participate in he planning of their
own care
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The self-care unit provides for patients who are
physically self-sufficient and require diagnostic
and convalescent care in hotel-type
accommodations. This unit serves as a link between
the hospital and the home.
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In the long-term care unit are concentrated
patients requiring prolonged care. The grouping of
such patients will permit staffing patterns that
are less costly
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Home care, the fifth element of progressive
patient care, extends hospital services into the
home to assist the physician in the care of his
patients
USEFULNESS
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The patient centered approach was constructed to
be useful to nursing practice, with impetus for
it being nursing education.
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Abdellah’s publications on nursing education began
with her dissertation; her interest in education
for nurses continues into the present.
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Cont…
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Abdellah has also published on nursing, nursing
research, and public policy related to nursing in
several international publications. She has been a
strong advocate for improving nursing practice
through nursing research
VALUE IN EXTENDING
NURSING SCIENCE
She categorized nursing problems based on the
individual’s needs and developed developed a
typology of nursing treatment and nursing skills..
NURSING RESEARCH
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Very strong nursing centered orientation
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Little emphasis on what the client is to achieve
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Her framework is inconsistent with the concept of
holism
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Potential problems might be overlooked
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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 health needs of
people.
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From this framework, 21 nursing problems were
developed
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Abdellah’s theory provides a basis for determining
and organizing nursing care. The problems also
provide a basis for organizing appropriate nursing
strategies.
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It is anticipated that by solving the nursing
problems, the client would be moved toward health.
The nurse’s philosophical frame of reference would
determine whether this theory and the 21 nursing
problems could be implemented in practice.
1.
George Julia B. Nursing theories: The base of
professional nursing practice 3rd
edition. Norwalk, CN: Appleton and Lange; 1990.
2.
Abdellah, F.G. The federal role in nursing
education. Nursing outlook. 1987, 35(5),224-225.
3 .
Abdellah, F.G. Public policy impacting on
nursing care of older adults .In E.M. Baines (Ed.),
perspectives on gerontological nursing. Newbury, CA:
Sage publications. 1991.
4 .
Abdellah, F.G., & Levine, E. Preparing
nursing research for the 21st century.
New York: Springer. 1994.
5 .
Abdellah, F.G., Beland, I.L., Martin, A., &
Matheney, R.V. Patient-centered approaches to
nursing (2nd ed.). New York: Mac Millan.
1968.
6 .
Abdellah, F.G. Evolution of nursing as a
profession: perspective on manpower development.
International Nursing Review, 1972); 19, 3..
7 .
Abdellah, F.G.). The nature of nursing
science. In L.H. Nicholl (Ed.), perspectives on
nursing theory. Boston: Little, Brown, 1986.
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