Lydia Hall presents the nurse and patient with an

“the CORE, CARE and CURE circle” opportunity for closeness. As closeness
develops, the patient can share and
- Was born on New York on September explore feelings with the nurse.
21, 1906.
- Basic nursing education in the New York The Disease (The Cure)
Hospital School of Nursing in York,
- The nurse applies medical knowledge to
Pennsylvania in 1927.
the treatment of the person.
- Nursing experience in clinical,
- involves the administration of
education, research and supervisor role
medications and treatments. Hall
The 3 C’s Circle explains in the model that the nurse
The patient is a unity composed of the shares the cure circle with other health
following three overlapping parts: (1) a person professionals, such as physicians or
(the core aspect), (2) a pathologic condition physical therapists.
and treatment (the cure aspect), (3) and a body - In short, these are the interventions or
(the care aspect). actions geared toward treating the
patient for whatever illness or disease
The Person (The Core) he or she is suffering from. During this
- The nurse addresses the social and aspect of nursing care, the nurse is an
emotional needs of the patient for active advocate of the patient.
effective communication and a Metaparadigm
comfortable environment.
- The core has goals set by him or herself Person
rather than by any other person and
- The individual human who is 16 years of
behaves according to their feelings and
age or older and past the acute stage of
values. This involves the therapeutic use
long-term illness focuses on nursing
of self and is shared with other members
care in Hall’s work. The source of
of the health team.
energy and motivation for healing is the
- This area emphasizes the patient’s
individual care recipient, not the health
social, emotional, spiritual, and
care provider. Hall emphasizes the
intellectual needs concerning family,
individual’s importance as unique,
institution, community, and the world.
capable of growth and learning, and
This can help the patient verbally
requiring a total person approach.
express feelings regarding the disease
process and its effects by using the Nursing
reflective technique. Through such
expression, the patient can gain self- - Nursing can and should be professional.
identity and further develop maturity - Identifies and consisting participation in
the care, core and cure aspects of
The body (The Care) patient care.
- The nurse gives hands-on bodily care to Health
the patient in relation to activities of daily
living such as toileting and bathing. - According to Hall’s definition of
- Nurses are focused on performing the behavior, becoming ill is a behavior.
noble task of nurturing patients. This Illness is directed by feelings out of
circle solely represents the role of awareness, which are the root of
nurses and is focused on performing the adjustment difficulties.
task of nurturing patients. Environment
- also includes educating patients and
helping a patient meet any needs he or - The concept of society or environment is
she is unable to meet alone. This dealt with concerning the individual. Hall
 is credited with developing Loeb mental, physical or mental discomfort to
Center’s concept because she assumed extreme pain and extreme tortured ..."
that the hospital environment during
treatment of acute illness creates a
difficult psychological experience for the Meaning
ill individual. Loeb Center focuses on
providing an environment that is - Reason as oneself attributes
conducive to self-development. In such Nursing
a setting, the focus of the nurses’ action
is the individual. Any actions taken - Help man to find meaning in the
concerning society or the environment experience of illness and suffering.
are to assist the individual in attaining a - Responsibility to help individuals and
personal goal their families to find meaning.
- The nurses' spiritual and ethical choices,
Major Assumptions and perceptions of illness and suffering,
Hall’s Care, Cure, and Core Theory assumptions is crucial to helping to find meaning
are as follows: Hope
(1) The motivation and energy necessary - Nurse's job is to help the patient to
for healing exist within the patient rather maintain hope and avoid hopelessness.
than in the healthcare team. - Hope is a faith that can and will be
(2) The three aspects of nursing should not change that would bring something
be viewed as functioning independently better with it.
but as interrelated. And lastly, - Hope's core lies in a fundamental trust
the outside world, and a belief that
(3) The three aspects interact, and the others will help someone when you
circles representing them change size, need it.
depending on the patient’s total course
of progress. 6 important factors characteristics of
hope are
Joyce Travelbee’s
Human to Human Relationship - Strongly associated with dependence on
other people.
“The nurse is responsible for helping the - Future oriented.
patient avoid and alleviate the distress of - Linked to elections from several
unmet needs.” alternatives or escape routes out of its
situation.
- Human-to-Human Relationship Model
- The desire to possess any object or
presented in her book Interpersonal
Aspects of Nursing condition, to complete a task or have an
experience.
- She dealt with the interpersonal aspects
of nursing. - Confidence that others will be there for
one when you need them.
- She explains “human-to-human
- The hoping person is in possession of
relationship is the means through which
courage to be able to acknowledge its
the purpose of nursing if fulfilled”
shortcomings and fears and go forward.
