Running head: GRAND THEORIST REPORT 1 7 GRAND THEORIST REPORT Grand Theorist Report Grand Canyon University: NUR 502 April 24, 2018 Grand Theorist Report There are many grand nursing theories that have helped to set the foundation for the nursing profession. Faye Abdellah was one of the first pioneers for shaping nursing as a profession using her framework for Patient-Centered Approaches to Nursing. Abdellah’s theory is easy to apply to nursing practice in a healthcare institution because her framework is readable and clear (McEwen & Wills, 2014). In addition, another rationale for implementing her theory into practice at a healthcare institution is the fact that it clearly addresses the four metaparadigms—person, environment, health, and nursing. In this paper, we will discuss the theorist Faye Abdellah, her theory on Patient-Centered Approaches to Nursing, and how this theory can be integrated into practice at a healthcare institution. Description of Theorist Faye Abdellah was born in New York City on March 13, 1919. Abdellah decided at a very young age she wanted to pursue a career in nursing. She received her original certification in nursing from Fitkin Memorial Hospital. She continued her study of nursing at Columbia University getting her BA in Nursing along with her doctorate degree, which focused on psychology and education (Dewey, 2016). Abdellah was highly influential in the profession of nursing. She was the Chief Nursing Officer and Deputy United States Surgeon General until 1993, and she was ranked as a Rear Admiral. She retired in 2000 from her last position as Dean of the Graduate School of Nursing at the Uniform Services University of Health Sciences (McEwen & Wills, 2014). As a whole, throughout her career Abdellah received many academic honors for her achievements in nursing. Her main focus was to reshape nursing as a profession by encouraging nurses to look past a physical illness or diagnosis and see “patients as people with a complex of emotional and psychological needs” (Dewey, 2016, n.p.). Clearly, this concept of looking at patients as more complex beings significantly helped to influence and shape her Patient-Centered Approaches to Nursing. Category of Theory Abdellah’s Patient Centered Approaches to Nursing is considered a grand nursing theory that is based on human needs. She believed that patients should be seen as ‘people’ who have individual unique needs that require personalized care from nurses. Furthermore, Abdellah developed her theory based on how she practiced while providing care to patients—which is what helps to make the theory highly applicable. McEwen & Wills (2014) further explain that Abdellah’s theory is applicable not only in the hospital setting, but also in the community setting. Assumptions Underlying the Theory Abdellah’s original theory did not have any stated assumptions; however, as time passed she did add the following six assumptions related to: 1) change ...

1. Running head: GRAND THEORIST REPORT
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GRAND THEORIST REPORT
Grand Theorist Report
Grand Canyon University: NUR 502
April 24, 2018
Grand Theorist Report
There are many grand nursing theories that have helped to
set the foundation for the nursing profession. Faye Abdellah
was one of the first pioneers for shaping nursing as a profession
using her framework for Patient-Centered Approaches to
Nursing. Abdellah’s theory is easy to apply to nursing practice
in a healthcare institution because her framework is readable
and clear (McEwen & Wills, 2014). In addition, another
rationale for implementing her theory into practice at a
healthcare institution is the fact that it clearly addresses the
four metaparadigms—person, environment, health, and nursing.
In this paper, we will discuss the theorist Faye Abdellah, her
theory on Patient-Centered Approaches to Nursing, and how this
theory can be integrated into practice at a healthcare institution.
Description of Theorist

