Cebu Normal UniversityCollege of NursingGraduate School

NSG. 4001Theoretical and Philosophical Foundations of Nursing

Lydia E. HallAnd

The Care Core and Cure Model of Nursing

Prepared by:

Reynario Cabezada Ruiz Jr., R.N.Masterand

Submitted to:

Mr. Bong CorveraProfessor

The Theorist

Educator

A graduate of York Hospital School of Nursing, York Pennsylvania B.S. and M.A. degrees Teachers College, Columbia University in New York Faculty York Hospital School of Nursing and Fordham Hospital School of Nursing Consultant of Nursing Education to the Nursing Faculty at State University of New York,

Upstate Medical Center Instructor of Nursing Education at Teachers College

Writer

Authored 21 publications and a bulk of the articles and addresses regarding her nursing theory… published in t early to middle 1060.

Awarded for Distinguished Achievement in Nursing Practice from Colombia University

Achievements

Designed and Developed the Loeb Center for Nursing at Montifiore Hospital in New York Applied her theory to nursing practice An 80 bed capacity center For persons age 16 and older, no longer having acute biological disturbances Patients were recommended by physicians and those who had favorable potential fro

recovery and subsequent return to their community Where she served as the administrative director from its opening to her death in

February 1969 A non directive setting utilizing team approach For chronic disease or recovering from acute illness or surgical procedures Nurses and the interdisciplinary rehabilitation staff worked together with the patient

and the family. The nurse as the chief therapist Staffed with physician assistants around the clock, practical nurses and nurse

attendants assisted with the patient care but not as substitute for nurses The patient is viewed as individuals with goals The treatment plans were designed to meet those goals to achieve eventual

recovery and rehabilitation

Theoretical Sources

Carl Rogers’ Philosophy of client centered therapy (“patients achieve maximal potential through a learning process”)

Rogerian Therapeutic Approach ( the use of reflection) Rogers’ Theory of Motivation for Change Harry Stack Sullivan’s Interpersonal Behavior Theory John Dewey’s Educational Theories

Use of Empirical Evidence

Hall did not research her theory Blue Cross Insurance Indicated that:

Patients at Loeb recovered in half the time and less than half the cost and with fewer readmissions than patients admitted in Montifiore Hospital

Twenty two homecare programs in the New York area had a readmission rate five times higher than Loeb’s rate.

Forty physicians indicated the hospital stay of patient at Loeb center ranged from 3 to 43 days shorter than other hospitals with the usual difference of one to two weeks.

Indicated an increased nurse satisfaction Two UK centers: Griffiths and Wilson-Barnette found improved patient

independence, fewer readmissions, lower mortality and cost saving in the nurse-managed centers

The Theory

Concepts

Behavior – as everything that is said or done. Behavior is dictated by feelings both conscious and unconscious

Reflection – a Rogerian method of communication in which selected verbalizations of patients are repeated back to them with different phraseology to invite them to explore feelings further.

Self-awareness – refers to the state of being that nurses endeavor to help their patients achieve. The more self-awareness a person has of their feelings, the more control they have over their behavior.

Phases of Medical Care

Biologically Critical – lasts a few days to a week or more and is a period when physicians device treatment plans that helps the patient reach the second phase

Evaluative Follow up – second stage of illness, the 2nd phase of medical care once the doctor begin giving follow up care. This is also called the non acute recovery phase of illness. This stage is said to be conducive for learning and rehabilitation. The need for medical care is minimal although the need for nurturing and learning is great.

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.- The role of nurturing, teaching and advocacy in the fostering of healing

Central Concepts

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).

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 patients self awareness. The social sciences (the person).

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).

Paradigms and Major Assumptions

(Nursing) “Nursing can and should be professional”.

(Person) “Patients achieve their maximal potential through a learning process, therefore the chief therapy they need is teaching”

(Health) “Healing may be hastened by helping people move in the direction of self-awareness”

(Environment) “Hospital nursing services, she did not believe that they have patient care and teaching as their goal.”

Theoretical Assertions

1. Nursing functions differently in the three interlocking circles that constitute aspects of the patient.

2. As the patient needs less medical care, he or she needs more professional nursing care and teaching.

3. The wholly professional nursing care will hasten recovery.

Limitations

The theory is limited to:

The application of the theory to a population of patients of specific age and state of illness

Difficult to apply to infants, small children and comatose patients. Preventive health care and health maintenance is not addressed Provides little interaction between the nurse and the family 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 successful communication tool in dealing with patients.

Logical Form

Nursing care shortens patient recovery time Nursing care facilitates patient recovery Professional nursing improves patient care

Therefore “wholly professional nursing will hasten recovery.”

Diagrams

Figure 1. Care Core Cure Model of NursingFramework

X NCP Y

Patients Goals: Nursing Goals:

Rehabilitation Patient RehabilitationSuccess in Self actualization Fast patient recoverySelf Love Self-awarenessSelf-awareness

“CORE”

The Person

“CURE”

The Disease

“CARE”

The Body

Patients in the second stage of

illness.

Care

Core

Cure

Rehabilitation

Fast Recovery

Readmission

Figure 2. Tri-stage Theoretical Application Diagram

Figure 3. Nursing Care Plan utilizing CCC Model

Patient in the 2nd stage of illness

AssessmentPsychosocial and Pathophysiological

Diagnosis

Nursing Care

Planning and Interventions

Core AspectCare aspect Cure Aspect

Fast RecoveryRehabilitationReadmissionAutonomy