Abdellah was born on March 13, 1919, in New York City.

Years later, on May 6, 1937, the German hydrogen-fueled airship Hindenburg exploded over Lakehurst, New Jersey, where 18-year-old Abdellah and her family then lived, and Abdellah and her brother ran to the scene to help. In an interview with a writer for Advance for Nurses, Abdellah recalled: "I could see people jumping from the zeppelin and I didn't know how to take care of them, so it was then that I vowed that I would learn nursing." Abdellah earned a nursing diploma from Fitkin Memorial Hospital's School of Nursing (now Ann May School of Nursing). In the 1940s, this was sufficient for practicing nursing, but Abdellah believed that nursing care should be based on research, not hours of care. She went on to earn three degrees from Columbia University: a bachelor of science degree in nursing in 1945, a master of arts degree in physiology in 1947 and a doctor of education degree in 1955. With her advanced education, Abdellah could have chosen to become a doctor. However, as she explained in her Advance for Nurses interview, "I never wanted to be an M.D. because I could do all I wanted to do in nursing, which is a caring profession." As a practicing nurse, Abdellah managed a primary care clinic at the Child Education Foundation in New York City and managed the obstetrics gynecology floor at Columbia University's Presbyterian Medical Center. Transformed Nursing Profession 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 researched nursing practices and taught research methods and theory at several universities, including schools in Washington, Colorado, Minnesota, and South Carolina. She also held several administrative positions in medical facilities. In 1993 she founded and served as the first dean of the Graduate School of Nursing at the Uniformed Services University of Health Sciences in Bethesda, Maryland. Abdellah's first teaching job was at Yale University School of Nursing, where she worked when she was in her early twenties. At that time she was required to teach a class called "120 Principles of Nursing Practice," using a standard nursing textbook published by the National League for Nursing. The book included guidelines that had no scientific basis and, as Abdellah told Maura S. McAuliffe in an interview for Image: "Those Yale students were just brilliant and challenged me to explain why they were required to follow procedures without questioning the science behind them." After a year Abdellah became so frustrated that she gathered her colleagues in the Yale courtyard and burned the textbooks. The next morning the school's dean told her she would have to pay for the destroyed texts. It took a year for Abdellah to settle the debt, but she never regretted her actions. As she told Image: "Of the 120 principles I was required to teach, I really spent the rest of my life undoing that teaching, because it started me on the long road in pursuit of the scientific basis of our practice." Abdellah was an advocate of degree programs for nursing. Diploma programs, she believes, were never meant to prepare nurses at the professional level. Nursing education, she argued, should be based on research; she herself became among the first in her role as an educator to focus on theory and research. Her first studies were qualitative; they simply described situations. As her career progressed, her research evolved to include physiology, chemistry, and behavioral sciences. In 1957 Abdellah headed a research team in Manchester, Connecticut, that established the groundwork for what became known as progressive patient care. In this framework, critical care patients were treated in an intensive care unit, followed by a transition to immediate care, and then home care. The first two segments of the care program proved very popular within the caregiver profession. Abdellah is also credited with developing the first nationally tested coronary care unit as an outgrowth of her work in Manchester. The third phase of the progressive patient care equation - home care was not widely accepted in the mid-twentieth century. Abdellah explained in her Image interview that "Short-sighted people at the time kept saying home care would mean having a maid (nurse) in everyone's home. They could not understand that home care with nurses teaching self care would be a way of helping patients regain independent function." Forty years later home care had become an essential part of long-term health care. Established Standards In another innovation within her field, Abdellah developed the Patient Assessment of Care Evaluation (PACE), a system of standards used to measure the relative quality of individual health-care facilities that was still used in the health care industry into the 21st century. She was

