Lydia E-Louise Hall's Nursing Theory: Core, Care, and Cure Models, Study notes of Nursing

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N URSING T HEORY O F

LYDIA - E – HALL

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INDEX

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CONTENT PAGE.N O

(^01) Introduction 01- (^02) Evolution of theory 02- (^03) Concepts used by Hall 05- (^04) Presentation of Theory 07- (^05) Paradigm of Hall 10- (^06) Nursing process and Hall 11- (^07) Characteristics of theory 15- (^08) Limitation of theory 16- (^09) Research and practice with

Care, Core, Cure

(^10) Evaluation of Theory 18- (^11) Conclusion 20

12. (^) Bibliography 21

LYDIA – E – HALL

NURSING THEORY CORE, CARE AND CURE MODEL

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 therapy

1. The person accepts himself and his feelings more fully
2. 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 approach

The 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

 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 phase Phase 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:

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 ‘

 Core The 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.

 Care

The 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

Hall 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.

 Health

Hall 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.

 Environment

Hall 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.  Nursing

Nursing 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 Hall According 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

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.

Evaluation It 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

Example Me 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) Assessment Care: 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:

 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 THEORY

Hall’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