DESCRIPTION

Lydia’s Hall Care, Cure,

● define Nursing as the “participation in care,
Core Theory core and cure aspects of patient care, where
CARE is the sole function of nurses,
● used her knowledge of psychiatry and
whereas the CORE and CURE are shared
nursing experiences in the Loeb Center to
with other members of the health team.”
formulate her theory.
● The major purpose of care is to achieve an
● Also known as “the Three Cs of Lydia Hall,”
interpersonal relationship with the individual
it contains three independent but
to facilitate the development of the core.
interconnected circles: the core, the care,
and the cure.
● As Hall says, “To look at and listen to self is
often too difficult without the help of a
1. CORE
significant figure (nurturer) who has learned
➔ the patient receiving nursing care.
how to hold up a mirror and sounding board
The core has goals set by him or
to invite the behaver to look and listen to
herself rather than by any other
himself. If he accepts the invitation, he will
person and behaves according to
explore the concerns in his acts. As he
their feelings and values.
listens to his exploration through the
reflection of the nurse, he may uncover in
2. CURE
sequence his difficulties, the problem area,
➔ attention given to patients by
his problem, and eventually the threat which
medical professionals. Hall explains
is dictating his out-of-control behavior.”
in the model that the nurse shares
the cure circle with other health
ASSUMPTIONS
professionals, such as physicians or
physical therapists. These are the
(1) The motivation and energy necessary for
interventions or actions geared
healing exist within the patient rather than in the
toward treating the patient for
healthcare team.
whatever illness or disease they are
(2) The three aspects of nursing should not be
suffering from.
viewed as functioning independently but as
interrelated.
3. CARE
(3) The three aspects interact, and the circles
➔ addresses the role of nurses and is
representing them change the size, depending on
focused on performing the task of
the patient’s total course of progress.
nurturing patients. This means the
“motherly” care provided by nurses,
MAJOR CONCEPTS OF CARE, CORE, CURE
which may include comfort
measures, patient instruction, and
1. Individual/Person
helping the patient meet his or her
● The individual human who is 16
needs when help is needed.
years of age or older and past the
acute stage of long-term illness
● Hall’s theory emphasizes the total patient
focuses on nursing care in Hall’s
rather than looking at just one part and
work.
depends on all three components of the
● The source of energy and motivation
theory working together.
for healing is the individual care
recipient, not the health care
Lydia Hall’s: Care, Core, Cure
provider.
● the individual’s importance as
Nursing theory, in line with Lydia Hall, is nothing
unique, capable of growth and
short of revolutionary. In the 1960s, she put down,
learning, and requiring a total person
in her own simple words, her thoughts about
approach.
nursing. She did not consider herself a nurse
theorist but instead talked about her transparent
2. Health
thoughts and remarkable nursing care ideas as she
● state of self-awareness with a
learned them over the years. These lead to the
conscious selection of optimal
development of her “Care, Cure, Core Theory,” also
behaviors for that individual.
known as the “Three Cs of Lydia Hall.”
● need to help the person explore the
meaning of his or her behavior to
identify and overcome problems
 through developing self-identity and
maturity.
3. Society and Environment
● dealt with concerning the individual.
● Hall is credited with developing Loeb
Center’s concept because she
assumed that the hospital
environment during treatment of
acute illness creates a difficult
psychological experience for the ill
individual.
● Loeb Center focuses on providing an
environment that is conducive to
self-development. In such a setting,
the focus of the nurses’ action is the
individual.
● Any actions taken concerning
society or the environment are to
assist the individual in attaining a
personal goal.
4. Nursing
● participating in the care, core, and
cure aspects of patient care.
SUBCONCEPTS
● Lydia Hall’s theory has three components
which are represented by three independent
but interconnected circles.
● The three circles are the core, the care, and
the cure.
● The size of each circle constantly varies
and depends on the state of the patient.
1. The Care Circle (the body)
● Intimate bodily care; represents the
patient’s body
● Nurses are focused on performing
the noble task of nurturing patients.
This circle solely represents the role
of nurses and is focused on
performing the task of nurturing
patients. Nurturing involves using
the factors that make up the concept
of mothering (care and comfort of
the person) and provide for
teaching-learning activities.
● defines a professional nurse’s
primary role, such as providing
bodily care for the patient and
helping the patient complete such
basic daily biological functions as
eating, bathing, elimination, and
dressing. When providing this care,
the nurse’s goal is the comfort of the
patient.
● nurse’s role also includes educating
patients and helping a patient meet
any needs he or she is unable to
meet alone. This presents the nurse
and patient with an opportunity for
