The Care, Core, Cure Theoretical Framework

Lydia Hall was a renowned nurse and a theorist, who used her knowledge in psychiatry and nursing to formulate the nursing theory known as "the Three Cs of Lydia Hall." This model comprises of three independent yet interconnected circles: the care, the core, and the cure.

Hall’s theory defines Nursing as the 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. The main purpose of care is to achieve an interpersonal relationship with the individual that will facilitate the development of the core. 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 and 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."

Major Concepts

The patient as a whole comprises of the following three overlapping parts:

1. a person (the core aspect)
2. a pathologic condition and treatment (the cure aspect)
3. a body (the care aspect)

Assumptions

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.

Concept Definitions

Behavior

Lydia Hall defined behavior as everything that is said or done. Behavior is dictated by feelings, both consciously and unconsciously.

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 a person is self-aware 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 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.

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 Circle

This represents the body, and this is where the knowledge of natural and biological sciences are applied.

In Lydia Hall's theory, the care circle represents the nurturing and supportive role that nurses play in promoting patient well-being. The care circle encompasses the actions and interactions that nurses undertake to help patients meet their physical, emotional, and psychosocial needs.

The care circle defines the primary role of a professional nurse in providing motherly care, such as providing bodily care, and helping the patient complete basic functions like eating, bathing, dressing, etc. The role of the nurse also includes educating patients, and helping the patient meet any needs he or she is unable to meet alone. Through this, the patient is comforted, and this presents the opportunity to develop an interpersonal relationship with the patient. As the nurse and patient becomes close, the patient may share and explore feelings with the nurse.

Key aspects of the care circle:

1. Nurturing: Nurses provide care that is akin to the nurturing role of a mother, fostering a sense of comfort, security, and support for patients.
2. Promoting self-care: Nurses assist patients in developing self-care skills and behaviors to enhance their independence and ability to manage their health effectively.
3. Patient education: Nurses provide patients with clear and understandable information about their health conditions, treatment plans, and self-care strategies.
4. Advocacy: Nurses advocate for patients' rights, needs, and preferences, ensuring that their voices are heard and respected within the healthcare system.
5. Emotional support: Nurses offer emotional support to patients, helping them cope with stress, anxiety, and other emotional challenges associated with illness.

Core Circle

This represents the person, and this is where the knowledge of social sciences and the therapeutic use of self are applied.

The core circle represents the patient as an individual with unique needs, values, and goals. It emphasizes the patient's autonomy and self-determination, recognizing that they are the central figure in their own care.

The core (the patient), according to Hall's theory, has goals that he/she has to set rather than by any other person. This goal is affected by his/her feelings and values. This involves the therapeutic use of self. This area emphasizes on the social, emotional, spiritual, and intellectual needs of 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. Reflective technique is used by the nurse in a way that he or she acts as a mirror to the patient to help the latter explore his or her own feeling regarding his or her current health status and related potential changes in lifestyle. This will help the patient make conscious decisions towards their own self and the outcome of their own treatment.

Key characteristics of the core circle:

1. Individuality: The core circle acknowledges that each patient is a unique individual with their own personal experiences, beliefs, and perspectives.
2. Self-determination: Patients are the ultimate decision-makers regarding their care, and nurses should respect their choices and preferences.
3. Self-awareness: Patients are encouraged to develop self-awareness and understand how their thoughts, feelings, and behaviors influence their health.
4. Self-care: Patients are empowered to take responsibility for their own health by developing self-care skills and behaviors.
5. Goal-setting: Patients should be actively involved in setting realistic and achievable goals for their care.

Cure Circle

This represents the disease, and this is where the knowledge of pathological and therapeutic sciences are applied.

The cure circle represents the medical and nursing interventions aimed at treating the underlying causes of disease or illness. It encompasses the actions and interactions that healthcare professionals undertake to restore the patient's health.

Lydia Hall explains that the cure circle is shared by the nurse with other health professionals, such as physicians or physical therapists. These involve interventions or actions geared toward treating the patient for whatever illness or disease he or she is suffering from. Nurses administer prescribed medications and treatments, and acts as an investigator, checking if the treatment is correct. This where the nurse is an active advocate of the patient and their family.

Key aspects of the cure circle:

1. Medical interventions: The cure circle encompasses the administration of medications, therapies, and procedures prescribed by physicians and other healthcare providers.
2. Nursing interventions: Nurses play a crucial role in implementing and coordinating medical interventions, ensuring that they are administered safely, effectively, and in a patient-centered manner.
3. Monitoring and evaluation: Nurses continuously monitor patients' responses to treatment and evaluate the effectiveness of interventions.
4. Collaboration: The cure circle requires collaboration among various healthcare professionals, including physicians, nurses, pharmacists, and therapists, to ensure a comprehensive and coordinated approach to treatment.
5. Patient education: Nurses provide patients with clear and understandable information about their treatment plans, potential side effects, and self-care strategies related to the treatment.

Interrelation of the Circles

The three circles in Lydia Hall's theory are interconnected and interdependent. The care circle and cure circle work together to promote the patient's overall well-being. The care circle provides the emotional and psychosocial support that patients need to cope with their illness, while the cure circle addresses the underlying medical causes of the illness. The core circle, representing the patient, is central to both the care circle and cure circle. Nurses must consider the patient's individual needs, values, and goals when providing care and treatment.

Hall's theory emphasizes the importance of a holistic approach to nursing care. Nurses must be able to provide care that addresses the patient's physical, emotional, and psychosocial needs. They must also be able to collaborate with other healthcare professionals to ensure that the patient receives comprehensive and coordinated care.

The size of each circle constantly varies and depends on the state of the patient. A nurse functions in all three circles but to different degrees. For example, in the care phase, the nurse gives hands-on bodily care to the patient in relation to the activities of daily living such as toileting and bathing. In the cure phase, the nurse applies medical knowledge to the treatment of the person, and in the core phase, the nurse addresses the social and emotional needs of the patient for effective communication and a comfortable environment.

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 patient’s 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 them 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 (if person is religious). 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. Hall’s 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 (non-acute 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 qualified 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 members 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

• Hall’s theory of nursing has a limited generality. Hall’s 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 doesn't include 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.