This paper attempts to analyze and evaluate a relevant nursing conceptual model authored by a renowned nurse theorist— Faye Glenn Abdellah in light of a framework of analysis and evaluation of conceptual nursing theories and models. In addition this paper provides the insights and a critical evaluation of the author with respect to the main components of the theory. Another portion of this paper is an application of the said theory in a nurse-patient situation and how this ideology was able to influence the plan of action and the delivery of care to the patient. A brief analysis is also presented to determine whether the presented nursing theory is still applicable to modern nursing practice.
Dr. Faye Glenn Abdellah formulated her structural model with the goal of teaching and evaluating students and at the same time emphasizing the need to create a body of knowledge (Sigma Theta Tau International Honor Society of Nursing, 1998). It is the belief of this writer that this body of knowledge was made exclusively for the nursing profession with the objective to achieve independence from the control of the medical profession toward patient-centered care and diagnosis. In addition, the typology had major impact on the nursing profession as well as on the development of other nursing theories, even when Dr. Abdellah drafted the typology of 21 nursing problems in the 1960s, within the edition of Patient-Centered Approaches to Nursing (Sigma Theta Tau International Honor Society of Nursing, 1998).
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.
In analyzing and evaluating Dr. Abdellah’s theory, her work cannot be separated from the historical background where the conceptualization of the 21 nursing problems started. It was in the 1950s when the nursing profession faced a considerable amount of difficulties coming from speedy societal change and increasing demand for technological advancement. The methods and system used at that time did not hold up and meet the demands of the rapid change thus creating a backlog in the nursing community. There was a lack of definition of nursing— its focus, scope and limitations especially that healthcare delivery to patients is mainly based on achieving institutional goals rather than meeting patient’s needs. The present system did not assist both the students and professionals in being attuned with the changes. Dr. Abdellah related this to the lack of scientific body of knowledge unique to the profession. That is why the formulation of the theory differentiated the practice of nursing from the practice of medicine emphasizing focus on 21 nursing problems that help patient in achieving state of wellness (Marriner-Tomey, 1994).
Dr. Abdellah used the problem-solving approach in formulating the theory. It is this writer’s belief that Dr. Abdellah’s a nurse should be able to identify and solve problems of patients in order to make available safe and quality care to patients. This identification of nursing problems, analysis and effectual interventions in assisting patient towards state of wellness is clearly similar to the nursing process. Dr. Abdellah explained that patients cannot get quality care if it is done improperly. It is my belief that Abdellah’s approach is effective in the sense that the approach guarantees positive client response if the steps are specifically and carefully executed. This approach also improves a nursing professional skills and attitude by enhancing problem-solving abilities through identification of nursing problems in meeting the needs of the patient (Marriner-Tomey, 1994).
Dr. Abdellah’s model incorporates four (4) fundamental concepts that is essential to nursing which is the person, environment, health and nursing (Marriner-Tomey, 1994). The first major concept is the person. The concept of person is described as people having physical, physiological and sociological needs. In her conceptual model, the person or patient is the main reason for the existence of nursing. On the other hand, this is quite contradicting since the typology of 21 nursing problems lacks holism. The model entails that an individual returns to an improved state only by resolving each problem recognized by a nursing professional. Take for instance a person in medical attention and in healing. It is only by individually tackling his/her problems that there is a high probability that the person would be cured of his/her ailments. That is why it is important to create a sturdy sense of communication and caring between the nurse and the patient as exerted by other nursing theories such as Dr. Jean Watson’s theory on caring. But as compared to other ideologies, one of its shortfalls may be because it lacks holism in the sense that the patient or person which, is considered as a whole is not greater than the sum of it parts represented by his problems.
The second major concept is the relationship of the environment. This concept is the least emphasized in her theory. This is mentioned limitedly in problem number 17. The model explains that the patient more often than not is interconnected and responds to his/her environment. It also explains that the nurse is also a part of the patient’s environment thus the nurse takes responsibility in making the environment conducive for restoration of health. It is also pointed out that the environment is not limited only to the hospital setting but can be the community or the home the patient came from (Potter & Perry, 1993). Take for instance a patient’s well-being if he/she were to be housed in a un-sanitized and unsuitable medical facility. It would be a matter of time that if his/her illness would not get the better of him, the foul and inhospitable medical facility will. It has been shown that the environment on which patients are located clearly affect the patients well-being. And it is with this that nurses should give the utmost attention to this factor in order to affect the patient’s health and well-being.
The third fundamental appended to the 21 nursing problems is health. Dr. Abdellah discussed health as a state without illness. For instance a person as how he/she is without any identifiable or unidentifiable disease as compared to his/her state if he/she were to be in sickness. It is defined as a state without unmet needs and no anticipated or actual impairment. This can be crucial as being able to determine a patient’s status when he/she is not sick can be made into his/her standard or benchmark. Given that a person has already medical history of no illnesses, this can be used in order to determine what would be the cause of his/her disease if he/she was to be stricken with disease. This is clearly exemplified in the list of 21 nursing problems. Dr. Abdellah also exerts for a holistic approach to patient-centered care and furthering the relevance of environmental factors in the concept of health (Potter & Perry, 1993).