2. Faye Abdellah was born in New York City on March 13,
1919. Abdellah decided at a very young age she wanted to
pursue a career in nursing. She received her original
certification in nursing from Fitkin Memorial Hospital. She
continued her study of nursing at Columbia University getting
her BA in Nursing along with her doctorate degree, which
focused on psychology and education (Dewey, 2016).
Abdellah was highly influential in the profession of nursing.
She was the Chief Nursing Officer and Deputy United States
Surgeon General until 1993, and she was ranked as a Rear
Admiral. She retired in 2000 from her last position as Dean of
the Graduate School of Nursing at the Uniform Services
University of Health Sciences (McEwen & Wills, 2014). As a
whole, throughout her career Abdellah received many academic
honors for her achievements in nursing. Her main focus was to
reshape nursing as a profession by encouraging nurses to look
past a physical illness or diagnosis and see “patients as people
with a complex of emotional and psychological needs” (Dewey,
2016, n.p.). Clearly, this concept of looking at patients as more
complex beings significantly helped to influence and shape her
Patient-Centered Approaches to Nursing.
Category of Theory
Abdellah’s Patient Centered Approaches to Nursing is
considered a grand nursing theory that is based on human needs.
She believed that patients should be seen as ‘people’ who have
individual unique needs that require personalized care from
nurses. Furthermore, Abdellah developed her theory based on
how she practiced while providing care to patients—which is
what helps to make the theory highly applicable. McEwen &
Wills (2014) further explain that Abdellah’s theory is applicable
not only in the hospital setting, but also in the community
setting.
Assumptions Underlying the Theory
Abdellah’s original theory did not have any stated
assumptions; however, as time passed she did add the following
six assumptions related to: 1) change and anticipated changes

3. that impact the nursing profession, 2) the importance of how
social enterprises and social problems are related, 3) how
poverty, racism, pollution, education, etc. impact health and
health care delivery, 4) changes in nursing education, 5)
continuing education for nurses, and 6) development of nursing
leaders (McEwen & Wills, 2014).
In addition, it is important to clearly define the
metaparadigm concepts/assumptions underlying the theory as
well. Abdellah’s Patient-Centered Approaches to Nursing is all
encompassing, and the metaparadigms addressed in the theory
are related to person, environment, health, and nursing.
Person
Person is defined as the patient needing care. McEwen &
Wills (2014) explain that Abdellah’s theory views the patient as
the “individual who needs nursing care and who is dependent on
the health care provider” (p. 141). When using Patient-Centered
Approaches to Nursing, it is important to know that Abdellah
emphasized the significance of individualized care and knowing
the person’s needs.
Environment
When using Abdellah’s theory, it is important to know that
the environment from the patient’s standpoint is interconnected
to include not only the physical environment, but also external
factors that impact the patient such as social problems, poverty,
racism, etc. These are all factors within the environment that
affect the health of patients and how they approach health care
delivery (McEwen & Wills, 2014).
Health
Health can be viewed as a better state of being. The
purpose of Abdellah’s theory is to identify problems that are
negatively impacting patients and eliminating these problems.
Later we will discuss Abdellah’s 21 Nursing Problems and
nursing’s responsibility to identify these problems.
Nursing

4. Nursing is considered “a service to individuals and
families to society, which helps people cope with their health
needs” (McEwen & Wills, 2014, p. 141). Nursing is expected to
identify nursing problems and work collaboratively with the
healthcare team to ensure that patients get desired outcomes.
Major Concepts of the Theory
The major concepts related to Abdellah’s theory involve
using ten steps to identify and develop treatment to nursing
problems related to patients. Abdellah explains that there are 21
basic nursing problems related to patients, and it is important
for nurses to know these identified nursing problems so they
can use them while trying to identify what needs to be the plan
of care. Below is an abbreviated version of Abdellah’s 21
Nursing Problems.
Abdellah’s 21 Nursing Problems
Maintenance of Hygiene and Comfort
Recognition of physiological responses to conditions
Maintenance of Nutrition for Body Cells
Promotion of activity, exercise, rest, etc.
Maintenance of normal body functions
Achievement of spiritual goals
Promotion of Safety
Appropriate sensory function
Maintenance of Therapeutic Environment
Maintenance of Proper Body Mechanics
Identification and acceptance of positive and negative expressed
and reacting appropriately
Awareness of physical, emotional, and developmental needs
Appropriate Oxygenation

