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NURSING THEORY OFLYDIA - E – HALL

CORE CARE AND CURE MODELS

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INDEX

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CONTENT PAGE.NO

01 Introduction 01-02

02 Evolution of theory 02-05

03 Concepts used by Hall 05-07

04 Presentation of Theory 07-09

05 Paradigm of Hall 10-11

06 Nursing process and Hall 11-15

07 Characteristics of theory 15-16

08 Limitation of theory 16-17

09 Research and practice with Care, Core, Cure

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10 Evaluation of Theory 18-19

11 Conclusion 20

12. Bibliography 21

LYDIA – E – HALL NURSING THEORY CORE, CARE AND CURE MODEL

INTRODUCTION:Lydia Hall was born in New York City on September 21, 1906. Lydia E Louise Hall received her basic nursing education at York Hospital School of Nursing in York, Pennsylvania and graduated in 1927. Both her B.S in Public health nursing (1937) and her M.A in teaching natural sciences (1942) are from Teachers college, Columbia University, New York. Hall had faculty positions at the York Hospital School of Nursing and was a Consultant in nursing education to the nursing faculty at State University of New York. Upstate Medical Center. She also was and instructor of Nursing education at Teacher’s College. Hall’s Career interests revolved around Public Health Nursing, Cardio-vascular Nursing, Pediatric Cardiology and nursing long term illnesses.Lydia Hall authored 21 publications with the bulk of articles and addresses regarding her nursing theories published in the early to middle 1960’s. In 1967 she received the Award for Distinguished Achievement in Nursing Practice from Columbia University.

Perhaps Hall’s greatest achievement in nursing was her design and development of the Loeb Center for Nursing at Montefiore Hospital in New York. Established to apply her theory to nursing practice, the center opened in January 1963. It demonstrated extreme success and provided empirical evidence to support the major concepts in Hall’s theory. Hall served as an Administrative Director of the Loeb Center for Nursing from its opening until her death in February 1969. Her experience in Nursing spans the clinical, educational, research and Supervisory components. Her publications include several articles on the definition of nursing and quality of care. Lydia Hall articulated what she considered a basic philosophy of Nursing upon which the nurse may base patient care. As a nurse theorist Lydia Hall in unique in that her beliefs about nursing were demonstrated in practice with relatively little documentation in the literature. The Loeb Center’s functioning concept was that the need for professional nursing care increases at the need for medical care decreases.

EVOLUTION OF THEORY:

Lydia Hall drew extensively from the schools of Psychiatry and Psychology in theorizing about the nurse – patient relationship. She was a proponent of Carl Rogers’s philosophy of Client centered therapy.

Client – centered therapy

This method of therapy entails establishing a relationship of warmth and safety. Conveying a sensitive empathy with the client’s feeling and communications as expressed. Patients achieve their maximal potential through a learning process.

Changes that occurs in client centered therapy1. The person accepts himself and his feelings more fully2. He becomes more self-confident and self directing.3. He changes maladaptive behaviors, even chronic ones.4. He becomes more open to evidence of what is going on

both inside and outside of him.Extension documentation indicates the result of this treatment is that physiological and psychological tensions are reduced and that the change lasts. Roger’s hypothesizes that in a client-centered relationship,

the patients.Will re-organize himself at both the conscious and deeper levels of his personality in such a manner as to cope with life more constructively. He shows more of the characteristics of the healthy, well – functioning person. He is less frustrated by stress, and recovers from stress more quickly. Psychotherapy - facilitates significant learning by:1. Pointing out and labelling unsatisfying behaviors.2. Exploring objectives with the client the reasons for the

behaviors.3. Establishing through re-education more effective problem

- solving habits.

