Dr. Faye Abdellah's theory of Twenty-One Nursing Problems has played a large part in
transforming nursing education and practice. It focuses on patient centered care rather
than disease centered care and is considered a human needs theory.
Dr. Abdellah began developing her nursing theory while she was an instructor at the
Yale University School of Nursing in the late 1940s. She and her students were very
dissatisfied with the nursing text that she was required to use, 120 Principles of
Nursing Practice, a curriculum guide published in 1937 by the National League for
Nursing. In fact, she was so dissatisfied that she burned the books. She found no
scientific basis for the principles and said that she spent the rest of her life
undoing that teaching because it inspired her to research and pursue scientific facts
for nursing practice.
The Twenty-One Nursing Problems theory is quite detailed and was an early example of
what is now used as nursing diagnoses by the North American Nursing Diagnosis Association.
She spoke of the nursing diagnosis at a time when diagnosis was thought to be outside
the scope of nursing. She felt that nursing was comprehensive and included many different
Services of Nursing
- Recognizes the patients' problems
- Decides on courses of action that are compatible with nursing principles
- Provides continuous care for patients' needs
- Relieves pain and discomfort and provides security for patients
- Adjusts nursing care plans to meet each patient's needs
- Helps patients become self-sufficient in reaching or maintaining health in mind and body
- Teaches others to help patients become self-directing within their capabilities
- Helps patients accept their limitations and overcome emotional problems
- Works with other health professionals to improve health on local, state, national and international levels
- Evaluates and researches nursing techniques to improve the health care of all people
In addition to creating the theory of Twenty-One Nursing Problems, Abdellah developed
a list of 10 steps to identify patients' problems and 11 steps to be used in creating
a care plan.
- Nurses anticipate changes that affect nursing.
- Social services and social problems are interconnected.
- The delivery of health care is impacted by education, poverty, racism, pollution and other problems.
- Nursing education must constantly evolve.
- Professional nurses need continuing education.
- Nursing leaders must come from underserved groups.
Ten Steps to Identify Patients' Problems
- Meet and get to know patients
- Evaluate important and pertinent data
- Make generalizations based on data from other patients with similar nursing problems
- Identify the therapeutic plan
- Assess the generalizations and make additional generalizations if needed
- Ask for patients' evaluations of their nursing problems
- Identify attitudes that may affect patients' behaviors
- Involve patients and their families in the nursing care plans
- Discover how the nurses feel about the patients' nursing problems
- Develop an inclusive nursing care plan
Eleven Nursing Skills
- Observe the health status of patients
- Communicate effectively with patients
- Apply knowledge
- Teach patients and families
- Plan and organize work
- Use resource materials
- Use personnel resources
- Solve problems
- Teach and direct work of others
- Use self as a therapeutic tool
- Perform nursing procedures with skill
The 21 nursing problems are divided into three major categories.
- Problems common to all patients
- Physical, psychological and sociological needs of patients
- Interpersonal relationships between nurses and patients
Basic to All Patients
- Maintaining physical comfort and good hygiene
- Promoting an optimal level of exercise, rest and sleep
- Preventing the spread of infection and preventing accidents and injury
- Maintaining optimal body alignment to prevent and correct deformities
- Facilitating oxygen supply throughout the body
- Facilitating and maintaining elimination
- Maintaining fluid and electrolyte balance
- Recognizing body responses to disease
- Facilitating the maintenance of regulatory functions
- Facilitating the maintenance of sensory function
- Discovering and validating patients' positive and negative emotions and reactions
- Realizing the correlation between emotions and illness
- Facilitating and maintaining verbal and nonverbal communication
- Promoting effective interpersonal relationships
- Facilitating the achievement of patients' spiritual growth
- Creating and maintaining a healing environment
- Facilitating patients' awareness of selves as individuals with unique physical, emotional and social needs
There are four major concepts of Abdellah's theory.
- Accepting the best possible outcomes while taking into account the patients' limitations
- Using community support to help resolve problems
- Understanding the role that social problems play in illness
- Nursing is a caring and helping profession.
- Nursing provides care or information to people with the purpose of meeting their needs, restoring self-sufficiency and relieving impairment.
- The 21 problem areas act as a guide for nursing and promote nursing judgment.
- Nursing is a comprehensive profession.
- All people have physical, psychological and social needs.
- People are the only reason for nursing.
- Patients and their families benefit from nursing.
- Nursing services help people achieve and maintain health.
- Health is a state without illness.
- Nursing is a comprehensive service that addresses all health needs.
Society and Environment
Dr. Abdellah's theory interconnects health concepts with nursing problems and solutions.
The problem solving is logical, based on scientific principles and is easy to use. Its
structure focuses on patients and nursing practice. Testing and interpretation of the
theory contribute to the knowledge of nursing.
The Twenty-One Nursing Problems theory provides nurses with a solid, scientific base
with which to practice nursing. It uses the problem solving approach to fulfilling
the health needs of all patients and provides the basis for shaping and organizing
- The focus of nursing is the individual patient, but society is included in the total care plan.
- The patient's environment is his or her home or community.
Publications related to the Twenty-One Nursing Problems
- Preparing Nursing Research for the 21st Century: Evolution, Methodologies, Challenges
- Better Patient Care through Nursing Research
- Patients and personnel speak: A method of studying patient care in hospitals
- Abdellah, Faye G. Nursing's Role in the Future: The Case for Health Policy Decision Making
- Abdellah, Faye G. and Moore, Stephen R. Background Papers
- Abdellah, Faye G. Overview of Nursing Research
- Abdellah, F.G., Beland, I.L., Martin, A. and Matheney, R.V. Patient-centered Approaches to Nursing
- Nursing Theories: The Base for Professional Nursing Practice (6th Edition)