Patient Centered Approaches in Nursing

7/27/2019 Patient Centered Approaches in Nursing

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PATIENT-CENTERED APPROACHES IN NURSING

Faye Glenn Abdellah

Background of the Theorist

She was born in New York City on March 13, 1919.

1942 – graduated from Fitkin Memorial Hospital School of Nursing in Neptune, New Jersey

1945 – received her B.S. in Nursing

1947 – received her M.A. in Nursing

1955 – received her Ed.D. (all from Teachers College, Columbia University)

She taught at Yale. The frustrations that arose from this teaching experience led to the

beginnings of her pursuit of the scientific basis of nursing practice.

She served as Deputy Surgeon General and as Chief Nurse Officer for the U.S. Public Health

Service, Department of Health and Human Services, Washington, DC.

She retired from the USPHS with the rank of rear admiral.

1993 – she became Dean of the newly formed Graduate School of Nursing, Uniformed Services

University of the Health Sciences.

She has been granted 11 honorary doctorates by various institutions.

She has been a research consultant to the WHO.

She has been recognized by Sigma Theta Tau as a Distinguished Research Fellow, and recipient

of the Excellence in Nursing Award, and the first Presidential Award.

She was awarded the Allied Signal Award for her groundbreaking research in aging.

The Institute of Medicine presented her with the Gustav O. Lienhard.

Major Assumptions in Abdellah’s Theory

1) Change and anticipated changes that affect nursing

2) Need to appreciate the interconnectedness of social enterprises and social problems

3) Impact of problems such as poverty, racism, pollution and so forth on health and health care

delivery

4) Changing nursing education

5) Continuing education for professional nurses

6) Development of nursing leaders from underserved groupsLogical Form

The logical form can be best described as an inductive approach. The typology developed

inductively from research toward theory.

Abdellah’s Major Concepts in her Theory

A) Health

Her concept of health may be the dynamic pattern of functioning where there is continued

interaction with internal and external forces that results in the optimal use of necessary resources that

serve to minimize vulnerabilities.

By performing nursing services through a holistic approach to the patient, the nurse helps the

patient achieve a state of health.

To effectively perform these services, the nurse must accurately identify the lacks and deficitsregarding health that the patient is experiencing. These lacks or deficits are the patient’s health needs.

B) Nursing Problems

The patient’s health needs can be viewed as:

1) Overt – can be seen

2) Covert – hidden; can be:

a) Emotional

b) Sociological



c) Interpersonal

Nursing problem presented by a patient is a condition faced by the patient or patient’s family

that the nurse can assist them to meet.

*Nursing Problems = “Nursing Functions” or “Nursing Goals”

*Nursing Problems are not “Patient-centered Problems”

*Nursing diagnoses were a determination of the nature and extent of nursing problems

presented by individuals receiving nursing care.

*Nursing functions were nursing activities that contributed to the solution for the same nursing

problem.

Within the practice of nursing, it was anticipated that these 21 problems guide care and

promote the development of the nurse’s judgmental ability. In each of the broad nursing problems are

numerous specific overt and covert problems.

In her typology of 21 nursing problems presented by patients, she includes three columns:

a) Basic nursing problem presented by the patient

b) Specific problem of patient

c) Common conditions

Example of Typology of Basic Nursing Problems Presented by Patients

Basic Nursing ProblemPresented by Patient

Specific Problem of the Patient Common Conditions

5. To facilitate the maintenance

of a supply of oxygen to all

body cells

Supply of oxygen Anesthesia

High altitudes

Clear airway Asthmatic

Postoperative

Chest surgery

Foreign bodies

Unconscious patient

Adequate functioning of

neuromuscular system

Bulbar poliomyelitis

Medulla damageMyasthenia gravis

Muscular dystrophy

Adequate absorbing surface Far-advanced tuberculosis

Congestive heart failure

Pulmonary edema

Pneumonia

Ability to transport oxygen Anemia

Congestive heart failure

Occlusive arterial disease

Carbon monoxide poisoning

Ability to utilize oxygen Cyanide poisonMoribund state

Nursing care to decrease

patient’s need for oxygen and

to supply higher concentration

of oxygen

Through control of his

environment

Through reducing his activity

C) Problem Solving



Quality professional nursing care requires that nurses can be able to identify and solve

overt and covert nursing problems. These requirements can be met by the problem-solving

approach.

