The Twenty-One Nursing Problems Theory was developed by Faye Glenn Abdellah. Her
model of nursing was progressive for the time in that it refers to a nursing diagnosis
during a time in which nurses were taught that diagnoses were not part of their role in
There are specific characteristics identifiable in the Twenty-One Nursing Problems.
The theory has interrelated the concepts of health, nursing problems, and problem-solving.
Problem-solving is an activity that is inherently logical in nature. The framework focuses
on nursing practice and individual patients.
The twenty-one nursing problems identified in the nursing theory are comprised of
ten steps used to identify the patient's problems and eleven skills used in developing
a treatment typology or nursing care plan.
The ten steps to identify the patient's problems are:
Learn to know the patient
Sort out relevant and significant data
Make generalizations about available data in relation to similar nursing problems presented by other patients
Identify the therapeutic plan
Test generalizations with the patient and make additional generalizations
Validate the patient's conclusions about his nursing problems
Continue to observe and evaluate the patient over a period of time to identify any attitudes and clues affecting his behavior
Explore the patient's and family's reaction to the therapeutic plan and involve them in the plan
Identify how the nurses feel about the patient's nursing problems
Discuss and develop a comprehensive nursing care plan
The eleven nursing skills in the theory are:
observation of health status
skills of communication
application of knowledge
teaching of patients and families
planning and organization of work
use of resource materials
use of personnel materials
direction of work of others
therapeutic use of the self
The twenty-one nursing problems fall into three categories: physical, sociological,
and emotional needs of patients; types of interpersonal relationships between the
patient and nurse; and common elements of patient care.
The needs of patients are divided into four categories: basic to all patients, sustenal
care needs, remedial care needs, and restorative care needs.
Needs that are basic to all patients are to maintain good hygiene and physical comfort;
promote optimal activity, including exercise, rest and sleep; promote safety through the
prevention of accidents, injury or other trauma and through the prevention of the spread
of infection; and maintain good body mechanics and prevent or correct deformity.
Sustenal care needs facilitate the maintenance of a supply of oxygen to all body cells;
facilitate the maintenance of nutrition of all body cells; facilitate the maintenance of
elimination; facilitate the maintenance of fluid and electrolyte balance; recognize the
physiological responses of the body to disease conditions; facilitate the maintenance of
regulatory mechanisms and functions; and facilitate the maintenance of sensory function.
Remedial care needs identify and accept positive and negative expressions, feelings,
and reactions; identify and accept the interrelatedness of emotions and organic illness;
facilitate the maintenance of effective verbal and non-verbal communication; promote the
development of productive interpersonal relationships; facilitate progress toward achievement
of personal spiritual goals; create and maintain a therapeutic environment; and facilitate
awareness of the self as an individual with varying physical, emotional, and developmental
Restorative care needs include the acceptance of the optimum possible goals in light of
limitations, both physical and emotional; the use of community resources as an aid to
resolve problems that arise from illness; and the understanding of the role of social
problems as influential factors in the case of illness.
According to the Twenty-One Nursing Problems model, patients are described as having
physical, emotional, and sociological needs. People are also the only justification
for the existence of nursing. That is, without people, nursing would not be a profession
since they are the recipients of nursing.
Patient-centered approaches to nursing health are described as a state mutually exclusive
of illness. Abdellah does not provide a definition of health, but speaks to "total health
needs" and "a healthy state of mind and body" in her description of nursing.
In this nursing model, society is included in "planning for optimum health on local, state,
national, and international levels." However, the focus of nursing is the individual. The
environment is the home or community from which the patient comes.
Nursing is a helping profession. 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. The role of the nurse is to help the
patient achieve goals to reach optimum health.
Abdellah explained nursing as a comprehensive service, which includes:
Recognizing the nursing problems of the patient
Deciding the appropriate course of action to take in terms of relevant nursing principles
Providing continuous care of the individual's total needs
Providing continuous care to relieve pain and discomfort and provide immediate security for the individual
Adjusting the total nursing care plan to meet the patient's individual needs
Helping the individual to become more self-directing in attaining or maintaining a healthy state of body and mind
Instructing nursing personnel and family to help the individual do for himself that which he can within his limitations
Helping the individual to adjust to his limitations and emotional problems
Working with allied health professions in planning for optimum health on local, state, national, and international levels
Carrying out continuous evaluation and research to improve nursing techniques and to develop new techniques to meet people's health needs
The twenty-one problems can be applied to the nursing process. In the assessment phase,
the nursing problems provide guidelines for data collection. The results of data collection
determines the patient's specific problems, which leads to the nursing diagnosis. The
statements of nursing problems resemble goal statements, so once the patient has been
diagnosed, nursing goals have already been established. The goals can be used as a
framework to develop a plan and nursing interventions. In terms of evaluation, the
nurse's progress or lack of progress toward the achievement of stated goals is the
appropriate evaluation. The theory provides a basis for determining and organizing
nursing care, as well as a basis for organizing nursing strategies.