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Lydia Hall

Lydia Hall

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Published by bbasya eihyna
Core, Care and Cure Model by Lydia Hall
Core, Care and Cure Model by Lydia Hall

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Published by: bbasya eihyna on Oct 21, 2009
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02/22/2013

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Lydia HallLydia Hall
TheoryTheory” ” 
The Care, Cure, and Core Model The Care, Cure, and Core Model 
IntroductionIntroduction
Congestive heart failure patients have decreased physical endurance and emotionalCongestive heart failure patients have decreased physical endurance and emotional concerns resulting from significant changes in their quality of life. Congestive heartconcerns resulting from significant changes in their quality of life. Congestive heart failure patients’ perception of quality of life depends on individual health status andfailure patients’ perception of quality of life depends on individual health status and limitations in caring for themselves. Programs with a focus on patient education andlimitations in caring for themselves. Programs with a focus on patient education and disease management can improve quality of life and decrease hospital readmission ratesdisease management can improve quality of life and decrease hospital readmission rates for congestive heart failure patients (Chelho, Ramos, Prata, Bettercourt, Ferreira &for congestive heart failure patients (Chelho, Ramos, Prata, Bettercourt, Ferreira & Cerqueira-Gomes, 2005).Cerqueira-Gomes, 2005).Congestive heart failure is a chronic disease that progressively decreases patients’Congestive heart failure is a chronic disease that progressively decreases patients’ abilities of self-care due to significant weakness that is experienced as a result of abilities of self-care due to significant weakness that is experienced as a result of  compromised cardiac and respiratory systems. This disease is present in 10% of elderlycompromised cardiac and respiratory systems. This disease is present in 10% of elderly over the age of 70. Congestive heart failure patients’ readmission rate to hospitals due toover the age of 70. Congestive heart failure patients’ readmission rate to hospitals due to  poor disease management is an ongoing problem. The cost of congestive heart failure poor disease management is an ongoing problem. The cost of congestive heart failure admissions to the hospital ranges from 8 to 15 billion dollars a year (Quaglletti, Atwood,admissions to the hospital ranges from 8 to 15 billion dollars a year (Quaglletti, Atwood, Ackerman, & Froelicher, 2000).Ackerman, & Froelicher, 2000).Current patient care models focus on the physical, social, emotional, and educationalCurrent patient care models focus on the physical, social, emotional, and educational needs of patients. Congestive heart failure patients may have physical, social, emotionalneeds of patients. Congestive heart failure patients may have physical, social, emotional and/or education needs depending on the severity and stage of their disease process,and/or education needs depending on the severity and stage of their disease process, knowledge of the disease, and current social support systems. It is imperative to evaluateknowledge of the disease, and current social support systems. It is imperative to evaluate and analyze various patient care models, and to choose one that best meets the particular and analyze various patient care models, and to choose one that best meets the particular   patient’s needs because care plans are the essential framework through which nurses patient’s needs because care plans are the essential framework through which nurses work to provide the care a patient needs (Anderson & McFarlane, 2004).work to provide the care a patient needs (Anderson & McFarlane, 2004).Lydia Hall’s Care, Cure, and Core Model (Figure A) refers to patients as having threeLydia Hall’s Care, Cure, and Core Model (Figure A) refers to patients as having three needs of care: the physical, the medical, and the social needs. Nurses can easily provideneeds of care: the physical, the medical, and the social needs. Nurses can easily provide the Care, Core and Cure model of nursing to meet the needs of patients with chronicthe Care, Core and Cure model of nursing to meet the needs of patients with chronic disease (Touhy & Birnbach, 2001).disease (Touhy & Birnbach, 2001). Nurses using Lydia Hall’s model, assist with education, medical management, and Nurses using Lydia Hall’s model, assist with education, medical management, and  provide physical, emotional, or social support for congestive heart failure patients. The provide physical, emotional, or social support for congestive heart failure patients. The medical management and education offered by nurses increases patients’ knowledge andmedical management and education offered by nurses increases patients’ knowledge and ability to manage their disease and prevent exacerbations and reduce hospitalability to manage their disease and prevent exacerbations and reduce hospital readmissions (Quaglietti et al., 2000).readmissions (Quaglietti et al., 2000).Development of the nurse and patient relationship is critical in problem solving andDevelopment of the nurse and patient relationship is critical in problem solving and  providing care and education to promote effective health management for the congestive providing care and education to promote effective health management for the congestive heart failure patient. Open communication and trust is necessary to facilitate care, provideheart failure patient. Open communication and trust is necessary to facilitate care, provide education, and arrange discharge planning (Touhy & Birnbach, 2001).education, and arrange discharge planning (Touhy & Birnbach, 2001).
Framework Framework 
Lydia Hall’s model for nursing provides a framework to encourage open communicationLydia Hall’s model for nursing provides a framework to encourage open communication  between patients and nurses. The model has three interrelated circles that represent between patients and nurses. The model has three interrelated circles that represent medical and clinical management nurses give to patients.medical and clinical management nurses give to patients.The care circle is the intimate care nurses provide to patients to assist in bathing, dressingThe care circle is the intimate care nurses provide to patients to assist in bathing, dressing and assistance with daily activities. The disease management and treatment of the patientand assistance with daily activities. The disease management and treatment of the patient 
 
