Discussion: Nursing Theoretical Foundations
Discussion: Nursing Theoretical Foundations
Discussion: Nursing Theoretical Foundations
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There are many grand nursing theories that have helped to set the foundation for the nursing profession. Faye Abdellah was one of the first pioneers for shaping nursing as a profession using her framework for Patient-Centered Approaches to Nursing. Abdellah’s theory is easy to apply to nursing practice in a healthcare institution because her framework is readable and clear (McEwen & Wills, 2014). In addition, another rationale for implementing her theory into practice at a healthcare institution is the fact that it clearly addresses the four metaparadigms—person, environment, health, and nursing. In this paper, we will discuss the theorist Faye Abdellah, her theory on Patient-Centered Approaches to Nursing, and how this theory can be integrated into practice at a healthcare institution.
Description of Theorist
Faye Abdellah was born in New York City on March 13, 1919. Abdellah decided at a very young age she wanted to pursue a career in nursing. She received her original certification in nursing from Fitkin Memorial Hospital. She continued her study of nursing at Columbia University getting her BA in Nursing along with her doctorate degree, which focused on psychology and education (Dewey, 2016).
Abdellah was highly influential in the profession of nursing. She was the Chief Nursing Officer and Deputy United States Surgeon General until 1993, and she was ranked as a Rear Admiral. She retired in 2000 from her last position as Dean of the Graduate School of Nursing at the Uniform Services University of Health Sciences (McEwen & Wills, 2014). As a whole, throughout her career Abdellah received many academic honors for her achievements in nursing. Her main focus was to reshape nursing as a profession by encouraging nurses to look past a physical illness or diagnosis and see “patients as people with a complex of emotional and psychological needs” (Dewey, 2016, n.p.). Clearly, this concept of looking at patients as more complex beings significantly helped to influence and shape her Patient-Centered Approaches to Nursing.
Category of Theory
Abdellah’s Patient Centered Approaches to Nursing is considered a grand nursing theory that is based on human needs. She believed that patients should be seen as ‘people’ who have individual unique needs that require personalized care from nurses. Furthermore, Abdellah developed her theory based on how she practiced while providing care to patients—which is what helps to make the theory highly applicable. McEwen & Wills (2014) further explain that Abdellah’s theory is applicable not only in the hospital setting, but also in the community setting.
Assumptions Underlying the Theory
Abdellah’s original theory did not have any stated assumptions; however, as time passed she did add the following six assumptions related to: 1) change and anticipated changes that impact the nursing profession, 2) the importance of how social enterprises and social problems are related, 3) how poverty, racism, pollution, education, etc. impact health and health care delivery, 4) changes in nursing education, 5) continuing education for nurses, and 6) development of nursing leaders (McEwen & Wills, 2014).
In addition, it is important to clearly define the metaparadigm concepts/assumptions underlying the theory as well. Abdellah’s Patient-Centered Approaches to Nursing is all encompassing, and the metaparadigms addressed in the theory are related to person, environment, health, and nursing.
Person
Person is defined as the patient needing care. McEwen & Wills (2014) explain that Abdellah’s theory views the patient as the “individual who needs nursing care and who is dependent on the health care provider” (p. 141). When using Patient-Centered Approaches to Nursing, it is important to know that Abdellah emphasized the significance of individualized care and knowing the person’s needs.
Environment
When using Abdellah’s theory, it is important to know that the environment from the patient’s standpoint is interconnected to include not only the physical environment, but also external factors that impact the patient such as social problems, poverty, racism, etc. These are all factors within the environment that affect the health of patients and how they approach health care delivery (McEwen & Wills, 2014).
Health
Health can be viewed as a better state of being. The purpose of Abdellah’s theory is to identify problems that are negatively impacting patients and eliminating these problems. Later we will discuss Abdellah’s 21 Nursing Problems and nursing’s responsibility to identify these problems.
Nursing
Nursing is considered “a service to individuals and families to society, which helps people cope with their health needs” (McEwen & Wills, 2014, p. 141). Nursing is expected to identify nursing problems and work collaboratively with the healthcare team to ensure that patients get desired outcomes.
