GROUP 1 LYDIA HALL

Theory: Care, Core, and Cure

a. Short introduction about the theorist - ABUEL, KARHYLLE KHAYE

b. Presentation of concepts, relationships, model, and nursing paradigm - PALILEO,
DIANNE ISABELLE
c. Application of the Theory in the fields of Practice, Academe, and Research - PAMBID,
ANDREA

LYDIA HALL

Getting to Know the Theorist

Lydia Hall, born on September 21, 1906, was
the firstborn of Louis and Anna Williams (Gonzalo,
2014). She had several clinical, educational, and
supervisory nursing experiences, leading her to
publish several articles and articulate a basic nursing
philosophy. In 1927, Hall completed her primary
nursing education at the York Hospital School of
Nursing in Pennsylvania. Meanwhile, her Bachelor of
Science and Master of Arts degrees are from
Columbia University in New York (George, 2014).
She worked as a registered nurse at Metropolitan Life
Insurance Company in her early years. She also
practiced nursing at Visiting Nurse Service of New
York from 1941 to 1947 (Gonzalo, 2014).

As a visionary rehabilitation nurse, Hall

became well known for her unique conceptual framework for nursing practice (Parker & Smith,
2010). She used her vision and philosophy of professional nursing in establishing the Loeb Center
for Nursing and Rehabilitation. As the founder and administrative director of the Loeb Center from
1963 until 1969, Hall supervised the functioning concept of the center. This concept refers to the
increasing need for high-quality professional nursing care to clients in the post-acute stage of
illness or rehabilitation phase (George, 2014).

According to Alligood (2014), during Hall’s time as the director, her work, Nursing: What
Is It?, was presented in The Canadian Nurse in 1964. Meanwhile, in 1969, the International Journal
of Nursing Studies discussed Hall’s work, The Loeb Center for Nursing and Rehabilitation. Hall
suggested in this groundbreaking paper that hospitals should organize beds into therapeutic nursing
units. In many aspects, this provision resembled what later became known as primary nursing
(Gonzalo, 2014).
 Besides the presentations of her works, Hall also received awards and honors. She received
the Teacher’s College Nursing Education Alumni Association (TCNEAA) Achievement in
Nursing Practice Award in 1967 and was the Nursing Hall of Fame inductee (Parker & Smith,
2010). Also, she became the American Nurses Association (ANA) Hall of Fame inductee in 1984
(Gonzalo, 2014).

In February 1969, Hall died of heart disease, but her legacy was kept alive at the Loeb
Center until 1984. Remembered by many for her passion for nursing, Hall became a force of
change as the theorist of the now-famous Care, Core, and Cure Theory (Parker & Smith, 2010). In
this theory, she used three overlapping circles representing the aspects of patient and nursing
functions. Hence, it can demonstrate improvement in the nursing process and patient-nurse
communication, self-growth, and self-awareness in patients (Alligood, 2014).

Presentation of Concepts, Relationships, Model, and Nursing Paradigms

Lydia Hall’s observations of hospital care at the time in Loeb Center led her to articulate
her beliefs about the value of professional nursing to patient welfare. She believed that care should
be the primary focus. Moreover, the most qualified to provide the type of care that would enable
patients to achieve their maximum potential are the nurses. She inspired commitment and
dedication through her unique conceptual framework for nursing practice that viewed professional
nursing as the key to the care and rehabilitation of patients. Hall enumerated three aspects of the
person as a patient, and these aspects were viewed as overlapping circles that influence each other
(Parker, 2001).

The Care, Core, and Cure Theory

Care
The care aspect of nursing defines the primary role of nurses, to provide intimate bodily
care, such as bathing, feeding, and dressing, with the intent to give comfort to their patients. This
aspect is exclusive to nursing and represents the nurturing component which includes the concept
of mothering and teaching-learning activities (Parker, 2001). The goal of nurses is to help their
patients complete daily tasks and meet the needs he or she is incapable of meeting alone. According
to George (2014), when functioning in the care circle, the nurse applies knowledge of the natural
and biological sciences. The patient views the nurse as a potential comforter, one who provides
care and comfort through the laying on of hands.

Core
According to Hall’s theory, the core refers to the recipient of nursing care – the
patient. This area emphasizes the social, emotional, spiritual, and intellectual needs of the patient
in relation to family, institution, community, and the world (Hall, 1955, 1958, 1965). The core
aspect 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 helps the patient look at and explore feelings
regarding his current health status, and related possible changes in lifestyle (George, 2014).
Through the closeness offered by the provision of intimate bodily care, the patient will feel
comfortable enough to explore with the nurse “who he is, where he is, where he wants to go and
will take or refuse help in getting there—the patient will make amazingly more rapid progress
toward recovery and rehabilitation” (Hall, 1958, p. 3).

Cure

The cure circle, which is based in pathological and therapeutic sciences, represents nursing
which involves administration of medications and treatments given by medical professionals.
Nurses apply their knowledge of disease to assist and educate their patients with the medical,
surgical, and rehabilitative prescriptions made by the physician. The role of nurses in this aspect
also includes being an active advocate of their patient and developing care plans in the best
interests of their patients. (George, 2014).

