In Focus: Faye Glenn Abdellah’s Patient-Centered Approaches

For years, the existence and acceptance of nursing theories in different settings and aspects of nursing practice has transformed the profession in diverse ways both here and abroad. The utilization of such theories has provided the nursing community with specific knowledge and ways to enhance and develop skills and attitudes of nursing professionals in the practice of the profession. It has greatly helped in creating and sustaining our professional independence from the field of medicine by guiding our educational system, research methods and practice towards safe and quality care to patients (Marriner-Tomey, 1994; McLemore & Hill, 1965).The significance of studying nursing theories does not end with the benefits it may serve the profession in general. It also helps an individual, either a student or a nursing professional in several ways. An individual is able to develop critical thinking skills, able to differentiate values and hypotheses and able to find out purpose of functions in relation to the scope of practice of the nursing profession (Kozier, Erb, & Oliviere, 1995).In line with this, this paper attempts to analyze and evaluate a relevant nursing conceptual model authored by a renowned nurse theorist— Faye Glenn Abdellah, using the J. Fawcett’s Framework of Analysis and Evaluation of Conceptual Models of Nursing.Influenced by Virginia Henderson’s 14 principles of nursing, Maslow’s hierarchy of needs and Erik Erickson stages of development, Abdellah formulated her structural model with the goal of teaching and evaluating students and at the same time emphasize the need to create a body of knowledge exclusive to our profession that will help in gaining independence from the control of the medical profession  toward  patient-centered  care (Sigma Theta Tau International Honor Society of Nursing, 1998).Faye Glenn Abdellah authored the typology of 21 nursing problems which was initially published in the 1960 edition of Pat ient-Centered Approaches to Nursing. Since its initial appearance, the typology had major impact on the nursing profession as well as on the development of other nursing theories (Sigma Theta Tau International Honor Society of Nursing, 1998).Abdellah’s typology of 21 nursing problems is a conceptual model which describes the significant concerns of nursing instead of linking different relationships into phenomena. The conceptual model is mainly concerned with patient’s needs and the role of nurses in problem identification using a problem-solving 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. Logically speaking,Abdellah’s model can be described as inductive since she derived observations from previous studies which became the basis for her conceptualization. Philosophical statements are said to be based on opinions, arguments or propositions of different people. 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).In  analyzing  and  evaluating  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  lot  of  difficulties  arising  from  the  rapid   societal change and increasing demand for technological advancement. The methods and system used at that time  did not support 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. 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).Abdellah used the problem-solving approach in formulating the theory. She believes that a nurse should be able to identify and solve problems of patients in order to provide safe and quality care to patients. This identification of nursing problems, selection of data necessary to formulating and testing of interventions in assisting patient towards state of wellness closely resembles the nursing process. Abdellah pointed out that patients cannot receive quality care if the steps are done improperly. In my opinion, 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).Abdellah’s model includes four (4) fundamental concepts essential to nursing— person, environment, health and nursing. 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. However, this is quite contradicting since the typology of 21 nursing problems lacks holism. The model entails that a person returns to an improved state only by resolving each problem identified by a nursin g professional. 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 (Marriner-Tomey, 1994).Another major concept included in her theory is the concept of environment. This concept is the least conferred  and least emphasized in her theory. This is mentioned limitedly in problem number 17. The model explains that the patient more often than not interrelate and act in response to the 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. Abdellah also states that environment is also the home and community from where the patient comes from that is why Abdellah emphasized the need to broaden our scope in identifying problems and not limit our scope in the hospital setting (Potter & Perry, 1993).The third concept is health. Abdellah discussed hea lth as a state without illness. It is defined as a state without unmet needs and no anticipated or actual impairment. This is clearly exemplified in the list of 21 nursing problems. Abdellah also advocates 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; therefore 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. Abdellah therefore viewed nursing as a helping profession (Sigma Theta Tau International Honor Society of Nursing, 1998)..Although Abdellah’s work provided a comprehensive meaning of the four major concepts, there are no statements in Abdellah’s writing tha t states any direct relationships among the four concepts. Each concept was only defined implicitly and no relational statements can be made out of it. 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 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, 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 id entify 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).Abdellah’s work has also provided significant changes in the area of nursing research as well since her work is basically based on research too. Many theories have been developed since the introduction of Abdellah’s work. The present nursing diagnosis classification system is presumed to be an outgrowth of this typology. This nursing philosophy continues to be a preferred basis of nursing studies at present (Sigma Theta Tau In ternational Honor Society of Nursing, 1998).Nursing education also benefited from Abdellah’s work. As previously explained, there was a lack of scientific body unique to our profession that hindered our independence from the medical profession. Abdellah’s work presented such unique body and gave the nursing profession a chance to come out of the control of the medical model. Gaining professional autonomy has helped the nursing community project a professional identity that has been widely accepted all over the world   (Potter & Perry, 1993).Abdellah’s nursing philosophy brings about nursing activities that meet not only client’s needs but of the society as well in the long run if each goal is carefully achieved through the problem-solving approach making this nursing philosophy socially significant. 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).In conclusion, 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.Abdellah’s work is very straightforward and uncomplicated. It explicitly described 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.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).To date, Abellah did not only meet the goal of her work. Her work has also affected different aspects of nursing— nursing practice, nursing research and nursing education in general. As emphasized in this paper, 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 enhances and promotes nurse-patient interaction as we make patients the central focus of care instead of focusing on the disease process (Parascandola, 1994).Nursing has been practiced as profession for more than a century. The profession was based merely on rules, concepts and experiences passed on by professionals to students. It was only in the advent of serious discussion and testing of theories that nursing has been established as a science. Through 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).