Abdellah's Theory-01-03-12

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INTRODUCTION A theory is a set of concepts, definitions, relationships and assumptions that project a systematic view of phenomena. For example, Orem’s self care deficit theory defines nursing as a helping service, a creative effort to help people.

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BACKGROUND OF THE THEORIST FAYE GLENN ABDELLAH began her nursing career in 1942 when she received diploma in nursing from Fitkin Memorial Hospital, School of Nursing, Neptune, NJ. In 1945, she received her BS, in 1947, her MA, and 1955, her EdD from Teacher’s College, Columbia University, New York City.

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Her varied background includes appointments as Chief Nurse Officer of United States Public Health Service in 1970 and as Concurrent Deputy Surgeon General in 1982. She retired in 1989, she was a leader in Nursing Research and has over 100 publications related to Nursing Care, Education for Advanced Practice in Nursing, and Nursing Research.

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TYPOLOGY OF NURSING PROBLEMS Abdellah was motivated to develop her typology by desire to promote comprehensive, client centered nursing care. She developed her typology because she realized that nursing needed strong knowledge base to achieve full professional status and autonomy. She used the problem solving approach as base for her typology.

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Her typology of nursing problem was first published in 1960, in Patient Centered Approaches to Nursing. She devised her typology from several research studies conducted in the 1950s. In 1973, she refined some of her beliefs about nursing.

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GENERAL INFORMATION The major component of Abdellah’s typology is a list of nursing problems, or health care needs of the client. 2. She defines the nursing problem as any condition presented or faced by a client or family for which a nurse can offer assistance. 3. The problem can be a. Overt (An apparent condition faced by a client family) b. Covert (A concealed or hidden condition)

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Abdellah described 21 nursing problems subsumed under one of these categories: Physical, Social, and Emotional needs of Clients Interpersonal relationship between a nurse and a client Common elements of care 5. Abdellah also describes a means of solving a client’s problem

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AS PER ABDELLAH, NURSING AS A COMPREHENSIVE SERVICE INCLUDES Recognizing the nursing problems of the patient. Deciding the appropriate course of action to take in terms of relevant nursing principles . Providing continuous care of the individuals total needs. Providing continuous care to relieve pain and discomfort and provide immediate security for the individual.

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5. Adjusting the 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 & body. 7. 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. 9. Working with allied health professions in planning for optimum health on local, state, national and international levels. 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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PHILOSOPHICAL UNDERPINNINGS OF THE THEORY Abdellah’s patient- centred approach to nursing was developed inductively from her practice and is considered a human needs theory. The theory was created to assist with nursing education and is most applicable to the education of nurses. 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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10 STEPS TO IDENTIFY THE CLIENT’S PROBLEMS Learn to know the patient Sort out relevant and significant data Make generalizations about available data in relation to similar nursing problems presented by other patients Identify the therapeutic plan

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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 his behavior

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Explore the patient’s and family’s reaction to the therapeutic plan and involve them in the plan Identify how the nurses feels about the patient’s nursing problems 10.Discuss and develop a comprehensive nursing care plan

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11 NURSING SKILLS Observation of health status Skills of communication Application of knowledge Teaching of patients and families Planning and organization of work

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6. Use of resource materials 7. Use of personnel resources 8. Problem-solving Direction of work of others Therapeutic use of the self 11.Nursing procedure

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21 NURSING PROBLEMS This identification and classification of problems was called the typology of 21 nursing problems. Abdellah and her colleagues thought the typology would provide a method to evaluate a student's experiences and also a method to evaluate a nurse's competency based on outcome measures.

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THREE MAJOR CATEGORIES Physical, sociological, and emotional needs of clients Types of interpersonal relationships between the nurse and patient Common elements of client care

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BASIC TO ALL PATIENTS(4 PROBLEMS) To maintain good hygiene and physical comfort. 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 deformity.

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SUSTENAL CARE NEEDS(7 problems) 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 elimination 4. To facilitate the maintenance of fluid and electrolyte balance

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5. To recognize the physiological responses of the body to disease conditions 6. To facilitate the maintenance of regulatory mechanisms and functions 7. To facilitate the maintenance of sensory function.

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REMEDIAL CARE NEEDS(7 problems) To identify and accept positive and negative expressions, feelings, and reactions. To identify and accept the interrelatedness of emotions and organic illness. To facilitate the maintenance of effective verbal and non verbal communication.