5. Understand relationship between emotions and illness
Acceptance of optimal goals despite physical & emotional
limitations
Appropriate Elimination
Maintenance of appropriate verbal and nonverbal
communication
Willing to use community resources
Maintenance of Fluid & Electrolyte Balance
Development of positive interpersonal relationships
Recognition that social problems impact illness
(McEwen & Wills, 2014)
Clearly, it is very important to know the 21 Nursing
Problems because these are the problems nurses must link to
their findings while using the ten steps for identification and
development of a nursing care plan. The ten steps build upon
each other from learning about the basics of a patient, then
getting more specific to identify the exact nursing problem(s)
that need to be addressed. Below are the ten steps that nurses
must follow to successfully develop a plan of care and reach
expected patient outcomes.
Ten Nursing Skills to Identifying Problems & Developing a
Treatment Plan
1. Get to know the patient
6. Validate conclusions with patient
2. Define relevant and irrelevant information
7. Observe and Evaluate Patient
3. Develop generalizations
8. Evaluate patient & family reaction to plan— incorporate
family in care if possible
4. Identify a therapeutic nursing plan
9. Nursing’s perception of patient’s problems

6. 5. Test generalizations and modify plan if needed
10. Discuss & develop a nursing care plan
(McEwen & Wills, 2014)
Understanding how to use the 21 Nursing Problems along with
the Ten Nursing Skills is important for nurses to grasp in order
to see the full potential of this nursing theory for patients. Each
of the Ten Nursing Skills needs to be followed so nurses can
individualize care plans and work collaboratively with the
patient and family to improve the patient’s state of health.
Major Propositions
The major proposition of Abdellah’s theory focuses on looking
at the patient as a human being, not an illness. While her
theory touches on many factors, it primarily focuses on patient
centered care (McEwen & Willis, 2014). Due to its broad
nature, it is testable in principle such as patient satisfaction and
nursing care.
How has it been used?
In the past, Abdellah’s theory has been used in nursing
education and nursing research. In nursing education, her
theory has been used to organize lectures and curricula by
categorizing nursing problems based on the patient’s needs and
developing a classification of nursing skills and treatment
(McEwen & Willis, 2014). Abdellah’s nursing theory has also
been used in research such as patient-centered approach to
nursing, evolution of nursing, perspectives on nursing theory,
public policy impacting on nursing care of older adults, and
preparing nursing research for the 21st century to name a few
(McEwen & Willis, 2014).
Action Plan
It would behoove this institution to adopt Abdellah’s theory as a
foundation of practice. The following action plan could be used
as daily practice for all nurses to not only hone their critical
thinking skills, but to also give more person centered care
(PCC). PCC is important and has been a focus for many
healthcare institutions for years. In 1969, Edith Balint
described person centered care as “understanding the patient as

7. a unique human being” (Santana et al., 2017, p. 430). Many
healthcare systems are adopting a PCC to help gauge high
quality care.
This action plan would focus around the Person-Centered
Nursing (PCN) Framework developed by McCormack and
McCance. The PCN Framework comes from research focusing
on PCC with older people and the experience of caring in
nursing (McCance, McCormack, & Dewing, 2011). The PCN
Framework is comprised of four steps.
The first is prerequisites, which focuses on the professional
competence of the nurse and his or her commitment to their job.
The nurse needs to be able to demonstrate their beliefs and
values and know himself or herself before they can move on.
The second step is the care environment. This includes if the
nurse and the service line are an appropriate fit, making sure the
nurse is equipped with the skills and the knowledge to take care
of patients. It is important that the heath care system is
organized and can offer a supportive system for its employees
so that they can safely deliver patient care and have effective
relationships with one another. Third is person-centered
process, which can be thought of as one of the most important
steps. This step includes care that is focused on cultural
competence, employee and patient engagement, staff being
present, and providing holistic care. The fourth and final step
is outcomes. This is known as the central component of the
PCN Framework and where we can tie it all together. This
includes patient and nurse satisfaction, feeling of well being,
and obtaining a therapeutic work environment (McCance et al.,
2011).
Integration
A PCC Team would need to come together to develop current
data within their hospital. Data would include patient
satisfaction scores, nurse satisfaction scores, readmission rates,
and a basis of patient-centered care knowledge among nurses by
developing a questionnaire for them to fill out. The PCC Team
would them form a class for all currently employed nurses with

