Typology of 21 Nursing problems – Application to Nursing Practice
There are a variety of nursing problems that can occur during the provision of nursing care. While all nurses should be aware of these potential problems, it is also important to know the individual characteristics and prevalence of each problem. By understanding the typology of nursing problems, nurses can better manage their patients and provide more effective care.
Faye Glenn Abdellah developed the typology of 21 nursing problems theory with a focus on the needs of patients and the roles of nurses in identifying problems using an analysis of the problem approach. Her theory focused on four major concepts; Nursing – A profession that helps people, where nursing care is given with desired goals to meet all needs of individuals. Person – Different individuals with emotional, physical, and sociological needs with patients justifying nursing existence. Health achievement is defined as the reason for nursing care with families or individuals as nursing recipients. Health – Having healthy states of mind and body without being necessarily ill in the nursing comprehensive service. Society and Environment – Nursing is focused on individuals and inclusion of planning the achievement of optimal care at different levels with the environment being where someone comes from.
The theory interrelates health concepts to nursing problems and solving the problems. She did not believe in using experiments but in analyzing, rationalizing, and logical arguments. She observed studies that had been done before to create a base for conceptualization. The theory considers the current practice of nursing and patients, therefore, empowering nurses to be responsible for all nursing actions. The 21 nursing problems approach helps nurses in the assessment of patients, diagnosing various conditions, and creating a nursing care plan with interventions. Faye aimed to improve nursing education as she believed it would impact nursing practice positively. She also believed in patient-centered care that is basing nursing problems on the needs of individuals and initializing nursing goals and treatments as determinants of nursing care. Patient-centered care emphasizes the need for each nursing goal to be aimed to take care of the patient wholly without focusing only on the disease.
In her theory, she created a framework for the identification of relations between different nursing interventions. It also gave a clearly defined structure to nursing as a curriculum. She described the nursing service users as individuals (and families), health as providing total health needs to patients and achieving a healthy state of mind and body. According to Abdellah, “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.” The theory has three components; sociological, emotional, and physical needs of the patients. A list of 10 steps used for identifying nursing problems and 11 nursing skills nurses need to identify problems was also composed.
The ten steps to identify the patient’s problems are:
- Learn to know the patient
- Sort out relevant and significant data
- Make generalizations about available data with 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 time to identify any attitudes and clues affecting his behavior
- Explore the patient’s and family’s reaction 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
Faye Abdellah’s theory of nursing has 11 essential skills. They 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 use of the self
- Nursing procedure
Major assumptions in the theory were that Faye referred to nurses as she and he to doctors and patients. she also referred to service users as patients and not clients or consumers. She introduced nursing diagnosis at a time nurses were not taught about it. The assumptions were related to; Changes that affected nursing and anticipations, the impact of social problems on the delivery of healthcare, the need to appreciate relations between problems and enterprises, changes in nursing education, education continuity for nursing professionals, and the development of nursing leaders from minority groups.
The 21 nursing problems are categorized according to patient needs that is; basic needs of all patients, sustenal care needs, remedial care needs, and restorative care needs. Basic needs to all patients are; to maintain good hygiene and physical comfort; promote optimal activity, including exercise, rest and sleep; promote safety through the prevention of accidents, injury or other trauma and through the prevention of the spread of infection; and maintain good body mechanics and prevent or correct deformity. Sustenal care needs are; to 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. Remedial care needs are; to 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. 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 resolve problems that arise from illness; and the understanding of the role of social problems as influential factors in the case of illness.
How the theory is applied in the nursing process
The typology of 21 nursing problems can be applied to the nursing process in the following ways. On assessment, the problems in nursing will act as a guide to collecting data. On diagnosis, data collected will identify the cause of each problem and help the nurse create a relevant diagnosis using direct or indirect approaches. In planning, nursing problem statements align with goal statements. Nursing goals are established after determining the problems. In interventions, The established goals create a base to plan for nursing interventions. On evaluation, achieving or not achieving the desired outcomes will come into place. The nursing problems theory helps nurses determine and organize care and strategies in nursing.
Conclusion
As nurses, we need to use our skills, competencies, and attitude to provide all needs to sick individuals and work toward achieving a healthy state of body and mind. Meeting the basic needs of patients will influence quick recovery and optimum healthcare provision. Faye’s main focus was continuity of nursing education which in turn would improve nursing practice. Nurses need to consider using the nursing process approach to solve patient problems. The 21 nursing problems help nurses come up with an organized nursing care plan where a problem is identified, a hypothesis formulated through data collection, and revised based on data conclusions. Assisting patients in achieving good health helps nurses motivation and improvement in their practice.
References
Nursing theories: The base of professional nursing practice 3rd edition. George Julia B. Norwalk, CN: Appleton and Lange; 1990.
The federal role in nursing education. Nursing outlook. Abdellah, F.G. 1987, 35(5),224-225.
Duffy, T., Donnell, A., & Snowden, A. (2014). Faye Glenn Abdellah. In pioneering theories in nursing (p. Chapter 4). Quay Books Division.
Patient-centered approaches to nursing (2nd ed.). Abdellah, F.G., Beland, I.L., Martin, A., & Matheney, R.V. New York: Mac Millan. 1968.
Evolution of nursing as a profession: perspective on manpower development. Abdellah, F.G. International Nursing Review, 1972); 19, 3..
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