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Evolution of theory
Concepts used by Hall
Presentation of Theory
Paradigm of Hall
Nursing process and Hall
Characteristics of theory
Limitation of theory
Research and practice with



Care, Core, Cure

Evaluation of Theory




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 Teachers College. Halls
Career interests revolved around Public Health Nursing, Cardiovascular Nursing, Pediatric Cardiology and nursing long term
Lydia Hall authored 21 publications with the bulk of articles and
addresses regarding her nursing theories published in the early
to middle 1960s. In 1967 she received the Award for
Distinguished Achievement in Nursing Practice from Columbia
Perhaps Halls 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 Halls 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 Centers functioning
concept was that the need for professional nursing care
increases at the need for medical care decreases.
Lydia Hall drew extensively from the schools of Psychiatry and
Psychology in theorizing about the nurse patient relationship.
She was a proponent of Carl Rogerss 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 clients 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.
Rogers 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
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

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
Motivation for change
Hall also adopted Rogers 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 theories
Hall 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 Halls emphasis on
the teaching - learning process with the nurses primary
responsibility as one of teacher.
Core, Care, Cure aspect
Sullivans 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 patients
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
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 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 nurses goal is to help the patient
learn. Motivation to learn is assured by advocating the
patients learning goals and not the doctors 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

* 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 Halls 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 patients 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.
The Person
Social Sciences
Therapeutic use of
Self-aspect of
Nursing the Core

The Body
Natural and
Biological Sciences

the Disease
Pathological and

Intimates bodily
Care aspects of

seeing the patient

and family through
the medical care
aspects of Nursing

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.
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 nurses 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.
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 nurses 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
Paradigm of Hall
Although 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 being

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.
Hall viewed becoming ill is behaviour. Illness is directed by
ones 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 selfidentify and maturity.
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
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.
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.
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 patients new level of awareness. The
nurse works with patient to help keep the goals consistent
with the medical prescriptions.

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.
It is the process of assessing the patients 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


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)
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.
Doesnt like being in hospital, wants to be at home. Will not
discuss how she will be cared for at home.
Incisions are healing normally, pedal pulses present in both
feet although diminished on the right.
Relocation stress syndrome related to hospitalization.
Out comer:

Have MA involved in solving the challenger associated with

her care needs at home.
Develop a plan of care to be used at home.
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.
MA agreed to home health referral and indicated her
husband will find someone to help with the housekeeping.
Also he can cook.
Halls work and Characteristics of Theory:
Halls 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. Halls theory is formulated using inductive logic moves
from specific observations to a generalized concept. For
Nursing care shortens patient recovery time
Nursing care facilitates patient recovery.

Professional nursing improves patients care

Therefore, wholly professional nursing will hasten
3. Halls works is simple in its presentation. However, the
openness and flexibility required for its application may
not be simple.
4. Halls work has been demonstrated in the research
conducted to evaluate the effectiveness of Loeb Center.
5. Halls work was designed for practice and has been
implemented successfully Loeb Centers and their centers.
Halls 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
Halls 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 Halls

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
nurses 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 patients own medical care. It does not
allow for helping a family increase awareness of the
familys self and limits. The use of the theory to the
individual as the unit of care.
Finally, Halls 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.
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 Halls 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 Halls theory on length of stay, readmission rates and
other quantitative measures of the outcomes of health care.

Halls 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 Halls theory of Nursing is

its limited generality. Halls 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.
Halls 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.
Halls 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 Halls 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


After Halls 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 Halls 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


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