closeness. As closeness develops,
the patient can share and explore
feelings with the nurse.
2. The Core Circle (the person)
● It is the patient receiving nursing
care.
● Represents the inner feelings and
management of the person
● The core has goals set by him or
herself rather than by any other
person and behaves according to
their feelings and values.
● This involves the therapeutic use of
self and is shared with other
members of the health team.
● emphasizes the patient’s social,
emotional, spiritual, and intellectual
needs concerning family, institution,
community, and the world.
● This can help the patient verbally
express feelings regarding the
disease process and its effects by
using the reflective technique.
Through such expression, the patient
can gain self-identity and further
develop maturity.
● The professional nurse uses the
reflective technique to act as a
mirror to the patient to help the latter
explore his or her own feelings
regarding his or her current health
status and related potential changes
in lifestyle.
● Motivations are discovered through
the process of bringing into
awareness the feelings being
experienced. With this awareness,
the patient can now make conscious
decisions based on understood and
accepted feelings and motivation.
3. The Cure Circle (the disease)
● Seeing the patient and family through
medical care; represents the disease
that affect the patient’s physical
system
● the cure is nursing, which involves
the administration of medications
and treatments.
● Hall explains in the model that the
nurse shares the cure circle with
other health professionals, such as
physicians or physical therapists.
● In short, these are the interventions
or actions geared toward treating the
 patient for whatever illness or
disease he or she is suffering from.
During this aspect of nursing care,
the nurse is an active advocate of
the patient.
● The three interlocking circles may change in
size and overlap concerning the patient’s
phase in the disease process.
● A nurse functions in all three circles but to
different degrees.
➔ For example, in the care phase, the
nurse gives hands-on bodily care to
the patient about daily living
activities such as toileting and
bathing. In the curing phase, the
nurse applies medical knowledge to
the treatment of the person. In the
core phase, the nurse addresses the
patient’s social and emotional needs
for effective communication and a
comfortable environment.
STRENGTHS
● Lydia Hall’s model appears to be completely
and simply logical. Her work may be viewed
as the philosophy of nursing.
● The three Cs (care, core, and cure) in this
theory were unique. IN ALL THE MODEL
CIRCLES, THE NURSE IS PRESENT, although
the NURSE’S FOCUS IS ON THE CARE
CIRCLE.
WEAKNESSES
● Lydia Hall’s model is considered to be plain
and simple in its presentation. However, the
receptiveness and resilience necessary for
its utilization and function may not be so
simple for nurses whose personality,
educational preparation, and experience
have not prepared them to function with
minimal structure. This and the
self-imposed age and illness requirements
limit the generalizability.
● The age requirement for applying her theory
16 years of age and above limits the theory
since it cannot be disregarded that nurses
are faced with pediatric clients now and
then.
● The concept of a patient aggregate, such as
having families and communities as the
focus of nursing practice, was not tackled. It
is purely on the individual himself. Although,
the role of the family or the community
within the patient’s environment was
modestly discussed.
CONCLUSION
● Lydia Hall used her knowledge of psychiatry
and nursing experiences in the Loeb Center
as a framework for formulating the Care,
Core, and Cure Theory.
● Her model contains three independent but
interconnected circles. The three circles are
the core, the care, and the cure.
➔ The CORE IS THE PATIENT.
➔ The CURE REFERS TO THE
MEDICAL AND NURSING
INTERVENTIONS
➔ CARE IS THE NURTURING
PROVIDED BY NURSES.
➔ Nursing functions in all three of the
circles but shares them to different
degrees with other disciplines.
 Joyce Travelbee’s 5 INTERACTIONAL PHASES OF TRAVELBEE’S
MODEL
Human-to-Human Relationship
Model ● consecutive order and developmentally
achieved by the nurse and the patient as
their relationship with each other goes
● Travelbee proposed that the goal of nursing
deeper and more therapeutic.
was to assist an individual, family, or
community to prevent or cope with the
A. The phase of the Original Encounter
experiences of illness and suffering and, if
necessary, to find meaning in these
● Emotional knowledge colors
experiences, with the ultimate goal being
impressions and perceptions of both
the presence of hope
nurse and patient during initial
● Travelbee’s work was conceptual, and she
encounters.
wrote about illness, suffering, pain, hope,
● The task is “to break the bond of
communication, interaction, empathy,
categorization in order to perceive
sympathy, rapport, and therapeutic use of
the human being in the patient” and
self.
vice versa.
● Patients are the same human beings
She proposed that nursing was accomplished
as us and families; only that they
through human-to-human relationships that began
need other human beings,
with the following:
specifically nurses and doctors for
maintaining health.
(1) the original encounter and progressed
