Application To Nursing Practice

Dr . Abdellah 's typology of 21 nursing problems is a conceptual model mainly concerned with patient 's needs and the role of nurses in problem identification using a problem analysis approach . Abdellah 's work is classified under the nursing philosophy category in the sense that her work is based on analysis , rationalization , research and logical argument instead of using experiential methods . It can be asserted that Abdellah 's model can be described as inductive since she derived observations from previous studies which became the basis for her conceptualization . These statements are not experimental in nature because such statements based on goal , traditions and /or values cannot be tested for its correctness or wrongness (Marriner-Tomey , 1994 , hence the classification of Dr . Abdellah 's model as philosophical.

Using the scientific foundation of the theory will empower the nurse to give meaning to each and every nursing action that he/ she will perform. Using the 21 nursing problems technique, the clinical practitioner could assess the patient, make a nursing diagnosis and plan interventions. Abdellah’s main goal is the improvement of the nursing education. She believed that as the education of nurses improves, nursing practice improves as well. It transformed the focus of the profession from being “disease-centered” to “patient-centered.” The patient-centered approach was constructed to be useful to nursing practice as it helped bring structure and organization to what was often been a disorganized collection of nursing care experiences. Individual’s needs were the basis of the nursing problem, a typology of nursing treatment and nursing goals were formulated which served as a basis for determining and organizing nursing care. Client centered care emphasizes the principle that every nursing goal should be geared towards treating the patient and not just the mere illness.

Research played a great part in the selection of the 21 problem classifications. Her researches were actually the major strengths of her works. In fact, her framework continues to stimulate research about the role and responsibilities of the nurse. The broad nature of the concepts in her framework offers opportunities to identify directional relationships in nursing interventions. 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. The extensive research done regarding the patient’s needs and problems has served as a foundation for the development of what is now known as nursing diagnoses. The typology utilized by Abdellah became the root for cultivating the nursing care model and was then employed for setting up the staffing outline in clinical settings.

It was during 1950’s when Abdellah’s theory were formulated and developed, thus, providing structure to the nursing curriculum. Abdellah’s extraordinary researches, publications and other works and her worldwide reputation have been instrumental in disseminating the patient-centered approach to educational programs around the world.Abdellah’s typology of 21 nursing problems had the most compelling effect on the educational system. Educators came to the realization that revisions are of prime importance if nurses were to become self-governing. They saw that the biggest flaw in the profession was the absence or limited base of a scientific body of knowledge unique to nursing. The typology satisfied this void and gave the most crucial and timely opportunity to move away from the medical replica of cultivating nurses. Professors and educators realized the importance of client centered care rather than focusing on medical interventions. Nursing education then slowly deviated its concentration from the complex, medical concepts, into exercising better attention to the client as the primary concern.

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."

There are specific characteristics identifiable in the Twenty-One Nursing Problems. The theory has interrelated the concepts of health, nursing problems, and problem-solving. Problem-solving is an activity that is inherently logical in nature. The framework focuses on nursing practice and individual patients.

I work as a Psychitaric Nurse in a Mental Health Institution so let me share to you where I can apply Abdellah’s theory to real life scenario.

1.To maintain good hygiene and physical comfort.
Patients are bathed every morning after waking up and in the government hospital, charity ward, they are altogether taking a bath assisted by the nurses. After that, they are provided by hospital gowns to keep them clean.
2. To promote optimal activity: exercise, rest, and sleep.
Every morning, they are encouraged to exercise altogether and one patient leads the rest to perform daily workout like stretching or dance class. After taking their night medications, they are allowed to rest and sleep. As a nurse, I keep a calm and quiet environment for them to have a good sleep.
3. To promote safety through prevention of accident, injury, or other trauma and through the prevention of the spread of infection.
As many patients stay together in one single room in a ward, we prevent spread of infection by isolating patients with communicable diseases like scabies. We always maintain safety precautions because patients with mental illness are likely to have suicidal, homicidal and escape precautions therefore as a nurse you should be aware of their happenings all the time.
4. To maintain good body mechanics and prevent and correct deformity.
With patients with bed sores, good body mechanics is very important so we turn the patient from side to side or change position to prevent immobility and pressure.
5. To facilitate the maintenance of a supply of oxygen to all body cells.
If a patient verbalizes difficulty of breathing and upon assessment he is grasping for air, after proper referral we attach supply of oxygen via nasal cannula or face mask.
6. To facilitate the maintenance of nutrition of all body cells.
Patients eat altogether in a pantry where they are supplied with the same tray of food. For patients who eat very fast, they are prone to choking so you have to supervise their feeding and divide large pieces of food into small pieces. With patients who don’t want to eat, we feed them. You don’t want patients to be malnourished due to poor food intake.
7. To facilitate the maintenance of elimination.
Patients who have difficulty in elimination, we provide dietary supplements like fiber-rich foods for those with constipation. Most disturbed patients are with restraints so they just urinate on the floor, you have to change their clothes to prevent infection.
8. To facilitate the maintenance of fluid and electrolyte balance.
Some patients have electrolyte imbalance so we hook intravenous fluids like PNSS or D5LR to maintain their electrolytes in balance.
9. To recognize the physiological responses of the body to disease conditions—pathological, physiological, and compensatory.
If a patient has a disease like heart problem, in a psychiatric ward, he is referred at the Infirmary to pave way to his medical condition. There, he is given medications and proper treatment.
10. To facilitate the maintenance of regulatory mechanisms and functions.
For a patient with hallucinations like auditory and visual, it is therapeutic to present reality.
11. To facilitate the maintenance of sensory function.
When a patient is admitted who is already deaf and mute, we communicate to them by body language to maintain their basic need despite of inadequacy to the sensory function.
12. To identify and accept positive and negative expressions, feelings, and reactions.
Most patients are already confined for long period of time from months to years and talking with them therapeutically makes them ventilate their feelings both positive and negative.
13. To identify and accept interrelatedness of emotions and organic illness.
Most patients complain somatic complaints but as a psychiatric nurse, you should distinguish one from malingering. With proper assessment and keen observation, you can relate whether it is true or not.
14. To facilitate the maintenance of effective verbal and nonverbal communication.
Different patients converse in the way they are diagnosed. With Bipolar patients, one time they are talkative (manic stage) and then at one moment they are very quiet (depressed stage). We intervene through both verbal and nonverbal ways so that patients would still comply.
15. To promote the development of productive interpersonal relationships.
Families and relatives are very effective support system for patients who are confined in a psychiatric institution, allow for their private time together when family visits.
16. To facilitate progress toward achievement of personal spiritual goals
With Catholic patients, we assist them every Sunday to attend Holy Mass at the Chapel located inside the hospital. Respect also other patient’s different way of worship and faith.
17. To create and/or maintain a therapeutic environment.
Maintaining a therapeutic environment is very crucial for a mental institution. By communicating with them from time to time, you practice an area for ventilation of feelings and emotions.
18. To facilitate awareness of self as an individual with varying physical, emotional, and developmental needs.
Different wards and pavilions in the hospital cater different patients. With a ward which caters all male patients, we nurses respect their human needs like giving them privacy when they need to.
19. To accept the optimum possible goals in the light of limitations, physical, and emotional.
Different patients have individualized needs therefore optimum goals is ought to achieve in all of them. For example a patient who is withdrawn, the goal is for him to be participative to divert attention. Remotivation therapy is provided.
20. To use community resources as an aid in resolving problems arising from illness.
One problem of confinement for long periods is the distance of the family from the patients. We extend the community resources to social workers to find the families of vagrant patients who just came from the streets and no family to accept them.
21. To understand the role of social problems as influencing factors in the cause of illness.
Many psychiatric illness accounts to the social problems that predispose most of the patients to have mental problems, therefore, we as nurses, have to understand and accept the role of society as a huge effect to the patients. Conducting health education and health teachings to the family and as well as to the community.

