Lydia E. Hall: Core, Care and Cure Model

 

Lydia Eloise Hall

1906-1969

BACKGROUND

ü  Lydia Hall began her prestigious career in nursing as a graduate of the York Hospital School of Nursing in York, Pennsylvania.

ü  She earned B.S. and M.A. degrees from Teachers College, Columbia University, in New York.

ü  Had faculty position at the York Hospital School of Nursing and Fordham Hospital School of Nursing

ü  Became consultant in Nursing Education to the Nursing Faculty at the State University of New York, Upstate Medical Center. She also was an instructor of nursing education at Teachers College.

ü  Career Interests: Public Health Nursing, cardiovascular nursing, pediatric cardiology and nursing of long term illness.

ü  Authored 21 publications and the bulk of the articles and addresses regarding her nursing theory were published in in the early to middle 1960s.

ü  In the 1967, she received the award for Distinguished Achievement in Nursing Practice from Columbia University.

ü  Greatest Achievements:              Hall design and develop Loeb Center for Nursing at Montefiore Hospital in New York City and apply her theory to nursing practice. Opened at January 1963. A 80 bed capacity for persons aged 16 years or older who were no longer having acute biological disturbances. Patients were recommended by their physicians and had favourable potential for recovery and subsequent return to their community. Hall served as administrative director of the Loeb Center for Nursing for from its opening until her death in February 1969.

CONCEPTS

Behavior

Hall broadly defines behavior as everything that is said or done. Behavior is dictated by feelings both conscious and unconscious

Reflection

Reflection is a Rogerian method of communication in which selected verbalizations of patients is repeated back to them with different phraseology to invite them to explore feelings further.

Self-awareness

Self-awareness refers to the state of being that nurses endeavor to help their patients achieve. The more self-awareness a person has of their feelings, the more control they have over their behavior.

Second-Stage illness

The patient enters the second phase of medical care once the doctors begin giving only follow up care. Hall defines second-stage illness as a nonacute recovery phase of illness. This stage is conducive to learning and rehabilitation. The need for medical care is minimal, although the need for nurturing and learning is great. Therefore this is the ideal time for wholly professional nursing.

Wholly Professional Nursing

Wholly Professional Nursing implies nursing care given exclusively by professional registered nurses, educated in the behavioral sciences who take the responsibility and opportunity to coordinate and deliver the total care of their patients. This concept includes the roles of nurturing, teaching and advocacy in the fostering of healing.

CENTRAL CONCEPTS

Care

Care alludes the “hands on”, intimate bodily care aspect of nursing of the patient and implies a comforting, nurturing relationship. While intimate physical care is given, the patient and the nurse develop a close relationship representing the teaching and learning aspect of nursing. The natural and biological sciences (the Body).

q  Nurturing component of care

q  It is exclusive to nursing

q  “Mothering”

q  Provides teaching

and learning activities

q  Nurses goal is to “comfort” the patient

q  Patient may explore and share feelings with nurse

q  Nurse is concerned with intimate bodily care

q  Nurse applies knowledge of natuaral and biological sciences

q  Nurse act as potential comforter

Core

        Core involves the therapeutic use of self in communicating with the patient. The nurse through the use of reflective technique helps the patient clarify motives and goals, facilitating the process of increasing the patients self awareness. The social sciences (the person).

q  Patient care is based on social sciences

q  Therapeutic use of self

q  Helps patient learn their role is in the healing process

q  Patient is able to maintain who they are

q  Patient able to develop a maturity level when nurse listens to them and acts as sounding board

q  Patient able to make informed decisions

q  Emphasis on social,emotional,spiritual and intellectual needs

q  Patient makes more rapid progress towards recovery and rehabilitation

Cure

Cure is the aspect of nursing involved with the administration of medications and treatments. The nurse functions in his role as an investigator and potential cause of pain related to skills such as injections and dressing changes. Seeing the patient and family through the medical care aspect of nursing. The pathological and therapeutic sciences (the disease).

