Hall's CORE, CARE, CURE INTRODUCTION    The Care, Cure, Core Theory of Nursing was developed by Lydia Hall, who used her knowledge of psychiatry and nursing experiences in the Loeb Center as a framework for formulating the theory. It contains three independent but interconnected circles: the core, the care, and the cure. The focus of the nurse’s role is on the care circle. This is where she acts as a professional in order to help the patient meet his or her needs and attain a sense of balance. HISTORY & BACKGROUND    Lydia Eloise Hall (September 21, 1906 – February 27, 1969) was a nursing theorist who developed the Care, Cure, Core model of nursing. Her theory defined Nursing as “a participation in care, core and cure aspects of patient care, where CARE is the sole function of nurses, whereas the CORE and CURE are shared with other members of the health team.” She was an innovator, motivator, and mentor to nurses in all phases of their careers and an advocate for chronically ill patients and worked to involve the community in public health issues as well. Lydia Hall was born on September 21, 1906 in New York City as Lydia Eloise Williams. She was the eldest child of Louis V. Williams and Anna Ketterman Williams and was named after her maternal grandmother. Her brother, Henry, was several years younger. At a young age, her family decided to move to York, Pennsylvania, where her father was a physician in general practice. Education   Lydia Hall graduated from York Hospital School of Nursing in 1927 with a diploma in nursing. However, she felt as if she needed more education. She entered Teacher’s College at Columbia University in New York and earned a Bachelor of Science degree in public health nursing in 1932. After a number of years in clinical practice, she resumed her education and received a master’s degree in the teaching of natural life sciences from Columbia University in 1942. Later, she pursued a doctorate and completed all of the requirements except for the dissertation. In 1945, she married Reginald A. Hall who was a native of England. Care, Cure, Core Theory      Lydia Hall used her knowledge of psychiatry and nursing experiences in the Loeb Center as a framework for formulating her theory. Also known as “the Three Cs of Lydia Hall,” it contains three independent but interconnected circles: the core, the care, and the cure. The core is the patient receiving nursing care. The core has goals set by him or herself rather than by any other person, and behaves according to his or her feelings and values. The cure is the attention given to patients by medical professionals. Hall explains in the model that the cure circle is shared by the nurse with other health professionals, such as physicians or physical therapists. These are the interventions or actions geared toward treating the patient for whatever illness or disease he or she is suffering from. The care circle addresses the role of nurses, and is focused on performing the task of nurturing patients. This means the “motherly” care provided by nurses, which may include comfort measures, patient instruction, and helping the patient meet his or her needs when help is needed. Hall’s theory emphasizes the total patient rather than looking at just one part and depends on all three components of the theory working together. Death  Hall died on February 27, 1969, at Queens Hospital in New York. Genrose Alfano continued her work at the Loeb Center until the focus of the center was changed to that of custodial care in 1985. PUBLISHED BOOKS & WORKS  Aside from being a nurse, Lydia Hall also managed to balance her time in writing. In the 1960s, she authored 21 publications and a bulk of articles regarding the Loeb Center and her theories of long-term care and chronic disease control. Her work was presented in “Nursing: What Is It?” in The Canadian Nurse. In 1969, it was discussed in “The Loeb Center for Nursing and Rehabilitation” in the International Journal of Nursing Studies. In her innovative work at the Loeb Center, Hall argued that a need exists in society for the provision of hospital beds grouped into units that focus on the delivery of therapeutic nursing. The Loeb plan has been seen in many ways as similar to what later emerged as “primary nursing.” AWARDS & HONORS    1967 - Lydia Hall received the Teacher’s College Nursing Education Alumni Association (TCNEAA) Achievement in Nursing Practice Award 1967 - also was their Nursing Hall of Fame inductee 1984 - She was inducted into the American Nurses Association (ANA) Hall of Fame. INFLUENCES OF THE THEORY  Hall did not consider herself as a nurse theorist, but instead talked about her views of nursing care as she learned it over the years with the influence of Lilian Wald, Carl Rogers, John Dewey, and many others (Tomey, 1995).   Hall felt that care represented the nurturing influence of the professional nurse and was exclusive to nursing. From her experience at Loeb Center, she developed her care cure core framework which also emerged formally as the model upon when rehabilitative care was based MAJOR CONCEPTS  The following the major concepts of Lydia Hall’s Care, Core, Cure nursing theory including their definitions. INDIVIDUAL/PERSON   Hall's work focus in nursing care is the individual human who is 16 years of age or older and past the acute stage of longterm illness. The source of energy and motivation for healing is the individual care recipient, not the health care provider. -Hall emphasizes the importance of the individual as unique, capable of growth and learning, and requiring a total person approach. HEALTH   Health can be inferred to be a state of self-awareness with a conscious selection of behaviors that are optimal for that individual. Hall stresses the need to help the person explore the meaning of his or her behavior to identify and overcome problems through developing self-identity and maturity. SOCIETY AND ENVIRONMENT   The concept of society or 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 treatment of acute illness creates a difÏcult psychological experience for the ill individual. Loeb Center focuses on providing an environment that is conducive to self-development.  In such a setting, the focus of the action of the nurses is the individual, so that any actions taken in relation to society or environment are for the purpose of assisting the individual in attaining a personal goal. NURSING  Hall identified Nursing as consisting of participation in the care, core, and cure aspects of patient care. KEY 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 selfawareness 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 secondstage 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).  Nurturing component of care  It is exclusive to nursing  “Mothering”  Provides teaching and learning activities  Nurses goal is to “comfort” the patient  Patient may explore and share feelings with nurse  Nurse is concerned with intimate bodily care  Nurse applies knowledge of natural and biological sciences  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 patient’s selfawareness. The social sciences (the person).  Patient care is based on social sciences  Therapeutic use of self  Helps patient learn their role is in the healing process  Patient is able to maintain who they are  Patient able to develop a maturity level when nurse listens to them and acts as sounding board  Patient able to make informed decisions  Emphasis on social, emotional, spiritual and intellectual needs  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).  Care based on pathological and therapeutic sciences  Application of medical knowledge by nurses  Nurse assisting the doctor in performing tasks  Nurse is patient advocate in this area  Nurse is a patient advocate  Nurses role changes from positive quality to negative quality  Medical surgical and rehabilitative care  COPERATE WITH FAMILIES OR CARE GIVERS ASSUMPTIONS The assumptions of Hall’s Care, Cure, Core Theory are as follows: 1. The motivation and energy necessary for healing exist within the patient, rather than in the healthcare team. 2. The three aspects of nursing should not be viewed as functioning independently but as interrelated. 3. The three aspects interact, and the circles representing them change size, depending on the patient’s total course of progress. STRENGTHS   Lydia Hall’s model appears to be completely and simply logical. Her work may be viewed as the philosophy of nursing. The three Cs (care, core and cure) in this theory were unique. In all the circles of the model, the nurse is present, although focus of the nurse’s role is on the care circle. LIMITATIONS     Hall’s Theory of Nursing has a limited generality. Hall’s primarily 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 illness. The theory would be most difÏcult 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 patients 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 patients. APPLICATION TO NURSING PRACTICE, EDUCATION & RESEARCH    Care, Cure, Core Nursing Theory is applicable in assessment, planning and implementation of patient care. The theory will help Nurses to improve to meet the needs of the patient with better professional nursing care. The theory will help the establishment of nurse-patient relationships and so as the collaboration with other health professionals.