 Learn to know the patient

 Sort out relevant and significant data

Faye Glenn Abdellah's Theory  Make generalizations about available data in relation to similar
nursing problems presented by other patients
Twenty-One Nursing Problems  Identify the therapeutic plan
 Test generalizations with the patient and make additional
generalizations
INTRODUCTION.  Validate the patient’s conclusions about his nursing problems
 Continue to observe and evaluate the patient over a period of time to
 "Nursing is based on an art and science that mould the attitudes, identify any attitudes and clues affecting his behavior
intellectual competencies, and technical skills of the individual nurse  Explore the patient’s and family’s reaction to the therapeutic plan and
into the desire and ability to help people , sick or well, cope with their involve them in the plan
health needs." - Abdellah  Identify how the nurses feels about the patient’s nursing problems
 Discuss and develop a comprehensive nursing care plan
Abdellah explained nursing as a comprehensive service, which includes:

1. Recognizing the nursing problems of the patient

11 nursing skills
2. Deciding the appropriate course of action to take in terms of relevant
nursing principles  Observation of health status
3. Providing continuous care of the individuals total needs
 Skills of communication
4. Providing continuous care to relieve pain and discomfort and provide
immediate security for the individual  Application of knowledge
5. Adjusting the total nursing care plan to meet the patient’s individual  Teaching of patients and families
needs  Planning and organization of work
6. Helping the individual to become more self directing in attaining or
 Use of resource materials
maintaining a healthy state of mind & body
7. Instructing nursing personnel and family to help the individual do for  Use of personnel resources
himself that which he can within his limitations  Problem-solving
8. Helping the individual to adjust to his limitations and emotional  Direction of work of others
problems
9. Working with allied health professions in planning for optimum health
 Therapeutic use of the self
on local, state, national and international levels  Nursing procedure
10. Carrying out continuous evaluation and research to improve nursing
techniques and to develop new techniques to meet the health needs
of people 21 NURSING PROBLEMS

(In 1973, the item 3, - “providing continuous care of the individual’s total health Three major categories
needs” was eliminated.)

 Physical, sociological, and emotional needs of clients

ABOUT THE THEORIST AND THEORETICAL SOURCES  Types of interpersonal relationships between the nurse and patient
 Common elements of client care
 Birth:1919
BASIC TO ALL PATIENTS
 Abdellah’s patient - centred approach to nursing was developed
inductively from her practice and is considered a human needs  To maintain good hygiene and physical comfort
theory.
 To promote optimal activity: exercise, rest and sleep
 The theory was created to assist with nursing education and is most
applicable to the education of nurses.  To promote safety through the prevention of accidents, injury, or other
trauma and through the prevention of the spread of infection
 Although it was intended to guide care of those in the hospital, it also
has relevance for nursing care in community settings.  To maintain good body mechanics and prevent and correct deformity

SUSTENAL CARE NEEDS

MAJOR ASSUMPTIONS, CONCEPTS &
RELATIONSHIPS  To facilitate the maintenance of a supply of oxygen to all body cells
 To facilitate the maintenance of nutrition of all body cells
 She uses the term ‘she’ for nurses, ‘he’ for doctors and patients, and  To facilitate the maintenance of elimination
refers to the object of nursing as ‘patient’ rather than client or  To facilitate the maintenance of fluid and electrolyte balance
consumer.  To recognize the physiological responses of the body to disease
 She referred to Nursing diagnosis during a time when nurses were conditions
taught that diagnosis was not a nurses’ prerogative.  To facilitate the maintenance of regulatory mechanisms and functions
 To facilitate the maintenance of sensory function.
Assumptions were related to
REMEDIAL CARE NEEDS
 change and anticipated changes that affect nursing;
 the need to appreciate the interconnectedness of social enterprises  To identify and accept positive and negative expressions, feelings,
and social problems; and reactions
 the impact of problems such as poverty, racism, pollution, education,  To identify and accept the interrelatedness of emotions and organic
and so forth on health care delivery; illness
 changing nursing education  To facilitate the maintenance of effective verbal and non verbal
 continuing education for professional nurses communication
 development of nursing leaders from under reserved groups  To promote the development of productive interpersonal relationships
 To facilitate progress toward achievement of personal spiritual goals
Abdellah and colleagues developed a list of 21 nursing problems.They also  To create and / or maintain a therapeutic environment
identified 10 steps to identify the client’s problems. 11 nursing skills to be used in  To facilitate awareness of self as an individual with varying physical ,
developing a treatment typology
emotional, and developmental needs

