According to Abdellah’s Twenty-One Nursing Problems theory of nursing, “Nursing is
based on an art and science that moulds 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 patient-centered approach to nursing was developed from Abdellah’s practice,
and the theory is considered a human needs theory. It was created to help with nursing
education, so it most applicable in that area. The nursing model is intended to guide
care in hospitals, but can be applied to community nursing, as well.
The model has interrelated concepts of health and nursing problems, as well as problem-solving,
which is an activity inherently logical in nature.
Abdellah’s theory identifies ten steps to identify the patient’s problem and 11 nursing
skills used to develop a treatment typology. The ten steps are:
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.
Test generalizations with the patient and make additional generalizations.
Validate the patient’s conclusions about his nursing problems.
Continue to observe and evaluate the patient over a period of time to identify any attitudes and clues affecting his or her behavior.
Explore the patient and his or her family’s reactions to the therapeutic plan and involve them in the plan.
Identify how the nurses feel about the patient’s nursing problems.
Discuss and develop a comprehensive nursing care plan.
The 11 nursing skills 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
The model identifies nursing as a helping profession. Nursing care is doing something
to or for a patient, or providing information to the patient with the intention of meeting needs, increasing self-ability, or alleviating impairment. In other words,helping patients become more healthy.
Abdellah describes health as a state mutually exclusive of illness. There is no definition of health given by her in the theory, but she speaks to “total health needs” and “a healthy state of mind and body” in her description of nursing as a comprehensive service.
The nursing process in Abdellah’s Twenty-One Nursing Problems theory is: assessment, nursing diagnosis, planning, implementation, and evaluation.
In the 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 is collected. The overt or covert nature of problems necessitates a direct or indirect approach, respectively.
The results of the collection of data in the assessment phase determine the patient’s
specific problems, which can be grouped under one or more of the broader nursing problems.
This creates the nursing diagnosis.
The statement of nursing problems most closely resembles goal statements. Using the
goals in the framework, a nursing care plan is developed and appropriate nursing interventions are determined. Putting those interventions in action is the implementation phase of the nursing process.
After the interventions have been carried out, the evaluation takes place. The most appropriate evaluation would be the nurses progress or lack of progress toward the achievement of the goals established in the planning phase.