Problem-solving Process:

a) Identification of Problem

b) Selection of Pertinent Data

c) Formulation of Hypotheses

d) Collection of Data

e) Test of Hypotheses

f) Revision of Hypotheses

The problem solving approach was selected because of the assumption that the correct

identification of nursing problems influences the nurse’s judgment in selecting the next steps in

solving the patient’s nursing problems.

The 21 Nursing Problems

Abdellah’s 21 Nursing Problems

1) To maintain good hygiene and physical comfort.2) To promote optimal activity; exercise, rest and sleep.

3) To promote safety through the prevention of accident, injury, or other trauma and

through the prevention of the spread of infection.

4) To maintain good body mechanics and prevent and correct deformities.

5) To facilitate maintenance of a supply of oxygen to all body cells.

6) To facilitate the maintenance of nutrition of all body cells.

7) To facilitate the maintenance of elimination.

8) To facilitate the maintenance of fluid and electrolyte balance.

9) To recognize the physiological responses of the body to disease conditions –

pathological, physiological, and compensatory.

10) To facilitate the maintenance of regulatory mechanisms and functions.

11) To facilitate the maintenance of sensory functions.

12) To identify and accept positive and negative expressions, feelings, and reactions.

13) To identify and accept the interrelatedness of emotions and organic illnesses.

14) To facilitate the maintenance of effective verbal and nonverbal communication.

15) To promote the development of productive interpersonal relationships.

16) To facilitate progress toward achievement of personal spiritual goals.

17) To create and/or maintain a therapeutic environment.

18) To facilitate awareness of self as an individual with varying physical, emotional,

developmental needs.

19) To accept the optimum possible goals in the light of limitations, physical and emotional.

20) To use community resources as an aid in resolving problems arising from illness.

21) To understand the role of social problems as influencing factors in the cause of illness.

3 Major Categories

1) Physical, sociological, and emotional needs of the patient

2) Types of interpersonal relationships between the nurse and the patient

3) Common elements of patient care

Categories of Needs

1) Basic Needs (1 – 4)

2) Sustenal Care Needs (5 – 11)



3) Remedial Care Needs (12 – 19)

4) Restorative Care Needs (20 – 21)

Abdellah’s Theory and Nursing’s Metaparadigm

A) Individual

Individual is the recipient of nursing (including families, and society).

Her 21 nursing problems deal with biological, psychological, and social areas of individuals and

can be considered to represent areas of importance to them.

B) Health (or the achieving of health)

It is the purpose of nursing services.

Abdellah speaks to “total health needs” and “a healthy state of mind and body” in her

description of nursing as a comprehensive service.

C) Society

Society is included in “planning for optimum health on local, state, national, and international

levels”. She indicates that by providing a service to individuals and families, society is served but does

not discuss society as patient or define society.

D) Nursing

Nursing is broadly grouped into the 21 problem areas to guide care and promote the use of

nursing judgment.She considers nursing to be a comprehensive service that is based on art and science and aims

to help people, sick or well, cope with their health needs.

10 steps to identify the client’s problems:

1) Learn to know the patient.

2) Sort out relevant and significant data.

3) Make generalizations about available data in relation to similar nursing problems presented

by other patients.

4) Identify the therapeutic plan.

5) Test generalizations with the patient and make additional generalizations.

6) Validate the patient’s conclusions about his nursing problems.

7)

Continue to observe and evaluate the patient over a period of time to identify any attitudesand clues affecting his behaviour.

8) Explore the patient’s and family’s reaction to the therapeutic plan and involve them in the

plan.

9) Identify how the nurse feels about the patient’s nursing problems.

10) Discuss and develop a comprehensive nursing care of plan.

10 nursing skills to be used in developing a treatment typology:

1) Recognizing the nursing problems of the patient.

2) Deciding the appropriate courses of action to take in terms of relevant nursing principles.

3) Providing continuous care of the individual’s total health needs.

4) Providing continuous care to relieve pain and discomfort and provide immediate security for

the individual.

5) Adjusting the total nursing care plan to meet the patient’s individual needs.

6) Helping the individual to become more self-directing in attaining or maintaining a healthy

state of mind and body.

7) Instructing nursing personnel and family to help the individual do for himself that which he

can within his limitations.

8) Helping the individual to adjust to his limitations and emotional problems.

