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Lydia Eloise Hall

1906-1969
CORE

Social Sciences and


Therapeutic use of
Self Aspect of
Nursing

The Person

CARE CURE

Intimate Bodily Pathological and


Care Aspect of Medical Aspects of
Nursing Nursing

The Body The Disease

Conceptual Framework of Care Core and Cure Model of Nursing

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).

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).

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).

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 patients 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. Halls 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

Halls theory of nursing has a limited generality. Halls 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.
Theoretical Application

In February 2010, Zandra Len Estrella Salvador applied the concepts


of this theory in her clinical paper on the perioperative care of a client with
Hydatidiform Mole.

Assessment
Core

Diagnosis
Core

Outcome and Planning


Care and Core

Implementation
Care and Core

Evaluation
Optimum Level of Functioning

Proposed Home Care


Management
Schematic Diagram of the Conceptual Framework of the Study
Statements of the Problem

1. What were the assessment findings of the client in the following stages
of surgery:
1.1 Preoperative stage;
1.2 Intra-oprative stage;
1.3 Post-operative stage?
2. What is the Psychopathophysiology of the clients illness?
3. What nursing diagnoses and plans of care were identified in each of
the three stages of surgery based on Halls theory?
4. What nursing care interventions were rendered to the client in each of
the three stages of surgery?
5. What was the evaluation of the nursing care interventions for each
nursing diagnosis identified?

Nursing Care Plan (Sample)

Intraoperative Stage
Nursing Diagnosis: Impaired skin integrity related to mechanical interruption
of skin/tissues secondary to surgery.
Scientific Basis: Wounds made aseptically with a minimum of tissue
destruction that are properly closed heal with little tissue reaction by
first intention (Smeltzer and Bare, 2008)
Core:
Presence of incision on abdomen secondary to total abdominal
hysterectomy.
Outcome Interventions Evaluation
Criteria Care Cure
Desired Outcome 1. Assess the 2. Monitor Vital Actual Outcome
Within 10 degree of skin signs After 10 hours
hours of nurse impairment of nurse client
client interaction R: For baseline interaction during
during the R: Assessment is data and/or the intensive
intensive the primary step monitor how the practicum, the
practicum, the to be undertaken client is client successfully
client will before any responding to underwent total
undergo a interventions the surgery abdominal
successful total must be made to (Smeltzer and hysterectomy
abdominal note the degree Bare, 2008) with no
hysterectomy and type of complications
with no signs of management 3. Observe the noted.
complications required of any principle of
and/or disease condition surgical
unusualities in (Smeltzer and asepsis all
the incision site Bare, 2008). throughout
during and after the entire
the operation. operation.

R: To prevent
infection or
minimize the
spread of
microorganisms
(Smeltzer and
Bare, 2008)

Assessment Tool

Name: Sex: Doctor:


Age: Religion:
Civil Status: Date of Admission:
Place of Residence:
How patient was admitted:
Admitting complaints:
Date complaints were noted:
Number of Prior admissions:
Case Number/Hospital Number:
Diagnosis/Impression:

History of Present Illness

(Can you narrate to me what exactly happened prior to your admission?)


When did it start?
What symptoms did you observe?
For how long?
Precipitating factors? Stress?
What did you do/were you doing when it happened?
Relieving factors? What activity relieves the problem?
Did you self medicate? What were these drugs? Any relief?
Did you practice herbal medication? What were these? Compliance?
Relief noted?
Diagnosis made by the doctor prior to admission?
Any laboratory examinations done before the admission? Results?
Who recommended hospitalization? Who prompted you to seek medical
attention?
Past Health History

Hypertensive?
If yes: For how many years now?
When diagnosed? By whom?
Normal average BP? Highest BP?
Any maintenance meds? What are these? Relief noted? Compliance?

Diabetic?
If yes: For how many years now?
When diagnosed? By whom?
Last known blood sugar level? Highest? Average?
Any maintenance meds? What are these? Relief noted? Compliance?

Smoker
If yes: how many sticks per day?
For how long now? When and why did you smoke?
How often do you smoke?

Alcoholic
If yes: How many bottles?
How long have you been drinking?
How often do you drink?
What do you usually drink?
Why do you drink?

Food and allergies?


Heredo familial disease? On maternal side? On paternal side?

Previous Hospitalization

How many times have you been hospitalized?


For each hospitalization:
When were you hospitalized?
Can you recall the exact date/year?
Did condition improve upon discharge?
Admitting complaints? How long did you stay in the hospital?
Procedures performed?
Actions taken? Who was the doctor?
What was the final diagnosis?
Medications given during hospitalization?
Take home meds prescribed? Compliance of the prescribed meds?
Alteration in ALDs or body function after?

Along with the above questions to gather pertinent data of the client,
the researcher also included he Gordons Functional Health Pattern and the
Comprehensive Physical Assessment (head to toe).

Bibliography

Anonuevo, et al., Theoretical Foundations of Nursing; UP Open University


Press; 2005
Potter and Perry; Fundamentals of Nursing, Fifth Edition; Mosby Publishers;
2001
George, J.B.; Nursing Theories: The Base for Professional Nursing Practice;
2000
Estrella-Salvador, Z., Halls Care Core and Cure Theory in the Perioperative
Care of a Client; Cebu Normal University College of Nursing
Graduate Studies; 2010
http://www.napnes.org/practice/news/clinical_articles/care_of_the
%20_congestive_heart_failure_patient.html
http://www.authorstream.com/Presentation/libbylou01-219589-lydia-hall-
nursing-theory-1-education-ppt-powerpoint/