Fay Abdella’s Twenty-One Nursing Problems Theory

Table of Contents

A nursing theory used in this paper is Fay Abdella’s Twenty One Nursing Problems, which contains 21 statements about the tasks and responsibilities of a nurse. Twenty-One Nursing Problems theory is based on the typical issues that patients face during a hospital stay, including maintaining proper body functions and their physical comfort. This theory is applicable for this pressure ulcer intervention since one of its premises is to “promote good hygiene and physical comfort” (“Faye Glenn Abdellah,” n.d., para. 1). Another aspect of this theory is the prevention of injuries and maintaining proper body mechanics. Although this theory includes various other parts of nursing care, such as respecting that patients may have negative feelings, this intervention uses the claims about physical comfort and prevention from the theory as the basis. Hence, the Twenty One Nursing Problems theory explains the critical tasks of a nurse and addresses the danger of overlooking pressure ulcers and factors that may contribute to the development.

Implementation Plan and Outcome Measures

To implement this ulcer hospital management plan, the responsible medical professional should assess the hospital’s existing environment and the available resources. Suppose the study shows the significant impact of microclimate management and patient position movement. In that case, the hospital management should purchase the appropriate equipment and develop new forms that nurses will use to manage patients’ positions and risks for developing pressure ulcers. The equipment for climate management will require the administration to train the nurses to use it, and the nurses should be briefed on how to change patient positions and document these changes. Outcome measures include the number of pressure ulcer cases per patient, with the microclimate management, documentation, and without the intervention and the number of microclimate management equipment.

Evidence-Based Practice

Before developing a PICOT question for the research, the author reviewed many studies on pressure ulcer prevention. Since this problem is common, it gained attention from researchers and practitioners alike. Kottner et al. (2018) investigated how climate can reduce the likelihood of developing pressure ulcers, while van Leen et al. (2018) studied innovative microclimate management technology and its effect on human skin. The change of patient positions is a commonly used practice with a plethora of evidence suggesting its effectiveness. It is also cited as a possible measure for reducing risks in the articles by Kottner et al. (2018) and van Leen et al. (2018). Hence, as with any healthcare intervention, this paper offers a pressure ulcer management plan developed based on the theoretical knowledge of human skin and its functions and the studies that show the positive effects of the proposed measures on reducing the number of pressure ulcer cases. The sample size, type of intervention, and the specific steps for this research were developed using evidence-based practices, mainly from research published in peer-reviewed sources on the same topic.

Evaluating the Intervention

This intervention will be evaluated based on the number of pressure ulcer cases. The comparison will be made between the patients from the intervention group compared to no intervention. The number of cases and the severity of pressure ulcers and the number of them can be used to measure which initiative was more effective. If the nurse observes that patients have fewer pressure ulcers in a microclimate group when compared to the position change group, this means that the former intervention is more effective and should be used as standard.


The implementation plan has several potential barriers, and this section will offer strategies for overcoming them. First and foremost, the ward microclimate changes require equipment that has to be purchased by the hospital, where the intervention will take place. This requires financial resources and may become an issue because hospitals have annual plans and budgets, meaning that the change will be implemented quickly. However, healthcare organizations spend substantial resources annually on preventing pressure ulcers. Hence, if this intervention proves successful, the hospitals will be able to save money and improve their patients’ wellbeing by investing in a pressure ulcer prevention measure that is more effective than what they used before. The main way of overcoming this barrier is to ensure that the hospital’s management supports the initiative, which can be done by showing them the results of empirical studies and discussing the potential benefit of this change.

Secondly, resistance to change may become an issue, and nurses may be unwilling to use the technology and position management protocols. This can be addressed by educating them on how to use the equipment, the benefits of it for the patients, and the impact that this will have on nurses’ workload. This approach’s premise is that if nurses understand how to use microclimate management and how it can prevent pressure ulcers, they will be willing to use the new protocols to help their patients. Moreover, microclimate management shows better results for patients, which means that the nurses will have less work in terms of preventing and treating pressure ulcers.


. (n.d.) 2020, Web.

Kottner, J., Black, J., Call, E., Gefen, A., & Santamaria, N. (2018). . Clinical Biomechanics, 59, 62-70. Web.

van Leen, M., Halfens, R., & Schols, J. (2018). Preventive effect of a microclimate-regulating system on pressure ulcer development: A prospective, randomized controlled trial in Dutch nursing homes. Advances in Skin & Wound Care, 31(1), 1-5. Web.

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