also one of the first people in the health care industry to develop a classification system for patient care and patient-oriented records. Classification systems have evolved in different ways within in the health-care industry, and Abdellah's work was foundational in the development of the most widely used form: Diagnostic related groups, or DRGs. DRGs, which became the standard coding system used by Medicare, categorize patients according to particular primary and secondary diagnoses. This system keeps health-care costs down because each DRG code includes the maximum amount Medicare will pay out for a specific diagnosis or procedure, while also taking into account patient age and length of stay in a health care facility. Providers are given an incentive to keep costs down because they only realize a profit if costs are less than the amount specified by the relevant DRG category. In addition to leading to the DRG system, Abdellah's work with classification has been instrumental in the ongoing development of an international classification system for nursing practice. As she explained in Image, "There is a major effort ongoing to develop an international classification for nursing practice - to provide a unifying framework for nursing." Served in Military Abdellah served for 40 years in the U.S. Public Health Service (PHS) Commissioned Corps, a branch of the military. She served on active duty during the Korean War and was the first nurse officer to achieve the rank of two-star rear admiral. Outside her wartime work, as a public health nurse, she focused much of her attention on care of the elderly. She was one of the first to talk about gerontological nursing, to conduct research in that area, and to influence public policy regarding nursing homes. During the 1970s she was responsible for establishing nursinghome standards in the United States. Abdellah checked on nursing homes by making unannounced visits and wandering throughout the facility checking areas visitors rarely saw. She found many fire hazards and also discovered that it was often hard to trace ownership of nursing homes. Abdellah's scrutiny was not welcomed, even by the licensing boards charged with looking out for their elderly patients, and some states prohibited Abdellah and others from making unannounced visits. Abdellah has frequently stated that she believes nurses should be more involved in public-policy discussions concerning nursing home regulations. As she told Image, "Our general attitude is let someone else do it. We need to make inroads in counties, states, and regions before we get to the federal level. Then we can have more of a voice at the national level. I am convinced that if we want to have an effect on legislators, the most important way is to get nurses assigned as congressional fellows 'they' are the ones who actually draft the legislation." In 1981 U.S. Surgeon General C. Everett Koop named Abdellah deputy surgeon general, making her the first nurse and the first woman to hold the position. She served under the U.S. surgeon general for eight years and retired from the military in 1989. As deputy surgeon general, it was Abdellah's responsibility to educate Americans about public-health issues, and she worked diligently in the areas of AIDS, hospice care, smoking, alcohol and drug addiction, the mentally handicapped, and violence. In her government position, Abdellah also continued her efforts to improve the health and safety of America's elderly. She prepared and distributed a series of leaflets designed to inform people about Alzheimer's disease, arthritis, the safe use of medicines, influenza, high blood pressure, and other threats to elderly health. Under her guidance, the PHS also worked with physicians to make them aware of the latest research on health issues regarding older patients. For instance, physicians were warned that ordinary drug dosages may not be appropriate for elderly patients. International Contributions As a consultant and educator, Abdellah shared her nursing theories with caregivers around the world. She led seminars in France, Portugal, Israel, Japan, China, New Zealand, Australia, and the former Soviet Union. She also served as a research consultant to the World Health Organization. From her global perspective, Abdellah learned to appreciate nontraditional and complementary medical treatments and developed the belief such non-Western treatments deserved scientific research. Abdellah has written many articles in professional journals as well as several books, including Effect of Nurse Staffing on Satisfactions with Nursing Care (1959), Patient-centered Approaches to Nursing (1960), Better Patient Care through Nursing Research (1965; revised 1986), and Intensive Care, Concepts and Practices for Clinical Nurse Specialists (1969). She is the recipient of over 70 awards and honorary degrees and is a fellow of the American Academy of Nursing. Abdellah

was named to the Nursing Hall of Fame at Columbia University in 1999. In 2000 Abdellah was inducted into the National Women's Hall of Fame in Seneca, New York. During her Hall of Fame induction speech, Abdellah said, "We cannot wait for the world to change. Those of us with intelligence, purpose, and vision must take the lead and change the world. Let us move forward together! I promise never to rest until my work has been completed!" FAYE GLENN ABDELLAH'S THEORY TWENTY ONE NURSING PROBLEMS INTRODUCTION

Although it was intended to guide care of those in the hospital, it also has relevance for nursing care in community settings.