8. an in depth explanation of the PCN Framework and what each
step includes. Role-playing and case studies could be used in
order to help staff put PCC into play in a practice setting. This
portion would be integral to the roll out of PCC because it helps
nurses to see the importance of person-centered care within
their own healthcare setting and would help them to deliver
higher quality care (McCance et al., 2011). Once staff is
completely trained, leaders will be able to put the PCN
Framework into action. According to McCance et al., “using
the Framework ‘in action’ within the workplace as a tool to
evaluate care during handovers or during analysis of critical
events, both positive or negative; and using the Framework to
assess the experience of patients being cared for in each site”
(para. 17) we can evaluate the outcomes listed previously:
patient satisfaction scores, nurse satisfaction scores, and
readmission rates. It would be important to reevaluate the
nurses after one year with the same questionnaire that was
handed out at the beginning of the PCN Framework roll out.
The PCC Team would be able to assess their effectiveness in
delivering the information and the data from the satisfaction
scores and readmission rates would give them the ability to
verify how well the PCN Framework works.
After data is collected, the PCC Team would move forward
in presenting the information to all new hire nurses and
developing a curriculum for preceptors to be able to teach the
PCN Framework and to help to develop new nurses within it. It
would be important to continue with the PCC knowledge
questionnaire so the PCC Team can continue to evaluate the
efficiency of their team. After one year of new hire education,
the team will then collect satisfaction scores and readmission
rates to submit to the Board of Directors for the healthcare
institution so that the PCN Framework can be presented as a
standard of practice in all hospitals within the healthcare
institution.
In conclusion, health care costs are rising at an exponential
level and due to this rise; patients and their insurance

9. companies are expecting higher-grade care. Nursing as
profession needs to move towards a more patient centered
approach. Without this approach, nursing is just assumed to be
medicine and patients will continue to feel that they have no
place in their care team. Currently, patients are being told what
medications they should take, when they should take it, and who
will be overseeing their care. In order to reduce readmission
rates and subsequently cut costs, patients need to have ample
say in their treatment plan and should be able to have open
conversations with their caregivers about how they feel about
their illness and their plan of care. If they feel their nurses are
competent in their skills and that they truly care about their
wellbeing, patients will feel safer and more willing to speak up
when they do not understand something and will trust in their
care plan to continue it after discharge, thus reducing their risk
of readmission.
References
Dewey, J. P. (2016). Faye Abdellah. Salem Press Biographical
Encyclopedia. Retrieved from
http://eds.b.ebscohost.com.lopes.idm.oclc.org/eds/detail/detail?
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WxpdmUmc2NvcGU9c2l0ZQ%3d%3d#AN=113931050&db=ers
McCance, T., McCormack, B., & Dewing, J. (2011, May 2). An
exploration of person-centeredness in practice. The Online
Journal of Issues in Nursing, 16.
http://dx.doi.org/10.3912/OJIN.Vol16No02Man01
McEwen, M., & Willis, E. M. (2014). Theoretical Basis for
Nursing (4 ed.). Philadelphia: Lippincott Williams & Wilkins.
Santana, M. J., Manalili, K., Jolley, R. J., Zelinsky, S., Quan,
H., & Lu, M. (2017, September 30). How to practice person-
centred care: A conceptual framework. Health Expectations,
429-440.
http://dx.doi.org/http://dx.doi.org.lopes.idm.oclc.org/10.1111/he
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