Designing a Nursing Care Plan Based on Faye Glenn Abdellah Model in Patients with Diabetes Type 2: A Case Study

Abstract

Background: Faye Abdullah's theory is simple and mainly focused on solving patients' problems and has used the theories of Henderson, Maslow, and Erikson in its initial form. Considering the main focus of this theory; it can be applied in different parts. Aim: This study aimed at assessing patients' problems and developing a care plan for patients with diabetes based on Abdullah's model. Methodology: The present study is a case study that investigated the nursing process in the patients with diabetes based on Faye Abdullah's model. Result: Implementing the nursing process in form of this theory, the intended purposes were achieved. Nursing functioning in form of Faye Abdullah's theory contributed to improvement of nursing care. This theory appeared to make a proper framework to diagnose the nursing problems.

Headnote

Abstract

Background: Faye Abdullah's theory is simple and mainly focused on solving patients' problems and has used the theories of Henderson, Maslow, and Erikson in its initial form. Considering the main focus of this theory; it can be applied in different parts.

Aim: This study aimed at assessing patients' problems and developing a care plan for patients with diabetes based on Abdullah's model.

Methodology: The present study is a case study that investigated the nursing process in the patients with diabetes based on Faye Abdullah's model.

Result: Implementing the nursing process in form of this theory, the intended purposes were achieved. Nursing functioning in form of Faye Abdullah's theory contributed to improvement of nursing care. This theory appeared to make a proper framework to diagnose the nursing problems.

Key words: clinical skill_ theory-clinical gap _ Faye Abdellah Theory _ nursing theory-guided practice _ nursing theory

Introduction

Diabetes is a chronic progressive disease that causes physical, social and psychological challenges, which in turn increases the risk of mental problems (Uchendu and Blake, 2017). The number of diabetes patients has increased four times in the last three decades, and diabetes mellitus is the ninth leading cause of death(Zheng et al., 2018). According to the International Diabetes Organization, the number of people with diabetes has risen from 151 million in 2000 to 415 million in 2015 and is estimated to be 642 million by 2040(Namayandeh et al., 2019). The statistics in Iran show that 4.5 million adults suffered from diabetes in 2011 and it is estimated to be 9.2 million by 2030(Esteghamati et al., 2017).

Nursing, like other sciences, is at the beginning and nurses, like other professions, need theories(Ghanbari, 2004). Increased influence of nursing as a field of study has caused interest in explaining nursing science based on new theories. One of the persistent problems in nursing is a weakness in clinical observations and accurate data collection. Use of nursing theories and models is limited since these models are abstract (Rolfe, 1993). Remarkable advances in the nursing profession led to growing evidenceand theory-based functioning and knowledge and commitment for care, based on these principles, provide the patients with better and more comprehensive care. Theory contributes to categorize nursing functioning in the clinic, description, explanation, and predicting the patients' responses to clinical care and decisionmaking(Alligood, 2017, Alligood, 2018). Using the nursing theories results in achieving therapeutic goals and continue treatment and improving the quality of life in patients with diabetes (Araújo et al., 2018).

The nurses in the internal and surgical wards usually care from various kinds of people and are obliged to provide comprehensive care to them(Ahmad et al., 2015). Nursing functioning as a theory contributes to improve the quality of nursing care(Y ounas and Quennell, 2019).

Management of a chronic disease including diabetes needs consistent follow-up and care as well as a skilled and specialist team(Molayaghobi et al., 2019). Therefore, this study aimed at using a theory for further care examinations.

Definition of theory

Abdellah's theory was derived from Henderson's theory; it is, in fact, the extension of Henderson's 14 basic human needs. However, Abdellah used a problem-solving approach to solve the nursing problems. In developing her theory, she used Maslow's hierarchical needs theory and Erikson's development theory. Her "21 nursing problems theory" was formulated as a scientific theory and differentiated between the nursing model and medical model in nursing education. Abdellah identified 21 problems to maintain or attain physical, psychological, and social balance of patients. Moreover, the needs of patients are further divided into four categories: physiologic, safety, love and belonging (emotional), selfactualization needs, derived from Maslow's pyramid hierarchy of needs.

