Faye Glenn Abdellah (1919 - )

Faye Glenn Abdellah, pioneer nursing researcher, helped transform nursing theory, nursing care and nursing education. After receiving her nursing certificate from the Ann May School of Nursing and her Bachelor's, Master's, and Doctoral degrees in Education from Columbia University, Dr. Abdellah embarked on her distinguished career in health care. She was the first nurse officer to receive the rank of a two-star rear admiral. Her more than 150 publications, including her seminal works, Better Nursing Care Through Nursing Research and Patient-Centered Approaches to Nursing, changed the focus of nursing theory from a diseasecentered to a patient-centered approach and moved nursing practice beyond the patient to include care of families and the elderly. Her Patient Assessment of Care Evaluation method to evaluate health care is now the standard for the nation. Her development of the first tested coronary care unit has saved thousands of lives. As the first nurse and the first woman to serve as Deputy Surgeon General, Dr. Abdellah developed educational materials in many key areas of public health, including AIDS, the mentally handicapped, violence, hospice care, smoking cessation, alcoholism, and drug addiction. Dr. Abdellah, after teaching at several prestigious universities, founded the Graduate School of Nursing at the Uniformed Services University of the Health Sciences and served as the school's first dean. Beyond the classroom, Dr. Abdellah presents workshops around the world on nursing research and nursing care. Dr. Abdellah's work has been recognized with 77 professional and academic honors, including the prestigious Allied Signal Award for her pioneering research in aging. She is also the recipient of eleven honorary degrees. As a leader in health care, she has helped transform the practice of nursing and raised its standards by introducing scientific research into nursing and patient care. Her leadership, her publications, and her accomplishments have set a new standard for nursing and for women in the health care field. Additional Resources: Abdellah, et al. Preparing Nursing Research for the 21st Century: Evolution, Methodologies, Challenges. New York:

Quick Facts

Birth: 1919 Death:

Year Inducted: 2000

Achievement In: Science

Springer Publishing, 1994. With Eugene Levine. Better Patient Care Through Nursing Research. New York: Macmillan, 1965. Abdellah, et al. Patient-centered Approaches to Nursing. New York: Macmillan, 1960. Papers, 1952-1989. Archives and Modern Manuscripts Program, History of Medicine Divisnion, U.S. National Library of Medicine. Bethesda, Maryland.

Faye Glenn Abdellah's Theory Twenty-One Nursing Problems This page was last updated on March 1, 2011 INTRODUCTION

Faye Glenn Abdellah, pioneer nursing researcher, helped transform nursing theory, nursing care and nursing education Birth:1919 Dr Abdellah worked as Deputy Surgeon General in US and Chief Nurse Officer for the US Public Health Service , Department of Health and human services, Washington, D.C. She was a leader in nursing research and has over one hundred publications related to nursing care, education for advanced practice in nursing and nursing research. According to her, nursing is based on an art and science that mould the attitudes, intellectual competencies, and technical skills of the individual nurse into the desire and ability to help people , sick or well, cope with their health needs.

As per Abdellah, nursing as a comprehensive service 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 individuals 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 patients individual needs

6. Helping the individual to become more self directing in attaining or maintaining a healthy state of mind & body 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 the health needs of people (In 1973, the item 3, - providing continuous care of the individuals total health needs was eliminated.) PHILOSOPHICAL UNDERPINNINGS OF THE THEORY

Abdellahs patient-centred approach to nursing was developed inductively from her practice and is considered a human needs theory. The theory was created to assist with nursing education and is most applicable to the education of nurses. Although it was intended to guide care of those in the hospital, it also has relevance for nursing care in community settings.

MAJOR ASSUMPTIONS, CONCEPTS & RELATIONSHIPS

The language of Abdellahs framework is readable and clear. She uses the term she for nurses, he for doctors and patients, and refers to the object of nursing as patient rather than client or consumer. She referred to Nursing diagnosis during a time when nurses were taught that diagnosis was not a nurses prerogative.

Assumptions were related to

change and anticipated changes that affect nursing; the need to appreciate the interconnectedness of social enterprises and social problems; the impact of problems such as poverty, racism, pollution, education, and so forth on health care delivery; changing nursing education continuing education for professional nurses development of nursing leaders from under reserved groups

Abdellah and colleagues developed a list of 21 nursing problems.They also identified 10 steps to identify the clients problems. 11 nursing skills to be used in developing a treatment typology 10 steps to identify the clients problems

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 patients 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 patients and familys reaction to the therapeutic plan and involve them in the plan Identify how the nurses feels about the patients nursing problems Discuss and develop a comprehensive nursing care plan

11 nursing skills

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 resources Problem-solving Direction of work of others Therapeutic use of the self Nursing procedure

21 NURSING PROBLEMS Three major categories

Physical, sociological, and emotional needs of clients Types of interpersonal relationships between the nurse and patient Common elements of client care

BASIC TO ALL PATIENTS

To maintain good hygiene and physical comfort To promote optimal activity: exercise, rest and sleep To promote safety through the prevention of accidents, injury, or other trauma and through the prevention of the spread of infection To maintain good body mechanics and prevent and correct deformity

SUSTENAL CARE NEEDS

To facilitate the maintenance of a supply of oxygen to all body cells To facilitate the maintenance of nutrition of all body cells To facilitate the maintenance of elimination To facilitate the maintenance of fluid and electrolyte balance To recognize the physiological responses of the body to disease conditions To facilitate the maintenance of regulatory mechanisms and functions To facilitate the maintenance of sensory function.

REMEDIAL CARE NEEDS

To identify and accept positive and negative expressions, feelings, and reactions To identify and accept the interrelatedness of emotions and organic illness To facilitate the maintenance of effective verbal and non verbal communication To promote the development of productive interpersonal relationships To facilitate progress toward achievement of personal spiritual goals To create and / or maintain a therapeutic environment To facilitate awareness of self as an individual with varying physical , emotional, and developmental needs

RESTORATIVE CARE NEEDS

To accept the optimum possible goals in the light of limitations, physical and emotional To use community resources as an aid in resolving problems arising from illness To understand the role of social problems as influencing factors in the case of illness

ABDELLAHS THEORY AND THE FOUR MAJOR CONCEPTS NURSING

Nursing is a helping profession. In Abdellahs model, nursing care is doing something to or for the person or providing information to the person with the goals of meeting needs, increasing or restoring self-help ability, or alleviating impairment. Nursing is broadly grouped into the 21 problem areas to guide care and promote use of nursing judgment. She considers nursing to be comprehensive service that is based on art and science and aims to help people, sick or well, cope with their health needs.

PERSON

Abdellah describes people as having physical, emotional, and sociological needs. These needs may overt, consisting of largely physical needs, or covert, such as emotional and social needs. Patient is described as the only justification for the existence of nursing.

Individuals (and families) are the recipients of nursing Health, or achieving of it, is the purpose of nursing services.

HEALTH

In PatientCentered Approaches to Nursing, Abdellah describes health as a state mutually exclusive of illness. Although Abdellah does not give a definition of health, she speaks to total health needs and a healthy state of mind and body in her description of nursing as a comprehensive service.

SOCIETY AND ENVIRONMENT

Society is included in planning for optimum health on local, state, national, and international levels. However, as she further delineated her ideas, the focus of nursing service is clearly the individual. The environment is the home or community from which patient comes.

ABDELLAHS WORK AND CHARACTERISTICS OF A THEORY Characteristic 1

Abdellahs theory has interrelated the concepts of health, nursing problems, and problem solving as she attempts to create a different way of viewing nursing phenomenon Nursing is the use of problem solving approach with key nursing problems related to health needs of people.

Characteristic 2

Problem solving is an activity that is inherently logical in nature.