Therapeutic approachThe major therapeutic approach advocated by Hall is also Rogerian. This approach is the use of reflection, a nondirective method of helping the patient clarify, explore and validate what he says. Roger states, the therapist procedure what (clients) had found most helpful was that the therapist clarified and openly stated feelings which the client had been approaching hazily and hesitantly.Hall derived her postulates regarding the nature of feeling – based behaviour from Rogers, who repeatedly speaks to the interaction of known feelings and feelings out – of – awareness. Motivation for changeHall also adopted Roger’s theory on motivation for change. In this theory Rogers asserts that although the therapist does not motivate the client, neither is the motivation supplied by the client. Alternatively, motivation for change “ springs from the self actualizing tendency of life itself. In the proper psychological climate, this tendency is released. Educational and interpersonal theoriesHall also integrated educational and interpersonal theories into the theory. Hall developed her ideas regarding interpersonal behaviour from Harry Stack Sullivan and also utilized teaching and learning ideas integrated from John Dewey. Hall did not utilize the ideas of the contemporary nursing theorists.

The influence of Dewey can be seen in Hall’s emphasis on the teaching - learning process with the nurse’s primary responsibility as one of teacher. Core, Care, Cure aspectSullivan’s influence was evidenced in the role of the nurse as nurturer for the patient within the ‘core’ circle. The patient is a unity composed of three

overlapping parts. A person (the core aspect)

A body (the care aspect)A pathology and treatment (the cure aspect)

The nurse is the bodily care given. Provision of bodily care allows the nurse to comfort and learn the patient’s pathology, treatment aspect, and person. Understanding, resulting from the integration of all these areas, allows the nurse to be an effective teacher and nurtures. The patient learns and is nurtured in the person (that is in the core aspect).Nurturance leads to effective rehabilitation, greater levels of self actualization and self-love.Nursing occurs during one of two phases of medical care.

Phase I: Medical care in the diagnostic and treatment phasePhase II: Is the evaluative, follow – up phase.

The professional nurses role is in Phase II and professional nursing practice requires a setting in which patients are free to learn. In phase II the nurse’s goal is to help the patient learn. Motivation to learn is assured by advocating the patient’s learning goals and not the doctor’s curative goals. Once patient learning goals are codetermined with the nurse and motivation therefore assured. The patient will learn and nurturance, rehabilitation and self-love follow. The overall goal for the client is rehabilitation, which inspires greater measures of self-actualization and self-love.Concepts used by Hall* Behaviour: refers to everything that is said or done.

Behaviour is dictated by feelings, both conscious and unconscious.

* Reflection: refers to a method of communication in which selected verbalizations for the patient are repeated back to him using different phraseology, to invite him to explore his feelings further.

Phases of medical care:Hall devides medical care into two phases:Biologically critical and evaluative follow-up.During first phase, the patient receives intensive medical care and multiple diagnostic. The second phase starts when doctors begin giving only follow up care. Hall defines second stage of illness as the non-acute 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 care.Wholly professional nursing:It implies nursing care given exclusively by RNS educated in the behavioural sciences who take the responsibility and opportunity to co-ordinate and deliver the roles of nurturing, teaching, and advocacy in the fostering of healing.Care, Core and Cure: Nursing circles of care, core and cure are the central concepts of Hall’s theory. Care alludes to the hands on intimate bodily care of the patient implies a comforting, nurturing relationship. Core involves the therapeutic use of self in communicating with the patient.The nurse reflects questions appropriately and helps the patient clarify motives and goals facilitating the process of increasing the patient’s self-awareness. Cure is the aspect of nursing involved with administration of medications and treatments. The nurse functions in this role as an investigator representation of these concepts shown.

Presentation of Theory:Lydia Hall presented her theory of nursing visually by drawing three interlocking circles, each circle presenting a particular aspect of nursing. The circles represents core, care and cure.

CORE, CARE AND CURE MODELS

The PersonSocial Sciences

Therapeutic use ofSelf-aspect of

Nursing the ‘ Core’ The Body the Disease Natural and Pathological and

Biological Sciences therapeutic sciences

Intimates bodily seeing the patient Care aspects of and family through Nursing the medical care The ‘ CARE ‘ aspects of Nursing The ‘ CURE ‘