10 steps to identify the client’s problems

RESTORATIVE CARE NEEDS  A principle underlying the problem solving approach is that for each
identified problem, pertinent data are collected.
 To accept the optimum possible goals in the light of limitations,  The overt or covert nature of the problems necessitates a direct or
physical and emotional indirect approach, respectively.
 To use community resources as an aid in resolving problems arising
from illness
NURSING DIAGNOSIS
 To understand the role of social problems as influencing factors in the
case of illness
 The results of data collection would determine the client’s specific
overt or covert problems.
ABDELLAH’S THEORY AND THE FOUR MAJOR  These specific problems would be grouped under one or more of the
broader nursing problems.
CONCEPTS
 This step is consistent with that involved in nursing diagnosis

NURSING
PLANNING PHASE

 Nursing is a helping profession.

 The statements of nursing problems most closely resemble goal
 Nursing care is doing something to or for the person or providing statements. Once the problem has been diagnosed, the nursing goals
information to the person with the goals of meeting needs, increasing have been established.
or restoring self-help ability, or alleviating impairment.
 Nursing is broadly grouped into the 21 problem areas to guide care
and promote use of nursing judgment. IMPLEMENTATION
 Nursing to be comprehensive service.
 Using the goals as the framework, a plan is developed and
appropriate nursing interventions are determined.
PERSON

 Abdellah describes people as having physical, emotional, and EVALUATION

sociological needs.
 Patient is described as the only justification for the existence of
 The most appropriate evaluation would be the nurse progress or lack
nursing.
 Individuals (and families) are the recipients of nursing of progress toward the achievement of the stated goals..
 Health, or achieving of it, is the purpose of nursing services.
Progressive Patient Care :: Models of Nursing Care Delivery

HEALTH
CONCLUSION
 In Patient–Centered Approaches to Nursing, Abdellah describes
health as a state mutually exclusive of illness.  Using Abdellah’s concepts of health, nursing problems, and problem
 Although Abdellah does not give a definition of health, she speaks to
“total health needs” and “a healthy state of mind and body” in her solving, the theoretical statement of nursing that can be derived is the
description of nursing as a comprehensive service. use of the problem solving approach with key nursing problems
related to health needs of people. From this framework, 21 nursing
SOCIETY AND ENVIRONMENT problems were developed.

 Society is included in “planning for optimum health on local, state,

national, and international levels”. However, as she further delineated  Abdellah’s theory provides a basis for determining and organizing
her ideas, the focus of nursing service is clearly the individual. nursing care. The problems also provide a basis for organizing
 The environment is the home or community from which patient
appropriate nursing strategies.
comes.

REFERENCES
CHARACTERISTICS OF THE THEORY
1. George Julia B. Nursing theories: The base of professional nursing
practice 3rd edition. Norwalk, CN: Appleton and Lange; 1990.
 Abdellah’s theory has interrelated the concepts of health, nursing
2. Abdellah, F.G. The federal role in nursing education. Nursing outlook.
problems, and problem solving.
1987, 35(5),224-225.
3. Abdellah, F.G. Public policy impacting on nursing care of older
 Problem solving is an activity that is inherently logical in nature. adults .In E.M. Baines (Ed.), perspectives on gerontological nursing.
Newbury, CA: Sage publications. 1991.
4. Abdellah, F.G., & Levine, E. Preparing nursing research for the 21st
 Framework focus on nursing practice and individuals. century. New York: Springer. 1994.
5. Abdellah, F.G., Beland, I.L., Martin, A., & Matheney, R.V. Patient-
centered approaches to nursing (2nd ed.). New York: Mac Millan.
 The results of testing such hypothesis would contribute to the general
1968.
body of nursing knowledge 6. Abdellah, F.G. Evolution of nursing as a profession: perspective on
manpower development. International Nursing Review, 1972); 19, 3..
 Easy to apply in practice. 7. Abdellah, F.G.). The nature of nursing science. In L.H. Nicholl (Ed.),
perspectives on nursing theory. Boston: Little, Brown, 1986.

