Theoretical Foundations in Nursing

STUDENT ACTIVITY SHEET BS NURSING / FIRST YEAR

Session # 10

LESSON TITLE: Materials:

▪ NANCY ROPER-WINIFRED LOGAN-ALISON Pen and notebook
TIERNEY'S MODEL OF NURSING BASED ON
ACTIVITIES OF LIVING
▪ LYDIA HALL’S CARE, CURE, CORE THEORY OF
NURSING

LEARNING TARGETS:
Upon completion of this lesson, you can:
▪ Acknowledge the background and credentials of these
nursing theorists;
▪ Identify the major concepts with their definitions as
utilized in their respective theory;
▪ List down their specific theoretical assertions or
assumptions;
▪ Highlight their major contributions in the nursing field;
▪ Enumerate the major assumptions enclosed within
their theory;
▪ Describe each of these theories in view of the four
metaparadigms; Reference:
▪ Apply the significance of these theories in the nursing Alligood, M. (2018). Nursing theories and their
education, research, and practice; and, work (9th ed.). Singapore: Elsevier.
▪ Recognize the application of these theories in nursing
today and in the clinical setting.

LESSON REVIEW/PREVIEW
Let us have a review of what you have learned from the previous lesson. Kindly answer the following questions on the
space provided. You may use the back page of this sheet, if necessary. Have fun!

1. Empathy
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2. Sympathy
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3. Rapport
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MAIN LESSON
You will study and read their book, if available, about this lesson.

NANCY ROPER-WINIFRED LOGAN-ALISON TIERNEY'S MODEL OF NURSING BASED ON ACTIVITIES OF LIVING

““Nursing is the practice of assisting patients live through life.”

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 Nancy Roper Winifred Logan Alison Tierney

✔ This model incorporates a life span approach wherein the characteristics of the person are considered with
respect to prior development, current level of development, and likely future development.
✔ In conjunction with the life span approach an independence/dependence continuum is used.
✔ The model then incorporates a set of 12 activities of living which represent those activities engaged in by
individuals whether sick or well.

12 Activities of Living: together these elements are referred to as a “model of living”

1. Maintaining a safe environment 7. Personal cleansing and dressing
2. Breathing 8. Maintaining body temperature
3. Communication 9. Working and playing
4. Mobilizing 10. Sleeping
5. Eating and Drinking 11. Expressing sexuality
6. Eliminating 12. Dying

5 Main Factors that Influenced the ADLs:

▪ Biological ▪ Sociocultural
▪ Psychological ▪ Environmental
▪ Politico-economic

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 ▪ The model has been a significant guide towards advancing nursing practice, research, and education in that it
places great emphasis on the nurse’s ability to perform continuous patient assessment, provide assistance in the
performance of activities of living and individualizing patient care.
▪ Health is viewed as a reflection of the person’s ability to perform the activities of living in the light of the five factors
that influence its degree of performance and within the context of the person’s developmental age.

Major Concepts & Definitions:

▪ Individuality of living
→ the way in which the person attends to his activities of living with respect to his developmental age or his
place in the life span, on the dependence-independence continuum, and as influenced by biological,
psychological, environmental, and politico-economic factors
▪ The activities of living
→ describe the person in the complex process of living from the perspective of an amalgam of activities

▪ Life span
→ refers to the concept of continuous change from birth until death and may refer to developmental age

▪ The dependence-independence continuum

→ relates to the factors and activities of the person
→ the continuum ranges from full incapacitation to having the ability to achieve activities of living
→ both concepts occur at anticipated points across the lifespan and at unexpected times throughout life

Application of the Theory: 

▪ The Theory of the Elements of Nursing: A Model Based on a Model of Living emphasizes the importance of
developmental assessment and of individualizing patient care.
▪ No two patients can have similar reactions to a particular disease condition or illness state because of the concept
of individuality of living.
▪ The first vital step towards high quality patient care is for the nurse to individualize patient care and to make a
thorough nursing and health assessment.