CoreThe person social security therapeutic use and self-aspect of nursing. The core circle of patient case is based in the social sciences involves the therapeutic use of self and is shared with other members of the health team. The professional nurse, by developing an inter-personal relationship with the patient, is able to help the patient verbally express feelings regarding the disease process and its effect. Through such expression the patient is able to gain self-identify and further develop maturity. The professional nurse by use of the reflective technique (acting as a mirror for the patient) helps the patient look at and explores feelings regarding his or her current health status and related potential changes in life style. The nurses use a freely offered closeness to help the patient bring into awareness the verbal and non verbal messages, being sent to others. Motivations are discovered

through the process of bringing into awareness of the feelings being experienced with the awareness. This awareness the patient is now able to make conscious decisions based on understood and accepted feelings and motivations. The motivations and energy necessary for healing exist within the patient, rather than in the health care team. CareThe body Natural and Biological sciences. Intimate bodily care aspects of nursing ‘ The care’. The care circle represents the nurturing components of nursing and exclusive to nursing. Nurturing involves using the factors that makes up the concept of mothering Care and comfort of the person may provide for teaching – learning activities. The professional nurse provides bodily care for the patient and helps the patient to complete such basic daily biological functions as eating, bathing, elimination and blessing. When providing this care, the nurse’s goal is comfort of the patient, while providing care, the nurse gets an opportunity for closeness. This closeness gives an opportunity to explore feelings represents the teaching - learning aspect of nurturing. When functioning the care circle, the nurse applies knowledge of the natural and biological sciences to provide a strong theoretical base for nursing implementation. In this patient views the nurse as a potential comforter. Cure

The ‘ cure ‘ circle of patient care is based on pathological and therapeutic sciences and is shared with other members of the health team. The professional nurse helps the patient and family through the medical, surgical and rehabilitative prescriptions made by the physician. During this aspect of nursing care, the nurse is an active advocate of the patient. The nurse’s role during the cure aspect is different for the care circle because may of the nurses action take on a negative quality of avoidance of pain rather than a positive quality of comforting. For example giving injection, preparing and performing diagnosing procedure on patients. Pathological and Therapeutic sciences seeing the patient and family though the medical care aspects of nursing ‘ the Cure ‘ .Hall emphasizes the importance of a total person approach, it is important that the three aspects of nursing not viewed as functioning independently but as interrelated. Here, the professional nurse functions most therapeutically. When the patients have entered the second stage of their hospital stay. (i.e. they are recuperating and are past the acute stage of illness). During this recuperation stage, the care and core aspects are the most prominent and the core aspect is less prominent.Paradigm of HallAlthough the concept of nursing is identified by Hall, she does not speak directly to other three concepts of human

health and environment. However, inferences made from her work in noted below: Human beingHall viewed a patient in composed of three aspects, body, pathology and person. She emphasizes the importance of the individual as unique, capable of growth and learning and requiring total person approach. Patients achieve their maximal potential through learning process, therefore, the chief therapy they need is teaching. HealthHall viewed becoming ill is behaviour. Illness is directed by one’s feelings – out – awareness, which are the roots adjustment difficulties. Heal can be inferred to be a state of self-awareness with conscious selection of behaviours that are optimal for that individual. She stresses the need to help the person explore the meaning of his or her behaviour to identify and overcome problems through developing self-identify and maturity. EnvironmentHall said ‘ any career that is defined around work that has to be done and how it is divided to get it done is a trade ‘. She vehemently opposed the ideas of anyone other educated, professional nurses taking direct care of patients and decried the fact that nursing has trained, non-professionals to function as practical nurses, so that professional nurses can function as practical doctors. The concept of environment is dealt with in relation to the individual. Hall is credited with

developing the concept of Loeb Center because she assumed that the Hospital environment during the treatment pf acute illness creates a difficult psychological experience for the ill individual. Loeb Center focuses on providing an environment, i.e. Conducive to self development in which any action of the nurses is for assisting the individual in attaining a personal goal. NursingNursing is identified as consisting of participation in the care, core and cure aspects of patient care. Care is the sole function of nurse, whereas core and cure are shared with other members of the Health Care Team. However, the major purpose of care is to achieve an interpersonal relationship with the individual that will facilitate the development of core. i.e. The development of self – identify and self – direction by the patient.Nursing Process and HallAccording to Hall, the motivation and energy needed for healing within the patient. This aspect of her theory influences the five phases of nursing process as follows.Assessment: Involves data collection about health status of the person. Hall viewed the process of data collection is directed for the benefit of the patient rather than benefit the nurse. It should be directed towards increasing the patient self awareness. Through the use of observation and reflection, the nurse is able to assistant the patient in becoming aware of both

verbal and non-verbal behaviour. In the individual, increased awareness of feelings and needs in relation to health status increases the ability of self-healing. This Phase helps guiding patients through the cure aspects of nursing.