Relationship

The major purpose of the care aspect of Hall’s theory is to achieve an interpersonal
relationship with the individual to facilitate the development of the core (Gonzalo, 2021). The role
of the nurse to provide comfort and educate the patient creates an atmosphere of trust and open
communication between the nurse and patient; thus, it presents an opportunity for closeness. As
this closeness develops, the patient will be able to comfortably share and express his thoughts and
feelings to the nurse. Through such expression, the patient can be able to attain maturity and self-
identity. As Hall says,

“To look at and listen to self is often too difficult without the help of a significant figure
(nurturer) who has learned how to hold up a mirror and sounding board to invite the behaver
to look and listen to himself. If he accepts the invitation, he will explore the concerns in
his acts. As he listens to his exploration through the reflection of the nurse, he may uncover
in sequence his difficulties, the problem area, his problem, and eventually the threat which
is dictating his out-of-control behavior.”

Hall believed that the role of professional nursing was enacted through the provision of
care that facilitates the interpersonal process and invited the patient to learn to get at the core of
his difficulties while seeing him through the possible cure. Through the professional nursing
process, the patient has the opportunity of making the illness a learning experience from which he
may emerge even healthier than before his illness (Hall, 1965).
Model

The care-core-cure circles. (Adapted from Hall, L. Nursing—What is it? P. 1. Publication of the
Virginia State Nurses’ Association, Winter 1959.)

Lydia Hall used her knowledge of psychiatry and nursing experiences as the framework to
formulate the care, core, and cure theory of nursing also known as “The Three C’s of Lydia Hall”.
She enumerated three aspects of the person as a patient: (1) the person, (2) the body, and (3) the
disease. These aspects were represented by three interrelated and overlapping circles that change
in size as the patient progresses through a medical crisis to the rehabilitative phase of the illness
(Parker, 2001). Hall believed that the care, core, and cure model reflects the professional
interpersonal process nature of nursing. She described two phases of medical care: Phase 1, also
known as acute phase, is when the patient is in biological crisis and in need of intensive medicine;
and Phase 2, also known as follow-up phase, is when the patient’s acute crisis is stabilized and in
need of evaluative medicine – the phase where professional nursing is most important. The size of
these circles varies depending on the phase where the patient is currently into. During the acute
phase, the largest is the cure circle, while in the follow-up or evaluative phase, the predominant
one is the care circle. The nurse functions in all three circles but with different degrees (Alligood,
2014).

Nursing Metaparadigm

Person

The three C’s theory of Lydia Hall focuses on humans who are 16 years of age or older,
and past the acute stage of long-term illness. Hall also emphasized the importance of individuals
as unique, capable of growth and learning (George, 2014).
Health

Health, according to the theory of care, core, and cure, can be inferred as a state of self-
awareness with a conscious selection of behaviors that are optimal for that individual. Hall
emphasizes that the person needs to explore the meaning of his or her behavior to identify and
overcome problems through developing self-identity and maturity (George, 2014).

Environment

According to Hall, the environment is dealt with concerning the individual, and providing
a setting conducive to self-development. The actions taken concerning society, or the environment
are meant to assist the individual in attaining a personal goal (Gonzalo, 2021).

Nursing

Nursing is defined as the participation in care, core, and cure aspects of patient care, where
care is the sole function of nurses.

Analysis of the Three C’s Theory of Lydia Hall

Strength

The three C’s theory of Lydia Hall is simple and logical. According to Parker (2001), it
stresses the need for care of the whole person. It emphasizes the importance of the total patient
rather than viewing only one aspect.

Weaknesses

The theory of care, core, and cure has several areas that limit its application to general
patient care. One of these is the age requirement. It eliminates younger patients seeking for self-
identity because only 16 years old and above are included in Hall’s theory of nursing. The concepts
of care, core, and cure can be applied to every age group, but none was specified. Aside from that,
another limiting factor is the stage of illness. The theory is applied only to patients who are past
the acute stage of illness. The way to achieve self-awareness in this theory, which is through
reflective technique, is also a limiting factor; there can be other therapeutic communication
techniques, such as nonverbal support and active listening, to facilitate development of self-
identity. Furthermore, the care, core, and cure theory apply only to ill people and has nothing to
do with healthy individuals. This limiting factor contradicts the concept of health maintenance and
preventive health care. Generally, the theory formulated by Lydia Hall applies only to adults past
the acute stage of illness (George, 2014).
Application of the Theory in the fields of Practice, Academe, and Research Practice

Practice

The care, core, cure theory of Lydia Halls is important to be viewed as interconnected
rather than independent. Based on available resources, the nurse develops a plan to meet the
patient's need for assistance: what the patient believes, knows, can do, and has done. Lydia’s
concerns for this concept demonstrate support for her theory. The concept of nurses being able to
take responsibility for their practice is relevant and applicable.