LYDIA HALL’S CARE, CURE, CORE THEORY OF NURSING

“Nursing is a distinct body of knowledge that provides nursing care to patients who are in
need of nursing care in support of medical interventions, in collaboration with other members
of the health team, or exclusively and independently by the nurse herself.”

Life Story:
✔ Born in New York City September 21, 1906
✔ Graduated from York Hospital School of Nursing in Pennsylvania
✔ Bachelor of Science & Master of Arts from Teachers College, Columbia University
✔ Died February 27, 1969 of heart disease in Queens Hospital of New York

Interests & Research Focus:

✔ Research in the field of rehabilitation of chronically ill patient’s brought her to
develop the Care, Cure, Core Theory
✔ Interested in rehabilitative nursing and the role that the professional nurse played and the patient’s recovery and
welfare (Alligood & Tomey 2010)
✔ She became the founder and first director of the Loeb Center for Nursing and Rehabilitation at the Montefiore
Medical Center in Bronx, New York

Theory Description:
✔ This 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 major 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 behavior to look and listen to himself. If he

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 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.”

Theory Assumptions:
▪ The motivation and energy necessary for
healing exist within the patient, rather than in the
healthcare team.
▪ The three aspects of nursing should not be
viewed as functioning independently but as
interrelated.
▪ The three aspects interact, and the circles
representing them change size, depending on the
patient’s total course of progress.

Major Concepts & Definitions:

▪ Nursing theory in line with Lydia Hall is nothing

short of revolutionary.
▪ In the 1960s, she put down in her own simple
words, her thoughts about nursing.
▪ She did not consider herself a nurse theorist
but instead talked about her transparent thoughts and
remarkable ideas of nursing care as she learned it over
the years.
▪ These lead to the development of her “Care,
Cure, Core Theory” also known as the “Three Cs of
Lydia Hall”.
▪ She believed that patients should receive care
only from professional nurses.
▪ Nursing involves interacting with a patient in a complex process of teaching and learning.
▪ She was not pleased with the concept of team nursing.

✔ Limited to helping the patients or families deal with the measures instituted by the physician
✔ Exclusive to nursing
✔ Explains the role of nurses and focused on performing that noble task of the nurturing patients
✔ Component of this model is the “motherly care” provided by the nurses (George, J.B 2000)
✔ This may include:
CARE
▪ Comfort measures
▪ Patient instructions
▪ Helping patients meet their needs where help is needed
▪ Major purpose of care is to achieve an interpersonal relationship with the individual that will
facilitate the development of the core (Texas Woman’s University)
✔ Refers to medical interventions that are performed on the patient
✔ The foundation of this concept stems from pathological and therapeutic sciences that include
microbiology, parasitology, pharmacology, and pathology
✔ It includes nursing activities that are dependent upon the orders of the physician
CURE
✔ Applying medical knowledge
✔ Limited to helping the patients or families deal with the measures instituted by the physician
✔ Interventions or actions geared toward treating the patient for whatever illness or disease he or she is
suffering from (George, J.B 200)
✔ Refers to the person or recipient of care; includes the use of therapeutic self to relate with the patient
✔ It is anchored in the social sciences, using the self in relationship to the patient
✔ Shared with social workers, psychologist, clergy, and other professions
CORE ✔ The person or patient to whom nursing care is directed and needed
✔ Involves the therapeutic use of self, and empathizes the use of reflections (Texas Woman’s University)
✔ The core has goals set by himself and not by any other person
✔ Behaves according to his or hers feelings and values (George, J. B 200)

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 ✔ Interventions or actions geared toward treating the patient for whatever illness or disease he or she is
suffering from (George, J.B 200)

Subconcepts:
▪ Lydia Hall’s theory has three components which are represented by three independent but interconnected circles.
The three circles are: the care, the cure, and the core.
▪ The size of each circle constantly varies and depends on the state of the patient.