Nursing diagnosis:It is the statement of the patient needs or problems. Analysis and interpretation of data collects help identify nursing diagnosis, viewing the patient as the power of self healing power rests in the doctor or nurse. The patient is the one in conteol than one who identifies the need.

Planning:Involves setting priorities and mutually establishing patient centered goals. The patient decides what is of highest priority and what goals are desirable. The core is involved in planning. The role of the nurse is to use reflection to help the patient become aware of and understand needs feelings and motivations. Once motivation is clarified, the patient is the best person to set goals and arrange priorities. The nurse seeks to increase patient awareness and to support decision making based on the patient’s new level of awareness. The nurse works with patient to help keep the goals consistent with the medical prescriptions.

Implementation

Involves actual institution of the plan of care. This phase is the actual giving of nursing care. In this care and core circles, the nurse works with patient, helping with bathing, dressing, eating and other care of comfort needs. The professional nurse use a permissible non directive teaching – learning approach to implement nursing care, then helping the patients reach the established goals. This includes helping the patient with his feelings providing requested information and supporting patient made decision. The nurse also helps the patient and family through the cure aspects of nursing. Working with patient and family to help him understand and implement the medical plan.

EvaluationIt is the process of assessing the patient’s progress toward the health goals. This phase is directed toward the health goals. This phase is directed towards deciding whether or not the patient is successful in reaching the established goals and according to Hall, whether or not a person is growing in self-awareness regarding his or her feeling and motivations can be recognized through changes in his or her outward behaviour.

APPLICATION OF THEORY INTO PRACTICE

ExampleMe MA, known case of Rheumatoid arthritis got admitted in the hospital with the chief complaints of fall from stairs and X ray revealed fractures of the Right femur for which he had undergone ORIF (Open Reduction and Internal Fixation)AssessmentCare:Able to provide most of own hygiene, needs help bathing back and feet. Having little pain from surgical sites but needs pain relief for arthritis pain in hands and hips.Core:Doesn’t like being in hospital, wants to be at home. Will not discuss how she will be cared for at home.Cure:Incisions are healing normally, pedal pulses present in both feet although diminished on the right.Diagnosis:Relocation stress syndrome related to hospitalization.Out comer:

Have MA involved in solving the challenger associated with her care needs at home.Planning:Develop a plan of care to be used at home.

Implementation:Identify with MA what she can do for herself.Identify with MA what she will need help doing (for example, dressing changes, preparing meals, house keeping chores)Include MA in problem solving how these needs can be met. e.g. home health referral.Evaluation:MA agreed to home health referral and indicated her husband will find someone to help with the housekeeping. Also he can cook.

Hall’s work and Characteristics of Theory:Hall’s work may be considered a theory because it meets each of the characteristics of theories.1. The use of terms: Care, Core, Cure is unique to Hall. She is

inter related these concepts.2. Hall’s theory is formulated using inductive logic moves

from specific observations to a generalized concept. For example’

Nursing care shortens patient recovery time Nursing care facilitates patient recovery. Professional nursing improves patient’s care

Therefore, wholly professional nursing will hasten recovery.

3. Hall’s works is simple in its presentation. However, the openness and flexibility required for its application may not be simple.

4. Hall’s work has been demonstrated in the research conducted to evaluate the effectiveness of Loeb Center.

5. Hall’s work was designed for practice and has been implemented successfully Loeb Centers and their centers.

LIMITATION OF THE THEORYHall’s theory of nursing has several areas that limit its application to general patient care. The first limiting factor in the stage of illness.Hall applies her ideas of nursing to a patient who has passed the acute stage of biological stress – that is; the patient who is experiencing the acute stage of illness is not included in Hall’s approach to nursing care. However, it is possible to apply the care, core and cure ideas to the care of those who are actually ill.