Hall’s theory is more applicable in a long-term healing process. The three interlocking
circles: care, core, and cure are effective in this kind of process. Starting with “the care”, according
to Alligood (2014), the nurse provides basic needs to the patients such as eating, dressing, and
bathing. This type of care makes the patient comfortable and allows the nurse and patient to build
a relationship. Closeness to one another leads them to good communication wherein patients can
share feelings to the nurse with comfortability. This is the phase where “the core” enters. This
circle focuses on the social sciences such as the interpersonal relationship of the nurse with the
patient. The patient can express their feelings to the nurse regarding their situation, and the nurse
is able to discuss the patient’s role in his recovery because this is important. The goals of the
interpersonal process are to help patients to understand themselves as they participate in focusing
on the problem and how to solve the problem. Understanding the self can increase self-healing that
is why the nurse uses a reflective technique which is acting as a mirror to the patient. The goal of
the nurse is how to help the patient and recognize that the patient’s capability to heal lies in the
patient’s hand, not in the nurse. This technique helps the patient to see their current health status
and possible lifestyle changes (George, 2014). After making the patient comfortable by nurturing
and building relationships, the nurse is now able to provide a cure. It is like the main event of the
healing process because the healing process is more on technicality such as providing medical,
surgical, and rehabilitative prescriptions made by the physicians. For example, injecting patients
for their illness, getting blood samples, surgery, medication, etc.

Education (Academe)

Hall precisely describes her theory using the three interlocking circles wherein each of
them represents a particular aspect of nursing. These are the care, core, and cure. Hall emphasized
that it is important to recognize the three aspects of nursing as interrelated rather than seeing it as
functioning independently. The three circles interact and the sizes change depending on the
patient’s progress. According to Parker and Smith (2010), the “care” concept can be used in
nursing schools by receiving real-world learning experiences from the instructors such as
performing bodily care to the patient. Teaching students the proper ways of bathing, toileting,
positioning, moving, dressing, undressing, and maintaining a healthful environment and educating
the students on the importance of the “care” factor as the building of relationship to the patient will
develop their confidence in assuming their roles as a nurse. In the “core” concept, nursing schools
should implement the teaching of building relationships with the patient by conducting two-way
communication. This includes giving motivation and making the patient understand their current
situation in a well-mannered way. Educating students on the reflective technique wherein the
students should act as a mirror for their patients (George, 2014). It helps to explore the patient’s
feelings regarding his current situation. In the “cure” concept, the healing process is more technical
compared to the first two. Instructors should conduct diagnostic tests to discover the student’s
learning needs in terms of knowledge (de Leon et al., 2008). According to George (2014), this is
important because giving care in the “cure” phase is delicate. It is based on the pathological and
therapeutic science where nurses help patients through medical, surgical, and rehabilitative aspects
of healing.

Research

Lydia Hall influenced commitment and dedication through her exceptional conceptual
framework for nursing practice, which saw nursing as a profession as the key to patient care and
rehabilitation. She wrote 21 books and numerous articles about the Loeb Center and her long-
term care and chronic disease control theories (Alligood, 2010). Nurses who worked at Loeb
added to their case study research the 18-month follow-up study of the outcomes of care. It was
funded by the Department of Health, Education, and Welfare. According to George (2014), they
admitted people who were no longer experiencing an acute biological disruption from 16 years
of age or older who required continuous professional care and were transferred from the acute
care hospital to Loeb Center. The purpose of the study is to differentiate the two outcomes of two
groups exposed to different nursing environments. The research resulted in the Loeb group
achieving better outcomes with less total cost. The nurses at Loeb worked hard to assist patients
define and clarify their goals, and to collaborate with them to figure out how to reach those goals
at their own speed, in accordance with the medical treatment plan, and in keeping with the
patient's sense of identity. The other research led the nurses to support the benefit of the structure
to patient outcomes, such as the prevention of complications. The prevention of complications is
done in the care circle wherein the nurses are hands-on with the patient. According to Parker
(2005), complications can be prevented by hands-on nursing practices, and it can be used to
develop strategies to reduce cost.
 REFERENCES

Book Reference:

Alligood, M. R. (2014). Nursing theorists and their works (8th ed.). Elsevier Mosby.

George, J. B. (2014). Nursing theories: The basis for professional nursing practice (6th ed.). Pearson.

Octaviano, E. F. & Balita, C. E. (2008). Theoretical foundations of nursing: The Philippine perspective.
Ultimate Learning Series.

Parker, M. & Smith, M. (2010). Nursing theories & nursing practice (3rd ed.). F. A. Davis Company.

Parker, M. (2005). Nursing theories & nursing practice (2nd ed.). F. A. Davis Company.

Parker, Marilyn E. (2001). Nursing Theories And Nursing Practice . America: F.A. Davis Company.

Online Reference:

Gonzalo, A. (2021, March 5). Lydia Hall: Care, Cure, Core Nursing Theory. Nurseslabs.
https://nurseslabs.com/lydia-e-halls-care-cure-core-theory/#lydia_halls_care_core_cure

Gonzalo, A. (2014, September 16). Lydia Hall: Care, Cure, Core Nursing Theory. Nurseslabs.
https://nurseslabs.com/lydia-e-halls-care-cure-core-theory/