Characteristic 3

Framework focus on nursing practice and individuals.

Characteristic 4

The role of client within the framework.

Characteristic 5

The results of testing such hypothesis would contribute to the general body of nursing knowledge

Characteristic 6

Abdellahs problem solving approach can easily be used by practitioners to guide various activities within their practice that deals with clients who have specific needs and specific nursing problems.

Characteristic 7

Although consistency with other theories exist, many questions remain unanswered

USE OF 21 PROBLEMS IN THE NURSING PROCESS ASSESSMENT PHASE

Nursing problems provide guidelines for the collection of data. A principle underlying the problem solving approach is that for each identified problem, pertinent data are collected. The overt or covert nature of the problems necessitates a direct or indirect approach, respectively.

NURSING DIAGNOSIS

The results of data collection would determine the clients specific overt or covert problems. These specific problems would be grouped under one or more of the broader nursing problems. This step is consistent with that involved in nursing diagnosis

PLANNING PHASE

The statements of nursing problems most closely resemble goal statements. Once the problem has been diagnosed, the nursing goals have been established.

IMPLEMENTATION

Using the goals as the framework, a plan is developed and appropriate nursing interventions are determined.

EVALUATION

The most appropriate evaluation would be the nurse progress or lack of progress toward the achievement of the stated goals

CONCEPT OF PROGRESSIVE PATIENT CARE

PPC is defined as better patient care through the organization of hospital facilities, services and staff around the changing medical and nursing needs of the patient

PPC is tailoring of hospital services to meet patients needs PPC is caring for the right patient in the right bed with the right services at the right time PPC is systematic classification of patients based on their medical needs

ELEMENTS OF PPC INTENSIVE CARE

Critically and seriously ill patients requiring highly skilled nursing care, close and frequent if not constant, nursing observation are assigned to the ICU. One patient in an ICU requires at least three nurses to observe him in 24 hrs Intermediate care Patients assigned to this unit are both the moderately ill and those for whom the treatment can only be palliative Self care Ambulatory patients who are convalescencing or require diagnosis or therapy may be cared for in this unit Long term care unit This unit will provide services to certain patients now cared for in the general hospital, in nursing homes, or in their own homes and who would benefit by care in a hospital environment to achieve its maximum potential Home care This programme makes it possible to extend needed services to the patient after he leaves the hospital and returns to his home in the community

BENEFITS OF PPC PATIENT

better attention better adjustment minimized problems life saving care constant medical and nursing care

PHYSICIAN

assuring best nursing care drugs and equipments at hand orders carried out effectively better clinical an team service

HOSPITAL

effective and efficient use of staff improved public image

NURSING PERSONNEL

individual skills can be used

more time with patient helping pt. and family to solve problems job satisfaction in-service education

COMMUNITY

continuity with hospital services minimize the need of hospitalization

IMPLICATIONS OF PPC FOR NURSING EDUCATION

Many nurse educators feel that the PPC hospital where all five phases of care are available can provide clinical experience in which the nurse can learn to solve basic nursing problems in meeting patients needs. The three month assignment of professional nurses may no longer be realistic in such a setting. Organization of hospital and community services based on patients needs In the intensive care unit, the critically ill patients are concentrated regardless of diagnosis. These patients are under the constant audio-visual observation of the nurse, with life saving techniques and equipment immediately available In the intermediate care unit are concentrated patients requiring a moderate amount of nursing care, not of an emergency nature, who are ambulatory for short periods, and who are beginning to participate in he planning of their own care The self-care unit provides for patients who are physically self-sufficient and require diagnostic and convalescent care in hotel-type accommodations. This unit serves as a link between the hospital and the home. In the long-term care unit are concentrated patients requiring prolonged care. The grouping of such patients will permit staffing patterns that are less costly Home care, the fifth element of progressive patient care, extends hospital services into the home to assist the physician in the care of his patients

USEFULNESS

The patient centered approach was constructed to be useful to nursing practice, with impetus for it being nursing education. Abdellahs publications on nursing education began with her dissertation; her interest in education for nurses continues into the present. Abdellah has also published on nursing, nursing research, and public policy related to nursing in several international publications. She has been a strong advocate for improving nursing practice through nursing research

VALUE IN EXTENDING NURSING SCIENCE

It helped to bring structure and organization to what was often a disorganized collection of lectures and experiences. She categorized nursing problems based on the individuals needs and developed developed a typology of nursing treatment and nursing skills..

NURSING RESEARCH

She has been a leader in nursing research and has over one hundred publications related to nursing care, education for advanced practice in nursing and nursing research.

LIMITATIONS

Very strong nursing centered orientation Little emphasis on what the client is to achieve Her framework is inconsistent with the concept of holism Potential problems might be overlooked

CONCLUSIONS

Using Abdellahs concepts of health, nursing problems, and problem solving, the theoretical statement of nursing that can be derived is the use of the problem solving approach with key nursing problems related to health needs of people. From this framework, 21 nursing problems were developed Abdellahs theory provides a basis for determining and organizing nursing care. The problems also provide a basis for organizing appropriate nursing strategies. It is anticipated that by solving the nursing problems, the client would be moved toward health. The nurses philosophical frame of reference would determine whether this theory and the 21 nursing problems could be implemented in practice.

REFERENCES 1. George Julia B. Nursing theories: The base of professional nursing practice 3rd edition. Norwalk, CN: Appleton and Lange; 1990. 2. Abdellah, F.G. The federal role in nursing education. Nursing outlook. 1987, 35(5),224-225. 3. Abdellah, F.G. Public policy impacting on nursing care of older adults .In E.M. Baines (Ed.), perspectives on gerontological nursing. Newbury, CA: Sage publications. 1991. 4. Abdellah, F.G., & Levine, E. Preparing nursing research for the 21st century. New York: Springer. 1994. 5. Abdellah, F.G., Beland, I.L., Martin, A., & Matheney, R.V. Patient-centered approaches to nursing (2nd ed.). New York: Mac Millan. 1968.

6. Abdellah, F.G. Evolution of nursing as a profession: perspective on manpower development. International Nursing Review, 1972); 19, 3.. 7. Abdellah, F.G.). The nature of nursing science. In L.H. Nicholl (Ed.), perspectives on nursing theory. Boston: Little, Brown, 1986.

Changing The World... One Step At A Time (Faye G. Abdellah)

Faye Glenn Abdellah was one of the most influential nursing theorist and public health scientist in our era. It is extremely rare to find someone who has dedicated all her life to the advancement of the nursing profession and accomplish this feat with so much distinction and merit. In fact, when she was inducted into the National Women's Hall of Fame in 2000, Abdellah said, "We cannot wait for the world to change. Those of us with intelligence, purpose, and vision must take the lead and change the world. Let us move forward together! I promise never to rest until my work has been completed!" And she couldnt have said it any better. Let us get to know this extraordinary theorist by understanding her theory, appreciating how her life story influenced her scientific pursuit, and discerning how her theory can be applied in the ever-dynamic field of nursing.

