ward secretaries. Morning and evening shifts were
staffed at the same ratio. Night-shift staffing was
less; however, Hall (1965) noted that there were
“enough nurses at night to make rounds every hour
and to nurse those patients who are awake around
the concerns that may be keeping them awake”
(p. 2). In most institutions of that time, the number
of nurses was decreased during the evening and
night shifts because it was felt that larger numbers
of nurses were needed during the day to get the
work done. Hall took exception to the idea that
nursing service was organized around work to be
done rather than the needs of the patients.
The patient was the center of care at Loeb and
participated actively in all care decisions. Families
were free to visit at any hour of the day or night.
Rather than strict adherence to institutional rou-
tines and schedules, patients at the Loeb Center
were encouraged to maintain their own usual pat-
terns of daily activities, thus promoting independ-
ence and an easier transition to home. There was
no chart section labeled “Doctor’s Orders.” Hall be-
lieved that to order a patient to do something vio-
lated the right of the patient to participate in his or
her treatment plan. Instead, nurses shared the treat-
ment plan with the patient and helped him or her
to discuss his or her concerns and become an active
learner in the rehabilitation process. Additionally,
there were no doctor’s progress notes or nursing
notes. Instead, all charting was done on a form en-
titled “Patient’s Progress Notes.” These notes in-
cluded the patient’s reaction to care, his concerns
and feelings, his understanding of the problems,
the goals he has identified, and how he sees his
progress toward those goals. Hall believed that what
was important to record was the patient’s progress,
not the duties of the nurse or the progress of the
physician. Patients were also encouraged to keep
their own notes to share with their caregivers.
Referring back to Hall’s care, core, and cure
model, the care circle enlarges at Loeb. The cure cir-
cle becomes smaller, and the core circle becomes
very large. It was Hall’s belief that the nurse reached
the patient’s person through the closeness of inti-
mate bodily care and comfort. The interpersonal
process established by the professional nurse dur-
ing the provision of care was the basis for rehabili-
tation and learning on the part of the patient.
Alfano (1982) noted that “Hall’s process for nurs-
ing care was based upon a theory that incorporated
the teachings of Harry Stack Sullivan, Carl Rogers,
and John Dewey” (p. 213). Nurses were taught to
use a nondirective counseling approach that em-
phasized the use of a reflective process. Within this
process, it was important for nurses to learn to
know and care for self so that they could use the self
therapeutically in relationship with the patient
(Hall, 1965, 1969). Hall reflected:
If the nurse is a teacher, she will concern herself with
the facilitation of the patient’s verbal expressions and
will reflect these so that the patient can hear what he
says. Through this process, he will come to grips with
himself and his problems, in which case, he will learn
rapidly, i.e., he will change his behavior from sickness
to “wellness.” (1958, p. 4)Lydia Hall directed the Loeb Center from 1963
until her death in 1969. Genrose Alfano succeeded
her in the position of director until 1984. At this
time, the Loeb Center became licensed to operate as
a nursing home, providing both subacute and long-
term care (Griffiths, 1997b). The philosophy, struc-
ture, and organization of services established under
Hall, and continued under the direction of Genrose
Alfano, changed considerably in response to
changes in health-care regulation and financing.
Hall and others have provided detailed desciptions
of the planning and design of the original Loeb
Center, its daily operations, and the nursing work
that was done from 1963 to 1984 (Alfano, 1964,
1969, 1982; Bowar, 1971; Bowar-Ferres, 1975;
Englert, 1971; Hall, 1963a, 1963b; Henderson,
1964; Isler, 1964; Pearson, 1984).Implications for
Nursing PracticeThe stories and case studies written by nurses who
worked at Loeb provide the best testimony of the
implications for nursing practice at the time
(Alfano, 1971; Bowar, 1971; Bowar-Ferres, 1975;
Englert, 1971). Griffiths and Wilson-Barnett (1998)
noted: “The series of case studies from staff at the
Loeb illustrate their understanding of this practice
and describe a shift in the culture of care both be-
tween nurses and patient and within the nursing
management structure” (p. 1185). Alfano (1964)
discussed the nursing milieu, including the orienta-
tion, education, mentoring, and expectations of the120 SECTION II Evolution of Nursing Theory: Essential Influences