Guest Contributor: Erica Agudo
PhD Student, Texas Women’s University

Patient-centered care has been a “buzzword” in healthcare for at least a decade. Consumer-driven ideas such as convenience and patient experience have forced hospitals to develop new and creative ways to make the patient experience truly personalized to increase patient satisfaction scores. The Centers for Medicare and Medicaid Services (CMS) have incorporated quality and patient satisfaction metrics into the Hospital Consumer Assessment of Healthcare Providers and Systems survey or HCAHPS scores, directly affecting payment and reimbursement with the value-based purchasing model. At the same time, hospital census levels are increasing, with many nurses now exiting the profession. This leads to growing nurse-patient ratios and nurses having less time to apply truly individualized patient care. When Faye Abdellah (1960) developed her Patient-Centered Nursing Theory or 21 Problems Theory, she created a road map for nurses to follow to provide care to help patients achieve a state of health from hospitalization to post-hospitalization. She classified her theory as a human needs theory to influence and aid in the education of nurses. As she derived her 21 problems from Maslow’s hierarchy of needs, it was her belief that nurses could identify patient problems and use creative problem-solving to help patients achieve that healthy balance through what we now know as the entire nursing process: assessment, nursing diagnosis, planning, implementation, and evaluation.

Abdellah wanted to shift the pendulum in patient care from disease-centered to nursing-centered, with the patient falling right in the middle of that pendulum so that they could function at their fullest level possible. Individualized care is essential to the continuity of care from hospitalization to post-acute care. As Abdellah and others made revisions to her theory over time, she intended for the theory to be applied in acute care settings within community care. But is her theory really being used within acute care settings?

A quick literature search using the databases “CINAHL” and “Academic Search Complete” only returns two articles where Abdellah’s theory was used in practical nursing specifically by name. First, a case study by Mehraeen et al. (2020) applied the theory directly in designing a care plan for a patient. The authors noted they could use the theory to form a framework to assess and diagnose the patient’s problems and improve patient experience and care. The second article by dos Santos et al. (2011) applied Abdellah’s theory to the nursing process in the pediatric patient population. On a positive note, the authors felt that using the theory allowed them to form stronger bonds with patients, and the theory worked as a strategy to collect data on their lives and health conditions. However, the authors noted a time barrier in applying the theory in direct acute care settings, as they only had an average of 40 minutes to interact with patients. Abdellah’s theory has many steps, which could be a real challenge in using the theory in care settings when nurses are overworked and pressed for time.

Patient-centered care has taken on an entirely new meaning in healthcare from what Abdellah had initially intended. In 2001, the Institute of Medicine defined the concept of patient-centered care as a way for healthcare providers to “identify, respect, and care about patient differences, values, preferences, and expressed needs.” Metrics from the HCAHPS survey, such as how quiet the environment was and if your healthcare provider adequately discussed medication side effects with you, pull patient-centered metrics to the view of patient experience versus individual care treatment and plans derived from nursing assessment. A hospital stay could be compared to a vacation stay in a hotel.

When considering nursing theory in terms of patient-centered care, theories other than Abdellah’s come to mind. Theories such as Watson’s Theory of Human Caring, Roy’s Adaptation Model, and Leininger’s Transcultural Nursing Theory all incorporate concepts of nurses building collaborative and nurturing relationships with patients where patients feel valued, and considerations are made to create care plans that include interventions honoring patient culture and beliefs. This ensures that nurses provide holistic and beneficial patient care while targeting those ideals in the new definition of patient-centered care.

So does this mean that the concept of patient-centered care has evolved into an entirely new concept within modern day healthcare? With issues such as time constraints in patient care, is Abdellah’s theory still relevant to nursing instruction, and does it influence practical nursing application once nurses enter the workforce? How do we honor Abdellah’s contributions to nursing theory in today’s healthcare landscape to impact nursing instruction and care?

References

dos Santos, D. F. V., e Silva, L. D. G., dos Reis, L. M., Tacla, M. T. G. M., & Ferrari, R. A. P.
(2011). Application of Abdellah’s Theory in a nursing process in pediatrics: an experience report. Ciencia, Cuidado e Saude, 10(2), 353–358.

Institute of Medicine. (2001). Crossing the quality chasm: A new health system for the 21st
century. Washington, DC: National Academy Press.

Mehraeen, P., Nazarpour, P., & Ghanbari, A. (2020). Designing a Nursing Care Plan Based on
Faye Glenn Abdellah Model in Patients with Diabetes Type 2: A Case Study. International Journal of Caring Sciences, 13(3), 2250-2260.

About Erica Agudo

Erica has been a nurse since 2007 and has practiced throughout various areas of nursing including the Operating Room, Regulatory and Accreditation and now as a Nursing Supervisor in Utilization Review. She is a current student in the PHD in Nursing program at Texas Woman’s University and is passionate about bringing awareness and advancing health outcomes in the Gastroparesis patient population as she also suffers from the disorder.