This theory is a patient-centered theory in which nurses have a key role in identifying and solving problems. As mentioned, the nurse, in this theory, is expected to help patients to meet their needs through problem-solving method. It is determined after examining the patients' conditions and the nature and severity of the problem(Hojjati, 2015). Abdullah believes that this theory has various applications in education and can be used, in addition to clinical settings, in the society and is focused mainly on solving patients' problems. She considers philosophy, purpose, functioning and art as four basic elements of nursing and argues that clinical nursing is the art of helping, which identifies and meets patients' needs through various ways. She used Orlando's theory as well(McEwen and Wills, 2011).

Abdellah's school of thought was based on needs. Her theory falls into three main categories: health, nursing problems and problem solving. She viewed nursing as an art and science, which helps individuals, cope with their health needs through different aspects. She defined health as the dynamic pattern of functioning whereby there is a continued interaction with internal and external forces. Problem may be overt or covert addressed by the patient or his/her family and can be solved by the nurse. Overt nursing problems are conditions by which the patient or his/her family is faced, of which physical problems are more evident and nurses can solve them via professional functioning. Covert nursing problems include mostly social and psychological problems and the conditions that can be identified by the nurse through patient assessment, communication skills, and interaction with the patient. Problem solving process involves identifying the problem, collecting data and formulating hypotheses, testing hypotheses through the collection of data and revising hypotheses when necessary(Bhaskara Raj, 2011, Hojjati, 2015).

Abdellah's 21 Nursing Problems are the following:

1. To maintain good hygiene and physical comfort

2. To promote optimal activity: exercise, rest, sleep

3. To promote safety through prevention of accident, injury, or other trauma and through prevention of the spread of infection

4. To maintain good body mechanics and prevent and correct deformity

5. To facilitate the maintenance of a supply of oxygen to all body cells

6. To facilitate the maintenance of nutrition for all body cells

7. To facilitate the maintenance of elimination

8. To facilitate the maintenance of fluid and electrolyte balance

9. To recognize the physiologic responses of the body to disease conditions-pathologic, physiologic, and compensatory

10. To facilitate the maintenance of regulatory mechanisms and functions

11. To facilitate the maintenance of sensory function

12. To identify and accept positive and negative expressions, feelings, and reactions

13. To identify and accept interrelatedness of emotions and organic illness

14. To facilitate the maintenance of effective verbal and nonverbal communication

15. To promote the development of productive interpersonal relationships

16. To facilitate progress toward achievement and personal spiritual goals

17. To create or maintain a therapeutic environment

18. To facilitate awareness of self as an individual with varying physical, emotional, and developmental needs

19. To accept the optimum possible goals in the light of limitations, physical and emotional

20. To use community resources as an aid in resolving problems that arise from illness

21. To understand the role of social problems as influencing factors in the cause of illness

A Case Study

A 34-year-old female patient with the height of 169 cm and weight of 75 kg and BMI: 26.3 kg/m2 referred to Poursina Hospital in the city of Rasht. She was married and had no children. She had no previous hospitalization and surgery. She was no longer employed since the company she was working in had been closed and spent her free time at gym and reading books. She slept at nights for 8 hours and rarely sleeps in the day. Her defecation pattern was changed (1 time a day) and suffered from constipation.

She referred to the Hospital because of pain around her navel and side. She said that the pain was too intense and was even more severe when she lied down and nothing could relieve it. She also said that her pain was 6, based on the VAS. She had nausea and severe diarrhea, fever, chills, and headache. She first referred to Baharlu Hospital in Tehran and was diagnosed with appendicitis, but since she lived in Rasht, she was transferred to Poursina Hospital in Rasht under her consent. Further examinations showed two cysts in her right ovary, which were removed by appendectomy. She was not allowed discharge due to constipation and high WBC. She had a history of type 2 diabetes, anemia, measles for twice (in childhood and adolescence) and allergy in childhood. She had no history of diseases in the family other than her mother had diabetes.

The patient was asked the 21 Abdellah's problems through prominent nursing models such as those of Henderson, Maslow, and Erikson, as well as examining the texts of the designed questions. The physical examinations of the related systems were conducted (Bickley and Szilagyi, 2017)and finally, appropriate diagnosis and measures were written when necessary(Diagnoses, 2017).

List of diagnoses in terms of priority

Diagnosis 1: pain in the operated area (physical domain) associated with: tissue injury and muscle reflex spasm caused by the surgery.

Goal: the patient shows the signs of pain relief such as: expressing no pain/ disappearing the compression state of the face and body / participating in personal activities/ keeping the patient's vital signs within normal range (T=36°C RR=18/min PR=78/min BP=120/80mmhg).