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4. To promote the development of productive interpersonal relationships. 5. To facilitate progress toward achievement of personal spiritual goals. 6. To create and / or maintain a therapeutic environment. 7. To facilitate awareness of self as an individual with varying physical , emotional, and developmental needs.

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RESTORATIVE CARE NEEDS (3 problems) To accept the optimum possible goals in the light of limitations, physical and emotional To use community resources as an aid in resolving problems arising from illness To understand the role of social problems as influencing factors in the case of illness

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ABDELLAH’S THEORY AND THE FOUR MAJOR CONCEPTS NURSING 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. -aims to help people, sick or well, cope with their health needs.

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PERSON 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

HEALTH Abdellah describes health as a state mutually exclusive of illness. She speaks to “total health needs” and “a healthy state of mind and body”: 

HEALTH Abdellah describes health as a state mutually exclusive of illness . She speaks to “total health needs” and “a healthy state of mind and body”

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SOCIETY AND ENVIRONMENT Society is included in “planning for optimum health on local, state, national, and international levels”. The environment is the home or community from which patient comes.

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APPLICATION OF TYPOLOGY OF 21 NURSING PROBLEMS In the endoscopy unit, Faye Abdellah's 21 nursing problems were applied in the following ways: To maintain good hygiene and physical comfort – After colonoscopy, patients are usually soiled from the procedure. -clean them properly and change their diapers if applicable. -Physical comfort through proper positioning in bed, proper lighting are also provided to the patient

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 by decreasing environmental noise and dimming the light if necessary. : 

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 by 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, - prevent the spread of infection is through proper disinfection of the equipments: 

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, - 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. : 

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.: 

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.

6. To facilitate the maintenance of nutrition of all body cells - monitor the blood glucose level. - If patient's blood glucose falls, inform physician and start IV fluid as prescribed: 

6. To facilitate the maintenance of nutrition of all body cells - monitor the blood glucose level. - If patient's blood glucose falls, inform physician and start IV fluid as prescribed

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: 

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: 

8. To facilitate the maintenance of fluid and electrolyte balance – Proper regulation of the intravenous solutions

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.: 

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: 

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

11. To facilitate the maintenance of sensory function – Sometimes there are semi-conscious patients, - talk to patients. : 

11. To facilitate the maintenance of sensory function – Sometimes there are semi-conscious patients, - talk to patients.

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: 

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

13. To identify and accept interrelatedness of emotions and organic illness – Encourage patients to verbalize their feelings and allow them to cry: 

13. To identify and accept interrelatedness of emotions and organic illness – Encourage patients to verbalize their feelings and allow them to cry

14. To facilitate the maintenance of effective verbal and nonverbal communication - Talk to patients. - understand their nonverbal cues.: 

14. To facilitate the maintenance of effective verbal and nonverbal communication - Talk to patients. - understand their nonverbal cues.

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.: 

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.

16. To facilitate progress toward achievement of personal spiritual goals. - allowing them time to practice their faith: 

16. To facilitate progress toward achievement of personal spiritual goals. - 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 given in the unit.: 

17. To create and/or maintain a therapeutic environment - providing proper lighting, - proper room temperature, - a quiet environment are given in the unit.

18. To facilitate awareness of self as an individual with varying physical, emotional, and developmental needs. E.g. Allowing the parents to stay during the procedure help the pediatric patients in their emotional and developmental needs.: 

18. To facilitate awareness of self as an individual with varying physical, emotional, and developmental needs. E.g. 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. If patient has NG tube, the goal differs from that of normal patient.: 

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. If patient has NG tube, the goal differs from that of normal patient.

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: 

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 and also avoid drinking water that are not safe. : 

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 and also avoid drinking water that are not safe.

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APPLICATION OF ABDELLAH’S THEORY IN NURSING Nursing Practice 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.” It helped bring structure and organization in care.

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Nursing Education - to present a comprehensive clinical record for nursing students, thus, providing structure to the nursing curriculum. - implementation of the model in baccalaureate, associate degree and diploma nursing programs. - facilitated the move from the medical model to nursing model.

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Nursing Research 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.

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SUMMARY 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. From this framework, 21 nursing problems were developed.

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