The 21

Nursing
Problems

SHAFIQ UR RAHMAN
SANA SALEEM
TAYYAB
UZMA KHAN.

Faye Glenn
Abdellah
 Biography
Born on March 13,1919 in New York City.

She graduated Magna Cum Laude from Fitkin Memorial

Hospital School of Nursing in Neptune, New Jersey in
1942 (now Ann May School of Nursing).

She obtained her Bachelor of Science in 1945, her

Master of Arts in 1947, her Doctor of Education in 1955
from the Teachers Colleges at Columbia.

She was appointed Chief Nurse Officer of the U.S Public

Health Service (USPHS) in 1970 and serve that position in
17 years.
Firstwoman to serve as Deputy Surgeon General of
the United States.

She was inducted into the US National Women’s Hall

of Fame in 2000 due to her contributions in the field
of Education and Nursing Research

Shehas been a staff nurse, a head nurse, a faculty

member at Yale University and Columbia University
A public health nurse, and an author of more than
150 articles and books.

She has been a research consultant to the World

Health Organization.

She is a recipient of more than 79 academic

honors and professional awards in her excellence in
Nursing.

She developed a list of 21 unique nursing

problems related to human needs.
 In 1960, influenced by the desire to
promote client-centred comprehensive
nursing care she
Described nursing as a service to
individuals, to families, and, therefore, to
society.
 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
 The language of Abdellah’s 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:
 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
 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 his behavior

 8. Explore the patient’s and family’s reaction to the

therapeutic plan and involve them in the plan

 9.Identify how the nurses feels about the patient’s

nursing problems

 10. Discuss and develop a comprehensive nursing

care plan
 1. Observation of health status
 2. Skills of communication
 3.Applicationof 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
 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