BIOGRAPHY
Faye Glenn Abdellah was born on March 13, 1919, in New York City. Years later, on May 6, 1937, the German

hydrogen-fueled airship Hindenburg exploded over Lakehurst, New Jersey, where 18-year-old Abdellah and her family then lived, and Abdellah and her brother ran to the scene to help. In an interview with a writer for Advance for Nurses, Abdellah recalled: "I could see people jumping from the zeppelin and I didn't know how to take care of them, so it was then that I vowed that I would learn nursing." Educational Achievements

In 1942, Abdellah earned a nursing diploma and is magna cum laude from Fitkin Memorial Hospital's School of Nursing New Jersey (now Ann May School of Nursing). She received her Bachelor of Science Degree in 1945, a Master of Arts degree in 1947 and Doctor of Education in Teachers College, Columbia University. In 1947 she also took Master of Arts Degree in Physiology. With her advanced education, Abdellah could have chosen to become a doctor. However, as she explained in her Advance for Nurses interview, "I never wanted to be an M.D. because I could do all I wanted to do in nursing, which is a caring profession. As an Educator and Researcher

Abdellah went on to become a nursing instructor and researcher and helped transform the focus of the profession from disease centered to patient centered. She expanded the role of nurses to include care of families and the elderly. In 1957 Abdellah headed a research team in Manchester, Connecticut, that established the groundwork for what became known as progressive patient care. In this framework, critical care patients were treated in an intensive care unit, followed by a transition to immediate care, and then home care. Abdellah is credited with developing the first nationally tested coronary care unit as an outgrowth of her work in Manchester.

Abdellah's first teaching job was at Yale University School of Nursing. At that time she was required to teach a class called "120 Principles of Nursing Practice," using a standard nursing textbook published by the National League for Nursing that included guidelines that had no

scientific basis. After a year Abdellah became so frustrated that she gathered her colleagues in the Yale courtyard and burned the textbooks. As she told Image: "Of the 120 principles I was required to teach, I really spent the rest of my life undoing that teaching, because it started me on the long road in pursuit of the scientific basis of our practice." Established Nursing Standards In another innovation within her field, Abdellah developed the Patient Assessment of Care Evaluation (PACE), a system of standards used to measure the relative quality of individual health-care facilities that was still used in the health care industry into the 21st century. She was also one of the first people in the health care industry to develop a classification system for patient care and patient-oriented records. Military Nursing Service

Abdellah served for 40 years in the U.S. Public Health Service (PHS) Commissioned Corps, a branch of the military. In 1981 she

was named deputy surgeon general, making her the first nurse and the first woman to hold the position and hold the position for eight years. As deputy surgeon general, it was Abdellah's responsibility to educate Americans about publichealth issues, and she worked diligently in the areas of AIDS, hospice care, smoking, alcohol and drug addiction, the mentally handicapped, and violence. She was also the former Chief Nurse Officer for the U.S. Public Health Service, Department of Health and Human Services, Washington D.C. She was one of the first t

o talk about gerontological nursing, to conduct research in that area, and to influence public policy regarding nursing homes. She was responsible for establishing nursing-home standards in the United States. Abdellah has frequently stated that she believes nurses should be more involved in public-policy discussions. In her government position, Abdellah also continued her efforts to improve the health and safety of America's elderly.

What has influenced Faye Abdellah in

the development her own model of nursing?

1937 She wanted to be a nurse on the day she saw Hindenburg explode. In this time she was 18 years old on an outing with her family in New Jersey. The fire and injuries that resulted from this horrific event inspired in her wish to never again be helpless when people needed assistance. 1949 She spent 40 years in Public Health Service where she first became involved in research, being assigned to perform studies to improve nursing practices. 1960 She was influenced by the desire to promote clientcentered comprehensive nursing care. Abdellah described nursing as a service to individuals, to families and therefore to, to society. Acknowledging the influence of Henderson, expanded Henderson's 14 needs into 21 problems that she believed would serve as a knowledge base for nursing. Throughout her career, she strongly supported the idea that nursing research would be the key factor in helping nursing to emerge as a true profession. The research done regarding these common needs and problems has served as a foundation for the development of what is now known as

nursing diagnosis.

Now that we have learned her influences, lets get to know her concepts on the nursing concepts of man, health, environment, and nursing:
MAN/PERSON

Abdellah describes people as having physical, emotional, and sociological needs. These needs may overt, consisting of largely physical needs, or covert, such as emotional, sociological and interpersonal needs- which are often missed and perceived incorrectly. The patient is described as the only justification for the existence of nursing. The individuals (and families) are the recipients of nursing, and health, or achieving of it, is the purpose of nursing services HEALTH

Abdellahs concept of health maybe defined as the dynamic pattern of functioning whereby there is a continued interaction with internal and external forces that results in the optimal use of necessary resources that serve to minimize vulnerabilities (George, 1990). In PatientCentered Approaches to Nursing, Abdellah describes health as a state mutually exclusive of illness. Emphasis should be placed upon prevention and rehabilitation with wellness as a lifetime goal. Holistic approach must be taken by the nurse to help the client achieve state of health (George, 1990). However in order to effectively perform these services, the nurse must accurately identify the lacks or deficits regarding health that the client is experiencing. These lacks or deficits are the clients health needs. Although Abdellah does not give a definition of health, she speaks to total health needs and a healthy state of mind and body in her description of nursing as a comprehensive service. ENVIRONMENT/SOCIETY

The environment is implicitly defined by Abdellah as the home or community from which patient comes. Society is included in planning for optimum health on local, state, national and international levels. However, as Abdellah further delineated her ideas, the focus of nursing service is clearly the individual. Society is integrated when she discusses the implementation.

NURSING GOAL OF NURSING: To Abdellah, nursing is a service to individuals, to families and therefore to society. The goal of nursing according to Abdellah is the fullest physical, emotional, intellectual, social and spiritual functioning of the client which pertains to holistic care.

She stated that nursing is based on an art and science that molds the attitudes, intellectual competencies, and technical skills of the individual nurse into the desire and ability to help people,

sick or well, cope with their health needs (George, 1990). These would mean a comprehensive nursing service, this would include: 1. Recognizing the nursing problems of the patient. 2. Deciding the appropriate actions to take in terms of relevant nursing principles. 3. Providing continuous care of the individuals total health needs. 4. Providing continuous care to relieve pain and discomfort and provide immediate security for the individual. 5. Adjusting total nursing care plan to meet the patients individual needs. 6. Helping the individual to become more self directing in attaining or maintaining a healthy state of mind and body. 7. Instructing nursing personnel and family to help the individual do for himself that which he can with his limitations. 8. Helping the individual to adjust to his limitations and emotional problems. 9. Working with allied health professional in planning for optimum health on local, state, national and international needs. 10. Carrying out continuous evaluation and research to improve nursing techniques and to develop new techniques to meet all the health needs of the people. Nursing care for Abdellah is doing something to or for the person or providing information to the person with the goals of meeting needs, increase or restoring self-help ability or alleviating impairment. Her theory also stated that the nurse needs knowledge on basic science and specific nursing skills, as well as knowledge skills in the communication, psychology, sociology, growth and development and interpersonal relations. These 11

nursing skills that a nurse must possess includes the following:

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 resources 8. Problem-solving 9. Direction of work of others 10. Therapeutic use of the self 11. Nursing procedures

Nursing is broadly grouped into the 21 problem areas to guide care and promote use of nursing judgment. These deals with biological, psychological, and social areas of individuals. KEY CONCEPTS AND MODEL Faye Abdellah proposed a classificatory framework for identifying nursing problems, based on her idea that nursing

is basically oriented to meeting an individual clients total health needs. Her major effort was to differentiate nursing from medicine and disease orientation. Abdellahs patient-centred approach to nursing was developed inductively from her practice and is considered a human needs theory. Although it was intended to guide care of those in the hospital, it also has relevance for nursing care in community settings. Abdellah was clearly promoting the image of the nurse who was not only kind and caring, but also intelligent, competent, and technically well prepared to provide service to the patient.

ABDELLAH'S TYPOLOGY OF 21 NURSING PROBLEMS

1. To maintain good hygiene and physical comfort. 2. To promote optimal activity: exercise, rest, and sleep. 3. To promote safety through prevention of accident, injury, or other trauma and through the 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 of all body cells. 7. To facilitate the maintenance of elimination. 8. To facilitate the maintenance of fluid and electrolyte balance. 9. To recognize the physiological responses of the body to disease conditionspathological, physiological, 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 of personal spiritual goals 17. To create and/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 arising from illness. 21. To understand the role of social problems as influencing factors in the cause of illness.

