relevant now, as we face a rapidly increasing older
population with needs for long-term care and an
era of cost containment that often limits access to
professional care and services.
Vision of Nursing
Lydia Hall would not have considered herself a
nurse-theorist. She did not set out to develop a the-
ory of nursing but rather to offer a view of profes-
sional nursing. Wiggins (1980, p. 10) reflected on
the status of nursing theory during this time and
stated: “[T]he excitement of the possibility of de-
velopment by nurses of nursing theories was in its
barest beginnings.” Hall’s observations of hospital
care at the time led her to articulate her beliefs
about the value of professional nursing to patient
welfare. She observed that care was fragmented; pa-
tients often felt depersonalized; and patients, physi-
cians, and nurses were voicing concern about the
lack and/or poor quality of nursing care. She re-
flected that in the early part of the twentieth cen-
tury, a person came to the hospital for care. In the
1950s and 1960s, the focus changed, and a person
came to the hospital for cure. However, the health
problems of the time were long-term in nature and
often not subject to cure. It was Hall’s belief that in
It was Hall’s belief that in spite of suc-
cesses in keeping people alive, there was a
failure in helping patients live fully with
chronic pathology.spite of successes in keeping people alive, there was
a failure in helping patients live fully with chronic
pathology. After the patient’s biological crisis was
stabilized, Hall believed that care should be the pri-
mary focus and that nurses were the most qualified
to provide the type of care that would enable pa-
tients to achieve their maximum potential. In fact,
she questioned why medicine would want the lead-
ership and suggested that the patient with a long-
term illness would come to nursing (Hall, 1965).
Hall described the two phases of medical care
that she saw existing in hospitals at the time. Phase
1 is when the patient is in biological crisis with a
need for intensive medicine. Phase 2 begins when
the acute crisis is stabilized and the patient is in
need of a different form of medicine. Hall labeled
this as “follow-up”—evaluative medicine—and felt
that it is at this point that professional nursing is
most important. She criticized the practice of turn-
ing over the patient’s care to practical nurses and
aides at this point while the professional nurse at-
tended to new admissions in the biological crisis
phase. Hall stated:Now when the patient reaches the point where we
know he is going to live, he might be interested in
learning how to live better before he leaves the hospi-
tal. But the one nurse who could teach him, the one
nurse who has the background to make this a true
learning situation, is now busy with the new patients
in a state of biological crisis. She rarely sees those
other patients who have survived this period, unless
there is something investigative or potentially paining
to do! The patients in the second stage of hospitaliza-
tion are given over to straight comforters, the practi-
cal nurses and aides. No teaching is available and the
patient doesn’t change a bit. No wonder so many peo-
ple keep coming back for readmission. They’ve never
had the invitation nor the opportunity to learn from
this experience. So I say, if that’s the way it is, take [the
patient] from the medical center at this point in his
follow-up evaluative medical care period and transfer
him to the Loeb Center, where nurturing will be his
chief therapy and medicine will become an ancillary
one. (1969, p. 87)Hall also opposed the concept of team nursing,
which was being implemented in many acute care
settings at the time. According to Hall (1958), team
nursing viewed nursing as a set of functions, rang-
ing from simple to complex. Simple functions were
considered those in which few factors were taken
into consideration before making a nursing judg-
ment. The tasks or activities of nursing were di-
vided among nursing personnel, who were simply
or complexly educated, with the highest educated
leading the nursing team. Hall believed that the
concept of team nursing was detrimental to nurs-
ing and reduced nursing to a vocation or trade. Hall
(1958) stated: “There is nothing simple about pa-
tients who are complex human beings, or a nurse
who is also complex and who finds herself involved
in the complexities of disease and health processes
in a complex helping relationship” (p. 1). Hall was
convinced that patient outcomes are improved
when direct care is provided by the professional
nurse.116 SECTION II Evolution of Nursing Theory: Essential Influences