nurses at the Loeb Center. Before hiring, the phi-
losophy of nursing and the concept of professional
practice were discussed with the applicant. Alfano
stated: “If she agrees to try the nondirective ap-
proach and the reflective method of communica-
tion, and if she’s willing to exercise all her nursing
skills and to reach for a high level of clinical prac-
tice, then we’re ready to join forces” (1964, p. 84).
Nurses were given support in learning and develop-
ing their professional practice. Administration
worked with nurses in the same manner in which
they expected nurses to work with patients, empha-
sizing growth of self. Bowar (1971) described the
role of senior resource nurse as enabling growth
through a teaching-learning process grounded in
caring and respect for the “integrity of each nurse
as a person” (p. 301).
Staff conferences were held at least twice weekly
as forums to discuss concerns, problems, or ques-
tions. A collaborative practice model between
physicians and nurses evolved, and the shared
knowlege of the two professions led to more effec-
tive team planning (Isler, 1964). The nursing stories
published by nurses who worked at Loeb describe
nursing situations that demonstrate the effect of
professional nursing on patient outcomes.
Additionally, they reflect the satisfaction derived
from practicing in a truly professional role (Alfano,
1971; Bowar, 1971; Bowar-Ferres, 1975; Englert,
1971). Alfano stated: “The successful implementa-
tion of the professional nursing role at Loeb was
associated with an institutional philosophy of nurs-
ing autonomy and with considerable authority
afforded clinical nurses in their practice” (1982,
p. 226). The model of professional nursing practice
developed at Loeb has been compared to primary
nursing (Griffiths & Wilson-Barnett, 1998).
Questions arise about why the concept of the
Loeb Center was not replicated in other facilities.
Alfano (1982) identified several deterrents to repli-
cation of the model. Foremost among these was her
belief that many people were not convinced that it
was essential for professional nurses to provide di-
rect patient care. Additionally, she postulated that
others did not share the definition of the term “pro-
fessional nursing practice” that was espoused by
Hall. She noted that “those who have tried to repli-
cate the program, but have employed nonprofes-
sional or less-skilled persons, have not produced
the same results” (Alfano, 1982, p. 226). Other fac-
tors included economic incentives that favored
keeping the patient in an acute care bed, and the
difficulties encountered in maintaining a popula-
tion of short-term rehabilitation patients in the ex-
tended care unit. Pearson (1984) suggested that the
philosophy of the center may have been “threaten-
ing to established hierarchies and power relation-
ships” (p. 54). Alfano (1982, p. 226) speculated that
the Loeb Center may have been an “idea ahead of
its time” and that dissatisfaction with nursing
homes, the nation’s excess hospital bed capacities,
and an increasing emphasis on rehabilitation might
contribute to replication of the Loeb model in the
future.
Interestingly, the Loeb model was the prototype
for the development of several nursing-led in-
patient units (NLIUs) in the United Kingdom. Two
British nurses, Peter Griffiths and Alan Pearson,
both traveled to the Loeb Center in preparation for
the development of NLIUs in the United Kingdom.
Both have done extensive writing in the literature
describing the units and are involved in active out-
come research. In a comprehensive review of the
literature, Griffiths and Wilson-Barnett (1998)
identify several nursing-led in-patient units, in-
cluding Loeb; they describe their structure and dis-
cuss the research that was conducted to evaluate the
centers. The operational definition of nursing-led
in-patient units derived from this study includes
the following characteristics:- In-patient environment offering active treat-
ment - Case mix based on nursing need
- Nurse leadership of the multidisciplinary clini-
cal team - Nursing is conceptualized as the predominant
active therapy - Nurses have authority to admit and discharge
patients (Griffiths & Wilson-Barnett, 1998,
p. 1185)
Unencumbered at the present time by the finan-
cial constraints of the American health-care sys-
tem, the potential for the further development of
nursing-led in-patient centers in the United
Kingdom seems promising. However, Griffiths
(1997b) suggested that future development of
NLIUs in the United Kingdom may soon be influ-
enced by financial constraints similar to those in
the United States.
CHAPTER 10 Lydia Hall:The Care, Core, and Cure Model and Its Applications 121