Major Concepts of the Theory
The major concepts related to Abdellah’s theory involve using ten steps to identify and develop treatment to nursing problems related to patients. Abdellah explains that there are 21 basic nursing problems related to patients, and it is important for nurses to know these identified nursing problems so they can use them while trying to identify what needs to be the plan of care. Below is an abbreviated version of Abdellah’s 21 Nursing Problems.
Abdellah’s 21 Nursing Problems
| Maintenance of Hygiene and Comfort | Recognition of physiological responses to conditions | Maintenance of Nutrition for Body Cells |
| Promotion of activity, exercise, rest, etc. | Maintenance of normal body functions | Achievement of spiritual goals |
| Promotion of Safety | Appropriate sensory function | Maintenance of Therapeutic Environment |
| Maintenance of Proper Body Mechanics | Identification and acceptance of positive and negative expressed and reacting appropriately | Awareness of physical, emotional, and developmental needs |
| Appropriate Oxygenation | Understand relationship between emotions and illness | Acceptance of optimal goals despite physical & emotional limitations |
| Appropriate Elimination | Maintenance of appropriate verbal and nonverbal communication | Willing to use community resources |
| Maintenance of Fluid & Electrolyte Balance | Development of positive interpersonal relationships | Recognition that social problems impact illness |
(McEwen & Wills, 2014)
Clearly, it is very important to know the 21 Nursing Problems because these are the problems nurses must link to their findings while using the ten steps for identification and development of a nursing care plan. The ten steps build upon each other from learning about the basics of a patient, then getting more specific to identify the exact nursing problem(s) that need to be addressed. Below are the ten steps that nurses must follow to successfully develop a plan of care and reach expected patient outcomes.
Ten Nursing Skills to Identifying Problems & Developing a Treatment Plan
| 1. Get to know the patient | 6. Validate conclusions with patient |
| 2. Define relevant and irrelevant information | 7. Observe and Evaluate Patient |
| 3. Develop generalizations | 8. Evaluate patient & family reaction to plan— incorporate family in care if possible |
| 4. Identify a therapeutic nursing plan | 9. Nursing’s perception of patient’s problems |
| 5. Test generalizations and modify plan if needed | 10. Discuss & develop a nursing care plan |
(McEwen & Wills, 2014)
Understanding how to use the 21 Nursing Problems along with the Ten Nursing Skills is important for nurses to grasp in order to see the full potential of this nursing theory for patients. Each of the Ten Nursing Skills needs to be followed so nurses can individualize care plans and work collaboratively with the patient and family to improve the patient’s state of health.
Major Propositions
The major proposition of Abdellah’s theory focuses on looking at the patient as a human being, not an illness. While her theory touches on many factors, it primarily focuses on patient centered care (McEwen & Willis, 2014). Due to its broad nature, it is testable in principle such as patient satisfaction and nursing care.
How has it been used?
In the past, Abdellah’s theory has been used in nursing education and nursing research. In nursing education, her theory has been used to organize lectures and curricula by categorizing nursing problems based on the patient’s needs and developing a classification of nursing skills and treatment (McEwen & Willis, 2014). Abdellah’s nursing theory has also been used in research such as patient-centered approach to nursing, evolution of nursing, perspectives on nursing theory, public policy impacting on nursing care of older adults, and preparing nursing research for the 21st century to name a few (McEwen & Willis, 2014).
Action Plan
It would behoove this institution to adopt Abdellah’s theory as a foundation of practice. The following action plan could be used as daily practice for all nurses to not only hone their critical thinking skills, but to also give more person centered care (PCC). PCC is important and has been a focus for many healthcare institutions for years. In 1969, Edith Balint described person centered care as “understanding the patient as a unique human being” (Santana et al., 2017, p. 430). Many healthcare systems are adopting a PCC to help gauge high quality care.
This action plan would focus around the Person-Centered Nursing (PCN) Framework developed by McCormack and McCance. The PCN Framework comes from research focusing on PCC with older people and the experience of caring in nursing (McCance, McCormack, & Dewing, 2011). The PCN Framework is comprised of four steps.
The first is prerequisites, which focuses on the…