USE OF 21 PROBLEMS IN THE NURSING

PROCESS

ASSESSMENT PHASE

 Nursing problems provide guidelines for the collection of data.

 10. The allowance for existential-phenomenological
forces.

JEAN WATSON
The first three carative factors form the “philosophical
10 carative factors
NURSING: HUMAN SCIENCE AND HUMAN CARE foundation” for the science of caring. The remaining seven
carative factors spring from the foundation laid by these first
Introduction three.

 Theorist - Jean Watson was born in West Virginia, US 1. The formation of a humanistic- altruistic system of values
 Educated: BSN, University of Colorado, 1964, MS,
University of Colorado, 1966, PhD, University of  Begins developmentally at an early age with values
Colorado, 1973 shared with the parents.
 Distinguished Professor of Nursing and Chair in  Mediated through ones own life experiences, the
Caring Science at the University of Colorado Health learning one gains and exposure to the humanities.
Sciences Center.  Is perceived as necessary to the nurse’s own
 Fellow of the American Academy of Nursing. maturation which then promotes altruistic behavior
 Dean of Nursing at the University Health Sciences towards others.
Center and President of the National League for
Nursing
2. Faith-hope
 Undergraduate and graduate degrees in nursing and
psychiatric-mental health nursing and PhD in
educational psychology and counseling.  Is essential to both the carative and the curative
 Six (6) Honorary Doctoral Degrees. processes.
 Research has been in the area of human caring and  When modern science has nothing further to offer the
loss. person, the nurse can continue to use faith-hope to
 In 1988, her theory was published in “nursing: human provide a sense of well-being through beliefs which
science and human care”. are meaningful to the individual.

3. Cultivation of sensitivity to one’s self and to others

The seven assumptions
 Explores the need of the nurse to begin to feel an
1. Caring can be effectively demonstrated and practiced
emotion as it presents itself.
only interpersonally.
 Development of one’s own feeling is needed to
2. Caring consists of carative factors that result in the
interact genuinely and sensitively with others.
satisfaction of certain human needs.
 Striving to become sensitive, makes the nurse more
3. Effective caring promotes health and individual or
authentic, which encourages self-growth and self-
family growth.
actualization, in both the nurse and those with whom
4. Caring responses accept person not only as he or she
the nurse interacts.
is now but as what he or she may become.
 The nurses promote health and higher level
5. A caring environment is one that offers the
functioning only when they form person to person
development of potential while allowing the person to
relationship.
choose the best action for himself or herself at a given
point in time.
6. Caring is more “ healthogenic” than is curing. A 4. Establishing a helping-trust relationship
science of caring is complementary to the science of
curing.  Strongest tool is the mode of communication, which
7. The practice of caring is central to nursing. establishes rapport and caring.
 Characteristics needed to in the helping-trust
relationship are:
The ten primary carative factors
o Congruence
o Empathy
1. The formation of a humanistic- altruistic system of
o Warmth
values.
2. The installation of faith-hope.
3. The cultivation of sensitivity to one’s self and to  Communication includes verbal, nonverbal and
others. listening in a manner which connotes empathetic
4. The development of a helping-trust relationship understanding.
5. The promotion and acceptance of the expression of
positive and negative feelings. 5. The expression of feelings, both positive and negative
6. The systematic use of the scientific problem-solving
method for decision making  “Feelings alter thoughts and behavior, and they need
7. The promotion of interpersonal teaching-learning. to be considered and allowed for in a caring
8. The provision for a supportive, protective and /or relationship”.
corrective mental, physical, socio-cultural and spiritual  Awareness of the feelings helps to understand the
environment. behavior it engenders.
9. Assistance with the gratification of human needs.
6. The systematic use of the scientific problem-solving method
for decision making
Watson’s theory and the four major
 The scientific problem- solving method is the only concepts
method that allows for control and prediction, and that
permits self-correction.
1. Human being
 The science of caring should not be always neutral
and objective.
 Human being refers to “….. a valued person in and of
him or herself to be cared for, respected, nurtured,
7. Promotion of interpersonal teaching-learning understood and assisted; in general a philosophical
view of a person as a fully functional integrated self.
 The caring nurse must focus on the learning process He, human is viewed as greater than and different
as much as the teaching process. from, the sum of his or her parts”.
 Understanding the person’s perception of the situation
assist the nurse to prepare a cognitive plan.
2. Health