MAJOR ASSUMPTIONS, CONCEPTS & RELATIONSHIPS

The language of Abdellahs framework is readable and clear. 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. She referred to nursing diagnosis during a time when nurses were taught that diagnosis was not a nurses prerogative. Assumptions were related to

Faye Glenn Abdellah, pioneer nursing researcher, helped transform nursing theory, nursing care and nursing education Birth:1919 Dr Abdellah worked as Deputy Surgeon General Former Chief Nurse Officer for the US Public Health Service , Department of Health and human services, Washington, D.C. 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. 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. 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. As a comprehensive service ,nursing includes;

o o o o o o

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 care delivery; changing nursing education continuing education for professional nurses development of nursing leaders from under reserved groups

Abdellah and colleagues developed a list of 21 nursing problems. They also identified 10 steps to identify the clients problems 11 nursing skills to be used in developing a treatment typology

10 steps to identify the clients problems 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 patients 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 8. Explore the patients and familys reaction to the therapeutic plan and involve them in the plan 9. Identify how the nurses feels about the patients nursing problems 10. Discuss and develop a comprehensive nursing care plan 11 nursing skills 1. Observation of health status 2. Skills of communication 3. Application of knowledge 4. Teaching of patients and families 5. Planning and organization of work 6. Use of resource materials 7. Use of personnel resources 8. Problem-solving 9. Direction of work of others 10. Therapeutic use of the self 11. Nursing procedures The twenty one nursing problems Three major categories 1. Physical, sociological, and emotional needs of clients 2. Types of interpersonal relationships between the nurse and patient 3. Common elements of client care

o o o o o o o o o o

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 Adjusting the total nursing care plan to meet the patients individual needs Helping the individual to become more self directing in attaining or maintaining a healthy state of mind & body Instructing nursing personnel and family to help the individual do for himself that which he can within his limitations Helping the individual to adjust to his limitations and emotional problems Working with allied health professions in planning for optimum health on local, state, national and international levels Carrying out continuous evaluation and research to improve nursing techniques and to develop new techniques to meet the health needs of people These original premises have undergone an evolutionary process. As result, in 1973, the item 3, - providing continuous care of the individuals total health needs was eliminated. From these premises, Abdellahs theory was derived.

PHILOSOPHICAL UNDERPINNINGS OF THE THEORY

Abdellahs 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.

21 NURSING PROBLEMS BASIC TO ALL PATIENTS

that results in the optimum use of necessary resources that serve to minimize vulnerabilities

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 deformities NURSING PROBLEMS

Nursing problem presented by a client is a condition faced by the client or clients 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. 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. 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 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.

SUSTENAL CARE NEEDS

To facilitate the maintenance of a supply of oxygen to all body cells To facilitate the maintenance of nutrition of all body cells To facilitate the maintenance of elimination To facilitate the maintenance of fluid and electrolyte balance To recognize the physiological responses of the body to disease conditions To facilitate the maintenance of regulatory mechanisms and functions To facilitate the maintenance of sensory function

PROBLEM SOLVING

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

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.

ABDELLAHS THEORY AND THE FOUR MAJOR CONCEPTS Nursing

Nursing is a helping profession. In Abdellahs 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. Nursing is broadly grouped into the 21 problem areas to guide care and promote use of nursing judgment. 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.

RESTORATIVE CARE NEEDS

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 Person

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. ABDELLAHS THEORY AND NURSING

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. Patient is described as the only justification for the existence of nursing. Individuals (and families) are the recipients of nursing Health, or achieving of it, is the purpose of nursing services.

Health

Although Abdellahs 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. Abdellahs 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

In Patient Centered Approaches to Nursing, Abdellah describes health as a state mutually exclusive of illness. 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.

NURSING

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.

Society/Environment

HEALTH

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. The environment is the home or community from which patient comes.

Health is a dynamic pattern of functioning whereby there is a continued interaction with internal and external forces

ABDELLAHS WORK AND CHARACTERISTICS OF A THEORY

Characteristic1

Abdellahs theory has interrelated the concepts of health, nursing problems, and problem solving as she attempts to create a different way of viewing nursing phenomenon The result was the statement that nursing is the use of problem solving approach with key nursing problems related to health needs of people.

