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, 5th Edition