Measures: examining the patient's usual responses to pain/ examining nonverbal symptoms of pain/ asking the patient about the quality, location, and distribution of pain/ examining the exacerbating or improving factors/ doing activities to relive pain, such as back massage and changing the position, and training relaxation techniques including deep breathing, distraction, positive visualization, and music therapy(Diagnoses, 2017).

Diagnosis 2: constipation (physical domain) associated with: reduced gastrointestinal motility due to reduced activity/ decreased liquid intake/ reduced intake of high fiber foods/ suppressing the excretion reflex due to unwillingness to excrete in bed.

Goal: returning to her natural excretion pattern (once a day).

Measures: routine exercise training (Kegel) to strengthen abdominal muscles/ increasing activity level based on tolerance/ encouraging the patient to excrete when needed/ helping the patient to go to bathroom/ keeping privacy at excretion/ drinking enough liquid / including high fiber foods in her diet(Diagnoses, 2017).

Diagnosis 3: anxiety (psychological domain) associated with: lack of enough information about diagnostic and treatment methods/ impact of disease on her lifestyle and the patient's role/ severe pain/ costs of treatment.

Goal: expressing reduction of fear and anxiety by the patient/ disappearing the compression state of face and body and feeling calm/ natural color of skin/ normal vital signs.

Measures: learning relaxation techniques such as deep breathing, distraction, and positive visualization/ educating the patient's close people how to support her/ encouraging the patient to accept the fears and anxiety and provide appropriate feedback/ assuring the patient that nurses are always available/ communicating in a secure manner and respecting the principle of confidentiality(Diagnoses, 2017).

Diagnosis 4: problem in physical activities (physical domain) associated with: pain, weakness and fatigue/ sleep disorder and problems in resting/ unwilling to do activities due to fear of falling/ having surgical wound.

Goal: having maximum physical activities, considering the limitations of treatment and surgery methods.

Measures: studying restrictive factors of physical activities/ adjusting rest-activity period/ encouraging the patient to participate in doing activities and self-care as much as she can tolerate/ asking the patient companions to help her walk/ doing isometric activities(Diagnoses, 2017).

Diagnosis 5: sleep pattern disorder (psychological-physical domain) associated with: fear and anxiety/ environmental noise/ unfamiliar environment/ pain/ reduced physical activities.

Goal: sleeping enough/ feeling lively after waking up/ not yawning frequently.

Measures: examining symptoms and signs of sleep disorder/ observing behavioral changes such as irritability and lethargy/ meeting the basic needs such as hunger, thirst, and excretion before going to bed/ reducing fear and anxiety/ minimizing noise and extra activities(Diagnoses, 2017).

Diagnosis 6: probability of infection (physical domain) associated with: reduced intake of liquid / diabetes/ surgery/ using urinary catheter.

Goal: disappearing the symptoms of infection.

Measures: examining the signs and symptoms of infection, such as increased temperature, chills, increased respiratory rate, increased white blood cell count, urine turbidity and odor, and informing the physician if the symptoms of infection are observed(Diagnoses, 2017).

Diagnosis 7: probability of injury and trauma (physical domain) associated with: weakness and fatigue/ sensory-motor disorder/ sedative effects.

Goal: preventing injuries caused by falling down the bed.

Measures: examining the patient in terms of probable risk of injury/ availability of alarms/ taking the extra things out of the room/ avoiding activities that require muscle strength(Diagnoses, 2017).

Diagnosis 8: disorder in skin and tissue (physical domain) associated with: surgical incision/ delay in wound healing due to decreased blood flow to the wound/ improper nutrients and vitamin deficiency/ irritation of skin due to the use of skin glue/ long pressure on the tissue due to reduced activity/ reduced liquid volume/ inadequate tissue oxygenation.

Goal: maintaining the health of skin, healing the wound through a normal process such that no red spots or inflammation can be seen on the surface of skin/ absence of any skin damage/ gradual reduction of red spots and inflammation of the wound/ forming granulation tissue on the surface of the wound/ smooth edges of the wound.

Measures: reporting signs and symptoms of disorder in wound healing process, such as redness and inflammation around the wound, pallor and necrosis of the wound and separation of the wound edges/ reporting the signs and symptoms of skin irritation/ cleaning the skin around the wound and changing the dressing on the wound(Diagnoses, 2017).

