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Description
Faye Glenn Abdellah (Arabic: عبد الله, romanized: ʻAbd Allāh – “Servant of God”) was born in 1913 in New York to an Algerian father and a Scottish mother. She was a pioneer in nursing research and referred to the theory created by her and her colleagues as a framework for nursing practice (Abdellah et al., 1960).
When she was 18 years old, she witnessed an explosion of a hydrogen-filled airship, Hindenburg. After watching scorched people exiting the burning dirigible, she decided to become a nurse to be always able to help others (Lessing, 2004). After getting her nursing diploma, she became a staff nurse and then a head nurse, but she decided to change to education and public health. She received a bachelor’s in science in nursing from Columbia University and secured her first teaching position at Yale University. At this position, she complained to the dean of nursing that the nursing books were outdated and inadequate and she requested to switch to a modern and appropriate text, but her idea was rejected. Then, she gathered all the books and burned them in the courtyard of Yale University. The next day, she was told that her contract would not be renewed and she was responsible for reimbursement of the incinerated books (Lessing, 2004). This rebellion started her career as an educator and researcher – she received a Master of Art in psychology in 1947 and a Doctor of Education in 1955. However, her research was limited because of the perception of the role of nurses in science, which could be explained by the response she received from a nursing journal after a research report submission:
“Nurses do not research; they are not interested in research and that furthermore research has no place in nursing.” (Abdellah, 1969, p.390).
She tried to change the perception and move nursing from a service occupation to a research-based profession. In the first step, she conducted a survey among 40 nursing schools to identify all problems or barriers that needed to be changed to advance nursing to a profession (Johnson and Webber, 2005). In the second step, she used the survey and Handerson’s 14 basic human needs to develop her theory – 21 Nursing Problems. This grand theory uses a typological order of 21 nursing problems that address four patients’ needs: basic, sustenal (supportive), remedial, and restorative. The problems are as follows:
To maintain good hygiene and physical comfort.
To promote optimal activity: exercise, rest, sleep
To promote safety by preventing accidents, injuries, or other trauma and preventing the spread of infection.
To maintain good body mechanics and prevent and correct the deformity.
To facilitate the maintenance of a supply of oxygen to all body cells.
To facilitate the maintenance of nutrition for all body cells.
To facilitate the maintenance of elimination.
To facilitate the maintenance of fluid and electrolyte balance.
To recognize the physiologic responses of the body to disease conditions—pathologic, physiologic, and compensatory.
To facilitate the maintenance of regulatory mechanisms and functions.
To facilitate the maintenance of sensory function.
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 nonverbal communication.
To promote the development of productive interpersonal relationships.
To facilitate progress toward achievement and personal spiritual goals.
To create or maintain a therapeutic environment.
To facilitate awareness of self as an individual with varying physical, emotional, and developmental 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 that arise from an illness.
To understand the role of social problems as influencing factors in the cause of illness.
She also developed a problem-solving method that identified 10 steps to recognize a patient’s problem and 10 nursing skills useful in developing treatment typology. These steps were also useful in distinguishing between nursing diagnosis and nursing function; she defined nursing diagnosis as “a determination of the nature and extent of the nursing problem presented by individual patients or family receiving nursing care” (Abdellah & Levine, 1965, p. 28) while nursing functions were the activities that contributed to the solution of the problem (Abdellah & Levine, 1965).
Analysis
In 1973, Abdellah identified six assumptions in her work that are related to the change or anticipated change that affects 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 far on health care and health care delivery; changing nursing education; continuing education for professional nurses; and development of nursing leaders from underserved groups (Abdellah t al., 1973).
The language in Abdellah’s theory is clear and easily understood. The theory uses the problem-solving method that enables nurses to assist the patient in achieving a healthier state. However, the use of her pronounces reflects a bias – she uses she/her when referring to nurses and he/him when referring to doctors (Abdellah et al., 1960).
Evaluation
The 21 Nursing Problems theory was developed over sixty years ago, but many healthcare settings still use the model to address patient’s needs (McEwen & Wills, 2023). In the beginning, the model contributed to nursing science by increasing nurses’ education levels. It helped bring typology to nursing and research that replaced a disorganized collection of lectures and experiences (McEwen & Wills, 2023). The theory also clarified the nursing discipline and differentiated it from other professions. She moved the nursing attention from a disease-centered approach to a patient-centered approach. However, she anticipated that the nursing scope of practice would increase with the introduction of nurse practitioners, and it would need to be further developed:
“These responsibilities overlap with those of the physician. In addition, the role of the professional nurse is also expanding to include broader functions in the realm of nursing practice based on biological, sociological, and psychological aspects of nursing.” (Abdellah, 1976, p. 245).
Development.
Abdellah’s model is a conceptual model that is not directly testable because there are no, or at least very few, direct relationships. However, Abdellah and Levine (1965) mentioned a tool that measures patient’s satisfaction, so indirectly, it is possible to assess if her theory is working and we can use the QUALPAC (Quality Patient Care Scale) assessment tool developed in 1974, after the 21 Nursing Problems.
Her theory is useful in all nursing settings, from novices to advanced practitioners. However, Abdellah understood that change is very important and that nursing research will guide the nursing profession, so most likely, she anticipated that her theory would be adjusted as needed and one day replaced with another, more current theory. More importantly, her theory is the direction she pushed nursing toward – practice within a context of evidence and scientific premise.
References:
Abdellah, F. G. (1969). The nature of nursing science. Nursing Research, 18(5), 390–393.
Abdellah, F. G. (1976). Nurse Practitioners and Nursing Practice. American Journal of Public Health, 66(3), 245. https://doi.org/10.2105/AJPH.66.3.245
Abdellah, F. G. & Levine, E. (1965). Better patient car through nursing research. McMillan Publishing. New York.
Abdellah, F. G., Beland, I. L., Martin, A., & Matheney, R. V. (1960). Patient-centered approaches to nursing. MacMillan.
Abdellah, F. G., Beland, I. L., Martin, A., & Matheney, R. V. (1973). New directions in patient-centered nursing. MacMillan.
Johnson, B. M., & Webber, P. B. (2005). An introduction to theory and reasoning in nursing. Lippincott, Williams, & Wilkins. Philadelphia.
Lessing, M. (2004). Interview with Rear Admiral Faye Glenn Abdellah. Military Medicine, 169(11), 843.
McEwen, M., & Wills, E. (2023). Theoretical basis for nursing (6th ed.). Philadelphia, PA: Wolters Kluwer Health.