▪ Nurses are focused on performing the noble task of nurturing patients.

▪ This circle solely represents the role of nurses, & focused on performing the task of nurturing
patients.
▪ Nurturing involves using the factors that make up the concept of mothering (care and comfort of
the person) and provide for teaching-learning activities.
▪ The care circle defines the primary role of a professional nurse such as providing bodily care for
The Care Circle
the patient and helping the patient complete such basic daily biological functions as eating,
bathing, elimination, and dressing. When providing this care, the nurse’s goal is the comfort of
the patient.
▪ Moreover, the role of the nurse also includes educating patients, and helping a patient meet any
needs he or she is unable to meet alone. This presents the nurse and patient with an opportunity
for closeness. As closeness develops, the patient can share and explore feelings with the nurse.
▪ The cure as explained in this theory is the aspect of nursing which involves the administration of
medications and treatments. Hall explains in the model that the cure circle is shared by the nurse
The Cure with other health professionals, such as physicians or physical therapists.
Circle ▪ In short, these are the interventions or actions geared toward treating the patient for whatever
illness or disease he or she is suffering from. During this aspect of nursing care, the nurse is an
active advocate of the patient.

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 ▪ The core is the patient receiving nursing care. The core has goals set by him or herself rather
than by any other person and behaves according to his or her feelings and values. This involves
the therapeutic use of self and is shared with other members of the health team.
▪ This area emphasizes the social, emotional, spiritual, and intellectual needs of the patient in
relation to family, institution, community and the world. This is able to help the patient verbally
express feelings regarding the disease process and its effects by the use of the reflective
technique. Through such expression, the patient is able to gain self-identity and further develop
The Core
maturity.
Circle
▪ Reflective technique is used by the professional nurse in a way that he or she acts as a mirror
to the patient to help the latter explore his or her own feelings regarding his or her current health
status and related potential changes in lifestyle.
▪ Motivations are discovered through the process of bringing into awareness the feelings being
experienced. With this awareness, the patient is now able to make conscious decisions based on
understood and accepted feelings and motivation.

Theory in View of Metaparadigms:

Nursing Nursing is identified as consisting of participation in the care, core, and cure aspects of patient care.
▪ The individual human who is 16 years of age or older and past the acute stage of long-term illness
is the focus of nursing care in Hall’s work.
▪ The source of energy and motivation for healing is the individual care recipient, not the health care
Person
provider.
▪ Hall emphasizes the importance of the individual as unique, capable of growth and learning, and
requiring a total person approach.
Health can be inferred to be a state of self-awareness with a conscious selection of behaviors that are
Health optimal for that individual. Hall stresses the need to help the person explore the meaning of his or her
behavior to identify and overcome problems through developing self-identity and maturity.
The concept of society or environment is dealt with in relation to the individual. Hall is credited with
developing the concept of Loeb Center because she assumed that the hospital environment during
treatment of acute illness creates a difficult psychological experience for the ill individual. Loeb Center
Environment focuses on providing an environment that is conducive to self-development.
▪ In such a setting, the focus of the action of the nurses is the individual, so that any actions taken in
relation to society or environment are for the purpose of assisting the individual in attaining a
personal goal.

Strengths:
✔ This model appears to be completely and simply logical. Her work may be viewed as the philosophy of nursing.
✔ The three C’s in this theory were unique. In all the circles of the model, the nurse is present, although focus of the
nurse’s role is on the care circle.

Weaknesses:
✔ This model is considered to be plain and simple in its presentation. However, the receptiveness and resilience
necessary for its utilization and function may not be so simple for nurses whose personality, educational
preparation, and experience have not prepared them to function with minimal structure. This and the self-imposed
age and illness requirements limit the generalizability.
✔ The age requirement for the application of her theory which is 16 years of age and above limits the theory since it
cannot be disregarded that nurses are faced with pediatric clients every now and then.
✔ The concept of a patient aggregate such as having families and communities as the focus of nursing practice was
not tackled. It is purely on the individual himself. Although, the role of the family or the community within the
patient’s environment was modestly discussed.