A Second limiting factor is age.Hall refers only to adult patients in the second stage of their illness, thus eliminating all younger patients. On the basis of this theory Loeb Center admitted only patients 16 years of age and older. However, it would be possible to apply Hall’s theory with younger individuals.

A third limiting factor is the description of how to help a person toward self awareness. The only tool of therapeutic communication Hall discusses in reflection. By inference, all other therapeutic. Communications are eliminated. This emphasis on reflection arises from the belief that both the problem and the solution lie in the individual and the nurse’s function to help the individual find them.

Fourth, the family is mentioned only in the cure circle. This means that the nursing contact with families is used only in regard to the patient’s own medical care. It does not allow for helping a family increase awareness of the family’s self and limits. The use of the theory to the individual as the unit of care.

Finally, Hall’s theory relates only to those who are ill. This would indicate no nursing contact with healthy individuals, families or communities, and it negates the concept of health maintenance and health care to prevent illness.

RESEARCH AND PRACTICE WITH CARE, CORE AND CURE

Hall tested her theory through demonstrating its use in a practice setting and conducting quantitative research to evaluate the effectiveness of Loeb Center. This research was conducted at Hall’s insistence, in spite of the enthusiastic acceptance of her philosophy was conducted by those in the

Montefiore health are community (Brown, 1970). This research is evidence that hypotheses can be developed and tested. In addition the sharing of report about the Loeb Center in a congressional hearing is evidence of an increase in the general body of knowledge (Loeb center 1963). Quantitative methods can be used to test the impact of the use of Hall’s theory on length of stay, readmission rates and other quantitative measures of the outcomes of health care.

EVALUATION OF THEORY

Hall’s theory is simple and easily understood. The major concepts and relationships are limited and clear. The three aspects of professional nursing are identified both individually and as they relate to each other in the total process of patient care. Hall designed basic models to represent the major concepts and relationships of her theory, using individuals and interlocking circles to define the three aspects of nursing. The language used to define and describe the theory is easily understood and is indigenous to nursing.

Perhaps the most serious flaw in Hall’s theory of Nursing is its limited generality. Hall’s primary target in nursing theory is the adult patient who has passed the acute phase of his or her illness and has a relatively good chance at rehabilitation. This concept severely limits

application of the theory to a small population of patients of specific age and stage of illness. The use of therapeutic communication to help the patient look at and explore his feelings regarding his illness and the potential changes the illness might cause is discussed in the core aspect of nursing care.

Hall’s concept of professional nursing hastening patient recovery with increased care as the patient improves has been subjected to a great amount of testing at the Loeb Center for nursing.Hall’s theory has been tested at two other facilities, has been found to be successful. These two facilities still only care for adults, mainly those over 65 years if age, Therefore, empirical precision of Hall’s theory continues to be limited and further testing in facilities not caring for adults will still be needed.

The theory provides a general framework for nursing, and the concepts are within the domain of nursing, although the aspects of cure and core are shared with other health professionals and family members. Although the theory does not provide for the resolution of specific issues and problems, it does not address itself to the pertinent and contemporary issues of accountability, responsibility and professionalism.

CONCLUSION:

After Hall’s death in 1969 the Loeb Center became a nursing home in 1985; in 2004 the nursing home closed, and the space reverted to acute care. However it should be noted that the nurse who uses Hall’s theory, functions in a manner similar to the method of assignment that became known as primary nursing.

Hall also deserves praise not only for having courage to create a new environment to which she put ideas into practice but also for insisting that research be conducted to document the effects of that environment.

BIBILIOGRAPHY:

1. Basavanthappa B.T. Nursing theories, First edition, New Delhi:

Jaypee Brothers; 2007. P 86-95

2. George. B. Julia. Nursing theories, 6th edition, India’s Pearson Publishers; 2011 P 181-186

3. Smith. C. Marlaine & Parker. E. Marylyn, Nursing theories and Nursing practice, 3rd edition, Philadelphia: F.A Davis company; 2010 P 59-61

Website:

1. Current nursing.com