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Mother

Couples

Family of Adolescents Mother at Risk

Information them about the steps to be taken in Case of emergency at home

Child Care

GATHER G- Greeting A - Ask Open Ended Qs T - Tell Benefits H - Help in Decision E - Explain R - Return Visit

The need to give good life to children by keeping balance Between wages and children

The right age for marriage

Growth monitoring And identification of danger signs

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Abdellahs Theory in Nursing

Introduction/Brief history of Abdellah :-

Faye Glenn Abdellah was born in now York city. A 1942 Magna Cum laude graduate of fitkin Memorial hospital school of Nursing (now Ann may school of Nursing).She received her BS,MA, and EdD from teachers collage of Columbia work in 1955

Recognized as one of the countrys leading and best known researchers in health and public policy as well as an international expert of health problems. Abdellah has practiced in many settings I. She has been a staff Nurse 2. A head nurse, a faculty member at Yale University. 3. A public health nurse a researcher, and an author of more then 146 articles and books S 4. Abdellah has held various positions in the U.S public health Service including nurse education branch, senior consultant of nursing research. 5. Principle investigator in the progressive patient care project. 6. Chief of the research grants branch. 7. Director of nursing home affairs, and director of long term care

-3Abdellah was appointed chief Nurse officer of the USPHS in 1970 and served in that position for 17 years. Concurrently, in 1982 she was selected as Deputy Surgeon General, the first nurse and first woman to hold the post until her retirement in 1989 in this position , she was the focal point for nursing and a chief advisor on long term care policy within the Office of the Surgeon General. Abdellah represented the interests oh health professional i9n all categories in the public Health service .She was advisor on matters related to nursing .long term care policy, mental retardation , the developmentally disable , home health service, aging, hospice, and AIDS . Because her effort were directed toward improvement of the quality oh health care for all Americans, she supervised the activities in both health and non health agencies. She is the recipient of over 60 academic honors and professional awards. These include selection as a charter fellow of the American Academy of Nursing 10 honorary degrees , including an honorary Doctor of Laws degree from case. Western Reserve University for pioneering nursing research and being responsible for the advent of the nurse-scientist scholar; an honorary degree from the university of Bridgeport for devoting her career to advancing the quality of health care through research and being an innovative and inspirational leader for nursing professionals; the federal Nursing Service Award for the advancement of professional nursing ; and the distinguished Service Honor Award of the US Department of health, Education, and welfare for exceptional leadership and professional commitment and the first presidential award of Sigma Theta Tau International

Evolution of Theory
Abdellah realized that for nursing to gain full professional status the control medicine and toward a philosophy comprehensive patient-centered Abdellah and her colleagues conceptualized 21 nursing problems first appeared in the 1960 edition of patient centered Approach of Nursing and ahd a far reaching development of Nursing theories

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20-Resource to resolve problem 19-Vitamin problem m 18-Awarenessof self

21-Role of Social Problem in illness

1-Hygiene and physical comfort 2-Activity and rest 3-Safety 4-Body mechanics b 5-Oxygenation

itamin acceptance 17-Therapeutic Environment 16-Spirituality 21 15-intepersonal relationship 14-Communication Nursing problems

6-Nutrition

7-Elimination 13-Emotions and illness interrelationship 12-Feeling and reactions 8-Fluid and electrolyte 9-Response to disease

11-Sensory Function

10-Regulatory mechanism

The 21 Problem categories as following

1. Hygiene and physical comfort 2. Activity and rest

-53. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. 14. 15. 16. 17. 18. 19. 20. 21. Safety Body Mechanics Oxygenation Nutrition Elimination Fluid and electrolytes Responses to disease Regulatory mechanisms Sensory function feeling and reactions Emotions and illness interrelationships Communication Interpersonal relationship Spirituality Therapeutic Environment awareness of self limitation acceptance resources to resolve problems Role of social problem in illness

Over and convert problems must be identified to make a nursing diagnosis identification of problem process in the method nurse use to establish and focus on a nursing diagnosis. The overall goal is a clients fullest possible functioning Individualized patient care is important for nursing both patients and nurses should be aware of the wholeness of clients and the need for continuity of care from before hospitalization to afterward. Individualized care will require in the organization and administration of nursing service and education

Abdellah was influenced by the desire to promote client centred comprehensive nursing care and described nursing as service to individuals and families and therefore, to Society Nursing is based on art and science that mould the attitudes, intellectual competencies, and technical skill of the individual nurse into the desire and ability to help people ,sick and well cope with their health needs. Nursing may be carried out under general or specific medical direction

Abdellah;s theory was derive from the following premises of comprehensive nursing care :---------

Recognizing the nursing problem of the patient.

