PATIENT-CENTERED APPROACHES TO NURSING

(FAYE G. ABDELLAH)

Jeelani Saima Habeeb, Lecturer , College Of Nursing, Baba Ghulam Shah

Badshah University, (J& K )

INTRODUCTION

"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." – Abdellah

Abdellah explained Nursing as a comprehensive service, which includes:

1. Recognizing the nursing problems of the patient

2. Deciding the appropriate course of action to take in terms of relevant nursing principles
3. Providing continuous care of the individuals total needs
4. Providing continuous care to relieve pain and discomfort and provide immediate security
for the individual
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
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

Biography and Career of Faye Glenn Abdellah

 Faye Glenn Abdellah was born on March 13, 1919 in New York City.
  Graduated from Fitkin Memorial Hospital School of Nursing in Neptune, New Jersey, in
1942.
 As a new graduate, she taught at Yale. The frustration that arose from this teaching
experience led to the beginnings of her pursuit of the scientific basis of Nursing Practice.
 She was the first nurse and the first woman to serve as a Deputy Surgeon General. Her
work changed the focus of nursing from disease-centered to patient-centered, and began
to include the care of families and the elderly in nursing care.
 Her publications include Better Nursing Care through Nursing Research and Patient-
Centered Approaches to Nursing.
 She is the author of more than 150 publications related to nursing care, education for
advanced practice in nursing, health care administration, and nursing research.
 She has been granted 11 honorary doctorates by various institutions.
 These honors recognized her work in nursing research, development of first nurse
scientist training programme as well as outstanding contribution to health of nation.
 She was inducted into the National Women's Hall of Fame in 2000.

Her International services include:

 Delegation member to Soviet Union, France and China.

 Consultant to Japanese Nursing Association.
 Consultant in Australia and New Zealand in relation to nursing education, home care, and
research.
 She has also been a research consultant to the WHO.
 Dr. Abdellah is a Charter Fellow of the American Academy of Nursing, has served as
Vice President and President, and received its Living Legend Award.
 She has been recognized by Sigma Theta Tau as a Distinguished Research Fellow and
was the recipient of the Excellence in Nursing Award, as well as the first Presidential
Award.

Abdellah’s patient - Centered approach to nursing was developed inductively from her
practice and is considered a human needs theory. In 1955, a subcommittee of the National
League for Nursing Committee on Records was charged with developing a meaningful clinical
record for professional student nurses. Dr. Abdellah chaired this subcommittee, which soon
identified three barriers to its task: the lack of clear definition of nursing, the current philosophy
of nursing education was cherished but not practiced, and nursing education curricula were not
patient – centered. Using a typology of nursing problems developed in 1953, the original 58
problems were refined to 21 and validated with the assistance of faculty from 40 basic collegiate
schools of nursing. This resulted in the publication of Patient – Centered Approaches to Nursing
in1960 after at least three research studies over a five – year period.

In this 1960 publication, nursing is described as serving individuals, families, and thus, society.
The basis of nursing is both 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."

The focus of care pendulum

In her attempt to bring nursing practice to 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.

MAJOR CONCEPTS
A. Nursing Problems
The client’s health needs can be viewed as problems, which may be overt as an apparent
condition, or covert as a hidden or concealed one.
Because covert problems can be emotional, sociological, and interpersonal in nature, they are
often missed or perceived incorrectly. Yet, in many instances, solving the covert problems may
solve the overt problems as well. (Abdellah, et al., 1960).
The Twenty-One Nursing Problems (Abdellah, 1960), Basic to all patients, are the following:

1. To maintain good hygiene and physical comfort.

2. To promote optimal activity: exercise, rest, and sleep.
3. To promote safety through the prevention of accidents, injury, or other trauma and
through the prevention of the spread of infection.
4. To maintain good body mechanics and prevent and correct deformities.
5. To facilitate the maintenance of a supply of oxygen to all body cells.
6. To facilitate the maintenance of nutrition of all body cells.
7. To facilitate the maintenance of elimination.
8. To facilitate the maintenance of fluid and electrolyte balance.
9. To recognize the physiological responses of the body to disease conditions –
pathological, physiological, and compensatory.
10. To facilitate the maintenance of regulatory mechanisms and functions.
11. To facilitate the maintenance of sensory functions.
12. To identify and accept positive and negative expressions, feelings, and reactions.
13. To identify and accept the interrelatedness of emotions and organic illness.
14. To facilitate the maintenance of effective verbal and nonverbal communication.
15. To promote the development of productive interpersonal relationships.
16. To facilitate progress toward achievement of personal spiritual goals.
17. To create and/or maintain a therapeutic environment.
18. To facilitate awareness of self as an individual with varying physical, emotional, and
developmental needs.
19. To accept the optimum possible goals in the light of limitations, physical and emotional.
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.