Basic Concepts
Communications
Suffering
"a strict necessity for good nursing care"
- "An experience that varies in intensity,
Using himself therapeutic
duration and depth ... a feeling of
unease, ranging from mild, transient - "One is able to use itself therapeutic."
 - Self-awareness and self-understanding, Nursing
understanding of human behavior, the
ability to predict one's own and others' - "An interpersonal process whereby the
behavior are important in this process. professional nurse practitioner assists
an individual, family or community to
Targeted intellectual approach prevent or cope with experience or
illness and suffering, and if necessary,
- Nurse must have a systematic to find meaning in these experiences.”
intellectual approach to the patient's
situation Other significant terms:
Metaparadigm Nurse- Patient Interaction
Person - refers to any contact between a nurse
and an ill person.
- Person is defined as a human being.
- Both the nurse and the patient are Therapeutic use of self
human beings.
- ability to use one’s personality
- a unique irreplaceable individual - a one
time being in this world- like yet unlike consciously and in full awareness in an
any person who has ever lived or ever attempt to establish relatedness and to
will live structure nursing intervention.
- a unique, irreplaceable individual who is Description of the theory
in continuous process of becoming,
evolving and changing. - Nursing is accomplished through
- Patients are only individual human human-to-human relationships that
beings in need of care, services and begin with the original encounter and
assistance of other human beings who then progress through stages of
can render the assistance that is emerging identities, developing feelings
needed. of empathy, and later feelings of
sympathy.
Health - The nurse and patient attain a rapport
in the final stage.
- Health is subjective and objective.
- For meeting the goals of nursing, it is a
Subjective health prerequisite to achieving a genuine
human-to-human relationships.
- Individually defined state of well-being - relationship can only be established by
in accord with self-appraisal of physical- an interaction process.
emotional-spiritual status.
Human-to-human relationship
Objective health
- an experience or series of experiences
- Absence of discernible disease, between nurse and patient
disability of defect as measured by - means thru which the purpose of
physical examination, laboratory tests nursing is accomplished
and assessment by spiritual director or
psychological counselor. Phasers of experience
Environment 1. original encounter
- first impressions
- Environment is not clearly defined.
2. emerging identities
Life experiences
- perceiving each other’s uniqueness
- suffering, hope, pain, illness 3. empathy
- can be indirectly equated to the - ability to share in the person’s experience
environment
4. sympathy resided. So together with her brother,
- when the nurse wants to lessen the cause of they ran to help the injured people
patient’s suffering - “First woman to become a surgeon
- therapeutic use of self general as a nurse”
- “When one sympathizes, one is involved but - Originated from nursing practice and
not incapacitated by the involvement.” desire to promote patient-centered
comprehensive care
5. rapport
- described as nursing interventions that Faye G. Abdellah’s Theory
lessens the patient’s suffering - Abdellah’s theory, “Nursing is based on
- relation as human being to human being an art and science that molds the
- “A nurse is able to establish rapport because attitudes, intellectual competencies, and
she possesses the necessary knowledge and technical skills of the individual nurse
skills required to assist ill persons and because into the desire and ability to help people,
she is able to perceive, respond to and sick or well, cope with their health
appreciate the uniqueness of the ill human needs.”
being.”
- “A nurse does not only seek to alleviate Metaparadigm
physical pain or render physical care – she
ministers to the whole person. The existence of
Person
the suffering whether physical, mental or - Having physical, emotional, and
spiritual is the proper concern of the nurse.” sociological needs.
Travelbee’s ideas - Needs may be OVERT largely physical
needs
- Greatly influenced the hospice - COVERT emotional, sociological and
movement in the west interpersonal needs- which are often
Faye Glen Abdellah missed and perceived incorrectly.
- Nursing Responsibilities
- Patient-Centered Approaches - Effective communication between
- 21 nursing problems patient and caregiver. Information is
accurate, timely and appropriate.
Background - Do everything possible to alleviate
- Born -March13.1919 patients’ pain and make them feel
- Nursing Diploma from Fitkin Memorial comfortable.
Hospital o Columbia University o - We provide emotional support and
Bachelor’s Degree in Nursing 1945 alleviate fears and anxiety.
- Master’s Degree in Physiology 1947 - We involve family and friends in every
- Doctorate in Education 1955 phase of our patients’ care.
- Patient is described as the only
May 6, 1937 justification for the existence of nursing.
- German hydrogen-fueled airship Health
Hindenburg exploded in Lakehurst, New
Jersey - Does not give a definition of health
- "I could see people jumping from the - “Total health needs” and “a healthy state
zeppelin and I didn't know how to take of mind and body” in her description of
care of them, so it was then that I vowed nursing as a comprehensive service.
that I would learn nursing." Environment
- Faye was 18 years old where she and
her brother witness the explosion of this - Home or community from which patient
airship in Lakehurst where her family comes.