Abdellah's typology was divided into three areas: 1. Physical, sociological,and emotional needs of the patients; 2. Types of interpersonal relationship between the nurse and the patient; 3. Common elements of patient care.

Theoretical Assertions
Several assertions were repeatedly stated by Abdellah although they were not labeled as such. These assertions are: 1. The nursing problem and nursing treatment typologies are the principles of nursing practice and constitute the unique body of knowledge that is nursing. 2. Correct identification of the nursing problem influences the nurse's judgment in selecting steps in solving the patient's problem. 3. The core of nursing is patient/client problems that focus on the patient and his/her problems.

With this knowledge, how, then, can we apply Abdellahs theory in our field of practice?

Nursing Practice First and foremost, Abdellahs main goal is the improvement of the nursing education. She believed that as the education of nurses improves, nursing practice improves as well.

The most important impact of Abdellahs theory to the nursing practice is that it helped transform the focus of the profession from being diseasecentered to patient-centered. The patient-centered approach was constructed to be useful to nursing practice as it helped bring structure and organization to what was often been a disorganized collection of nursing care experiences. She categorized nursing problems based on the individuals needs and developed a typology of nursing treatment and nursing goals which served as a basis for determining and organizing nursing care. Her twenty one nursing problems made nurses look at patients problems and come up with nursing plan of care in a thorough and organized way. Abdellahs identification of health needs as overt and covert assists nurses in exploring unmasked conditions about the client and plan appropriate

interventions to address them. Client centered care emphasizes the principle that every nursing goal should be geared towards treating the patient and not just the mere illness. It has been viewed that if all 21 problems are investigated, the patient would be likely to be thoroughly assessed and thus will aid the nurse organize appropriate nursing strategies. Currently, the 21 nursing problems have been updated to focus on the patient and nursing diagnosis. It has ultimately helped nurses develop their individual critical-thinking skills leading to increase in job satisfaction and more productive nurse-patient and nurse-family interaction.

The application of Abdellahs theory in nursing practice is greatly attributed to its strong influence to a patient-centered nurse-focused problem-solving approach. Abdellahs problem-solving process of identifying the problem, selecting pertinent data, formulating hypotheses through collection of data, and revising hypotheses on the basis of conclusions obtained from the data parallels the steps of the nursing process of assessment, diagnosis, planning, implementation and evaluation (Abdellah and Levine, 1986; George, 1995). Because of the strong nurse-centered orientation in the 21 nursing problems, their use in the nursing process is primarily to direct the nurse; indirectly, the client benefits (George, 1995). If the nurse assists the client in meeting the goals

states in the nursing problems, then the client will be moved toward good, optimum health. In the end, Abdellahs theory helps the practicing nurse organize the administration of care, nursing strategies and provides a scientific base for making decisions. As a theorist who was actively involved on nursing and health care internationally, Abdellah gave credence to the use of the model and is an advocate of applying new knowledge to improve practice. Nursing Education

Abdellahs theories and concepts were developed in the 1950s to present a comprehensive clinical record for nursing students, thus, providing structure to the nursing curriculum. The patientcentered approach that was based from her concepts supported and facilitated the move from the medical model that was used at the time to a nursing model. The major focus of her book, Patient-Centered Approaches (Abdellah, et al., 1960), was on the implementation of the model in baccalaureate, associate degree and diploma nursing programs. Abdellahs extraordinary researches, publications and other works and her worldwide reputation have been instrumental in disseminating the patient-centered approach

to educational programs around the world. Abdellahs typology of twenty one nursing problems was an awakening call for revisions and amendments of the nursing educational system in her era. Professors and educators realized the importance of client centered care rather than focusing on medical interventions. Nursing education then slowly deviated its concentration from the complex, medical concepts, into exercising better attention to the client as the primary concern. One of Abdellahs theorys major limitationits very strong nurse-centered orientationis, on the other hand, its major contribution to nursing education. With this orientation, the theory can be used to organize teaching contents for nursing students, to evaluate a students performance in a clinical area, or both (George, 1995). Nursing Research Research played a great part in the selection of the 21 problem classifications. Her researches were actually the major strengths of her works. In fact, her framework continues to stimulate research about the role and responsibilities of the nurse. The broad nature of the concepts in her framework offers opportunities to identify directional relationships in nursing interventions. Her theories continue to guide researchers to focus on the body of nursing knowledge itself, the identification of patient problems, the organization of nursing interventions, the improvement of nursing education, and the structure of the curriculum. Abdellah strongly believed the idea that nursing research would be the key factor in helping nursing emerge as a true profession. The extensive research done regarding the

patients needs and problems has served as a foundation for the development of what is now known as nursing diagnoses. Her Typology gave birth to more nursing research and studies. The concepts are very precise and straight forward, making it simple and applicable, thus, stimulating similar disciplines and researches. Her typology was also utilized by some clinical institutions in establishing their staffing outline, namely, the intensive care, intermediate care, long term care, self care and home care units. These were identified according to how Abdellah ideates patients needs in her concept of care. Now patients in varied medical institutions are categorized with similar client needs, than by their medical diagnosis and diseases. Also it helped nurses provide better patient care and improve critical thinking skills.

Let us see how nurses in various settings can use Abdellahs Typology of Needs Theory in their own work settings.
From an ICU nurse: Ruff Joseph Cajanding, RN

As an ICU nurse, Abdellah's model of nursing care equips me with specific guidelines as to how I can better manage various patient conditions with adeptness and grace. The spectrum of cases I have and will handle in the ICU is

diverse and multidimensional, ranging from the extremely common myocardial infarction, up until the most devastating Stevens-Johnson Syndrome, or porphyria, and their management could not get any more complicated. However, in planning for their care, I could utilize the principles underlying Abdellah's Typology inasmuch as it is synonymous to Maslow's hierarchy of needs. I will be guided by the fact that the basic needs should be met first (oxygenation, hydration, nutrition, etc.) before proceeding to higher level needs. Moreover, I will utilize the principle of treating patients in holistic manner, minding their psychosociospiritual needs inasmuch as I cater to their physical needs. Ultimately, Abdellah's typology provides nurses a framework as to how we can better organize our work in order to deliver quality nursing care to our clientelethe individual, the family, and the community in general. From an OR nurse: Francis Lloyd Borcelas, RN

As an OR suite nurse, my responsibilities are not only confined on being a scrub, circulating, or anesthetist nurse in the PACU. Managing the OR is a big responsibility, and we do function similarly to the bedside nurses in the ward. Once the patient is scheduled for a procedure, an hour should be rendered for pre-operative preparation including giving of pre-operative medications, performing physical as well as emotional, psychological and spiritual assessment, and reviewing the patients history and laboratory results, referrals and co-management needed. In this manner, we learn more about the patient through our review of relevant data and consequently uncover nursing problems presented

by the patient. Through this, we will be able to identify the therapeutic plan of care that needs to be delivered preoperative, intra-operative and post-operatively. The applicability of Abdellahs nursing theory is of valuable to patient care and management, and this allows nurses to manage patients in a holistic manner. From a medical-surgical nurse: Mae Claire N. Cabatania, RN