Essential to Abdellah’s theory is the correct identification of nursing problems for which the
nursing skills included are:
-Observation of health status -Skills of communication

-Application of knowledge -Teaching of patients and families

-Planning and organization of work -Use of resource materials

-Use of personnel resources -Problem-solving

-Direction of work of others -Therapeutic uses of the self

-Nursing procedure

B. Problem Solving
Quality professional nursing care requires that nurses be able to identify and solve overt and
covert nursing problems. These requirements can be met by the problem-solving process
involves identifying the problem, selecting pertinent data, formulating hypotheses, testing
hypotheses through the collection of data, and revising hypotheses when necessary on the basis
of conclusions obtained from the data. (Abdellah & Levine, 1986.)

Metapradigm, Research, and Practice with Patient-Centered Approaches:

Metapradigm Concept Abdellah’s Patient – Centered Approach
HUMAN: Characteristics of humans are not identified; the 21 nursing
problems cover biological, psychological, and social areas.
Health Not specifically defined, although total health needs and a healthy
state of mind and body are included as part of comprehensive
nursing service.
Society / Environment The focus is on the individual and family; society is served
through serving individuals.
Nursing Discussed as a comprehensive service, based on art and science,
and aiming to help people cope with health needs.
This theory was developed through multiple research projects conducted over 5 year period.
Abdellah used methodological research to identify the nursing problems of the patients. Abdellah
has indicated that nursing research needs to focus on evidence based research.

ASSUMPTIONS
Abdellah’s (Abdellah, Beland, Martin, & Matheney, 1973) assumptions relate to 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 and health care delivery; changing nursing education;
continuing education for professional nurses; and development of nursing leaders from
underserved groups.
According to Abdellah and coworkers (1960), nurses should do the following:
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 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 this behavior.
8. Explore the patient’s and family’s reaction to the therapeutic plan and involve them in the
plan.
9. Identify how the nurse feels about the patient’s nursing problems.
10. Discuss and develop a comprehensive nursing care plan.
STRENGTHS/WEAKNESSES
Strengths:
1. A major strength of Abdellah’s work is that the 21 nursing problems were developed
through extensive research.
2. As a logical and simple statement, Abdellah’s problem-solving approach can easily be
used by practitioners to guide various activities within their nursing practice.
3. The problem-solving approach is readily generalizable to client with specific health needs
and specific nursing problems.
4. Another strength can be seen in the emphasis placed on the importance of recognizing
and correctly identifying both overt and covert problems.

Weaknesses:
1. A major limitation is the lack of continued research to link the effectiveness of use of the
21 nursing problems to successful outcomes of nursing care.
2. The label of “nursing problems” is a limitation. Labeling the list of 21 problems as
nursing problems tends to lead the reader to the belief that Abdellah’s work is nursing
centered when she stated that she was seeking to move nursing to being patient centered.
It would have been helpful if she had used another terminology or explained more clearly
how this label relates to patient centered care.

CHARACTERISTICS OF THE THEORY

 Abdellah’s theory has interrelated the concepts of health, nursing problems, and problem
solving.
 Problem solving is an activity that is inherently logical in nature.
 Framework focus on nursing practice and individuals.
 The results of testing such hypothesis would contribute to the general body of nursing
knowledge
 Easy to apply in practice.

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.

NURSING DIAGNOSIS

 The 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

PLANNING PHASE

 The statements of nursing problems most closely resemble goal statements. Once the
problem has been diagnosed, the nursing goals have been established.

IMPLEMENTATION

 Using the goals as the framework, a plan is developed and appropriate nursing
interventions are determined.