How Do Nurses Relate?

▪ She proposed many ideas of professional practice, such as the nursing process
▪ Improvement of nurses to meet the needs of the patient with better professional nursing care
▪ Management of nursing care
▪ Establishment of nurse-patient relationship
▪ Collaboration with other health professionals
▪ Deliverance of care to ill patients

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Theory Assertions:
▪ Nursing is viewed as a distinct body of knowledge that provides nursing care to patients who are in need of
nursing care.
▪ Care of patients can be performed in support of medical interventions, in collaboration with other members of the
health team, or exclusively and independently by the nurse herself. Nursing is described as interacting with a
patient in a complex process of teaching and learning.
▪ The patient or person, in this case, is the recipient of care which may come from three different domains.

Application of the Theory:

▪ Nurses are able to carry out nursing interventions independently, dependently, or interdependently.
▪ The core aspect of the theory maintains that it is our responsibility to make sure that the patient receives the
highest level of care possible from all concerned health professions.
▪ The role of the nurse is in the collaboration, coordination, and cooperation with other members of the health care
team on matters that pertain to the patient’s welfare.
▪ The cure aspect of the theory clearly delineates nursing functions that are dependent on the members of the
medical profession.
▪ Examples of these include medication administration, performance of diagnostic procedures, and some other
interventions that need a written order from the doctor.
▪ The care domain of the theory refers to the independent roles and functions of the nurse insofar as her knowledge
and skills about the patient’s condition will allow her to carry on with her responsibilities.

Conclusion:
▪ Hall believed patients should only receive care from professional nurses.
▪ Hall defined her philosophy on the basis of the patient.
▪ Hall believed that patients come to the hospital in a biological crisis (acute episode of a disease) and that
medicine does a great job at treating this crisis, but fails to treat the chronic underlying disease. This is where she
felt nursing could make a significant difference.
▪ Hall felt that taking over this sub-acute phase was the way for nursing to legitimize itself into a true profession.

CHECK FOR UNDERSTANDING

You will answer and rationalize this by yourself. This will be recorded as your quiz. One (1) point will be given to the
correct answer and another one (1) point for the correct ratio. Superimpositions or erasures in your answer/ratio is not
allowed.