● HEALTH, which Travelbee defines in
through stages of
two categories: subjective and
(2) emerging identities
objective.
(3) developing feelings of empathy and,
○ Subjective health is an
(4) sympathy, until
individually defined state of
(5) the nurse and the
well-being in accord with
patient attained rapport in the final stage
self-appraisal of
physical-emotional-spiritual
● Travelbee believed that it was as important
status.
to sympathize as it was to empathize if the
○ Objective health is an
nurse and the patient were to develop a
absence of discernable
human-to-human relationship
disease, disability of defect
as measured by physical
INTERPERSONAL ASSUMPTIONS AND PHASES
examination, laboratory tests,
and assessment by the
● Nursing is fulfilled by means of
spiritual director or
human-to-human relationships.
psychological counselor.
● She defined nursing as “an interpersonal
process whereby the professional nurse
1. The phase of Emerging Identities
practitioner assists an individual, family or
community to prevent or cope with the
● Tasks in the second phase (visibility
experience of illness and suffering, and if
of personal or emerging identities)
necessary, to find meaning in these
include separating oneself and one’s
experiences”.
experiences from others AND
recognizing the different qualities
● Inspired by being a psychiatric nurse, she
that each possesses, transcending
struggles for a “Humanistic Revolution” in
roles by separating self and
nursing, with devotion to caring and
experiences from one another – not
compassion for patients. She expressed
using oneself to judge others.
that achieving the goal of nursing
● The nurse nor the patient is not to
necessitates a genuine human-to-human
stereotype the other as having a
relationship, which can only be established
particular vexatious characteristic as
by an interaction process, this process is
this is not facilitative to building a
further divided into five phases.
relationship. Tasks include and
avoiding “using oneself as a
yardstick” by which to evaluate
others. Barriers to such tasks may
 be due to role envy, lack of interest in
others, inability to transcend the self,
or refusal to initiate emotional
investment.
● This phase is described by the nurse
and patient perceiving each other as
unique individuals.
● At this time, the link of the
relationship begins to form.
2. The phase of Empathy
● This phase involves sharing
another’s psychological state but
standing apart and not sharing
feelings.
● It is characterized “by the ability to
predict the behavior of another”.
3. The phase of Sympathy
● Sharing, feeling, and experiencing
what others are feeling and
experiencing is accomplished.
● This phase demonstrates emotional
involvement and discredits
objectivity as dehumanizing.
● The task of the nurse is to translate
sympathy into helpful nursing
actions.
● Sympathy happens when the nurse
wants to lessen the cause of the
patient’s suffering. It goes beyond
empathy.
● “When one sympathizes, one is
involved but not incapacitated by the
involvement.”
● The nurse should use a disciplined
intellectual approach together with
the therapeutic use of self to make
helpful nursing actions.
4. The phase of Rapport
● Rapport is described as nursing
interventions that lessen the
patient’s suffering.
● The nurse and the sick person are
relating as human being to human
being.
● The sick person shows trust and
confidence in the nurse.
● “A nurse is able to establish rapport
because she possesses the
necessary knowledge and skills
required to assist ill persons and
because she is able to perceive,
respond to, and appreciate the
uniqueness of the ill human being.”
- Interaction Phases
DESCRIPTION OF THE INTERPERSONAL THEORY
● Travelbee believed nursing is accomplished
through human-to-human relationships that
begin with the original encounter and then
progress through stages of emerging
identities, developing feelings of empathy,
and later feelings of sympathy. Travelbee’s
ideas have greatly influenced the hospice
movement in the west.
● The nurse and patient attain a rapport in the
final stage. For meeting the goals of
nursing, it is a prerequisite to achieving
genuine human-to-human relationships.
This relationship can only be established by
an interaction process. It has five phases:
1. The inaugural meeting or
original encounter
2. Visibility of personal
identities/ emerging
identities.
3. Empathy
4. Sympathy
5. Establishing mutual
understanding and contact/
rapport
BASIC CONCEPTS & DEFINITIONS
1. Suffering
➔ “An experience that varies in
intensity, duration and depth … a
feeling of unease, ranging from mild,
transient mental, physical or mental
discomfort to extreme pain and
extreme tortured …”
2. Meaning
➔ reason as oneself attributes
3. Nursing
➔ help man to find meaning in the
experience of illness and suffering.
has a responsibility to help
individuals and their families to find
meaning.
➔ The nurses’ spiritual and ethical
choices and perceptions of illness
and suffering are crucial in helping
to find meaning.
4. Hope
➔ The nurse’s job is to help the patient
to maintain hope and avoid
hopelessness.
➔ Hope is a faith that can and will
change that would bring something
better with it. Hope’s core lies in a
fundamental trust in the outside
 world, and a belief that others will spiritual director or
help someone when you need it. psychological counselor.