I would like to cite a case of my client (a stroke patient) in the medical-surgical ward. He is 45 year old male patient diagnosed with CVA and was a trans-out from ICU. He is receiving oxygen therapy via nasal cannula and hooked to NGT for feeding, and there are times when the client would be restless. Upon receiving the client during endorsement I have identified the possible nursing problems of my client. First thing on the line is the performance of self care needs and safety. Self care needs such as personal hygiene is very important for client to maintain their integrity and enhance their recovery. Another nursing problem identified is the risk for injury. At times the patient is restless, raising of side rails is very important to prevent falls and injuries. Stroke patients are at risk for falls due to altered level of consciousness. To maintain my clients nutrition to support his recovery, he is fed via nasogastric tube as prescribed by physician. Also, my patient is at risk for aspiration that is why before feeding it is a must to check for the placement of nasogastric tube to avoid aspiration during feeding. From a medical-surgical nurse ward: Patricia Cornejo, RN

In this setting where clients receive direct nursing care, nurses provide a variety of measures to maintain good hygiene and physical comfort. For clients who are totally dependent and require total hygiene care such as clients with alteration in level of sensorium, a complete bed bath is rendered. While bathing the client, exposing only the areas being bathed, closing the door or pulling room curtains around the bathing area promote physical comfort. Clients in a hospital setting have their normal rest and sleep routine disrupted, which generally leads to sleep problems. The nurse can control the hospital environment in several ways. As an example, the nurse can close the curtains between clients in semiprivate rooms. Lights on the nurses station and clients room can be dimmed at night. To reduce noise, nurses can conduct conversations and reports in a private area away from the clients rooms and keep necessary conversations to a minimum, especially at night. Keeping bed clean and dry and in a comfortable position may help clients relax. Some clients suffer painful illnesses requiring special comfort measures such as application of dry or moist heat, use of supportive dressings or sprints, and proper positioning before retiring. In the rehabilitation unit, the nurse, in collaboration with other health care professionals such as physical therapists, promotes activity and exercise by teaching the use of canes, walkers, or crutches, depending on the assistive device most appropriate for the clients condition. Nursing interventions to facilitate supply of oxygen to all body cells include positioning and coughing techniques. Initially placing a dyspneic client in high-fowlers position can relieve dyspnea whereas deep breathing and coughing techniques for postoperative client prevent further

complications such as pneumonia. To create and/or maintain a therapeutic environment, a nurse can allow relatives to remain at clients bedside during hospitalization. To facilitate the maintenance of sensory function in the older adult clients, it helps to reduce any background noise by turning off or lowering the volume of any TV, appliance, or radio during a conversation. Since bedridden clients are at risk for sensory deprivation, a nurse routinely stimulates them through range-of-motion exercises, positioning, and self-care activities (as appropriate). To prevent the spread of infection, nurses can teach aseptic practices. Medical asepsis, which includes hand hygiene and environmental cleanliness, reduces the transfer of microorganisms. Proper disposal of body secretions such as sputum should be taught as well. Safety bars on toilets, locks on beds and wheelchairs, and call lights are examples of safety features found in the hospital to prevent accident, injury, or other trauma.

To further examine how Abdellahs Typology of 21 Nursing Problems can individually be applied in a specific nursing area, the following scenario is presented:
In my experience as a staff nurse in the endoscopy unit, Faye Abdellah's 21 nursing problems were applied in the following ways: Katherine D, RN 1. To maintain good hygiene and physical comfort After colonoscopy, patients are usually soiled from the procedure.

It is therefore important to clean th em properly and change their diapers if applicable. Physical comfort through proper positioning in bed, adjusting the airconditioning unit, as well as proper lighting are also provided to the patient, especially if they were sedated and have to stay in the unit. 2. To promote optimal activity: exercise, rest, and sleep Patients who were sedated during the procedure stay in the unit until the effect of the sedation has decreased to a safe level. During this time, patients are allowed to stay in the room and rest. As a nurse, I make sure the patients are able to rest and sleep well by providing a conducive environment for rest, such as decreasing environmental noise and dimming the light if necessary. 3. To promote safety through prevention of accident, injury, or other trauma and through the prevention of the spread of infection Making sure the siderails are always up when leaving the patient keeps them from fall accidents. In our unit, one way we prevent the spread of infection is through proper disinfection of the equipments we use. We use products such as Cidezime to disinfect the instruments. 4. To maintain good body mechanics and prevent and correct deformity Positioning the patient properly, allowing for the normal anatomical position of body parts. 5. To facilitate the maintenance of a supply of oxygen to all body cells when patients manifest breathing problems, oxygen is attached to them, usually via nasal cannula. Sedated patients are attached to cardiac monitor and pulse

oximeter while having the oxygen delivered. When the oxygen saturation falls below the normal levels, the rate of oxygen is increased accordingly, as per physician's order.

6. To facilitate the maintenance of nutrition of all body cells patients undergoing endoscopic procedures are on NPO. For this reason it is important to monitor the blood glucose level through HGT. When the patient's blood glucose falls from the normal value, we inject D50W to the patient or we change the patient's IVF to a dextrose containing fluid. 7. To facilitate the maintenance of elimination Providing bedpans or urinals to patients and at times, insertion of foley catheter when the patient is not able to void 8. To facilitate the maintenance of fluid and electrolyte balance Proper regulation of the intravenous solutions as well as proper incorporations it may have. An example is when patients have low serum potassium, KCl is incorporated in the solution 9. To recognize the physiological responses of the body to disease conditionspathological, physiological, and compensatory it is important to check the patients for signs of internal gastrointestinal bleeding by monitoring the blood

pressure and cardiac rate. 10. To facilitate the maintenance of regulatory mechanisms and functions When a patient has a difficulty in breathing and is showing an increase respiratory rate, elevating the head part of the bed is done to facilitate the respiratory function. 11. To facilitate the maintenance of sensory function Sometimes there are semi-conscious patients, in these cases, it is still necessary to talk to them while performing nursing interventions to maintain their auditory sense 12. To identify and accept positive and negative expressions, feelings, and reactions most patients feel anxious before undergoing the procedures. It is necessary to listen to the patients' expressions and allow them to ask questions. To decrease their anxiety, proper instructions are given, what they are to expect, how long the procedure will take, what they should do during and after the procedure as well as other concerns. 13. To identify and accept interrelatedness of emotions and organic illness Encourage patients to verbalize their feelings and allow them to cry when they have the need to do so will help them emotionally. Some patients are diagnosed with malignancy after the procedure and during this time the emotional needs of the patient is a priority. 14. To facilitate the maintenance of effective verbal and nonverbal communication when patients are not able to express themselves verbally, it is important to assess for nonverbal cues. For instance when patients are in pain, assessing for facial grimacing. Touch and eye contact are also done for a good patient care.

15. To promote the development of productive interpersonal relationships allow the patient's significant others to stay with the patient before and after the procedure. This allows for bonding and promotes interpersonal relationship. 16. To facilitate progress toward achievement of personal spiritual goals our supervisor is a nun and she usually visits the patients in the unit. Catholic patients may benefit from this, allowing them time to practice their faith 17. To create and/or maintain a therapeutic environment providing proper lighting, proper room temperature, a quiet environment are done to patients staying in the unit. 18. To facilitate awareness of self as an individual with varying physical, emotional, and developmental needs care to patients vary according to their developmental needs. Allowing the parents to stay during the procedure help the pediatric patients in their emotional and developmental needs. 19. To accept the optimum possible goals in the light of limitations, physical, and emotional The goals for each patient vary depending on the capability of the patient. The nutritional goal for a patient with a PEG tube for instance will be different, knowing that the patient has limited feeding options. 20. To use community resources as an aid in resolving problems arising from illness Some patients live far from the city and thus referral to health centers is sometimes done 21. To understand the role of social problems as influencing factors in the cause of illness Some patients who are diagnosed with amoebic colitis for instance are advised to

avoid buying street foods to which the preparation they are not sure of, and also avoid drinking water that are not safe. *** In conclusion, using Abdellahs concepts of health, nursing problems, and problem solving, the theoretical statement of nursing that can be derived is the use of the problem-solving approach with key nursing problems related to the health needs of people. From this framework, 21 nursing problems, which are comparable to Hendersons 14 components of nursing and Maslows hierarchy of needs, are developed. Her theory and framework provides a basis for determining and organizing nursing care. It is anticipated that by solving the nursing problems through appropriate and organized nursing strategies, the client will be moved towards ultimate health.