EVALUATION

 The most appropriate evaluation would be the nurse progress or lack of progress toward
the achievement of the stated goals..
 Progressive Patient Care :: Models of Nursing Care Delivery

APPLICATION

1. IN NURSING EDUCATION

 Nursing education slowly deviated its concentration from the complex, medical concepts,
into exercising better attention to the client as the primary concern.
  Its strong nurse-centered orientation is its major contribution to the nursing education.

2. IN NURSING RESEARCH
 Abdellah’s theories 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.
 Extensive research regarding patient’s needs and problems served as a foundation for
development of nursing diagnoses.

3. IN CLINICAL PRACTICE
 Nurses use problem solving approaches to solve the identified nursing problems. It is
primarily designed for hospital setting, but can also be applied in community areas.

4. RESEARCH INPUT

Faye Abdellah Model to Banishing Social Stigma of Head Lice Among School Students

Nehal A. Allam1, Wafa A. Al Megrin2, Lamya A. Alkeridis2

Published online February 23, 2016 in science journal of clinical medicine

Abstract: In this study, an experimental comparative study was carried out aiming to monitor
the effect of Faye Abdellah Theory Model on banishing social stigma of head lice among school
students and monitor its effect on their health status and self-esteem. For the study purpose a
sample of convenience of 1600 school students and their mothers was recruited from 16 schools
from both countries participated in the study. Four tools used, pre/post interviewing
questionnaire, observation checklists, Faye Abdellah model format, self-esteem scale sheet and
students/mothers guidance booklet. The results showed that the total numbers of students at 8
schools in Egypt were 800/16700, with prevalence ratio 20.8% and 800/14300 from Kingdom of
Saudia Arabia with the prevalence ratio 17.8%. The study documented that there is highly
significant effects of the model on students’ health status and banishing the social stigma and
there is a highly positive association between selfesteem and assurance to the health behavior. It
concluded that highly self-esteem had excellent health status and completely confident in coping
with self-care management. And it is recommended that knowledge is power and teaching
mothers and students about head lice myths and facts is key to demystifying the stigma.

CASE SCENARIO

Mr. Simar experienced severe chest pain. In addition he experienced shortness of breath,
tachycardia and profuse diaphoresis.

Nursing Assessment

Assessment reveals: cardiac damage, acute pain and lack of oxygenation to the body cells.

Past history reveals he had earlier experienced similar episodes in last two years.

Major Problems

• Pain
• Impaired cardiac functioning
• Work related stress and Failure to seek medical attention

STAGES OF ABDELLAH’S NSG. NSG. INTERVENTIONS

ILLNESS PROBLEM
BASIC CARE 1. To maintain good 1. Administer oxygen
hygiene and physical 2. Elevate head end
comfort 3. Repositioning the patient
4. Administer analgesics as
prescribed

SUSTENAL CARE 5. To facilitate the 1. Promote rest

NEEDS maintenance of supply 2. Place in sitting position
of oxygen to body cells 3. Promote deep breathing and
coughing exercises
4. Implement exercises as
 tolerated

REMEDIAL CARE 13. To identify and 1. To find the nature of his

NEEDS accept the 2. Explore his work related goals
interrelatedness of 3. Stress associated with job
emotional and organic
illness
RESTORATIVE 20. To use community 1. Teach early signs and
CARE NEEDS resources as an aid in symptoms of cardiac distress
resolving problems 2. Teach course of action
arising from illness

CRITIQUE OF THE THEORY

 Clarity- All the theoretical statements are logical in nature. Much focus is given to the
nursing and clients as a whole.
 Simplicity- The concepts are very simple and easy to understand.
 Generality- It can be easily reproduced in all the health care setting while working for
individuals, family and communities.
 Empirical precision- the concepts in the theory can be tested in the research for the
practicability and improve the various nursing interventions

CONCLUSION

 Abdellah’s theory provides a basis for determining and organizing nursing care. The
problems also provide a basis for organizing appropriate nursing strategies.
 As a whole, the theory is intended to guide care not just in the hospital setting, but can
also be applied to community nursing, as well.
  This theory is mainly focused on the clientsand nurses role in identification and solving
these problems.
 Her theory has changed the entire nursing focus from disease to patient centered
approach.

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