➔ Six important factors characteristics C. Environment

of hope are: ● NOT clearly defined.

1. It is strongly associated with dependence D. Nursing

on other people. ● “an interpersonal process whereby
2. It is future-oriented. the professional nurse practitioner
3. It is linked to elections from several assists an individual, family or
alternatives or escape routes out of its community to prevent or cope with
situation. experience or illness and suffering,
4. The desire to possess any object or and if necessary to find meaning in
condition, to complete a task or have an these experiences.”
experience.
5. Confidence that others will be there for you
when you need them.
6. The hoping person is in possession of
courage to be able to acknowledge their
shortcomings and fears and go forward
towards their goal

5. Communications
➔ “a strict necessity for good nursing
care” and “one is able to use itself
therapeuticly.”

6. Using “self” therapeutically”

➔ Self-awareness and
self-understanding, understanding of
human behavior, the ability to predict
one’s own and others’ behavior are
important in this process.

7. Targeted intellectual approach

➔ nurses must have a systematic
intellectual approach to the patient’s
situation.

NURSING METAPARADIGMS

A. Person
● is defined as a human being. Both
the nurse and the patient are human
beings.

B. Health
● Health is subjective and objective.
○ Subjective health is an
individually defined state of
well-being in accord with
self-appraisal of
physical-emotional-spiritual
status.
○ Objective health is an
absence of discernible
disease, disability, or defect
as measured by physical
examination, laboratory tests,
and assessment by a
 MAJOR CONCEPTS OF 21 NURSING PROBLEMS
Faye Abdellah’s 21 Nursing THEORY
Problems Theory ● The model has interrelated concepts of
health and nursing problems and
● Her theory changed the focus of nursing
problem-solving, which is inherently logical
from disease-centered to patient-centered
in nature.
and began to include the care of families and
the elderly in nursing care.
1. Individual
● According to Faye Glenn Abdellah’s theory,
➔ She describes nursing recipients as
“Nursing is based on an art and science that
individuals (and families), although
molds the attitudes, intellectual
she does not delineate her beliefs or
competencies, and technical skills of the
assumptions about the nature of
individual nurse into the desire and ability to
human beings.
help people, sick or well, cope with their
➔ People as having physical,
health needs.”
emotional, and sociological needs
● The patient-centered approach to nursing
was developed from Abdellah’s practice,
2. Health
and the theory is considered a human needs
➔ Health, or the achieving of it, is the
theory.
purpose of nursing services.
● It was formulated to be an instrument for
➔ In patient-centered approaches to
nursing education, so it is most suitable and
nursing, describes health as a state
useful in that field.
mutually exclusive of illness
● The nursing model is intended to guide care
➔ Although Abdellah does not define
in hospital institutions but can also be
health, she speaks to “total health
applied to community health nursing, as
needs” and “a healthy state of mind
well.
and body.”
➔ Health may be defined as the
ASSUMPTIONS
dynamic pattern of functioning
whereby there is a continued
● The assumptions Abdellah’s “21 Nursing
interaction with internal and external
Problems Theory” relate to change and
forces that results in the optimal use
anticipated changes that affect nursing; the
of necessary resources to minimize
need to appreciate the interconnectedness
vulnerabilities.
of social enterprises and social problems;
the impact of problems such as poverty,
3. Society (Environment)
racism, pollution, education, and so forth on
➔ Society is included in “planning for
health and health care delivery; changing
optimum health on local, state, and
nursing education; continuing education for
international levels.”
professional nurses; and development of
➔ However, as Abdellah further
nursing leaders from underserved groups.
delineates her ideas, the focus of
nursing service is clearly the
1. Learn to know the patient.
individual.
2. Sort out relevant and significant data.
3. Make generalizations about available data
4. Nursing
concerning similar nursing problems
➔ Nursing care is doing something to
presented by other patients.
or for the person or providing
4. Identify the therapeutic plan.
information to the person with the
5. Test generalizations with the patient and
goals of meeting needs, increasing
make additional generalizations.
or restoring self-help ability or
6. Validate the patient’s conclusions about his
alleviating impairment
nursing problems.
➔ Nursing is broadly grouped into the
7. Continue to observe and evaluate the
21 problem areas to guide care and
patient over a period of time to identify any
promote use of nursing judgment
attitudes and clues affecting this behavior.
8. Explore the patient’s and family’s reaction to
5. Nursing Problems
the therapeutic plan and involve them in the
➔ The client’s health needs can be
plan.