Results: this care plan was conducted within two working days since the patient was discharged after two days of hospitalization. Conducting the nursing care, the patient's anxiety and fear were reduced and she reported that her sleep pattern had improved and she could return to her normal excretion pattern. After training, the patient was asked to briefly describe the trainings; the information feedback evidently showed the patient's increased awareness. The patient was more careful about taking daily liquids and foods and her blood glucose level returned to normal level in the second day.

Conclusion: Nursing functioning as a theory contributes to improving the quality of nursing care. This theory can provide an appropriate framework to recognize nursing problems. Discharge of the patient after two days was one of the limitations in this study. It is suggested to conduct this study in a longer period and on more people. Abdellah's theory is derived from Henderson's theory; it is, in fact, considered to be the extension of Henderson's 14 principles. It has no specific tools and identifies only 21 key areas of work. In the present study, questions were designed in each of 21 domains of Abdellah's theory, in accordance with prominent nursing models such as those of Henderson, Maslow, and Erikson, and the physical examinations of the relevant systems were done.

References

References

Ahmad, M. M., Al-Daken, L. I. L. & Ahmad, H. M. (2015). Quality of life for patients in medicalsurgical wards. Clinical Nursing Research, 24, 375-387.

Alligood, M. R. (2017). Nursing Theorists and Their Work-E-Book, Elsevier Health Sciences.

Alligood, M. R. (2018). Nursing theorists and their work, United States of America, Elsevier.

Araújo, E. S. S., Silva, L. D. F. D., Moreira, T. M. M., Almeida, P. C. D., Freitas, M. C. D. & Guedes, M. V. C. (2018).Nursing care to patients with diabetes based on King's Theory. Revista Brasileira de Enfermagem, 71, 1092-1098.

Bhaskara Raj, D. E. (2011). nursing theories a practical view, New Delhi, Jaypee Brothers Medical Publisher (p) Ltd.

Bickley, L. S. & Szilagyi, P. G. (2017). Bates Guide to Physical Examination and History Taking, Philadelphila, Lippincott Williams & Wilkins.

Diagnoses, N. N. (2017). North American Nursing Diagnosis Association.

Esteghamati, A., Larijani, B., Aghajani, M. H., Ghaemi, F., Kermanchi, J., Shahrami, A., Saadat, M., Esfahani, E. N., Ganji, M. & Noshad, S. (2017). Diabetes in Iran: prospective analysis from first nationwide diabetes report of national program for prevention and control of diabetes (NPPCD-2016). Scientific Reports, 7, 13461.

Ghanbari, A. (2004).Making theory in nursing, Guilan,Iran, Guilan University of Medical Sciences Publishen.

Hojjati, H. (2015). Concepts and theories of nursing, Tehran, Iran, Jameenegar.

Mcewen, M. & Wills, E. M. (2011).Theoretical basis for nursing, philadelphia, Lippincott Williams & Wilkins.

Molayaghobi, N. S., Abazari, P., Taleghani, F. & Iraj, B. (2019). Diabetes management challenges in Iran: A qualitative content analysis. Journal of Nursing Management. 27(6): 1091 -1097

Namayandeh, S. M., Karimi, A., Fallahzadeh, H., Rahmanian, M., Bafghi, S. M. S., Soltani, M. & Hadiani, L. (2019). The incidence rate of diabetes mellitus (type II) and its related risk factors: A 10year longitudinal study of Yazd Healthy Heart Cohort (YHHC), Iran. Diabetes & Metabolic Syndrome: Clinical Research & Reviews, 13, 1437-1441.

Rolfe, G. (1993). Closing the theory-practice gap: a model of nursing praxis. Journal of Clinical Nursing, 2, 173-177.

Uchendu, C. & Blake, H. (2017). Effectiveness of cognitive-behavioural therapy on glycaemic control and psychological outcomes in adults with diabetes mellitus: a systematic review and meta analysis of randomized controlled trials. Diabetic Medicine, 34, 328-339.

Younas, A. & Quennell, S. (2017). Usefulness of nursing theory guided practice: an integrative review. Scandinavian Journal of Caring Sciences.

Zheng, Y., Ley, S. H. & Hu, F. B. (2018). Global aetiology and epidemiology of type 2 diabetes mellitus and its complications. Nature Reviews Endocrinology, 14, 88.