21 Nursing Problems Theory: Critique 

One of the first theorists in nursing is Faye Abdellah. She had many writings and publications that lead nursing to more patient-centered care rather than disease-centered (Zerwekh & Garneau, 2012). In 1960 Abdellah and her colleagues developed the 21 Nursing Problems theory, which was also called the patient-centered approach to nursing theory, after many research studies and from her practice (McEwen & Wills, 2014). This theory is subgrouped into sociological, physical and emotional needs of the patients. Abdellah’s theory utilized Virginia Henderson’s 14 basic human needs to create her 21 nursing problems theory list (Alligood, 2014). Abdellah and her colleagues also composed a list of 10 steps of how to identify nursing problems and 11 nursing skills nursing needs to be able to identify those problems (Petiprin, 2016). This theory was selected for this project because it has the most relevance to my clinical practice than the other theories noted. After reviewing the theory before selection, it was realized that this theory is used in my practice daily when assessing patients in the nursing practice of the heart hospital. Without knowing it, this theory is being utilized to give my patients the best care possible to get the patient to their optimum health.

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Analysis & Evaluation

The framework used to evaluate the theory of 21 nursing problems is Fawcett and DeSanto-Madeya’s analysis and evaluation of nursing theories (Meleis, 2012). The framework of this method requires the examination of the theory through its scope, context, content, significance, internal consistency, parsimony, testability, empirical adequacy and pragmatic adequacy as the criteria for evaluation of this theory (Meleis, 2012).

Scope

 This theory was projected to influence and direct nursing to care for patients in the hospital, but it can also be applied to patients in clinics, the community and nursing school clinical settings (McEwen & Wills, 2014). The theory has a broad scope that encompasses the nursing care for patients whether they are acutely ill, healthy or has a terminal diagnosis. Having a broad scope, in theory, gives it the ability to assist nurses in education but also in their nursing practice when it was developed and still today (McEwen & Wills, 2014).

Context

The context of this theory is clear and understandable. The theory includes the context that is all nursing related and as the central concept with the focus of patient-centered care while using nursing-centered skills (Abdellah, 1972). The theory derived from the problem-solving method that enables nurses to assist the patient in a healthier state. The downside to the theory is that the importance is nonexistent on what the patient is to achieve when the theory is used clearly. 

Content

 The content of the 21 nursing problems theory is clear and easy to follow. The content includes the list of 21 nursing problems, ten steps of how to identify the nursing problems and eleven nursing skills nursing needs to be able to identify those problems (Petiprin, 2016). All the terms defined in theory are consistent. The content focuses on the current nursing practice with the possibility of future patient problems. The content of the theory has highly concentrated nurse-centered direction which places the patient-centered context on the back burner.

Significance

 The 21 nursing problems of the theory are essential to the care nurses provide their patients. The significance of the theory is of great value since this theory remains in use today by most healthcare settings such as hospitals, clinics, nursing schools, and the community (McEwen & Wills, 2014). It can be efficiently utilized in the nursing practice to direct the nurse in their different activities in patient care. This theory can be used with all kinds of patients in the healthcare setting whether they are acutely ill, healthy, or their condition is terminal (Abdellah, 1972).

Internal Consistency

 The approach of this theory when utilized is found to function appropriately for all healthcare settings. The content and fluidity of the 21nursing problems are consistent and clear. The framework of the theory is uniform with the concept of holism by including our patients as a whole by concentrating on the emotional, sociological and physical needs of the patient (Duffy, Donnell, & Snowden, 2014).

Parsimony

 Abdellah’s theory is not parsimonious due to its clear focus and density of the contents it states. The theory affects different subjects in the nursing profession, but the prime focus is of the nursing education we provide our patients (McEwen & Wills, 2014). The theory of 21 nursing problems is broad and covers a wide range of nursing and patient-centered care guidelines that nurses can follow.

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Testability

 This theory is not able to be directly tested due to the few specified guiding relationships. It can be tested in opinion since a hypothesis can be developed from the material of the theory (McEwen & Wills, 2014). For example, it can be tested how beneficial the 21 nursing problems are when they utilize the nursing practice as compared to other nursing-centered or patient-centered models.

Empirical Adequacy

 Many healthcare settings still today utilize this theory and have had positive outcomes from it even though it was developed almost sixty years ago (Petiprin, 2016). The outcomes of using this theory are observable and accurate as it guides nurses to improve the care they provide in a well-organized and methodical manner. I use the contents of this theory in my nursing practice daily and have found that is has improved my assessment and patient-centered care skills, along with helping me gain autonomy.

Pragmatic Adequacy

The theory is used in the real world of the nursing practice when it was developed and remains in use today. The only skills or education needed to utilize this theory is that of nursing. The listed nursing problems, skills, and steps, in this theory, are clear, easy to follow and understandable to any nurse practicing patient-centered care (Duffy, Donnell, & Snowden, 2014). The theory’s content, when applied in the nursing profession, can lead to beneficial results of the patient’s health. If tested in opinion the results would show that when applying this theory to any nursing practice the results will be convincing and successful when it is followed correctly.

Conclusion

When we define nursing, I found that many can describe what it is successfully. One that stood out to me was, “nursing care is doing something for or to the patient or giving the patient information with the goals of meeting needs, increasing or restoring self-help ability, or alleviating impairments.” (Petiprin, 2016). Abdellah’s 21 nursing problems theory, skills, and steps guide nurses to achieve this. Overall this theory is one that can be used today that will still play a positive roll in the patient’s outcome. The theory is clear, concise, easy to read, understand and follow without difficulty for any nurse. The main flaw of the theory is that it has shown to be highly concentrated towards nurse-centered care which places the patient-centered context on the back burner. Abdallah’s theory has enhanced the nursing assessment and problem-solving and critical-thinking abilities required to recognize a patient’s problem and adequately formulate a nursing care plan for the patient (Alligood, 2014).

References

Alligood, M. R. (2014). Nursing theorists and their work (8 ed.). St. Louis, MO: Elsevier. Retrieved February 3, 2019

Duffy, T., Donnell, A., & Snowden, A. (2014). Faye Glenn Abdellah. In pioneering theories in nursing (p. Chapter 4). Quay Books Division.

McEwen, M., & Wills, E. (2014). Theoretical basis for nursing (4th ed.). Philadelphia, PA: Wolters Kluwer Health. Retrieved February 9, 2019

Meleis, A. I. (2012). Theoretical nursing: Development and progress (6th ed.). Philadelphia, PA: Wolters Kluwer. Retrieved February 8, 2019

Petiprin, A. (2016). 21 nursing problems by Faye Abdellah. Retrieved from Nursing Theory: http://www.nursing-theory.org/theories-and-models/Abdellah-twenty-one-nursing-problems.php

Zerwekh, J., & Garneau, A. Z. (2012). Nursing today: Transitions and trends (7th ed.). Elsevier.