 - Society is included in “planning for - Presented by a patient is a condition faced by
optimum health on local, state, national the patient or patient’s family that the nurse,
and international levels.” through the performance of professional
functions, can assist them to meet.
Nursing
- In her typology of basic nursing problems
- “Nursing is based on an art and science presented by patients, she includes three
that mold the attitudes, intellectual columns: basic nursing problems
competencies, and technical skills of the presented by the patient, specific problem
individual nurse into the desire and of patient, and common conditions.
ability to help people, sick or well, cope THE TWENTY-ONE NURSING PROBLEMS
with their health needs” The crucial element within Abdellah’s theory is
- Comprehensive nursing service the correct identification of nursing problems.
- Service to individuals, to families and These 21 nursing problems focus on the
therefore to society. physical, biological, and socio- psychological
- Goal of nursing is the fullest physical, needs of the patient and attempt to provide a
emotional, intellectual, social and more meaningful basis for organization than
spiritual functioning of the client which the categories of the systems of the body.
pertains to holistic care.
Basic to all Patients
11 Nursing Skills
1. To maintain good hygiene and physical
- Observation of health status comfort – After colonoscopy, patients are
- Skills of communication o Application of usually soiled from the procedure. It is
knowledge therefore important to clean them properly.
- Teaching of patients and families Physical comfort through proper positioning in
- Planning and organization of work bed.
- Use of resource materials 2. To promote optimal activity: exercise, rest,
- Use of personnel resources and sleep Patients who were sedated during
- Problem-solving the procedure stay in the unit until the effect of
- Direction of work of others the sedation has decreased to a safe level. As
- Therapeutic use of the self a nurse, make sure the patients are able to rest
- Nursing procedures and sleep well by providing a conducive
Four Categories of patients needs environment for rest, such as decreasing
environmental noise and dimming the light if
- Basic to all patients necessary.
- Substernal care needs 3. To promote safety through prevention of
- Remedial care needs accident, injury, or other trauma and through
- Restorative care needs. the prevention of the spread of infection – one
way we prevent the spread of infection is
Twenty-One Nursing Problems
through proper disinfection of the equipment.
- Serve as a knowledge base for nursing Bed alarm, call light at all times
(Categorized according to needs) 4. To maintain good body mechanics and
prevent and correct deformity – Positioning the
Abdellah’s Theory patient properly, allowing for the normal
States that nursing is the use of the problem- anatomical position of body parts.
solving approach with key nursing problems
related to the health needs of people. Sustenal Care Needs
Nursing Problems 5. Facilitate the maintenance of a supply of
- The patient’s health needs can be viewed as oxygen to all body cells – when patients
problems, which may be overt as an apparent manifest breathing problems, oxygen is
condition, or covert as a hidden or concealed attached to them. Sedated patients are
one. attached to cardiac monitor and pulse oximeter
while having the oxygen delivered. When the questions. to decrease their anxiety. 14. To
oxygen saturation falls below the normal levels, facilitate the maintenance of effective verbal
the rate of oxygen is increased accordingly, as and nonverbal communication – when patients
per physician's order. are not able to express themselves verbally, it
6. To facilitate the maintenance of nutrition of is important to assess for nonverbal cues. For
all body cells – patients undergoing endoscopic instance, when patients are in pain, assessing
procedures are on NPO. For this reason, it is for facial grimacing.
important to monitor the blood glucose level. 15. To promote the development of productive
When the patient's blood glucose falls from the interpersonal relationships – allow the patient's
normal value, we inject D50W to the patient or significant others to stay with the patient before
we change the patient's IVF to a dextrose and after the procedure. This allows for
containing fluid. bonding and promotes interpersonal
7. To facilitate the maintenance of elimination – relationship.
Providing bedpans or urinals to patients and at 16. To facilitate progress toward achievement
times, insertion of Foley catheter when the of personal spiritual goals – nurse usually visits
patient is not able to void the patients in the unit. Patients may benefit
8. To facilitate the maintenance of fluid and from this, allowing them time to practice their
electrolyte balance – Proper regulation of the faith.
intravenous solutions. 17. To create and/or maintain a therapeutic
9. To recognize the physiological responses of environment - providing proper lighting, proper
the body to disease conditions — pathological, room temperature, a quiet environment is done
physiological, and compensatory ex. Pt. with to patients staying in the unit.