 1. To maintain good hygiene and physical comfort –
After colonoscopy, patients are usually soiled from the
procedure. It is therefore important to clean them
properly. Physical comfort through proper positioning
in bed.
 2. To promote optimal activity: exercise, rest, and
sleep – Patients who were sedated during the
procedure stay in the unit until the effect of the
sedation has decreased to a safe level. As a nurse,
make sure the patients are able to rest and sleep well
by providing a conducive environment for rest, such as
decreasing environmental noise and dimming the light
if necessary.
 3. To promote safety through prevention of accident,
injury, or other trauma and through the prevention of
the spread of infection
Making sure the side rails are always up when leaving
the patient . one way we prevent the spread of infection
is through proper disinfection of the equipments .
 4. To maintain good body mechanics and prevent
and correct deformity –
Positioning the patient properly, allowing for the normal anatomical
position of body parts.
 5. facilitate the maintenance of a supply of oxygen to all body cells –
when patients manifest breathing problems, oxygen is attached to
them, usually via nasal cannula. Sedated patients are attached to
cardiac monitor and pulse oxi meter while having the oxygen
delivered. When the oxygen saturation falls below the normal levels,
the rate of oxygen is increased accordingly, as per physician's order.
 6. To facilitate the maintenance of nutrition of all body cells –
patients undergoing endoscopic procedures are on NPO. For this
reason it is important to monitor the blood glucose level. When the
patient's blood glucose falls from the normal value, we inject D50W
to the patient or we change the patient's IVF to a dextrose containing
fluid.
 7. To facilitate the maintenance of elimination –
Providing bedpans or urinals to patients and at
times, insertion of Foley catheter when the patient is
not able to void.
 8. To facilitate the maintenance of fluid and
electrolyte balance – Proper regulation of the
intravenous solutions as well as proper
incorporations it may have. An example is when
patients have low serum potassium; KCl is
incorporated in the solution.
 9. To recognize the physiological responses of the
body to disease conditions—pathological,
physiological, and compensatory – it is important to
check the patients for signs of internal
gastrointestinal bleeding by monitoring the blood
pressure and cardiac rate.
 10.To facilitate the maintenance of regulatory
mechanisms and functions – When a patient has a
difficulty in breathing and is showing an increase
respiratory rate, elevating the head part of the bed is
done to facilitate the respiratory function.
 11. To facilitate the maintenance of sensory function –
Sometimes there are semi-conscious patients, in these
cases, it is still necessary to talk to them while
performing nursing interventions to maintain their
auditory sense.
 12. To identify and accept positive and negative
expressions, feelings, and reactions – most patients
feel anxious before undergoing the procedures. It is
necessary to listen to the patients' expressions and
allow them to ask questions. To decrease their anxiety,
proper instructions are given, what they are to expect,
how long the procedure will take, what they should do
during and after the procedure as well as other
concerns
 13. To identify and accept interrelatedness of emotions
and organic illness – Encourage patients to verbalize
their feelings and allow them to cry when they have the
need to do so will help them emotionally. Some
patients are diagnosed with malignancy after the
procedure and during this time the emotional needs of
the patient is a priority.
 14. To facilitate the maintenance of effective verbal and
nonverbal communication – when patients are not able
to express themselves verbally, it is important to
assess for nonverbal cues. For instance when patients
are in pain, assessing for facial grimacing.
 15. To promote the development of productive
interpersonal relationships – allow the patient's
significant others to stay with the patient before and
after the procedure. This allows for bonding and
promotes interpersonal relationship.
 16. To facilitate progress toward achievement of
personal spiritual goals – nurse usually visits the
patients in the unit. Patients may benefit from this,
allowing them time to practice their faith.
 17. To create and/or maintain a therapeutic
environment providing proper lighting, proper room
temperature, a quiet environment are done to patients
staying in the unit.
 18. To facilitate awareness of self as an individual with
varying physical, emotional, and developmental needs
– care to patients vary according to their developmental
needs. Allowing the parents to stay during the
procedure help the pediatric patients in their emotional
and developmental needs.
 19. To accept the optimum possible goals in the
light of limitations, physical, and emotional – The
goals for each patient vary depending on the
capability of the patient. The nutritional goal for a
patient with a PEG tube for instance will be
different, knowing that the patient has limited
feeding options.
 20. To use community resources as an aid in
resolving problems arising from illness – Some
patients live far from the city and thus referral to
health centers is sometimes done.
 21. To understand the role of social problems as
influencing factors in the cause of illness – Some
patients who are diagnosed with amoebic colitis for
instance are advised to avoid buying street foods
to which the preparation they are not sure of, and
also avoid drinking water that are not safe
 BASIC TO ALL PATIENTS,
 SUSTENAL CARE NEEDS,
 REMEDIAL CARE NEEDS, AND
 RESTORATIVE CARE NEEDS.
 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
 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

 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
 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 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.
  SOCIETY/ENVIRONMENT

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

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

Nursing is a helping profession. In Abdellah’s 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.
  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.

 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.

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.
IMPLEMENTATION EVALUATION

 Using the goals as the The most appropriate

framework, a plan is evaluation would be
developed and the nurse progress or
appropriate nursing lack of progress
toward the achievement
interventions are
of the stated goals.
determined.

  SUMMARY

 Using Abdellah’s 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, 21 nursing problems

were developed .
  CONCLUSIONS

Abdellah’s 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 nurse’s philosophical frame of reference


would determine whether this theory and the 21
nursing problems could be implemented in
practice.
• Abdellah, F.G. The federal role in nursing education. Nursing
outlook. 1987, 35(5),224-225.
• Abdellah, F.G. Public policy impacting on nursing care of older
adults .In E.M. Baines (Ed.), perspectives on gerontological
nursing. Newbury, CA: Sage publications. 1991.
• Abdellah, F.G., & Levine, E. Preparing nursing research for the
21st century. New York: Springer. 1994.
• Abdellah, F.G., Beland, I.L., Martin, A., & Matheney, R.V. Patient-
centered approaches to nursing (2nd ed.). New York: Mac Millan.
1968.
• Abdellah, F.G. Evolution of nursing as a profession: perspective
on manpower development. International Nursing Review, 1972);
19, 3..
• Abdellah, F.G.). The nature of nursing science. In L.H. Nicholl
(Ed.), perspectives on nursing theory. Boston: Little, Brown, 1986