Uniformed Services University of the Health Sciences commencement exercises for the Class of 1998 held at DAR Constitution Hall, Washington, D.C. Shown here: General Charles Krulak, Commandant, USMC (C) receives the honorary degree Doctor of Military Science Honoris Causa. (L-R) Dr. James Zimble, Dr. FAye Abdellah, General Krulak, Dr. Lonnie Bristow, Dr. Val Hemming, Captain Daniel Yaroslowski, USMC.

Year Honored: 2000 Birth: 1919 - Death: Alive Born In: New York, United States of America Achievements: Science Educated In: New York, New Jersey Countries Educated In: United States of America Schools Attended: Teachers College, Columbia University, Douglass College, Rutgers University, Fitkin Memorial Hospital, School of Nursing, Ann May School of Nursing Worked In: Connecticut, New York, District of Columbia, Colorado, Minnesota, South Carolina, Maryland Countries Worked In: United States of America << Back to Search Results

Faye Glenn Abdellah

Faye Glenn Abdellah, pioneer nursing researcher, helped transform nursing theory, nursing care and nursing education. After receiving her nursing certificate from the Ann May School of Nursing and her Bachelor's, Master's, and Doctoral degrees in Education from Columbia University, Dr. Abdellah embarked on her distinguished career in health care. She was the first nurse officer to receive the rank of a two-star rear admiral. Her more than 150 publications, including her seminal works, Better Nursing Care Through Nursing Research and Patient-Centered Approaches to Nursing, changed the focus of nursing theory from a disease-centered to a patient-centered approach and moved nursing practice beyond the patient to include care of families and the elderly. Her Patient Assessment of Care Evaluation method to evaluate health care is now the standard for the nation. Her development of the first tested coronary care unit has saved thousands of lives. As the first nurse and the first woman to serve as Deputy Surgeon General, Dr. Abdellah developed educational materials in many key areas of public health, including AIDS, the mentally handicapped, violence, hospice care, smoking cessation, alcoholism, and drug addiction. Dr. Abdellah, after teaching at several prestigious universities, founded the Graduate School of Nursing at the Uniformed Services University of the Health Sciences and served as the school's first dean. Beyond the classroom, Dr. Abdellah presents workshops around the world on nursing research and nursing care. Dr. Abdellah's work has been recognized with 77 professional and academic honors, including the prestigious Allied Signal Award for her pioneering research in aging. She is also the recipient of eleven honorary degrees. As a leader in health care, she has helped transform the practice of nursing and raised its standards by introducing scientific research into nursing and patient care. Her leadership, her publications, and her accomplishments have set a new standard for nursing and for women in the health care field. The Hindenburg disaster took place on Thursday, May 6, 1937, as the German passenger airship LZ 129 Hindenburg caught fire and was destroyed during its attempt to dock with its mooring mast at the Lakehurst Naval Air Station, which is located adjacent to the borough of Lakehurst, New Jersey. Of the 97 souls on board[N 1] (36 passengers, 61 crew), there were 35 fatalities as well as one death among the ground crew. The disaster was the subject of spectacular newsreel coverage, photographs, and Herbert Morrison's recorded radio eyewitness report from the landing field, which was broadcast the next day. The actual cause of the fire remains unknown, although a variety of hypotheses have been put forward for both the cause of ignition and the initial fuel for the ensuing fire. The incident shattered public confidence in the giant, passenger-carrying rigid airship and marked the end of the airship era.[1]

Contents
[hide]

1 Flight o 1.1 Landing timeline o 1.2 First hints of disaster o 1.3 Disaster o 1.4 Historic newsreel coverage o 1.5 Death toll 2 Cause of ignition o 2.1 Sabotage theory o 2.2 Static spark theory o 2.3 Lightning theory o 2.4 Engine failure theory 3 Fire's initial fuel o 3.1 Incendiary paint theory o 3.2 Hydrogen theory o 3.3 Puncture theory 4 Other controversial hypotheses o 4.1 Structural failure o 4.2 Fuel leak o 4.3 Luger pistol among wreckage 5 Rate of flame propagation 6 Television investigations 7 Memorial 8 References in Media and Popular Culture o 8.1 Television o 8.2 Music 9 See also 10 References 11 External links

[edit] Flight

Post card carried on the D-LZ129 "Hindenburg" on its last flight and dropped enroute over Cologne (The Cooper Collections) After opening its 1937 season by completing a single round trip passage to Rio de Janeiro in late March, the Hindenburg departed from Frankfurt on the evening of May 3rd on the first of its 10 round trips between Europe and the United States scheduled for its second year of commercial service. The United States, American Airlines, which had contracted with the operators of the Hindenburg, was prepared to shuttle fliers from Lakehurst to Newark for connections to airplane flights.[2] Except for strong headwinds which slowed its passage, the Hindenburg's crossing was otherwise unremarkable until the airship's attempted early evening landing at Lakehurst three days later on May 6. Although carrying only half its full capacity of passengers (36 of 70) and 61 crew members (including 21 training crew members), the Hindenburg's return flight was fully booked with many of those passengers planning to attend the festivities for the coronation of King George VI in London the following week. The airship was hours behind schedule when it passed over Boston on the morning of 6 May, and its landing at Lakehurst was expected to be further delayed because of afternoon thunderstorms. Advised of the poor weather conditions at Lakehurst, Captain Max Pruss charted a course over Manhattan, causing a public spectacle as people rushed out into the street to catch sight of the airship. After passing over the field at 4 p.m., Captain Pruss took passengers on a tour over the seasides of New Jersey while waiting for the weather to clear. After finally being notified at 6:22 p.m. that the storms had passed, the airship headed back to Lakehurst to make its landing almost half a day late. However, as this would leave much less time than anticipated to service and prepare the airship for its scheduled departure back to Europe, the public was informed that they would not be permitted at the mooring location or be able to visit aboard the Hindenburg during its stay in port.

[edit] Landing timeline

Around 7:00 p.m. local daylight saving time, at an altitude of 650 feet (200 m), the Hindenburg approached the Lakehurst Naval Air Station. This was to be a high landing, known as a flying moor, because the airship would be moored to a high mooring point, and then winched down to ground level. This type of landing maneuver would reduce the number of ground crew, but would require more time. 7:09: The airship made a sharp full speed left turn to the west around the landing field because the ground crew was not ready. 7:11: The airship turned back toward the landing field and valved gas. All engines idled ahead and the airship began to slow. 7:14: At altitude 394 feet (120 m), Captain Pruss ordered all engines full astern to try to brake the airship.

7:17: The wind shifted direction to southwest, and Captain Pruss was forced to make a second, sweeping sharp turn, this time towards starboard. 7:18: The airship made another sharp turn and dropped 300, 300 and 500 kg of water ballast in successive drops because the airship was stern heavy. Six men (three of whom were killed in the accident)[N 2] were also sent to the bow to trim the airship. These methods worked and the airship was on even keel as it stopped. 7:21: At altitude 295 feet (90 m), the mooring lines were dropped from the bow, the starboard line being dropped first, followed by the port line. The port line was overtightened as it was connected to the post of the ground winch; the starboard line had still not been connected.