viewed as problems, overt as an
9. Identify how the nurse feels about the
apparent condition, or covert as a
patient’s nursing problems.
hidden or concealed one.
10. Discuss and develop a comprehensive
nursing care plan.
 ➔ Because covert problems can be
emotional, sociological, and
interpersonal in nature, they are
often missed or misunderstood. Yet,
in many instances, solving the covert
problems may solve the overt
problems as well.
6. Problem Solving
● Quality professional nursing care
requires that nurses be able to
identify and solve overt and covert
nursing problems. The
problem-solving process can meet
these requirements by identifying
the problem, selecting pertinent
data, formulating hypotheses,
testing hypotheses through
collecting data, and revising
hypotheses when necessary based
on conclusions obtained from the
data.
SUBCONCEPTS
● The following are the subconcepts of Faye
Abdellah’s “21 Nursing Problems” theory
and their definitions.
1.) ABDELLAH’S TYPOLOGY OF 21 NURSING
PROBLEMS
● The 21 nursing problems fall into
three categories:
(1) physical, sociological, and
emotional needs of patients;
(2) types of interpersonal
relationships between the
patient and nurse; and
(3) common elements of
patient care.
● She used Henderson’s 14 basic
human needs and nursing research
to establish the classification of
nursing problems. Abdellah’s 21
Nursing Problems are the following:
1. To maintain good hygiene and physical
comfort.
1. To promote optimal activity: exercise, rest,
sleep
2. To promote safety by preventing accidents,
injuries, or other trauma and preventing the
spread of infection.
3. To maintain good body mechanics (proper
posture) and prevent and correct the
deformity.
4. To facilitate the maintenance of a supply of
oxygen to all body cells (breathe normally;
proper breathing)
5. To facilitate the maintenance of nutrition for
all body cells.
6. To facilitate the maintenance of elimination.
7. To facilitate the maintenance of fluid and
electrolyte balance.
8. To recognize the physiologic responses of
the body to disease conditions—pathologic
(anything that is abnormal; illnesses),
physiologic (normal occurrence in the body),
and compensatory (body’s way in
compensating the stressor; feedback) .
9. To facilitate the maintenance of regulatory
mechanisms and functions.
10. To facilitate the maintenance of sensory
function.
11. To identify and accept positive and negative
expressions, feelings, and reactions.
12. To identify and accept interrelatedness of
emotions and organic illness (emotion
should be related to the illness).
13. To facilitate the maintenance of effective
verbal and nonverbal communication.
14. To promote the development of productive
interpersonal relationships.
15. To facilitate progress toward achievement
and personal spiritual goals.
16. To create or maintain a therapeutic
environment.
17. To facilitate awareness of self as an
individual with varying physical, emotional,
and developmental needs.
18. To accept the optimum possible goals in the
light of limitations, physical and emotional.
19. To use community resources as an aid in
resolving problems that arise from an
illness.
20. To understand the role of social problems
as influencing factors in the cause of
illness.
Moreover, PATIENTS’ NEEDS ARE FURTHER
DIVIDED INTO FOUR CATEGORIES:
➢ basic to all patients
➢ sustenance care needs
➢ remedial care needs
➢ restorative care needs.
A. Basic Needs
➔ maintain good hygiene and physical
comfort; promote optimal health
through healthy activities, such as
exercise, rest, and sleep; promote
safety through the prevention of
health hazards like accidents, injury,
or other trauma and the prevention
of the spread of infection; and
 maintain good body mechanics and
prevent or correct deformity.
B. Sustenal Care Needs
➔ facilitate the maintenance of a
supply of oxygen to all body cells;
facilitate the maintenance of
nutrition of all body cells; facilitate
the maintenance of elimination;
facilitate the maintenance of fluid
and electrolyte balance; recognize
the physiological responses of the
body to disease conditions; facilitate
the maintenance of regulatory
mechanisms and functions, and
facilitate the maintenance of
sensory function.
C. Remedial Care Needs
➔ identify and accept positive and
negative expressions, feelings, and
reactions; identify and accept the
interrelatedness of emotions and
organic illness; facilitate the
maintenance of effective verbal and
non-verbal communication; promote
the development of productive
interpersonal relationships; facilitate
progress toward achievement of
personal spiritual goals; create and
maintain a therapeutic environment;
and facilitate awareness of the self
as an individual with varying
physical, emotional, and
developmental needs.
D. Restorative Care Needs
➔ include the acceptance of the
optimum possible goals in light of
limitations, both physical and
emotional; the use of community
resources as an aid to resolving
problems that arise from an illness;
and the understanding of the role of
social problems as influential
factors in the case of illness.
● Abdellah’s work, based on the problem-solving
