Evidence Based Practice and Faye Abdellahs 21 Nursing Problems

Sandra Gilman Kimberly Potter Carly Macklin

Abdellahs 21 Nursing Problems

Faye Abdellahs nursing problems focused on the patient-centered approach to nursing. (Alligood, Tomey, 2010) Abdellah views nursing as both an art and a science that molds the attitude, intellectual competencies, and technical skills of the individual nurse into the desire and ability to help individuals cope with their health needs, weather they are ill or well (Alligood, Tomey). Although she believes that nursing actions are carried out under general or specific medical direction, she formulated 21 nursing problems based on a review of nursing research studies (Alligood, Tomey, 2010).

Practice Area Highlights:

For the purpose of this presentation we will be focusing on the following areas of Abdellahs Twenty-One Problems:
To maintain good hygiene and physical comfort To promote safety through prevention of accident, injury, trauma, or through spread of infection To facilitate maintenance of nutrition to all body cells To facilitate maintenance of elimination To promote the development of productive interpersonal relationships To facilitate maintenance of sensory function To promote optimal activity, exercise, rest sleep To create or maintain a therapeutic environment To facilitate awareness of self as an individual with varying physical, emotional and developmental needs (Alligood, Tomey, 2010, pg 57)

Pressure injury prevention: continence, skin hygiene, and nutrition

Took place at: The Prince Charles Hospital Conducted by: Kerri Roosen RN, Paul Fulbrook RN, PhD. Nursing Director of Research and Practice Development. Tracy Nowicki RN, clinical nurse consultant

Despite ongoing attempts to prevent pressure injury Prince Charles Hospital in Brisbane experienced a rate of increased pressure ulcers which was nearly doubled from two years prior. This project was implemented as an attempt to improve practice to reflect evidence based practice

To prevent pressure injuries, research indicates the importance of focusing on three key areas of practice; continence, skin hygiene, and nutrition (Fulbrook, Nowicki, Roosen, 2010, p. 34).

Faye Abdellahs Nursing problem #1

How to overcome the problem in this project

To

To maintain good hygiene and physical comfort : The Project found: Washable incontinent pads which allow for moisture to sit on the skin were still being used.

adequately care for skin, three simple steps are appropriate:

* Cleanse * Moisturize * Protect (Fulbrook et al, 2010, p. 31)

Abdellahs Nursing Problem #7

How to overcome the problem in this project

To facilitate the maintenance of elimination

Project states: that patients who are incontinent are at an increased risk for bacterial growth

Use of penile sheaths for men to decrease incontinent leakage. Use of barrier creams Increased education to decrease use of washable incontinent pads which keeps moisture against the skin

Abdellahs Nursing Problem #6

How to overcome the problem in this project

To facilitate the maintenance of nutrition to all body cells

Study projected: Malnutrition doubles the risk of pressure injuries (Fulbrook, etal, 2010, p. 33). It was discovered that patients were missing or skipping meals due to interruptions by hospital staff.

Dieticians presented information about the importance of nutrition for maintenance of skin integrity. protected meal times were implemented (Fulbrook, etal, 2010, p. 34)

FRAMEWORK: THIS PROJECT EASILY CORRELATES TO FAYE ABDELLAHS 21 NURSING PROBLEMS

Abdellahs nursing problem #3 To promote safety through prevention of accident, injury, and other trauma and through prevention of the spread of infection (Alligood, 2010, p. 58) This project was implemented to prevent pressure ulcers from forming. Pressure ulcers are a form of injury, and once formed increase the risk of spread of infection. Through attempts of decreasing pressure injuries, Abdelahs problems of nutrition, elimination and good hygiene are also addressed.

LIMITATIONS OF THE STUDY

It

was assumed that nurses used the information gained in the in-services to provide appropriate care.

STRENGTHS AND CREDIBILITY OF THE STUDY

Prince

Charles hospital was able to show evidence that pressure ulcers decreased from 13.78% in 2008 when the project was implemented to 5.5% in 2010. Clearly defined causes of skin break down and identified ways to overcome those causes.