ó  Care based on pathological and therapeutic sciences

ó  Application of medical knowledge by nurses

ó  Nurse assisting the doctor in performing tasks

ó  Nurse is patient advocate in this area

ó  Nurse is a patient advocate

ó  Nurses role changes from positive quality to negative quality

ó  Medical surgical and rehabilitative care

ó  COPERATE WITH FAMILIES OR CARE GIVERS

INTERACTIONS:

q  Emphasis placed on the importance of total person

q  Importance placed on all three aspects functioning together

q  All three aspects interact and change in size

Theoretical Assertions

1.  Nursing functions differently in the three interlocking circles that constitute the aspects of the patient. These three circles are interrelated and are influenced by each other. The three circles are: the patient’s Body, the Disease affecting the body, and the Person of the patient, which is affected by each of the other circles. Nursing operates in all three circles, but it shares then with the other professions to different degrees. Pathological conditions are treated with medical care (Cure); therefore nursing shares this with the physicians. The Person aspect (Core) is cared for by therapeutic use of self. Therefore this area is shared with psychiatry, psychology, social work, and religious ministry. The body of the patient is cared for exclusively by nursing (Care). The Care circle includes all intimate bodily care such as feeding, bathing, and toileting. The care component is the exclusive domain of nursing.

 2. Hall’s second assertion relates to the Core postulate of her theory. As the patient needs less medical care, he or she needs more professional nursing care and teaching. This inversely proportional relationship alters the ratio of nursing care in the three circles. Patients in the second stage of illness (nonacute phase) are primarily in need of rehabilitation through learning; therefore the Care and Core circles predominate the Cure circle.

 3.  The third assertion of the theory is that wholly professional nursing care will hasten recovery. Hall descried the concept of team nursing, which gives the care of less complicated cases to caregivers with less training. Nurses are complex people using a complex process of teaching and learning in caring for complex patients with complex diseases. Only professional nurses are inherently qualifies, to provide the teaching, counseling, and nurturing needed in the second stage of illness.

Assumptions and the Paradigm of Nursing

Nursing

        Nursing is identified as consisting of participation in the care core and cure aspects of nursing care. Nursing can and should be professional. Hall stipulated that patients should be cared for only by professional nurses who can take total responsibility for the care and teaching of their patients. Care is the sole function of the nurse, where as core and cure are shared with other member of the health team. However the major purpose of care is to achieve an interpersonal relationship with the individual that will facilitate the development of care.

       

Person

        Hall viewed a patient as composed of these three aspects: body, pathology and person. She emphasized the importance of the individual as unique, capable of growth and learning and requiring a total person approach. Patients achieve their maximal potential through learning process, therefore, the chief therapy they need is teaching.

Health

        Hall viewed becoming ill is a behavior. Illness is directed by feelings-out-of-awareness, which are the root of adjustment difficulties. Healing may be hastened by helping people move in the direction of self-awareness. Once people are brought to terms with their true feelings and motivations, they become free to release their own powers of healing. Through the process of reflection, the patient has the chance to move from the unlabeled threat of anxiety . . . through a mislabeled threat of phobia or disease . . . to a properly labeled threat (fear) with which he can deal constructively.

Environment

        The concept of environment is dealt with in relation to the individual. Hall was credited with developing the concept of Loeb Center for Nursing because she assumed that the hospital environment during the treatment of acute illness creates a difficult psychological experience for the ill individual. Loeb Center focuses on providing an environment conducive to self development in which the action of nurses is for assisting the individual in attaining a personal goal.

Limitations

·         Hall’s theory of nursing has a limited generality. Hall’s primary targets are the adult patients who have passed the acute phase of his or her illness and have a relatively good chance of rehabilitation. This concept severely limits the application of the theory to a small population of patients of specific age and stage of illness. The theory would be most difficult to apply to infants, small children and comatose patients.

·         The function of the nurse in preventive health care and health maintenance is not addressed nor is the nurses’ role in the community health, even though the model could be adapted.

·         Hall viewed the role of nurses as heavily involved in the care and core aspects of patient care. Unfortunately, this concept provides for little interaction between the nurse and the family, because her theory delineates the family aspect of patient care in the cure circle.

·         The only communication technique Hall described in her theory as means to assist patient to self awareness was reflection. This is very limited approach to therapeutic communication because not all nurses can effectively use the technique of reflection and it is not always the most effective and most successful communication tool in dealing with patients.

References:

Nursing Theorist and Their Work by Ann Marriner Tomey and Martha Raile Alligood, 5^th Edition

http://www.slideshare.net/narsglance/the-care-core-cure-model-of-nursing-by-lydia-hall

http://www.slideshare.net/krishnameera999/lydia-halls-theory


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