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 Abdellahs framework in Ryans care Consider a case of Ryan who experienced severe crushing chest pain shortness of breath, tachycardia and profuse diaphoresis

Characteristic2

Stage of illness is basic to care 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 administer oxygen elevate headrest reposition client administer prescribed analgesic remain with client Criterion measure- Amount of pain

Problem solving is an activity that is inherently logical in nature

Characteristic 3

Framework seems to focus quite heavily on nursing practice and individuals. This somewhat limit the ability to generalize although the problem solving approach is readily generalizable to clients with specific health needs and specific nursing problems

Characteristic4

One of the most important questions that arise when considering her work is the role of client within the framework. This question could generate hypothesis for testing and thus demonstrates the ability of Abdellahs work to generate hypothesis for testing

Characteristic5

The results of testing such hypothesis would contribute to the general body of nursing knowledge

CONCEPT OF PROGRESSIVE PATIENT CARE 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 PPC is tailoring of hospital services to meet patients needs PPC is caring for the right patient in the right bed with the right services at the right time PPC is systematic classification of patients based on their medical needs

Characteristic6

Abdellahs problem solving approach can easily be used by practitioners to guide various activities within their practice. This is true when considering nursing practice that deals with clients who have specific needs and specific nursing problems

Characteristic7

Although consistency with other theories exist, many questions remain unanswered

USE OF 21 PROBLEMS IN THE NURSING PROCESS ASSESSMENT PHASE

Elements of PPC 1. Intensive care

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.

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

2. Intermediate care

NURSING DIAGNOSIS

3. Self care

The results of data collection would determine the clients 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

Patients assigned to this unit are both the moderately ill and those for whom the treatment can only be palliative

Ambulatory patients who are convalescencing or require diagnosis or therapy may be cared for in this unit

PLANNING PHASE

4. Long term care unit

The statements of nursing problems most closely resemble goal statements. Therefore, once the problem has been diagnosed, the goals have been established. Given that these problems are called nursing problems, then it becomes reasonable to conclude that these goals are basically nursing goals.

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

5. Home care

IMPLEMENTATION

Using the goals as the framework, a plan is developed and appropriate nursing interventions are determined. Benefits of PPC PATIENT

This programme makes it possible to extend needed services to the patient after he leaves the hospital and returns to his home in the community

EVALUATION

According to the American Nurses Association Standards of Nursing Practice, the plan is evaluated in terms of the clients progress or lack of progress toward the achievement of the stated goals. This would be extremely difficult if not impossible to do for Abdellahs nursing problem approach since it has been determined that the goals are nursing goals, not the client goals.

better attention better adjustment minimized problems life saving care constant medical and nursing care

PHYSICIAN

assuring best nursing care drugs and equipments at hand orders carried out effectively better clinical an team service

She categorized nursing problems based on the individuals needs and developed developed a typology of nursing treatment and nursing skills..

NURSING RESEARCH

HOSPITAL effective and efficient use of staff improved public image

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.

LIMITATIONS

Very strong nursing centered

orientation

NURSING PERSONNEL individual skills can be used more time with patient helping pt. and family to solve problems job satisfaction in-service education

Little emphasis on what the client is to achieve Her framework is inconsistent with the concept of holism Potential problems might be overlooked

SUMMARY Using Abdellahs 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, developed 21 nursing problems were

COMMUNITY continuity with hospital services minimize the need of hospitalization

CONCLUSIONS Implications of PPC for nursing education

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. The three month assignment of professional nurses may no longer be realistic in such a setting.

Abdellahs theory provides a basis for 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 nurses philosophical frame of reference would determine whether this theory and the 21 nursing problems could be implemented in practice.

Organization of hospital and community services based on patients needs

In the intensive care unit, the critically ill patients are concentrated regardless of diagnosis. These patients are under the constant audio-visual observation of the nurse, with life saving techniques and equipment immediately available 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 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. 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 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

The patient centered approach was constructed to be useful to nursing practice, with impetus for it being nursing education. Abdellahs publications on nursing education began with her dissertation; her interest in education for nurses continues into the present. 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

It helped to bring structure and organization to what was often a disorganized collection of lectures and experiences.