DENGUE-it is important to check the patients 18. To facilitate awareness of self as an
for signs of bleeding by monitoring the BP, individual with varying physical, emotional, and
capillary refill developmental needs – care to patients vary
10. To facilitate the maintenance of regulatory according to their developmental needs.
mechanisms and functions – When a patient Allowing the parents to stay during the
has a difficulty in breathing and is showing an procedure help the pediatric patients in their
increase respiratory rate, elevating the head emotional and developmental needs.
part of the bed is done to facilitate the
Restorative Care Needs
respiratory function.
11. To facilitate the maintenance of sensory 19. To accept the optimum possible goals in
function – When a patient is admitted who is the light of limitations, physical, and emotional
already deaf and mute, we communicate to – The goals for each patient vary depending on
them by body language to maintain their basic the capability of the patient. The nutritional goal
need despite of inadequacy to the sensory for a patient with a PEG tube for instance will
function. Communicate to comatose patient. be different, knowing that the patient has
Remedial Care Needs limited feeding options
20. To use community resources as an aid in
12. To identify and accept interrelatedness of resolving problems arising from illness – Some
emotions and organic illness – Encourage patients live far from the city and thus referral
patients to verbalize their feelings and allow to health centers is sometimes done. Support
them to cry when they have the need to do so groups for depressed patients. Shelter homes
will help them emotionally. Some patients are for victims of abuse
diagnosed with malignancy after the procedure 21. To understand the role of social problems
and during this time the emotional needs of the as influencing factors in the cause of illness –
patient is a priority. Some patients who are diagnosed with
13. To identify and accept positive and amoebic colitis for instance are advised to
negative expressions, feelings, and reactions – avoid buying street foods to which the
most patients feel anxious before undergoing preparation they are not sure of, and also avoid
the procedures. It is necessary to listen to the drinking water that are not safe.
patients' expressions and allow them to ask
10 Ways to Identify a Client’s Problem individual characteristics and experiences,
behavior-specific cognitions and affect, and
- Learn to know the patient behavioral outcomes. The theory notes that
- Sort out relevant and significant data each person has unique personal
- Analyze and make generalizations about characteristics and experiences that affect their
available data health-related behavior
- Identify the therapeutic plan
- Test generalizations with the patient and Metaparadigm
make additional generalizations Person
- Validate the patient’s conclusion about
his nursing problems - In the HPM, the person refers to
- Continue to observe and evaluate the the individual or target population
patient over time to identify any attitudes for health promotion efforts.
and clues affecting his behavior Pender emphasizes that
- Explore the patient’s and family’s individuals are unique and
reaction to the therapeutic plan and complex, influenced by a range of
involve them in the plan personal characteristics such as
- Identify how the nurse feels about the beliefs, values, biological factors,
patient’s nursing problems and experiences.
- Discuss and develop a comprehensive
nursing care plan
Environment
Nola Pender - The internal and external factors
Health Promotion that can impact an individual's
health behavior (social, cultural,
- Born on August 16, 1941 in economic, and physical aspects
Lansing, Michigan, US. of the environment)
- Pender suggests that a person's
- Studied nursing at West
perception of their environment
Suburban Hospital in Oak Park,
can greatly influence their health-
Illinois, (Graduated on 1962)
related decisions and actions.
- Got her master’s degree in Health
human growth and development
from the same university. (1965) - A positive and holistic state of
well-being, rather than merely the
- She developed the Health
absence of disease.
Promotion Model (HPM) in 1982,
- It encompasses physical,
emphasizing individual
psychological, and social well-
motivations and perceptions in
being.
health-related decisions.
- Influenced by personal factors,
Health Promotion Model (HPM) behavior-specific cognitions and
affect, and the individual's
- A theoretical framework for behavioral outcomes.
understanding and promoting
health behaviors Nursing
- This model was created to - Refers to the role of nurses and
provide a comprehensive healthcare professionals in facilitating
approach to understanding and health promotion.
motivating individuals to engage - In the HPM, nursing involves not only
in health-promoting behaviors. providing care and interventions but
Components and Concept of the Theory also empowering individuals to make
Pender’s model focuses on three areas: positive health choices and engage in
health-promoting behaviors.
Major Assumptions
- People try to create conditions of
living through which they can
express their unique human
potential.
- People have the capacity for
reflective self-awareness,
including assessment of their own
competencies.
- People value positive growth, and
strive to find a balance between
stability and change.
- People seek to actively regulate
their own behavior.
- Nurses and other health
professionals make up a part of
the interpersonal environment,
which exerts influence on people
throughout their lifespan.
- Self-initiated reconfiguration of
the interactive patterns between
people and their environments is
necessary for a change in
behavior.