8. Provision for a supportive, protective and /or corrective  Watson adds the following three elements to WHO
mental, physical, socio-cultural and spiritual environment definition of health:
o A high level of overall physical, mental and
 Watson divides these into eternal and internal social functioning
variables, which the nurse manipulates in order to o A general adaptive-maintenance level of
provide support and protection for the person’s mental daily functioning
and physical well-being. o The absence of illness (or the presence of
 The external and internal environments are efforts that leads its absence)
interdependent.
 Nurse must provide comfort, privacy and safety as a
3. Environment/society
part of this carative factor.
 According to Watson, caring (and nursing) has
9. Assistance with the gratification of human needs existed in every society.
 A caring attitude is not transmitted from generation to
 It is based on a hierarchy of need similar to that of the generation.
Maslow’s.  It is transmitted by the culture of the profession as a
 Each need is equally important for quality nursing unique way of coping with its environment.
care and the promotion of optimal health.
 All the needs deserve to be attended to and valued.
4. Nursing

Watson’s ordering of needs  “Nursing is concerned with promoting health,

preventing illness, caring for the sick and restoring
 Lower order needs (biophysical needs) health”.
o The need for food and fluid  It focuses on health promotion and treatment of
o The need for elimination disease. She believes that holistic health care is
o The need for ventilation central to the practice of caring in nursing.
 Lower order needs (psychophysical needs)  She defines nursing as…..
o The need for activity-inactivity “a human science of persons and human health-
o The need for sexuality illness experiences that are mediated by professional,
 Higher order needs (psychosocial needs) personal, scientific, esthetic and ethical human
o The need for achievement transactions”.
o The need for affiliation
o Higher order need (intrapersonal- Watson’s theory and nursing process
interpersonal need)
o The need for self-actualization  Nursing process contains the same steps as the
scientific research process. They both try to solve a
10. Allowance for existential-phenomenological forces problem. Both provide a framework for decision
making.
 Phenomenology is a way of understanding people
from the way things appear to them, from their frame 1. Assessment
of reference.
 Existential psychology is the study of human  Involves observation, identification and review of the
existence using phenomenological analysis. problem; use of applicable knowledge in literature.
 This factor helps the nurse to reconcile and mediate  Also includes conceptual knowledge for the
the incongruity of viewing the person holistically while formulation and conceptualization of framework.
at the same time attending to the hierarchical ordering  Includes the formulation of hypothesis; defining
of needs. variables that will be examined in solving the problem.
 Thus the nurse assists the person to find the strength
or courage to confront life or death.
2. Plan

 It helps to determine how variables would be

examined or measured; includes a conceptual
approach or design for problem solving. It determines
what data would be collected and how on whom.

3. Intervention

 It is the direct action and implementation of the plan.

 It includes the collection of the data.