method, serves as a vehicle for delineating
nursing (patient) problems as the patient
moves toward a healthy outcome.
The theory identifies ten steps to identify the
patient’s problem and 11 nursing skills to develop a
treatment typology.
● TEN STEPS TO IDENTIFY THE
PATIENT’S PROBLEM are:
1. Learn to know the patient. (rapport)
2. Sort out relevant and significant data.
3. Make generalizations about available data
concerning similar nursing problems
presented by other patients.
4. Identify the therapeutic plan.
5. Test generalizations with the patient and
make additional generalizations.
(implementation)
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 his or her
behavior.
8. Explore the patient and their family’s
reactions to the therapeutic plan and involve
them in the plan.
9. Identify how the nurses feel about the
patient’s nursing problems. (should be
aware of your own emotions)
10. Discuss and develop a comprehensive
nursing care plan. (much broader and
complete nursing plan)
● 11 NURSING SKILLS TO DEVELOP A
TREATMENT TYPOLOGY are:
1. observation of health status
2. skills of communication
3. application of knowledge
4. the 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. the direction of work of others
10. therapeutic uses of the self
11. nursing procedure
● ABDELLAH ALSO 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 individual’s
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 body and mind
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 people’s
health needs
2.) PATIENT-CENTERED APPROACHES TO
NURSING
● Faye Abdellah’s work is a set of problems
formulated in terms of nursing-centered
services used to determine the patient’s
needs. The nursing-centered orientation to
client care appears to be contradicting the
client-centered approach that Abdellah
professes to support. This can be observed
by her desire to move away from a
disease-centered orientation.
● Focus of Care Pendulum of Faye Abdellah’s
Theory.
○ The nursing-centered orientation to
client care seems contrary to the
client-centered approach that
Abdellah professes to uphold. The
apparent contradiction can be
explained by her desire to move
away from a disease-centered
orientation.
○ In her attempt to bring the 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.
3.) 21 NURSING PROBLEMS AND THE NURSING
PROCESS
● The nursing process in Abdellah’s theory
includes:
➢ Assessment
➢ nursing diagnosis
➢ Planning
➢ Implementation
➢ evaluation.
A. Assessment Phase
➔ The nursing problems implement a
standard procedure for data
collection.
➔ 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.
B. Diagnosis Phase
➔ The outcome of the collection of
data in the first phase concludes the
patient’s possible problems, which
can be grouped under one or more
of the broader nursing problems.
This will further lead to the nursing
diagnosis.
C. Planning Phase
➔ After formulating the diagnosis, a
nursing care plan is developed, and
appropriate nursing interventions are
determined.
D. Implementation
➔ The nurse now sets those
interventions in action, which
complete the implementation phase
of the nursing process.
E. Evaluation
➔ takes place after the interventions
have been carried out. The most
convenient evaluation would be the
nurse’s progress or lack of progress
toward achieving the goals
established in the planning phase.
ANALYSIS
● With Faye Abdellah’s aim in formulating a
clear categorization of patient’s problems
as health needs, she rather conceptualized
nurses’ actions in nursing care, which is
contrary to her aim. Nurses’ roles were
defined to alleviate the problems assessed
through the proposed problem-solving
approach.
● The problem-solving approach introduced
by Abdellah has the advantage of increasing
the nurse’s critical and analytical thinking
skills since the care to be provided would be
 based on sound assessment and validation
of findings.
● One can identify that the framework is
strongly applied to individuals as the focus
of nursing care. The inclusion of an
aggregate of people such as the community
or society would make the theory of
Abdellah more generalizable since nurses
do not only provide one-person service,
especially now that the community
healthcare level is sought to have higher
importance than curative efforts in the
hospital.
STRENGTHS
The following are the strengths of Faye Abdellah’s
“21 Nursing Problems” theory.
● The problem-solving approach is readily
generalizable to the client with specific
health needs and specific nursing problems.
● With the model’s nature, healthcare
providers and practitioners can use
Abdellah’s problem-solving approach to
guide various activities within the clinical
setting. This is true when considering a
nursing practice that deals with clients with
specific needs and specific nursing
problems.
● The language of Faye Abdellah’s framework
is simple and easy to comprehend.
● The theoretical statement greatly focuses
on problem-solving, an activity that is
inherently logical in nature.
WEAKNESSES
The following are the limitations of Faye Abdellah’s
“21 Nursing Problems” theory.
● The major limitation to Abdellah’s theory
