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 health care.

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:

1. observation of health status
2. skills of communication
3. application of knowledge
4. teaching of patients and families
5. planning and organization of work
6. use of resource materials
7. use of personnel materials
8. problem-solving
9. direction of work of others
10. therapeutic use of the self
11. nursing procedure

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 needs.

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:

1. Recognizing the nursing problems of the patient
2. Deciding the appropriate course of action to take in terms of relevant nursing principles
3. Providing continuous care of the individual's total needs
4. Providing continuous care to relieve pain and discomfort and provide immediate security for the individual
5. Adjusting the total nursing care plan to meet the patient's individual needs
6. Helping the individual to become more self-directing in attaining or maintaining a healthy state of body and mind
7. Instructing nursing personnel and family to help the individual do for himself that which he can within his limitations
8. Helping the individual to adjust to his limitations and emotional problems
9. Working with allied health professions in planning for optimum health on local, state, national, and international levels
10. 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.