4. Evaluation

 Analysis of the data as well as the examination of the

effects of interventions based on the data.
 Includes the interpretation of the results, the degree to
which positive outcome has occurred and whether the
result can be generalized.
 It may also generate additional hypothesis or may
even lead to the generation of a nursing theory.

Watson’s theory and the characteristic

of a theory

1. Logical in nature.
2. Relatively simple
3. Generelizable
4. Based on phenomenological studies that generally
ask questions rather than state hypotheses.
5. Can be used to guide and improve practice.
6. Supported by the theoretical work of numerous
humanists, philosophers, developmentalists and
psychologists.

Strengths

 This theory places client in the context of the family,

the community and the culture.
 It places the client as the focus of practice rather than
the technology.

Limitations

 Biophysical needs of the individual are given less

important.
 The ten caratiive factors primarily delineate the
psychosocial needs of the person.
 Needs further research to apply in practice.
 she worked from 1957 to 1962 on all aspects of the project,
including construction and administration. As the founder and
LYDIA HALL the first director, she was determined that nurses were in
charge of everyday activities and transactions.
CARE CORE CURE THEORY (3 C’S)
Hall then worked as the first director of the Loeb Center for
Lydia Eloise Hall (September 21, 1906 – February 27, 1969) Nursing. Her nursing experience was in clinical nursing,
was a nursing theorist who developed the Care, Cure, nursing education, research, and a supervisory role. Through
Core model of nursing. Her theory defined Nursing as “a her leadership, the nursing-centered care reduced
participation in care, core and cure aspects of patient care, rehabilitation time and length of stay by up to one-half to one-
where CARE is the sole function of nurses, whereas the CORE third. The center became a prime example of nursing-led care,
and CURE are shared with other members of the health team.” and many centers in the United States and Canada followed its
principles. During her time there, Hall authored 21 publications
and bulk of articles and addresses regarding her theory.
She was an innovator, motivator, mentor to nurses in all
phases of their careers, and an advocate for chronically ill
patients. She worked to involve the community in public health Care, Cure, Core Theory
issues.
Lydia Hall used her knowledge of psychiatry and nursing
experiences in the Loeb Center to formulate her theory. Also
Education
known as “the Three Cs of Lydia Hall,” it contains three
independent but interconnected circles: the core, the care, and
Lydia Hall graduated from York Hospital School of Nursing in the cure.
1927 with a diploma in nursing. However, she felt as if she
needed more education. She entered Teacher’s College at
Columbia University in New York and earned a Bachelor of The core is the patient receiving nursing care. The core has
Science degree in public health nursing in 1932. After several goals set by him or herself rather than by any other person and
years in clinical practice, she resumed her education and behaves according to their feelings and values.
received a master’s degree in the teaching of natural life
sciences from Columbia University in 1942. Later, she pursued The cure is the attention given to patients by medical
a doctorate and completed all of the requirements except for professionals. Hall explains in the model that the nurse shares
the dissertation. the cure circle with other health professionals, such as
physicians or physical therapists. These are the interventions
In 1945, she married Reginald A. Hall, who was a native of or actions geared toward treating the patient for whatever
England. illness or disease they are suffering from.