1. Lydia E Hall believed that patient outcomes are improved by direct care as given by a professional nurse. Lydia Hall's
theory is called:
a. Human-to-Human Relationship Model
b. Human becoming theory
c. Care, Cure, Core Model
d. From Novice to Expert
ANSWER: ________
RATIO:___________________________________________________________________________________________
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2. Hall defined her philosophy of nursing on the basis of the patient, “if learning is the chief process he uses, then the
chief therapy he needs is teaching” (Hall, 1969). Which of the following concepts in Hall's independent and
interconnected circles is based on social sciences, involves the therapeutic use of self, and is shared with other
members of the healthcare team?
a. Cord c. Cure
b. Care d. Core
ANSWER: ________
RATIO:___________________________________________________________________________________________
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3. She believed that patients come to the hospital in a biological crisis (acute episode of disease) and that medicine
does a great job at treating this crisis, but fails to treat the underlying chronic disease. Which of the following is TRUE
regarding the cure concept of Hall's theory?
a. The nurse applies medical knowledge of disease to assist with the plan of care
b. The nurse sets goals to comfort the patient
c. Patient may explore and share feelings with the nurse
d. The nurse assists the patient make informed decision
ANSWER: ________
RATIO:___________________________________________________________________________________________
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4. Lydia Hall used her knowledge of psychiatry and nursing experiences in the Loeb Center as a framework for
formulating her theory. Also known as “the Three Cs of Lydia Hall,” that contains three independent but interconnected
circles: the core, the care, and the cure. Which of the following is the focus of the care circle?
a. The nurse is sharing the care of the patient with other members of the healthcare team to treat the patient
b. The nurse is performing the task of nurturing patients
c. Helps the patient learn what their role is in the healing process
d. Nurse assisting patients to make informed decisions
ANSWER: ________
RATIO:___________________________________________________________________________________________
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5. The patient views the nurse as a potential comforter, one who provides care and comfort through the laying on of
hands. Which of the following interdependent circles in Hall's theory is the situation pertaining to?
a. Cord c. Cure
b. Care d. Core
ANSWER: ________
RATIO:___________________________________________________________________________________________
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6. The nurse helps patients through surgical, and rehabilitative prescriptions made by physicians. The nurse is also
acting as an advocate for the patient. Which of the following interdependent circles in Hall's theory is the situation
pertaining to?
a. Cause c. Cure
b. Care d. Core
ANSWER: ________
RATIO:___________________________________________________________________________________________
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7. Lydia 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.” Hall
believed patients should receive care only from:
a. Doctors
b. Midwives
c. Ancillary Team
d. Professional Nurses
ANSWER: ________
RATIO:___________________________________________________________________________________________
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8. Which of the following is TRUE about the Model for Nursing Based on a Model of Living? (Select all that apply)
a. The purpose of the theory is as an assessment used throughout the patient’s care.

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 b. This theory categorizes the discoveries into activities of living through complete assessment, which leads
to interventions that support independence in areas that may be difficult for the patient to address alone.
c. The goal of the assessment and interventions is to promote maximum dependence for the patient.
d. In this theory, the nurse uses the model to assess the patient’s relative independence and potential for
independence in the activities of daily living.
ANSWER: ________
RATIO:___________________________________________________________________________________________
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9. In the Roper-Logan-Tierney Model of Nursing, all are considered to be ADLs, except:

a. sleeping
b. dying
c. playing
d. dancing
ANSWER: ________
RATIO:___________________________________________________________________________________________
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10. In the five factors of Module of Nursing that are used to determine the individual patient’s relative independence in
regards to the activities of daily living, which of the following pertains to the impact of the government, politics, and
economy?
a. biological c. sociocultural
b. psychological d. environmental
e. politico-economic
ANSWER: ________
RATIO:___________________________________________________________________________________________
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RATIONALIZATION ACTIVITY
The instructor will now provide you the rationalization to these questions. You can now ask questions and debate among
yourselves. Write the correct answer and correct/additional ratio in the space provided.
1. ANSWER: ________
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2. ANSWER: ________
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3. ANSWER: ________
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RATIO:________________________________________________________________________________________
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5. ANSWER: ________
RATIO:________________________________________________________________________________________
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6. ANSWER: ________
RATIO:________________________________________________________________________________________
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7. ANSWER: ________
RATIO:________________________________________________________________________________________
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8. ANSWER: ________
RATIO:________________________________________________________________________________________
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9. ANSWER: ________
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10. ANSWER: ________
RATIO:________________________________________________________________________________________
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LESSON WRAP-UP

You will now mark (encircle) the session you have finished today in the tracker below. This is simply a visual to help you
track how much work you have accomplished and how much work there is left to do.

You are done with the session! Let’s track your progress.

AL Activity: GUIDED DISCOVERY

This strategy leads you through practices that will help you develop deeper understanding and mastery. By posing one
question, you have the free will to answer it based on your own understanding in the Main Lesson. The more you dig
deeper, the more comprehensive the information you will relay. Here’s the question and enjoy! You can use the back page
of this sheet.

1. What are the three interlocking circles?

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2. The central theme of Lydia's Hall nursing theory has a focus on:
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3. What are the four major concepts of Lydia Hall’s Care, Cure, Core nursing theory including their definitions?
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