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Deciding the appropriates course of action . Providing continuous care to relieve pain and discomfort. Adjusting the total nursing care plan to meet the patient need Helping the individual to become or maintaining a healthy state of mind and body Instructing nursing personnel and family to help the individual Helping the individual to his limitations and emotional problems. Working with allied health professional in planning for optimum health on local : State national and international level. Cary out continuous evaluation.

NURSING PROBLEMS :-

The client health needs can be viewed as problem; The problem can be overt or covert Overt nursing problem is faced by the patient or family and nurse can assist him to meet through professional function Covert nursing problemesis a hidden conditions such as emotional sociological and inter personal

Identification and classification of problems was called TYPOLOGY OF 21 NURSING PROBLEMS AS LISITED BELOW

1. 2. 3. 4. 5. 6. 7. 8.

To maintain good hygiene and physical comfort: To promote optimal activity exercise rest sleep . To promote safety through prevention of accident injury other trauma and spread of infection To maintain good body mechanics and prevent and correct deformities To faciliate the maintainanace of a supply of oxygen to all body cells To facilitate the maintenance nutrition to all body cell To maintenance elimination To maintenance fluids and electrolytes balance

-79. To maintance regulatory mechanism and function 10. To reconise the physiological response of the body

11. 12. 13. 14. 15. 16. 17. 18. 19. 20. 21.

To facilitate the maintance of sensory functions. To identify and accept interrelatedness of emotion and organic illness. To identify and accpt positive and nagative expressions and feelings . To facilitate effective verbal and non verbal communiation. To promote the development of productive interpersonal relationship. To facilitate progress toward achievement of personal spiritual goals To creat awareness of self as an individual with varing physical emotional and developmental needs. To creat theraputic environment. To accpt the optimal possible goal in the light of limitations physical emotional. To use community resources as an aid in resolving problems arising from illness. To understand the role of social problems as influencing factors in the cause of illness.

Abdella typology was divided into three area :-

1. The physical sociological and emotional needs of the patients. 2. The types of interpersonal relationship between of the nurse and the patients. 3. The common elements of patient care.

In the process of identifying overt and problems and interpreting analyzing selection of appropriate course of action to solve these problems QUALITY PROFESSIONAL NURSING CARE REQUIRE THAT NURSES BE ABLE TO IDENTIFY AND SOLVE OVERT AND COVERT NURSING PROBLEMS.Many of these steps are from nursing process The problem solving approach was selected because of the assumption that the correct identification of nursing problems infleuences the nurse s judgement in selecting the next step in solving clients problems The problem solving approaches is also consistent with such basic element of nursing practice as observing reporting and interpreting the sign and symptoms that comprise the deviation from health and constitute nursing problems and analyzing the nursing problems and selecting the necessary course of action.

APPLICATION F THEORY IN FOUR MAJOR CONCEPTS :-

-81. 2. 3. 4. Human being. Health. Environment. Nursing

HUMAN BEING
She describe people as having physical emotional and sociological needs. In her typology of 21 needs and problems is said to evolve from recoginition of a need for patient centered approach .People helped by identification and all eviation of problems they are exerperience.

HEALTH.
Achieving of health is a purpose of nursing service.ABDELLA DOES NOT give the definition of health she speaks of total health needs and the healthy state of mind and body in her description of nursing as a comprehensive nursing services.

ENVIRONMENT
The environment is least discuss in her model. In nursing problem No 17 from typology is to create and maintance a theraputic envuponment and also tate that if the nurse reaction to patient is negative the environment of room may be negative. The means that patient interst an drespond to their environment

NURSING:-

Nursing is a helping profession:nursing care is doing something for aperson or Providing nursing care and information to meet the goal of patient Needs increasing or restoring self help ability or alleviating an impairment .She consider nursing to be a comprehensive service that is based on an art and science and aim to help people sick or well cope with these health needs.

