Lydia Hall (1906 - 1969)
Pioneer in Nursing Autonomy and Nurse-Driven Care
Nursing theory according to Lydia Hall is nothing short of revolutionary. In a time of change and revolution (1960’s), 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 views of nursing care as she learned it over the years with the influence of Lillian Wald, Carl Rogers, John Dewey, and many others (Tomey, 1995). In her articles, Hall talks about her Loeb Center for Nursing Rehabilitation from the perspective of director.
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). She believed that patients come to the hospital in 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. This is where she felt that nursing could make a significant difference. In fact, she felt that taking over this sub-acute care was the way for nursing to legitimize itself into a true profession at a time when nursing was even more disrespected.
Hall thought the trend toward team nursing in her day was moving away from professionalism. She says about team nursing, “Any career that is defined around the work that has to be done, and how it is divided to get it done, is a trade” (Hall, 1969). She also felt that physicians were delegating nurses more and more medical tasks and proposed that nursing was losing its identity and becoming “practical doctors” instead of nurturing professional nurses.
In her Loeb center she hired, “only those nurses licensed to practise professionally” (Hall, 1969). Loeb was run by nurses, had an all RN staff and medicine served only as an ancillary service. Hall increased staffing during evening and night shift and hired no nursing aides. The only auxiliary staff she hired were called messenger-attendants with a ratio of two RNs to one messenger and who, “get fired if they ever try to substitute for a nurse” (Hall, 1969).
In 1962, Hall opened up her Loeb center and implemented her ideas. Hall presented the patient as three aspects of being which overlapped in three circles as; the pathology or cure handled by medicine, the person or core handled by the social sciences and religion, and the care or body which she proposed as the main realm of the nurse (Hall, 1969). During the acute phase of disease she saw the cure as the dominant influence, but in the sub-acute phase of disease she saw the core and care as being the dominant influences. Thus, nursing could be most effective when the patient was out of biological crisis and needed help with care and core issues. Since the nurse physically takes care of the body (care) of the patient by touching or “the laying on of hands” she develops a nurturing/fostering relationship with the patient and is in the perfect position to teach the patient about his/her own feelings (core). The nurse reflects the patient’s feelings back to him/her in hope that this will lead to self-awareness. It is through this self-awareness that Hall says, “healing might be hastened” (Hall, 1969). Hall admits that there is no conclusive evidence that this self-awareness hastens healing, but she does point out the positive outcomes that are associated with the Loeb Center.
In the world today of managed care and evidence-based medicine it seems that Lydia Hall’s theory has vanished from American nursing, with one exception--Hahnemann Hospital--which in 2012 brought back all-RN care. But it has vanished at Loeb and almost everywhere else in the U.S. This may not be because it was not sound theory. The economic crisis in health care, the lack of nurses at the highest levels of power in the health care system and the improved nurses’ salaries from Hall’s day may rather be the cause. Additionally, it could be because Hall died after only seven years as director of the Loeb Center and she did not have time to further develop and refine her theory. Her theory lacks applications to other aspects of nursing care especially pediatrics and community health nursing (though it could be adapted), both of which she worked in during her career. Hall proposed many ideas of professional practice, such as the nursing process, that are still cornerstones of professional nursing models. The changing health care system has been steered by external forces instead of being improved by nursing to meet the needs of the patient with better professional nursing care. Today’s patients, sent home while still in biological crisis and given practical nursing by techs and nursing assistants, get cheated out of care and core and do not get the opportunity to learn how to cope with their conditions from nursing. Hall would not approve.