Lydia Hall’s nursing theory—Core, Care, and Cure Model—is client-centered (Anonuevo et al., 2000). Hall’s metaparadigm centers on the following: on a person as the Core, body as the Care and disease is for the Cure (Pearson, 2007; Tomey & Alligood, 2002; Parker, 2001; Anonuevo et al., 2000). In an editorial (Pearson, 2007), nurses primarily function within three realms: core, where nurses use their selves to relate with the patient; care, using hands-on caring for the body: and, cure, in the nurses’ application of medical know-how.
The Core of nursing focuses on the recipient of care—who can be an individual, family or community. The core of nursing encompasses various fields of study, including the biological, social and behavioral sciences and humanities (Pearson, 2007). It is the application of social sciences that focuses on the personal knowing, therapeutic use of self (Octaviano & Balita, 2008; Tomey & Alligood, 2002; Parker, 2001). The nurse uses relationships for therapeutic effect and emphasizes the social, emotional, spiritual and intellectual needs of the patient in relation to family, institution, community and the world—the core (Parker, 2001).
Hall’s Care pertains to the knowledge and activities of nursing (Pearson, 2007). The Body, from the inference of phenomena of natural and biological sciences, concerns the intimate bodily care (Tomey & Alligood, 2002). Nursing is required when people are not capable of performing intimate bodily care for themselves (Parker, 2001). Nursing care is the focus of the Care Model of Hall.
Cure involves the pathological and therapeutic sciences, focusing on the patient and family through the medical care (Tomey & Alligood, 2002). Cure provides the treatment of the disease by utilizing the nursing process in conjunction with medicine (Pearson, 2007; Parker, 2001). Cure is the medical side in the care of patients.
Geriatric syndromes are conditions experienced by older frail individuals that occur intermittently rather than either continuously or as single episodes. It may be triggered by acute insults, and often are linked to subsequent functional decline. More recently, geriatric syndromes have been viewed as conditions in which symptoms are assumed to result not only from discrete diseases but also from accumulated impairments in multiple systems and develop when the accumulated effect of these impairments in multiple domains compromise compensatory ability (Flacker, 2003).
Geriatric or the stage of ageing is the period of multiple impairments that predisposes to falling, incontinence and functional dependence which includes slow timed chair stands (lower extremity impairment), decreased arm strength (upper extremity impairment), decreased vision and hearing (sensory impairment), and either a high anxiety or depression score (affective impairment) (Tinetti et al., 1995).
Geriatric Assessment Tool: An Application of Core, Care, and Cure Modell
The 3C’s Meter of Geriatric Assessment is the combination of Hall’s Core, Care and Cure Model and Maslow’s Hierarchy of Human Needs in the application to the four functions of the nurse in giving care. This can help assess the level of functioning of geriatric patients in all aspects of his/her being (emotional, physical, social, etc.) and the patient’s support system. Thus, it can help identify the type of care and level of cure indicated to his/her condition to meet his/her needs to improve the quality of health care and the quality of life.
The Core. The core of human being is his/her needs to meet the Quality of Life (QOL). It is in these needs that makeup and creates an individual.
According to Costanza and colleagues (2007), QOL as a general term is meant to represent either how well human needs are met or the extent to which individuals or groups perceive satisfaction or dissatisfaction in various life domains. Kalish (1983) adapted Maslow’s Hierarchy of Needs and stated that: physiologic needs—food, air, water, temperature, elimination, rest and pain avoidance, including sex, activity, exploration, manipulation, and novelty; safety and security-focused on protection and prevention of trauma and injury; that love and belongingness assessed the closeness of the patient to family and support systems; that self-esteem is on body image and socialization, and that self-actualization is based on the patient’s satisfaction in consideration to present health condition.
When the body (core) is in a state of altered health pattern, one or all of these needs are deprived or are not being used by the body.