[edit] First hints of disaster

At 7:25pm, a few witnesses saw the fabric ahead of the upper fin flutter as if gas were leaking.[3] Witnesses also reported seeing blue dischargespossibly static electricity moments before the fire on top and in the back of the ship near the point where the flames first appeared.[4] Several other eyewitness testimonies suggest that the first flame appeared on the port side just ahead of the port fin, and was followed by flames which burned on top. Commander Rosendahl testified to the flames being "mushroom-shaped" and knew at once that the airship was doomed. One witness on the starboard side reported a fire beginning lower and behind the rudder on that side. On board, people heard a muffled explosion and those in the front of the ship felt a shock as the port trail rope overtightened; the officers in the control car initially thought the shock was due to a broken rope.

[edit] Disaster
At 7:25 p.m. local time, the Hindenburg caught fire and quickly became engulfed in flames.[3] Where the fire started is unknown; several witnesses on the port side saw yellow-red flames first jump forward of the top fin, around the vent of cell 4.[3] Other witnesses on the port side noted the fire actually began just ahead of the horizontal port fin, only then followed by flames in front of the upper fin. One, with views of the starboard side, saw flames beginning lower and farther aft, near cell 1. No. 2 Helmsman Helmut Lau also testified seeing the flames spreading from cell 4 into starboard. Although there were five newsreel cameramen and at least one spectator known to be filming the landing, no camera was rolling when the fire started and therefore there is no motion picture record of where it first broke out at the instant of ignition. Wherever it started, the flames quickly spread forward. Instantly, a water tank and a fuel tank burst out of the hull due to the shock of the blast. This shock also caused a crack behind the passenger decks, and the rear of the structure imploded. The buoyancy was lost on the stern of the ship, and the bow lurched upwards as the falling stern stayed in trim.

A rare surviving fire-damaged 9" duralumin cross brace from the frame of the "Hindenburg" salvaged in May 1937 from the crash site at NAS Lakehurst, NJ. (The Cooper Collections) As the Hindenburg's tail crashed into the ground, a burst of flame came out of the nose, killing nine of the 12 crew members in the bow. There was still gas in the bow section of the ship, so the bow continued to point upward as the stern collapsed down. A crack had formed behind the passenger decks during the initial fire, which now collapsed inward, causing the gas cell to explode. The scarlet lettering "Hindenburg" became erased by flames while the airship's bow lowered. The airship's gondola wheel touched the ground, causing the bow to bounce up slightly as one final gas cell burned away. At this point, most of the fabric on the hull had also burned away and the bow finally crashed to the ground. The ship was completely destroyed. Although the hydrogen had finished burning, the Hindenburg's diesel fuel burned for several more hours. The time it took for the airship to be completely destroyed has been disputed. Some observers believe it took 34 seconds, others say it took 32 or 37 seconds. Since none of the newsreel cameras were filming the airship when the fire started, the time of the start of the fire can only be estimated from various eyewitness accounts, and will never be known accurately. One careful analysis of the flame spread, by Addison Bain of NASA, gives the flame front spread rate across the fabric skin as about 49 ft/s (15 m/s), which would have resulted in a total destruction time of about 16 seconds (245 m / 15 m/s = 16.3 s). Some of the duralumin framework of the airship was salvaged and shipped back to Germany where it was recycled and used in the construction of military aircraft for the Luftwaffe as were the frames of the LZ 127 Graf Zeppelin and LZ 130 Graf Zeppelin II as well when both were scrapped in 1940.[5]

[edit] Historic newsreel coverage

Main article: Hindenburg Disaster Newsreel Footage

Universal Newsreel

The disaster is well recorded because of the significant extent of newsreel coverage and photographs, as well as Herbert Morrison's live coverage on-the-scene, eyewitness radio report being made from the landing field for station WLS in Chicago which was broadcast the next day. Heavy publicity about the first transatlantic passenger flight of the year by Zeppelin to the U.S. attracted a large number of journalists to the landing. (The airship had already made one round trip from Germany to Brazil that year.) Parts of the Morrison report were later dubbed onto the newsreel footage and this gave the impression to many modern viewers, more accustomed to live television reporting, that the words and film were recorded together intentionally. Morrison's broadcast remains one of the most famous in history. His plaintive words, "Oh, the humanity!" resonate with the impact of the disaster, and have been widely used in popular culture. Part of the poignancy of Morrison's commentary is due to its being recorded at a slightly slower speed to the disk, so when played back at normal speed it seems to be at a faster delivery and higher pitch. When corrected, his account is less frantic sounding, though still impassioned. It's practically standing still now they've dropped ropes out of the nose of the ship; and (uh) they've been taken ahold of down on the field by a number of men. It's starting to rain again; it's... the rain had (uh) slacked up a little bit. The back motors of the ship are just holding it (uh) just enough to keep it from...It's burst into flames! It's burst into flames and it's falling it's crashing! Watch it; watch it! Get out of the way; Get out of the way! Get this, Charlie; get this, Charlie! It's fire... and it's crashing! It's crashing terrible! Oh, my! Get out of the way, please! It's burning and bursting into flames and the... and it's falling on the mooring mast. And all the folks agree that this is terrible; this is the one of the worst catastrophes in the world. [indecipherable] its flames... Crashing, oh! Fouror five-hundred feet into the sky and it... it's a terrific crash, ladies and gentlemen. It's smoke, and it's in flames now; and the frame is crashing to the ground, not quite to the mooring mast. Oh, the humanity! And all the passengers screaming around here. I told you; itI can't even talk to people, their friends are out there! Ah! It's... it... it's a... ah! I... I can't talk, ladies and gentlemen. Honest: it's just laying there, mass of smoking wreckage. Ah! And everybody can hardly breathe and talk and the screaming. Lady, I... I... I'm sorry. Honest: I... I can hardly breathe. I... I'm going to step inside, where I cannot see it. Charlie, that's terrible. Ah, ah... I can't. Listen, folks; I... I'm gonna have to stop for a minute because [indecipherable] I've lost my voice. This is the worst thing I've ever witnessed. Herbert Morrison, describing the events, as transcribed for broadcast by WLS radio.

Spectacular motion picture footage and Morrison's passionate recording of the Hindenburg fire shattered public and industry faith in airships and marked the end of the giant passenger-carrying airships. Also contributing to the Zeppelins' downfall was the arrival of international passenger air travel and Pan American Airlines.[N 3] Aircraft regularly crossed the Atlantic and Pacific oceans much faster than the 130 km/h (80 mi/h)

of the Hindenburg. The one advantage that the Hindenburg had over aircraft was the comfort it afforded its passengers, much like that of an ocean liner. There had been a series of other airship accidents, none of them Zeppelins, prior to the Hindenburg fire. Many were caused by bad weather, and most of these accidents were dirigibles of British or U.S. manufacture. Zeppelins had an impeccable safety record. The Graf Zeppelin had flown safely for more than 1.6 million km (1 million miles), including the first circumnavigation of the globe by an airship. The Zeppelin company's promotions prominently featured the fact that no passenger had been injured on one of their airships.