9) Working with allied health professions in planning for optimum health on local, state,

national, and international levels.



10) Carrying out continuous evaluation and research to improve nursing techniques and to

develop new techniques to meet the health needs of peole.

Use of the 21 Problems in the Nursing Process

Assessment The nursing problems provide guidelines for the collection of data.

Nursing Diagnosis The results of the data collection would determine the patient’s specific overt and

covert problems. These specific problems would be grouped under 1 or more of

the broader nursing problems.

Planning The statements of the nursing problems contain the basis for desired outcomes

and most closely resemble goal statements.

Implementation Interventions that would be appropriate for the categories or nursing problems.

Evaluation It is evaluated in terms of the patient’s progress or lack of progress toward the

achievement of the stated outcomes and goals.

The patient’s ability to provide self -help in the identified areas must be evaluated.

*Criterion – is a value-free name of a measurable variable believed or known to be a relevant

indicator of the quality patient care.

– can be used to measure patient care. The measurement of criteria may be related

to the measurement of the achievement of the desired outcomes.

Criteria might be used to determine the effectiveness of patient-centered care:

1) The patient is able to provide for the satisfaction of his own needs.

2) The nursing care plan makes provision to meet four needs – sustenal care, remedial care,

restorative care, and preventive care.

3) The care plan extends beyond the patient’s hospitalization and makes provision for

continuation of the care at home.

4) The levels of nursing skills provided vary with the individual patient care requirements.

5) The entire care plan is directed at having the patient help himself.

6) The care plan makes provision for involvement of members of the family throughout thehospitalization and after discharge.

Comparison of Maslow’s, Henderson’s, and Abdellah’s Frameworks

Maslow Henderson Abdellah

Physiological

Needs

1. Breathe normally.

2. Eat and drink adequately.

3. Eliminate body waste.

4. Move and maintaindesirable posture.

5. Sleep and rest.

6. Select suitable clothing.

7. Maintain body

temperature.

5. To facilitate maintenance of a supply of oxygen to all

body cells.

6. To facilitate the maintenance of nutrition of all body

cells.

8. To facilitate the maintenance of fluid and electrolyte

balance.

7. To facilitate the maintenance of elimination.

4. To maintain good body mechanics and prevent andcorrect deformities.

2. To promote optimal activity; exercise, rest and

sleep.

10. To facilitate the maintenance of regulatory

mechanisms and functions.



8. Keep body clean and well

groomed and protect the

integument.

1. To maintain good hygiene and physical comfort.

Safety Needs 9. Avoid environmental

dangers and avoid injuring

others.

3. To promote safety through the prevention of

accident, injury, or other trauma and through the

prevention of the spread of infection.

11. To facilitate the maintenance of sensory functions.

Belonging and

Love Needs

10. Communicate with

others.

11. Worship according to

faith.

14. To facilitate the maintenance of effective verbal

and nonverbal communication.

15. To promote the development of productive

interpersonal relationships.

16. To facilitate progress toward achievement of

personal spiritual goals.

Esteem Needs 12. Work at something

providing a sense of

accomplishment.

13. Play or participate in

various forms of recreation.

14. Learn, discover, or satisfy

curiousity.

19. To accept the optimum possible goals in the light

of limitations, physical and emotional.

9. To use community resources as an aid in resolving

problems arising from illness.

12. To identify and accept the interrelatedness of

emotions and organic illnesses.

13. To identify and accept positive and negative

expressions, feelings, and reactions.

17. To create and/or maintain a therapeutic

environment.

18. To facilitate awareness of self as an individual with

varying physical, emotional, and developmental needs.

20. To understand the role of social problems asinfluencing factors in the cause of illness.

21. To recognize the physiological responses of the

body to disease conditions – pathological,

physiological, and compensatory.

Critique

A) Simplicity

The typology is very simple and is descriptive of nursing problems thought to be

common among patients.

The concepts of nursing, nursing problems, and the problem-solving are defined

explicitly.

The model has a limited number of concepts, and its only structure is a list.

The typology does not yet constitute a theory because it lacks sufficient relationship

statements.

B) Generality

The 21 nursing problems are general and linked to neither time nor environment.

The focus of the model varies in generality. The broadest goal is to positively affect

nursing education, while subgoals are to provide a scientific basis on which to practice and to

provide a method of qualitative evaluation of educational experiences for students.



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Patient Centered Approaches in Nursing