Patients Experiences of Interpersonal Relationships During First Time Acute Hospitalization

Written by:

Colette

Blockley, Maxine Alterio

IMPORTANCE OF THE NURSE/PATIENT RELATIONSHIP

Hospitals

all over the country have been moving toward patient centered care. As defined by Lesley McKerns Patientcentered care addresses patients concerns, provides ample communication and resources to alleviate concerns

Patients in the Irurita study appreciated nurses who took a personal interest in their comfort and shared aspects of their own lives(Alterio and Blockley, 2008, p. 17)
Faye Abdellah's Nursing Problem #15 To promote the development of productive interpersonal relationships

How this conclusion was determined o A study involving 12 first time acute care patients was performed.
o

Study shows: That interpersonal nurse/patient relationships improves patient outcomes and patient perceptions of care.

Data was collected, analyzed and verified by participants, supervisors and colleagues.

RESULTS OF STUDY

The study suggests that interpersonal relationships reduced patients vulnerability and the nurse held the key role in these relationships (Alterio and Blockley, 2008, p. 24).

FRAMEWORK: CORRELATION BETWEEN THIS STUDY AND FAYE ABDELLAHS 21 NURSING PROBLEMS

Faye Abdellah felt that it is important to improve on the nurse/patient relationship to develop a trusting healing bond. She felt this relationship is key to a patients well being, for overall better patient care and is considered a human need (Currentnursing.com, 2011).

The study performed proves that interpersonal relationships benefit patients. As one participant states There is that something extrahaving a personal touch: just realizing that it isnt a patient necessarily but its a person as well (Alterio and Blockley, 2008, p. 22).

LIMITATIONS TO THE STUDY

The study was conducted using a small number of patients. The patients experienced a wide range of ailments. Patients resided in a single geographical location (preventing the input of multicultural backgrounds). * Researchers felt that to be entirely conclusive the study would have to be performed with narrower guidelines but wider range of patients (Alterio and Blockley, 2008, p. 24).

STRENGTHS AND CREDIBILITY OF THE STUDY

Study

was performed by Colette Blockley, RN, MA. was reviewed by Maxine Alterio, MA, as well as being review by participants of the study.

Study

Delirium Prevention for Cognitive, Sensory, and Mobility Impairments

Sherry Robinson, PhD, CNS, BC Catherine Rich, MSN, MBA, RNBC Tina Weitzel , RN-BC, MA Charlene Vollmer, BSN-BC Brenda Eden , MS, APRN, BC

The Study

Effect of delirium prevention protocol developed for patients at risk during inpatient hospitalization on a renal unit (Robinson, Rich, Weitzel, Vollmer, and Eden, 2008, pg. 106). Identified risk factors: Over sixty-five years old, diagnosis of dementia, impaired mobility functioning and hearing and vision deficiencies. Two groups of eighty patients were involved in the study which took place over the course of a year (Robinson et al, 2008, pg. 106). One group of at risk patients were studied pre-intervention and another post-intervention. Robinson et al, 2008, pg. 106). Outcomes of delirium were evidenced by onset of acute confusion, mental status change, inattention, disorientation, hallucinations, agitation, inappropriate behavior, combativeness or decreased responsiveness (Robinson et al, 2008, pg. 106).

The following protocol of nursing care was implemented to prevent onset of delirium within the at-risk patients. See how these interventions relate and correspond to Faye Abdellahs 21 Nursing Problems.

The 21 Problems and Delirium Prevention Interventions

Problem # 2: To promote optimal activity (with additional focus on safety, Problem #3):

Problem # 11. To facilitate maintenance of sensory function (vision and hearing):

Facilitate and assist with twice daily ambulation, using proper footwear. Implement use of a walk board. Assist patient to get up with chair during mealtimes. Comply with fall prevention measures to assist patient ambulate to the toilet.