[edit] Death toll

See also: List of passengers and crew aboard the final flight of LZ 129 Hindenburg This section needs additional citations for verification. Please help improve this article by adding reliable references. Unsourced material may be challenged and removed. (March 2009) Despite the violent fire, many of the crew and passengers survived. Of the 36 passengers and 61 crew, 13 passengers and 22 crew died. Also killed was one member of the ground crew, civilian linesman Allen Hagaman. The majority of the crew who died were up inside the ship's hull, where they either did not have a clear escape route or else were close to the bow of the ship, which hung burning in the air too long for most of them to escape the fire. Most of the passengers who died were trapped in the starboard side of the passenger deck. Not only was the wind blowing the fire toward the starboard side, but the ship also rolled slightly to starboard as it settled to the ground, with much of the upper hull on that part of the ship collapsing outboard of the starboard observation windows, thus cutting off the escape of many of the passengers on that side.[N 4] To make matters worse, the sliding door leading from the starboard passenger area to the central foyer and the gangway stairs (through which rescuers led a number of passengers to safety) jammed shut during the crash, further trapping those passengers on the starboard side.[N 5] Nonetheless, some did manage to escape from the starboard passenger decks. A number of others did not. By contrast, all but a few of the passengers on the port side of the ship survived the fire, with some of them escaping virtually unscathed. Although the most famous of airship disasters, it was not the worst. Just over twice as many perished (73 of 76 on board) when the helium-filled U.S. Navy scout airship USS Akron crashed at sea off the New Jersey coast four years earlier on April 4, 1933. Some of the survivors were saved by luck. Werner Franz, the 14 year-old cabin boy, was initially dazed by the realization that the ship was on fire. As he stood near the officer's mess where he had been putting away dishes moments before, a water tank above him burst open, and he was suddenly soaked to the skin. Not only did this snap him back to his senses, as he later told interviewers, but it also put out the fire around him. He then made his way to a nearby hatch through which the kitchen had been provisioned before the flight, and dropped through it just as the forward part of the ship was briefly rebounding into the air. He began to run toward the starboard side, but stopped and turned around and ran the other way, because the flames were being pushed by the wind

in that same direction. He made it clear of the wreck with little more than singed eyebrows and soaking wet clothes. Werner Franz is one of the two people aboard who are still alive as of 2008.[citation needed] When the control car crashed on the ground, most of the officers had leapt through the windows, but became separated. First Officer Captain Albert Sammt found Captain Max Pruss trying to re-enter the wreckage to look for survivors. Pruss's face was badly burned, and he required months of hospitalization and reconstructive surgery, but he survived. Captain Ernst Lehmann escaped the crash with burns to his head and arms and severe burns across most of his back. Though his burns did not seem quite as severe as those of Pruss, he died at a nearby hospital the next day. When passenger Joseph Sph, a vaudeville comic acrobat, saw the first sign of trouble he smashed the window with his movie camera, with which he had been filming the landing (the film survived the disaster). As the ship neared the ground he lowered himself out the window and hung onto the window ledge, letting go when the ship was perhaps 20 feet above the ground. His acrobat's instincts kicked in, and Sph kept his feet under him and attempted to do a safety roll when he landed. He injured his ankle nonetheless, and was dazedly crawling away when a member of the ground crew came up, slung the diminutive Sph under one arm, and ran him clear of the fire.[N 6] [N 7] Of the 12 crewmen in the bow of the airship, only three survived. Four of these 12 men were standing on the mooring shelf, a platform up at the very tip of the bow from which the forward-most landing ropes and the steel mooring cable were released to the ground crew, and which was directly at the forward end of the axial walkway and just ahead of gas cell #16. The rest were standing either along the lower keel walkway ahead of the control car, or else on platforms beside the stairway leading up the curve of the bow to the mooring shelf. During the fire the bow hung in the air at roughly a 45-degree angle and flames shot forward through the axial walkway, bursting through the bow (and the bow gas cells) like a blowtorch. The three men from the forward section who survived (elevatorman Kurt Bauer, cook Alfred Grzinger, and electrician Josef Leibrecht) were those furthest aft of the bow, and two of them (Bauer and Grzinger) happened to be standing near two large triangular air vents, through which cool air was being drawn by the fire. Neither of these men sustained more than superficial burns.[N 8] Most of the men standing along the bow stairway either fell aft into the fire, or tried to leap from the ship when it was still too high in the air. Three of the four men standing on the mooring shelf inside the very tip of the bow were actually taken from the wreck alive, though one (Erich Spehl, a rigger) died shortly afterward in the Air Station's infirmary, and the other two (helmsman Alfred Bernhard and apprentice elevatorman Ludwig Felber) were reported by newspapers to have initially survived the fire, and then to subsequently have died at area hospitals during the night or early the following morning. The four crew members in the tail fin all survived; they were closest to the origin of the fire but sheltered by the structure of the lower fin. They escaped by climbing out the fin's access hatch when the tail hit the ground.

Hydrogen fires are notable for being less destructive to immediate surroundings than gasoline explosions because of the buoyancy of H2, which causes heat of combustion to be released upwards more than circumferentially as the leaked mass ascends in the atmosphere; hydrogen fires are more survivable than fires of gasoline and of wood.[7] The hydrogen in the Hindenburg burned out within about 90 seconds.

Interview with Faye G. Abdellah on nursing research and health policy.(Chief Nurse Officer and Deputy Surgeon General, U.S. Public Health Services, retired Rear Admiral)(Interview)
mage: Journal of Nursing Scholarship, 1998; 30:3,215-219. [C] 1998 Sigma Theta Tau International [Key words: health policy; research] Faye G. Abdellah is widely recognized throughout the world for her public service to nursing, education, and health policy. She has been Chief Nurse Officer and Deputy Surgeon General, U.S. Public Health Service and retired with the rank of Rear Admiral, the first nurse and woman to serve in this position in 200 years. She holds a bachelors, masters, and doctoral degree from Columbia University. She is the author or co-author of 150 publications, and the recipient of 11 honorary degrees from universities that have recognized her pioneering work in nursing research; in the development of the first nursescientist program; and as an international expert in health policy. Dr. Abdellah is the recipient of 75 professional and academic awards including Sigma Theta Tau awards: Excellence in Nursing, the First Presidential, and Emeritus Distinguished Scholar. In 1992, the American Academy of Nursing honored Dr. Abdellah with The Living Legend Award and she received the Allied Signal Award (1989) and the prestigious Gustav O. Lienhard Award (1984) from the U.S. Institute of Medicine for her contributions to aging and health policy. McAuliffe: You were one of the pioneers in developing the science of nursing. You developed the nursing theory of patient-centered approaches to help form a scientific basis for nursing practice. Please give us some background. Dr. Abdellah: First, let me set the stage. My first teaching job was at Yale University School of Nursing where students were admitted with baccalaureate degrees. Of course being young and a new graduate I thought I knew everything. I was required to teach the "120 Principles of Nursing Practice." My students were so perceptive and asked

questions like "Why are we doing this?" "Why is this important?" All I could say is, "Because the book says so." The book was the 1937 edition of The Curriculum Guide published by the National League for Nursing (NLN). After about a year, I was so frustrated I began graduate work in physiology. But meanwhile--remember I was in my early 20s and quite rebellious--I was dismayed by the NLN guidelines, which had no scientific basis, so I asked my colleagues to assemble in the Yale courtyard and I burned the books. Well, as I was on a contract, the dean called me in the next morning and said, "You will have to pay for all those books." It took me an entire year to pay for them--during which time all I could afford to eat was peanut butter sandwiches! My point is that sometimes you have to "create a revolution," and take the bull by the horns. I have mellowed since then.... Those Yale students were just brilliant and challenged me to explain why they were required to follow procedures without questioning the science behind them. Of the 120 principles I was required to teach, I really spent the rest of my life undoing that teaching, because it started me on the long road in pursuit of the scientific basis of our practice. This pursuit helped in the 1970s when I was setting up the first nurse-scientist graduate training program. Now in 1998, I think that we have come a long way. It was rewarding to attend the conference "Extending the Horizons of Health Care Through Research," sponsored by the National Institute of Nursing Research in May 1998 and learn about the excellent funded projects which provide scientific evidence for nursing practice. Many studies used randomized clinical trials. After 3 decades, we at last can begin to define the science behind nursing interventions. As you look at the evolution of nursing science, research had to start somewhere. Many of our early studies were qualitative studies, descriptive studies describing the situation and what was happening. We had to start there and that certainly provided the basis to build a theoretical base for nursing practice.