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48 UNIT I Evolution of Nursing Theories

the major curriculum in maternal and newborn control. In 1964, Hall’s work was presented in
health nursing when the Yale School of Nursing “Nursing: What Is It?” in The Canadian Nurse. In
established a master’s degree program (Kaplan & 1969, the Loeb Center for Nursing and Rehabilitation
King, 2000) and authored books used widely in nurs- was discussed in the International Journal of Nursing
ing education. Her definition of nursing reflects her Studies.
nurse-midwife background as follows: “People may Hall argued for the provision of hospital beds
differ in their concept of nursing, but few would dis- grouped into units that focus on the delivery of
agree that nursing is nurturing or caring for someone therapeutic nursing. The Loeb plan has been seen as
in a motherly fashion” (Wiedenbach, 1964, p. 1). similar to what later emerged as “primary nursing”
Wiedenbach’s orientation is a philosophy of nurs- (Wiggins, 1980). An evaluation study of the Loeb
ing that guides the nurse’s action in the art of nursing. Center for Nursing published in 1975 revealed that
She specified four elements of clinical nursing: philoso- those admitted to the nursing unit when compared
phy, purpose, practice, and art. She postulated that with those in a traditional unit were readmitted less
clinical nursing is directed toward meeting the patient’s often, were more independent, had higher postdis-
perceived need for help in a vision of nursing that charge quality of life, and were more satisfied with
reflects considerable emphasis on the art of nursing. their hospital experience (Hall, Alfano, Rifkin, &
She followed Orlando’s theory of deliberate rather than Levine, 1975).
automatic nursing and incorporated the steps of the Hall used three interlocking circles to represent
nursing process. In her book (1964), Clinical Nursing: aspects of the patient and nursing functions. The care
A Helping Art, Wiedenbach outlines nursing steps in circle represents the patient’s body, the cure circle
sequence. represents the disease that affects the patient’s physi-
Wiedenbach proposes that nurses identify patients’ cal system, and the core circle represents the inner
need for help in the following ways: feelings and management of the person (Figure 5-6).
1. Observing behaviors consistent or inconsistent The three circles change in size and overlap in relation
with their comfort to the patient’s phase in the disease process. A nurse
2. Exploring the meaning of their behavior functions in all three circles but to different degrees.
3. Determining the cause of their discomfort or For example, in the care phase, the nurse gives hands-
incapability on bodily care to the patient in relation to activities
4. Determining whether they can resolve their problems of daily living such as toileting and bathing. In the
or have a need for help cure phase, the nurse applies medical knowledge to
Following this, the nurse administers the help treatment of the person, and in the core phase, the
needed (Figure 5-4) and validates that the need for help nurse addresses the social and emotional needs of the
was met (Figure 5-5) (Wiedenbach, 1964). Wiedenbach patient for effective communication and a comfort-
proposed that prescriptive theory would guide and able environment (Touhy & Birnbach, 2001). Nurses
improve nursing practice. Her work is considered a also share the circles with other providers. Lydia Hall’s
philosophy of the art of nursing. theory was used to show improvement in patient-
nurse communication, self-growth, and self-awareness
Lydia Hall in patients whose heart failure was managed in the
home setting (McCoy, Davidhizar, & Gillum, 2007)
Core, Care, and Cure Model and for the nursing process and critical thinking
Lydia Hall was a rehabilitation nurse who used her linked to disaster preparedness (Bulson, & Bulson,
philosophy of nursing to establish the Loeb Center for 2011).
Nursing and Rehabilitation at Montefiore Hospital in Hall believed that professional nursing care has-
New York. She served as administrative director of tened recovery, and as less medical care was needed,
the Loeb Center from the time of its opening in 1963 more professional nursing care and teaching were
until her death in 1969. In the 1960s, she published necessary. She stressed the autonomous function of
more than 20 articles about the Loeb Center and nursing. Her contribution to nursing theory was the
her theories of long-term care and chronic disease development and use of her philosophy of nursing