The Care. The type of care a nurse will render in any case of altered health pattern can be in the form of promotive, preventive, curative, rehabilitative and palliative aspects of care. Promotive care focus on health promotion which is categorized with no source of health information, visits to well-clinic/centers or oriented to health programs and practicing a healthy lifestyle and with a good environment. Prevention is the end of health promotion.
Promotive and preventive care works together. When these fail, the curative aspect of care is given to a sick individual. In curative care, the nurse will assess if the patient is capable for self-care and can participate in the nursing interventions.
Minimal care is given if the patient needs assistance. Total care is given to the patient who cannot participate to the nursing interventions but with the support system (e.g., family) in doing the nursing care. The complete total care is given to patients without a support system, who need a “change agent”—the nurse—in providing complete total nursing care. Rehabilitative care is given to restore the patient’s health after the convalescence stage. Palliative is the last sort of care when all else failed, this stage prolonged life without treatment, care is given only to minimize suffering or lessen the depth of the present condition but does not promise long term relief or recovery.
The Cure. This identifies the level of care to be given to a person in case of an altered health pattern. Level 1 Cure covers promotive and preventive care are indications for primary health care management. The major purposes of this level are to promote wellness and prevent illness or disability. This level occurs at home or community and the participants in the care of geriatrics are the private/family/community nurse, family, and patient’s self that will emphasize the development of a healthy lifestyle and environment. Level 2, or the early stage of the curative phase, is an indication for secondary health care management.
This level aims to provide early intervention to alleviate disease and prevent further disability. An acute treatment center or hospital is advised for diagnostic and therapeutic services. Health team includes the nurses, doctors, diagnostic centers, and the support system. Level 3 includes late stage of curative, rehabilitative and palliative care, which is an indication for tertiary health care management. This aims to minimize the effects and permanent disability of chronic irreversible conditions.
Aggressive curative interventions occur at this level including medical-surgical procedures. This level seeks to restore an individual to the state that existed before the development of an illness or promote the maximum potential of wellness after the disease. Palliative management is given when all the interventions failed. The health team in this level includes nurses, physicians/surgeons, diagnostic centers, rehabilitation centers and other auxillary services. Clergy services, support system and family are also a very vital part in this level.
The main responsibility of the nurse is to care for the patient’s health. Both holistic and anatomic in nature, care respects man as a whole so as to improve the quality of life and provide health. Quality of life is akin to health and will always be a part of man’s basic needs—and every need has its hierarchy and level to attain the highest level of the health continuum. The search for the health of the patient is the primary method to provide one of man’s basic needs. To care is to provide what man needs, and such needs must be included in the nursing process.
—To care is to nurse and to nurse is to give yourself when you care.
References:
- Anonuevo, C.A. et al. (2000). Theoretical Foundations of Nursing. Philippines: UP Open University, 104–105, 22–36, 156–167, 169–178. Costanza, R. et al. (2007).
- Quality of life: An Approach Integrating Opportunities, Human Needs, and Subjective Well-being. Ecological Economics, 61, 267–276. Flacker, J.M. (2003).
- What Is A Geriatric Syndrome Anyway? Journal of the American Geriatrics Society, 51(4) , 574–576. Kalish, R.A. (1983).
- The Psychology of Human Behavior, 5th ed. California: Wadsworth. Maslow, A.H. (1968).
- Toward a Psychology of Being. 2nd ed. New York: Van Nostrand Reinhold.
- Octaviano, E.F. & Balita, C.E. (2008). Theoretical Foundations of Nursing: The Philippine Perspective, 33; 86–93; 151–159; 101–113. Philippines:
- Ultimate Learning Series. Parker, M.E. (2001). Nursing Theories and Nursing Practice. Philadelphia: F.A. Davis, 135–136; 143–149; 362–375; 330–341.
- Pearson, A. (2007). Dead Poets, Nursing Theorists Contemporary Nursing Practice. International Journal of Nursing Practice, 13, 321–323. Tinetti, M.E., et al. (1995).
- Shared risk factors for falls, incontinence, and functional dependence: Unifying the approach to geriatric syndromes. The Journal of the American Medical Association, 273(17), 1348–53.