As a nurse who is working in surgical and trauma unit, I don't have any idea that I experienced and applied Faye Abdellah Theory on my practice.
The moment that I admit my patient Abdellah's theory is working. Most of these patient's are irritable and they don't want to be disturbed specially if they are "VIP". My role as a nurse is to promote and develop a productive interpersonal relationship to gain their trust and approval.
I remember, I have a transfer-in patient from other unit who is post T11-L2 USS Fixation, Bilateral Mandible Fixation and ORIF Right Femur. She is 25 years old, mother of 3 young boys. In her history it is noted that she is a back passenger of a 4 wheel drive car without seatbelt and sustained polytrauma after that accident.
So how did I apply Abdellah's theory in taking care of Ms. HM? The moment she was transferred to our unit, I gave her my smile and touch which means that she is in good hands. I kept her comfortable on her bed, giving the access to her call bell and orient her how to use her new electric bed. I encouraged her to verbalize any complain or discomfort and informed her that she can just press the bell and I will be at her room anytime. I ordered mashed and fluid diet for her because she can't widely open her mouth due to surgery but she can tolerate food. Oral hygiene was given. She complained of pain most of the time, proper body alignment and mobilization in bed was done. Ordered analgesic was given also according to her pain score. Catheter care was done to avoid urinary tract infection and promote physical comfort. I learned from her that she didn't move her bowel for 4 days. I encourage her to increase fluid intake and helped her to move in her bed. Informed her doctor regarding the problem, Fleet Enema and laxative was ordered and she passed stool in bed pan.
A medical report was given to her husband to facilitate processing of her insurance claim.
This is just a part of my routine care for this patient; I am doing this because based on my knowledge this is the right and effective way to do it till the time that I read again Abdellah's theory. I was amazed and grateful at the same time that someone like her did her contribution for effective management of my patient.
At this time while I am writing this, Ms. HM able to stand out of bed with lumbar belt with the help of physiotherapist, her Foley catheter was removed and she can tolerate small amount of solid food.

-Marlene R. Estrella
 Rashid Hospital

"Nursing is based on an art and science that molds 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 Nurses this is what we are and what we ought to be.
As a staff nurse of Female Medical Ward, Faye Abdellah's theory has guided me in many ways. Firstly, meeting the needs that are basic to all patients such as maintaining hygiene, physical comfort preventing further injury and preventing spread of infection, are always considered as our goals whenever a patient is admitted considering his/her capabilities to full recovery. Secondly, is caring for total dependent patients, such as our two ventilated patients that are totally dependent in our care such as in bathing, feeding, suctioning, turning to sides. As care providers, its our responsibilty to give the care they deserve, although we all know that only machine is keeping them alive, their choice to continue to live despite of their situation means a lot for us. The evidence of our care, on how we maintain their sustenal care needs is observed to our 6 years ventilated patient who never developed bedsore at all. Lastly, as a Nurse working in another country wherein language, culture and tradition is totally different from my native land, therefore I have to be flexible enough to gain knowledge on how to deal with this kind of situation. Learning their language such as Arabic is really important and it helped me a lot in interacting with most of the patients who can't speak English at all. In this way, I can understand their feelings and at the same time I can intervene appropriately because I have identified their problems.Apart from that, understanding and adapting to their culture and traditions would definitely make me aware of the different factors affecting health situations of the people here in UAE. That's is how Faye Abdellah wants us to try, to care for everyone, even for the people we don't know, in any situations, we always face the challenge and always make a CHANGE.. That is the essence of being a NURSE :)

-Meilani U. Faustino Faraon
 Khorfakkan Hospital