NURSING PROCESS AND ABDELLAH :Assessment phase--Each of 21 nursing problems has following points :1. Collection of relevant data 2. Identify the overt and covert problems with direct or indirect approach

-9example overt problem of nutritional status can be assessed by measuring of weight food intake body size where as covert problem of maintaining a therap utic env require more indirect approach to data collection NURSING DIAGNOSIS:-The result of data collection would determine the client;s specific overt and covert problems These problems will be grouped under one or more of the broader nursing problems. Planning phase:--Once problem has been diagnose the goal has been established Many of nursing problem statements can be considered goals for either the nurse or the clients. Implementation phase:--- Using goals as frame work a plan is developed and nursing interventions are determined. Evaluation : - A plan is evaluated in terms of client;s progess or lack of prog ress or lackof progress toward the achievement of the goals

Chracterstics of theory

1 Abdellah theory has interrelated concepts of health nursing problems and problem solving as she attmpts to creat a different way of viewing nursing phenomina The result the statement that nursing is the use of the problems related to the people. 2. Theoretical statement place heavy emphasis on problem solving an activity that is inherently logical in nature.

3 Theoryis appearing to be limited to use which seems to focus quite heavily on nursing practice with individuls. Theory does not provide the frame on human and society in geneal. This limit the ability to generalizable.

4 One of the most important question that arise when considering her work is the role of the clients within the framework of a question that would generate hypothesis for testing. The result of testing such hypothesis would contribute to the general body of nursing knowledge.

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5.Abdella problem solving approach can easily be used by practitioners to guide various activities within their nursing practice that deals with clients who have specific needs and specific problems. 6.Abdella theory consint with other validated theoroies such as those of Maslow and Henderson .Althiugh the consistency exist many questions remain unanswered.

Evaluation of theory:1.The concept of nursing ,nursing problems and the problem-solving process ,which are central to this work are defined explicity The conceot of person health and environment which are associated There are no stated relation ship between Abdellah major concept or the nursing paradigm today 2.This model has a limited number of concepts and only structure is a list A some what mixed approach to concept definition is presant in this work .Nursing and nursing problems are connotatively defined while the problem-solving process is defined denotatively 3.It lacks sufficient relationship statement. 4.The 21 nursing problems are general and linked two neither time nor environment 5. Sje acknowlidge that her list is neither exhaustive nor listed accoeding to priorities Assuming thet persons experiences. Assuming that persons experience similar needs, the nursing goals stated in the list of 21 problems could be used by nurse in any time frame to meet patients needs However, according to this model, some persons do not need nursing 6. Other service professional could use the typology of 21 nursing problems to fouus on the psychosocial and emotional needs persented by patients. 7. The conceps are very specific with empirical referances thet are easily identifiable. The concepts are within the domain of nursing .Ready linkge of the concepts and typology to reality is secondary to an inductive approach to theory development. Validation of the typology was done by the 40 collegiate sohool of nursing 8. The topology provided a general framework in whioch to act,but continued neither specific nursing actions nor patient- contered outcomes despite the title of the book. However two subsequent publications did address outcome measures (effcet variables) and suggested models for organizing curricula to emphasize patient-centered outcomes .

- 11 9. The emphasis on problem solving is not limited by time or space and therefore provides a means for continused growth and change in the provision of nursing care . The problem solving process and the typology of 21 nursing problem can be respectivety considered precursors of the nursing care process and classification of nursing diagnoses in evidence today 10. In Patient- centerred Approches to Nursing Care .Abdellah addressed nursing education problems linked to the use of the medical model.Her typology provided a new way to qualitatively evalute experiences and retionales rather then note. 10. She proposes that nurses could take a leadership role in making the public aware that quality nursing health care is available . Quality is defined as the care that the patient needs.Need is determined by a classfication system that identifies the medical treatment and nursing care essential for that individual 11. Abdellah has made significant contribution to patient care, education and research in nursing and health care in this country and throughout the world

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SEMINAR ABDELLAHS THEORY OF 21 PROBLEMS

Presented to Principal Vara Luxmi Collage of Nursing Banglore

Presented by Shashi Rani Sharma Msc Nursing Ist year