is addressed in the cure circle of the framework. The core circle symbolizes the emotionalis addressed in the cure circle of the framework. The core circle symbolizes the emotional and social structure of the patient. The model is not static, but rather the patient can be inand social structure of the patient. The model is not static, but rather the patient can be in an individual circle or the circles can overlap depending on the needs of the patientan individual circle or the circles can overlap depending on the needs of the patient during management of their disease. Patients who have their care, cure, and core needsduring management of their disease. Patients who have their care, cure, and core needs met have improved self-esteem and awareness of the importance of disease managementmet have improved self-esteem and awareness of the importance of disease management and improved quality of life. The care, cure, core model provides an opportunity for and improved quality of life. The care, cure, core model provides an opportunity for  Patients to develop trust and communicate their fears and concerns in relation to diseasePatients to develop trust and communicate their fears and concerns in relation to disease management (Touhy & Birnbach, 2001).management (Touhy & Birnbach, 2001).
Care ModelCare Model
The care model (Figure B) dominates when Nurses provide hands on care to congestiveThe care model (Figure B) dominates when Nurses provide hands on care to congestive heart failure patients. Hands on care for patients produces an environment of comfort andheart failure patients. Hands on care for patients produces an environment of comfort and trust and promotes open communication between nurses and patients. Opentrust and promotes open communication between nurses and patients. Open communication encourages expressions of thoughts and fears and decreases anxiety.communication encourages expressions of thoughts and fears and decreases anxiety. Patients develop feelings of security and verbalize concerns of disease management,Patients develop feelings of security and verbalize concerns of disease management, emotional, and/or social issues in relation to the lifestyle changes they are experiencingemotional, and/or social issues in relation to the lifestyle changes they are experiencing secondary to congestive heart failure (Touhy & Birnbach, 2001).secondary to congestive heart failure (Touhy & Birnbach, 2001).Patient education and discharge planning begins in the care model. During this phase,Patient education and discharge planning begins in the care model. During this phase, nurses have the primary role of answering questions and address concerns in relation tonurses have the primary role of answering questions and address concerns in relation to disease process, disease management. Congestive heart failure patients’ needs aredisease process, disease management. Congestive heart failure patients’ needs are addressed as nurses and patients develop both interpersonal and professional workingaddressed as nurses and patients develop both interpersonal and professional working relationships (Touhy & Birnbach, 2001).relationships (Touhy & Birnbach, 2001).
Cure ModelCure Model
The cure model (Figure C) dominates when nurses perform physical assessments andThe cure model (Figure C) dominates when nurses perform physical assessments and care management plans for congestive heart failure patients. During this phase, nursescare management plans for congestive heart failure patients. During this phase, nurses assess patients’ ability to perform activities of daily living based on physical changes thatassess patients’ ability to perform activities of daily living based on physical changes that occur during walking, talking or bathing (Touhy & Birnbach, 2001). Nurses monitor occur during walking, talking or bathing (Touhy & Birnbach, 2001). Nurses monitor   patients fatigue level, respiratory status, blood pressure and oxygen saturation to patients fatigue level, respiratory status, blood pressure and oxygen saturation to determine patients’ tolerance level and need for supplemental oxygen. Lung sounds aredetermine patients’ tolerance level and need for supplemental oxygen. Lung sounds are osculated for diminished breath sounds or crackles for signs of fluid congestion.osculated for diminished breath sounds or crackles for signs of fluid congestion. Congestive heart failure patients’ pulse strength, edema, and temperature are assessed toCongestive heart failure patients’ pulse strength, edema, and temperature are assessed to monitor circulation status secondary to decrease cardiac output and potential of poolingmonitor circulation status secondary to decrease cardiac output and potential of pooling of fluid in the lower extremities (LeMone & Burke, 2004).of fluid in the lower extremities (LeMone & Burke, 2004).Education to congestive heart failure patients is essential to increase their understandingEducation to congestive heart failure patients is essential to increase their understanding of their disease process and to improve medication compliance. It is important that nursesof their disease process and to improve medication compliance. It is important that nurses review medications and stress the importance of compliance to medication schedules.review medications and stress the importance of compliance to medication schedules. Improved compliance can improve the quality of life for the congestive heart failureImproved compliance can improve the quality of life for the congestive heart failure  patient and result in decreased hospital readmissions (Coelho et al., 2005). patient and result in decreased hospital readmissions (Coelho et al., 2005).Diet compliance also improves the status of congestive heart failure patients. PatientsDiet compliance also improves the status of congestive heart failure patients. Patients who understand their ordered diet understand the importance of compliance to preventwho understand their ordered diet understand the importance of compliance to prevent weight gain due to fluid overload. Patients who recognize the symptoms that accompanyweight gain due to fluid overload. Patients who recognize the symptoms that accompany their disease understand when to notify the physician of weight gain, increased shortnesstheir disease understand when to notify the physician of weight gain, increased shortness of breath, fatigue, or dizziness (LeMone & Burke, 2004).of breath, fatigue, or dizziness (LeMone & Burke, 2004).
Core ModelCore Model
The core model (Figure D) of the framework dominates when nurses and patients are ableThe core model (Figure D) of the framework dominates when nurses and patients are able to discuss emotional concerns and distress to physical and mental changes due toto discuss emotional concerns and distress to physical and mental changes due to  patients’ disease process. Patients address emotional concerns and distress due to their  patients’ disease process. Patients address emotional concerns and distress due to their   perceived ability or inability to manage their disease, living alone, and general fear of  perceived ability or inability to manage their disease, living alone, and general fear of  their disease process. These emotions and concerns effect compliance to the medical plantheir disease process. These emotions and concerns effect compliance to the medical plan 
 