The last major concept is nursing. The concept of nursing is an essential element of her writing. In her model, nursing is defined as provision of service to individuals and families; and in a larger perspective, to society. It is mainly providing service to or for the patient or providing information that will significantly assist the patient in restoring health and alleviating impairment. Dr. Abdellah therefore viewed nursing as a helping and assisting profession (Sigma Theta Tau International Honor Society of Nursing, 1998). This can never be more stressed in the medical profession. For without such a critical pillar, medical institutions would be merely overwhelmed and would not function effectively. Although it may seem that in certain institutions nurses are considered secondary, there is a “revolution” of thought, a paradigm shift wherein nurses are considered more and more as partners because of ideologies such as these. They have the capacity to provide not only medical assistance but also general medical diagnosis and initial (that can also be considered critical in some cases) treatment.
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Although Dr. Abdellah’s work provided a comprehensive meaning of the four major concepts, there are no statements in Dr. Abdellah’s writing that states any direct relationships among the four concepts. The model is mainly concerned on development of a unique body of knowledge, which is nursing, through which identification of nursing problems and utilization of the problem-solving approach assists patients in meeting their needs. The model is said to have limited concepts and is only presented in a structural list. After Dr. Abdellah’s work has been published, her formulation of the 21 nursing problems has been a helpful tool in the areas of nursing practice, nursing research and nursing education (Sigma Theta Tau International Honor Society of Nursing, 1998).
In our nursing practice, Dr. Abdellah’s typology of 21 nursing problems has helped nursing professionals in dealing with patient care in an orderly and well-structured manner. In using this typology, a nursing professional, with the problem-solving approach, is able to make out patient’s problems, plan for his care and implement nursing interventions for the identified problem in a scientific manner. This problem-solving method has transformed our practice as we attempt to focus our attention to the client himself rather than focus on client’s medical condition which is more of the objective of the medical profession. Nursing professionals have also learned and understood the rationale behind each and every action we deliver to the client (Sigma Theta Tau International Honor Society of Nursing, 1998).
Dr. Abdellah’s work has also provided significant advances in the arena of ever advancing nursing research as well since her work is basically based on research too. The current nursing diagnosis classification system is presumed to be an consequence of this typology. This nursing philosophy continues to be a preferred basis of nursing studies at present (Sigma Theta Tau International Honor Society of Nursing, 1998). In addition, nursing education is also advancing and has greatly benefited from Dr. Abdellah’s work. Gaining professional autonomy has helped the nursing community project a professional identity that has been widely accepted all over the world (Potter & Perry, 1993).
In conclusion, Dr. Abdellah’s typology of 21 nursing problems remedied the predicaments faced by the profession in earlier times. It has helped teach and evaluate student’s competency through its formulation. It provided a means of gaining autonomy from the practice of medicine through the creation of a scientific body of knowledge unique to nursing.
It is the belief of this writer that Dr. Abdellah’s work is very straightforward and uncomplicated which can be used fundamentally across varying fields of the nursing profession. It explicitly describes the major concepts essential to nursing such as nursing itself, nursing problems and the problem-solving approach through which the problems can be intervened. The concepts of health, person and environment which are now included in the scope of nursing are also implied and considered in accordance to current nursing practices and ideologies. The goals of this model vary but all are directed to affect nursing. The extensive goal of this model is to generally elicit positive transformation in nursing education while its subgoals would include providing a scientific basis for practice and a tool in evaluating student’s capacity and competency (McLemore & Hill, 1965).
Currently, Dr. Abellah not only meet the initial goals of her work but has also affected different aspects of nursing such as nursing practice, nursing research and nursing education in general. As emphasized in this paper, Dr. Abdellah’s overall contribution to the body of nursing is the acquisition of professional autonomy and professional identity through the creation of the 21 nursing problems. Her problem-solving approach increases our assessment and critical-thinking skills needed in identifying client’s concerns to properly plan, select and implement our healthcare. It also encourages nurse-patient interaction as we make patients the central focus of care instead (Parascandola, 1994).
With regards to applying Dr. Abdellah’s nursing philosophy in current nursing practices, it is shown that utilizing the 21 nursing practices may spawn relevant nursing activities that meet not only client’s needs but of the society as well in the long run. Just as long as each goal is carefully achieved through the problem-solving approach making asserted by Dr. Abdellah in this nursing socio-philosophy. Dr. Abdellah’s work is socially significant because the 21 nursing problems elicit relevant nursing actions that lead to the improvement and restoration of client’s health status which in turn aids the client in resuming activities of daily living increasing his productivity level thus benefiting the society (Potter & Perry, 1993). Through Dr. Abdellah’s work and the development of other relevant nursing theories, we have proven that our profession can stand by itself and achieve our goals towards patient-centered care (Parascandola, 1994).
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