and the 21 nursing problems is their robust
nurse-centered orientation. She rather
conceptualized nurses’ actions in nursing
care which is contrary to her aim.
● Another point is the lack of emphasis on
what the client is to achieve was given in
client care.
● The framework seems to focus quite heavily
on nursing practice and individuals. This
somewhat limits the generalizing ability,
although the problem-solving approach is
readily generalizable to clients with specific
health needs and specific nursing.
● Also, Abdellah’s framework is inconsistent
with the concept of holism. The nature of
the 21 nursing problems attests to this. As a
result, the client may be diagnosed with
numerous problems leading to
fractionalized care efforts. Potential
problems might be overlooked because the
client is not deemed to be in a particular
illness stage.
CONCLUSION
● Abdellah’s typology of 21 nursing problems
is a conceptual model mainly concerned
with the patient's needs and nurses’ role in
problem identification using a problem
analysis approach.
● According to the model, patients are
described as having physical, emotional,
and sociological needs. People are also the
only justification for the existence of
nursing. Without people, nursing would not
be a profession since they are the recipients
of nursing.
● Patient-centered approaches to nursing
health are described as a state mutually
exclusive of illness. Abdellah does not
define health but speaks to “total health
needs” and “a healthy state of mind and
body” in her nursing description.
● However, Abdellah rather conceptualized
nurses’ actions in nursing care, contrary to
her aim of formulating a clear
categorization of patients’ problems as
health needs. Nurses’ roles were defined to
alleviate the problems assessed through the
proposed problem-solving approach.
● 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. The model has interrelated concepts
of health and nursing problems and
problem-solving, which is inherently logical
in nature.
● Furthermore, the 21 nursing problems
progressed to a second-generation
development referred to as patient
problems and patient outcomes. Abdellah
educated the public on AIDS, drug addiction,
violence, smoking, and alcoholism. Her
work is a problem-centered approach or
philosophy of nursing.
 needs, and the mind and body are
Virginia Henderson’s Need inseparable and interrelated.
Theory 2. Environment
➔ Although the Need Theory did not
● Virginia Henderson developed the Nursing
explicitly define the environment,
Need Theory to define the unique focus of
Henderson stated that maintaining a
nursing practice. The theory focuses on the
supportive environment conducive
importance of increasing the patient’s
to health is one of her 14 activities
independence to hasten their progress in
for client assistance.
the hospital. Henderson’s theory
➔ Henderson’s theory supports the
emphasizes the basic human needs and
private and public health sector’s
how nurses can meet those needs.
tasks or agencies to keep people
healthy. She believes that society
● “I believe that the function the nurse
wants and expects the nurse’s act
performs is primarily an independent one –
for individuals who cannot function
that of acting for the patient when he lacks
independently.
knowledge, physical strength, or the will to
act for himself as he would ordinarily act in
3. Health
health or in carrying out prescribed therapy.
➔ Although not explicitly defined in
This function is seen as complex and
Henderson’s theory, health was
creative, as offering unlimited opportunity to
taken to mean balance in all realms
apply the physical, biological, and social
of human life. It is equated with the
sciences and the development of skills
independence or ability to perform
based on them.” (Henderson, 1960)
activities without aid in the 14
components or basic human needs.
ASSUMPTIONS OF THE NEED THEORY
➔ On the other hand, nurses are key
persons in promoting health,
● Virginia Henderson’s Need Theory
preventing illness, and curing.
assumptions are:
According to Henderson, good
health is a challenge because it is
(1) Nurses care for patients until they can
affected by numerous factors such
care for themselves once again. Although
as age, cultural background,
not precisely explained
emotional balance, and others.
(2) patients desire to return to health
(3) Nurses are willing to serve, and “nurses
4. Nursing
will devote themselves to the patient day
➔ Virginia Henderson wrote her
and night.”
definition of nursing before the
(4) Henderson also believes that the “mind
development of theoretical nursing.
and body are inseparable and are
➔ She defined nursing as “the unique
interrelated.”
function of the nurse is to assist the
individual, sick or well, in the
MAJOR CONCEPTS OF THE NURSING NEED
performance of those activities
THEORY
contributing to health or its recovery
that he would perform unaided if he
The following are the major concepts (nursing
had the necessary strength, will or
metaparadigm) and definitions of the Need Theory
knowledge. And to do this in such a
of Virginia Henderson.
way as to help him gain