and quality of life (Touhy & Birnbach, 2001).and quality of life (Touhy & Birnbach, 2001).An essential role of nurses in the healthcare plan is to assist with management of An essential role of nurses in the healthcare plan is to assist with management of  congestive heart failure patients by providing medical, physical, and social care. Thecongestive heart failure patients by providing medical, physical, and social care. The framework of Lydia Hall is used in the following care plan to assist in meeting theframework of Lydia Hall is used in the following care plan to assist in meeting the  personal, medical, and social needs of congestive heart failure patients (Touhy & personal, medical, and social needs of congestive heart failure patients (Touhy & Birnbach, 2001).Birnbach, 2001).Congestive Heart Failure Plan of CareCongestive Heart Failure Plan of CareCare:Care:Problem 1: Potential for inability to care for self related to weakness and decreasedProblem 1: Potential for inability to care for self related to weakness and decreased mobilitymobilityInterventionIntervention1.1.Asses patient’s ability to bathe and dress self Asses patient’s ability to bathe and dress self 2.2.Assist with activities of daily living asAssist with activities of daily living asneeded for personal careneeded for personal care3.3.Teach importance of rest when bathing andTeach importance of rest when bathing anddressingdressingGoalGoal1.1.Patient will have increased strength toPatient will have increased strength to bathe and dress self  bathe and dress self 2.2.Patient will have assistance as needed foPatient will have assistance as needed fo personal care personal care3.3.Patient will verbalize and demonstrate thePatient will verbalize and demonstrate theimportance of rest when bathing and dressingimportance of rest when bathing and dressingProblem 2: Potential for decreased social interaction secondary to fear, anxiety, and trustProblem 2: Potential for decreased social interaction secondary to fear, anxiety, and trustInterventionIntervention1.1.Identify cause(s) of stress/anxietyIdentify cause(s) of stress/anxiety2.2.Provide comfort and supportProvide comfort and support3.3.Encourage open communicationEncourage open communication4.4.Identify strengthsIdentify strengthsGoalGoal1.1.Patient will verbalize stress andPatient will verbalize stress andanxiety issues and have decrease fear anxiety issues and have decrease fear 2.2.Patient will feel comfort and supportPatient will feel comfort and supportduring careduring care3.3.Patient will communicate openlyPatient will communicate openly4.4.Patient will verbalize strengths inPatient will verbalize strengths inability to care for self ability to care for self Cure:Cure:Problem #1:Problem #1:Activity intolerance secondary to decrease cardiac output and weaknessActivity intolerance secondary to decrease cardiac output and weaknessInterventionIntervention1.1.Assess vital signsAssess vital signs2.2.Monitor respiratory statusMonitor respiratory status3.3.Encourage rest periods during activityEncourage rest periods during activity

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