Career and Appointments The care circle addresses the role of nurses and is focused on
performing the task of nurturing patients. This means the
Just like any other nurses who have passion for their craft, “motherly” care provided by nurses, which may include comfort
Lydia Hall’s nursing experience was functional, proficient as measures, patient instruction, and helping the patient meet his
well as hypothetical. She spent her early years as a registered or her needs when help is needed.
nurse working for the Life Extension Institute of the
Metropolitan Life Insurance Company in Pennsylvania and Major Concepts of Care, Core, Cure
New York, where the main focus was on preventative health.
She also had the opportunity to work for the New York Heart The following the major concepts of Lydia Hall’s Care, Core,
Association from 1935 to 1940. In 1941, she became a staff Cure nursing theory, including their definitions.
nurse with the Visiting Nurses Association of New York and
stayed there until 1947. Hall also managed to be an advocate
of community involvement in public health issues. And in 1950, Individual
she became a professor at Teacher’s College at Columbia,
where she taught nursing students to function as medical The individual human who is 16 years of age or older and past
consultants. She was also a research analyst in the field of the acute stage of long-term illness focuses on nursing care in
cardiovascular disease. Hall’s work. The source of energy and motivation for healing is
the individual care recipient, not the health care provider. Hall
emphasizes the individual’s importance as unique, capable of
Hall’s interest and research in the field of rehabilitation of growth and learning, and requiring a total person approach.
chronically ill patients brought her to develop her now-famous
Care, Cure, Core Theory. She was always interested in
rehabilitative nursing and the role the professional nurse Health
played in its recovery and welfare. With these, she became
involved in establishing the Loeb Center for Nursing and Health can be inferred as a state of self-awareness with a
Rehabilitation at the Montefiore Medical Center (MMC) in the conscious selection of optimal behaviors for that individual.
Bronx, New York. The Solomon and Betty Loeb Memorial Hall stresses the need to help the person explore the meaning
Home for Convalescents had provided community services at of his or her behavior to identify and overcome problems
Montefiore Hospital since 1905. In 1957, the Board of Trustees through developing self-identity and maturity.
decided to expand the services and enter into a hospital
partnership to construct a new facility. Dr. Martin Cherkasky,
director of the hospital, contacted Hall to lead the venture, and
Society and Environment The Cure Circle

The concept of society or environment is dealt with concerning As explained in this theory, the cure is nursing, which involves
the individual. Hall is credited with developing Loeb Center’s the administration of medications and treatments. Hall explains
concept because she assumed that the hospital environment in the model that the nurse shares the cure circle with other
during treatment of acute illness creates a difficult health professionals, such as physicians or physical therapists.
psychological experience for the ill individual. Loeb Center
focuses on providing an environment that is conducive to self- In short, these are the interventions or actions geared toward
development. In such a setting, the focus of the nurses’ action treating the patient for whatever illness or disease he or she is
is the individual. Any actions taken concerning society or the suffering from. During this aspect of nursing care, the nurse is
environment are to assist the individual in attaining a personal an active advocate of the patient.
goal.

For example, in the care phase, the nurse gives hands-on

Nursing bodily care to the patient about daily living activities such
as toileting and bathing. In the curing phase, the nurse applies
Nursing is identified as participating in the care, core, and cure medical knowledge to the treatment of the person. In the core
aspects of patient care. phase, the nurse addresses the patient’s social and emotional
needs for effective communication and a comfortable
Subconcepts environment.

Lydia Hall’s theory has three components which are

represented by three independent but interconnected circles.
The three circles are the core, the care, and the cure. The size
of each circle constantly varies and depends on the state of the
patient.

The Care Circle

According to the theory, nurses are focused on performing the

noble task of nurturing patients. This circle solely represents
the role of nurses and is focused on performing the task of
nurturing patients. Nurturing involves using the factors that
make up the concept of mothering (care and comfort of the
person) and provide for teaching-learning activities.

The care circle defines a professional nurse’s primary role,

such as providing bodily care for the patient and helping the
patient complete such basic daily biological functions as
eating, bathing, elimination, and dressing. When providing this
care, the nurse’s goal is the comfort of the patient.

Moreover, the nurse’s role also includes educating

patients and helping a patient meet any needs he or she is
unable to meet alone. This presents the nurse and patient with
an opportunity for closeness. As closeness develops, the
patient can share and explore feelings with the nurse.

The Core Circle

The core, according to Hall’s theory, is the patient receiving

nursing care. The core has goals set by him or herself rather
than by any other person and behaves according to their
feelings and values. This involves the therapeutic use of self
and is shared with other members of the health team.

This area emphasizes the patient’s social, emotional, spiritual,

and intellectual needs concerning family, institution,
community, and the world. This can help the patient verbally
express feelings regarding the disease process and its effects
by using the reflective technique. Through such expression,
the patient can gain self-identity and further develop maturity.