independence as rapidly as
1. Individual
possible.”
➔ individuals have basic health needs
➔ The nurse’s goal is to make the
and require assistance to achieve
patient complete, whole, or
health and independence or a
independent. In turn, the nurse
peaceful death.
collaborates with the physician’s
➔ an individual achieves wholeness by
therapeutic plan.
maintaining physiological and
emotional balance.
➔ Nurses temporarily assist an individual who
➔ She defined the patient as someone
lacks the necessary strength, will, and
who needs nursing care but did not
knowledge to satisfy one or more of the 14
limit nursing to illness care. Her
basic needs.
theory presented the patient as a
sum of parts with biopsychosocial
 ➔ She states: “The nurse is temporarily the
consciousness of the unconscious, the love
life for the suicidal, the leg of the amputee,
the eyes of the newly blind, a means of
locomotion for the infant, knowledge, and
confidence of the young mother, the
mouthpiece for those too weak or
withdrawn to speak.”
➔ Additionally, she stated that “…the nurse
does for others what they would do for
themselves if they had the strength, the will,
and the knowledge. But I go on to say that
the nurse makes the patient independent of
them as soon as possible.”
➔ Her definition of nursing distinguished a
nurse’s role in health care: The nurse is
expected to carry out a physician’s
therapeutic plan, but individualized care
results from the nurse’s creativity in
planning for care.
➔ The nurse should be an independent
practitioner able to make an independent
judgment. In her work Nature of Nursing,
she states the nurse’s role is “to get inside
the patient’s skin and supplement his
strength, will or knowledge according to his
needs.” The nurse is responsible for
assessing the patient’s needs, helping them
meet health needs, and providing an
environment in which the patient can
perform activity unaided.
14 COMPONENTS OF THE NEED THEORY
The 14 components of Virginia Henderson’s Need
Theory show a holistic nursing approach covering
physiological, psychological, spiritual, and social
needs.
★ Physiological Components
1. Breathe normally
2. Eat and drink adequately
3. Eliminate body wastes
4. Move and maintain desirable postures
5. Sleep and rest
6. Select suitable clothes – dress and undress
7. Maintain body temperature within normal range
by adjusting clothing and modifying environment
8. Keep the body clean and well-groomed and
protect the integument
9. Avoid dangers in the environment and avoid
injuring others
★ Psychological Aspects of Communicating
and Learning
10. Communicate with others in expressing
emotions, needs, fears, or opinions.
14. Learn, discover, or satisfy the curiosity that
leads to normal development and health and use
the available health facilities.
★ Spiritual and Moral
11. Worship according to one’s faith
★ Sociologically Oriented to Occupation and
Recreation
12. Work in such a way that there is a sense of
accomplishment
13. Play or participate in various forms of
recreation
HENDERSON’S 14 COMPONENTS AS APPLIED TO
MASLOW’S HIERARCHY OF NEEDS
Since there is much similarity, Henderson’s 14
components can be applied or compared to
Abraham Maslow‘s Hierarchy of Needs.
➔ Components 1 to 9 are under Maslow’s
Physiological Needs, whereas the 9th
component is under the Safety Needs.
➔ The 10th and 11th components are under
the Love and Belongingness category, and
the 12th, 13th, and 14th components are
under the Self-Esteem Needs.
ANALYSIS OF THE NEED THEORY
● One cannot say that every individual with
similar needs indicated in the 14 activities
 by Virginia Henderson is the only thing that
human beings need in attaining health and
survival. With today’s time, there may be
added needs that humans are entitled to be
provided with by nurses.

● The prioritization of the 14 Activities was

not clearly explained whether the first one is
a prerequisite to the other. But still, it is
remarkable that Henderson was able to
specify and characterize some of the needs
of individuals based on Abraham Maslow’s
hierarchy of needs.

● Because of the absence of a conceptual

diagram, interconnections between
Henderson’s principles’ concepts and
subconcepts are not delineated.

STRENGTHS

● Virginia Henderson’s concept of nursing is

widely accepted in nursing practice today.
Her theory and 14 components are relatively
simple, logical, and applied to individuals of
all ages.

WEAKNESSES

● There is an absence of a conceptual

diagram that interconnects Henderson’s
theory’s 14 concepts and subconcepts. On
assisting the individual in the dying process,
there is little explanation of what the nurse
does to provide “peaceful death.”

APPLICATION OF THE NEED THEORY

● Henderson’s Needs Theory can be applied

to nursing practice as a way for nurses to
set goals based on Henderson’s 14
components. Meeting the goal of achieving
the 14 needs of the client can be a great
basis to further improve one’s performance
towards nursing care. In nursing research,
each of her 14 fundamental concepts can
serve as a basis for research, although the
statements were not written in testable
terms.