(Robinson et al, 2008, pg. 108)

Assist patient to use their glasses and hearing aids during waking hours. Use tools of hearing assistance, such as hearing amplifiers will be implemented. No shouting, face patient when speaking. Limit background noise. Provide magnifier glass. Red tape on objects: call light/bell, water cup/pitcher, remote control, phone, etc. Dry erase board use to remind patient of caregiver names. Large print menus and books

The 21 Problems and Delirium Prevention Interventions

Problem # 17: Maintain a therapeutic environment:

More!
The more you review these interventions, further relation to Abdellahs 21 Nursing Problems can be identified. For example: By assisting with ambulation to the bathroom, nurses facilitate elimination (problem #7) By working to provide foods and routine that the patient likes, the nurse facilitates awareness of self as an individual with varying physical, emotional and developmental needs (problem #18)

Obtain information on routine and patient preference Use a soothing, gentle voice Administer pain medication scheduled instead of PRN Keep education simple, explain each action Promote a environment of warmth Eliminate use of television Provide soothing music

(Robinson et al, 2008, pg. 108).

Faye Abdellahs 21 Problems impact all levels of patient care and health maintenance! (Alligood, Tomey, 2010, pg. 57)

Study Results and Strengths

Results of delirium onset within the preintervention group of patients with risk factors: A total of 30 (37.5%) patients had documented symptoms of delirium (Robinson et al, 2008, pg. 109). Results of the post intervention group using the prevention protocol: 11 (13.8%) patients exhibited symptoms of delirium (Robinson et al, 2008, pg. 109). Clear evidence is shown that episodes of delirium were prevented using the implemented nurse intervention protocols.

Study Limitations

Evidence of delirium was determined solely from retrospective review of nursing documentation. In short, the results are only as good as the nurses documentation (Robinson et al, 2008, pg. 110). Although education to nursing staff was done prior to the study regarding charting and evidence of delirium, no standardized test of delirium was performed with assessments to validate the evidence of onset (Robinson et al, 2008, pg. 110). Another limitation, at risk patients had varying levels of hearing, vision and mobility limitations, again with no formal validation tool used (Robinson et al, 2008, pg. 111).

Faye Abdellah and Evidenced Based Practice

As shown in the nursing research studies involving pressure injury prevention, interpersonal relationships and delirium prevention, its evident that Faye Abdellahs work and development of the TwentyOne Nursing Problems continues to serve as a foundation and standard for guidance and development of nursing interventions. Abdellahs problems are formulated in terms of nursing-centered services (Alligood, Tomey, 2010, pg. 57). The actions of the nurse must work to address and answer these problems.

Research and Nursing Practice

Commitment must be made to the ongoing nature of building knowledge and basing practice on evidence of efficacy (Kearney, 2006, pg. 117). Evidenced based practice must be the basis for all our nursing interventions, as rationale and purpose must drive our standards in efforts to provide better patient outcomes and more appropriate and adequate nursing care. With continued research, we must incorporate evidence when initiating changes into nursing practice as our knowledge grows and our patients needs evolve (American Nurses Association, 2010, pg. 51).

References
Alterio, M., & Blockley, C. (2008, July). Patients experiences of interpersonal relationships during first time acute hospitalization. Nursing Praxis in New Zealand. 24(2), p. 16-26. American Nurses Association. (2010). Nursing: Scope and standards of practice (2nd ed). Silver Spring, MA: Nursesbooks.org. Fulbrook, P., Nowicki, T., & Roosen, K. (2010, August). Pressure injury prevention: continence, skin hygiene, and nutrition management. Australian Nursing Journal. 18(2), p. 31-34. Kearney-Nunnery, R. (2008). Advancing your career: Concepts of professional nursing (4th ed.). Philadelphia, PA: F. A. Davis Company. Mayo Clinic (2011). Pressure sores. Retrieved from http://www.mayoclinic.com/health/medical/IM03884 Nursing Theories (2011, March 1). Faye Glenn Abdellah's Theory . Retrieved from http://currentnursing.com/nursing_theory/Abdellah.html

REFERENCES (CONT)
Robinson, S., Rich, C., Weitzel, T., Vollmer, C., Eden, B. (2008). Delirium prevention for cognitive, sensory, and mobility impairments. Research and Theory for Nursing Practice, 22(2), 103-113. doi:10.1891/0889-7182.22.2.103 Tomey, A.M., & Alligood M, R. (2006). Nursing theorists and their work. (6th ed.). St. Louis, MO: Mosby Elsevier. What is Patient Centered Care and How is it Better?, (n.d.) Retrieved from http://www.selfgrowth.com/articles/What_is_Patient_Centered _Care_and_how_is_it_Better.html