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210 UNIT III Nursing Conceptual Models

Applications to the Nursing Community early discussion of death and dying and believed that
women should be awakened after a breast biopsy and
Practice consulted about the next step.
Levine helps define what nursing is by identifying the Introduction to Clinical Nursing provides an orga-
activities it encompasses and giving the scientific nizational structure for teaching medical-surgical
principles behind them. Conservation principles, nursing to beginning students (Levine, 1969a, 1973).
levels of integration, and other concepts can be used In both the 1969 and 1973 editions, Levine presents a
in numerous contexts (Fawcett, 2000; Levine, 1990, model at the end of each of the first nine chapters.
1991). Hirschfeld (1976) has used the principles of Each model contains objectives, essential science con-
conservation in the care of the older adult. Savage cepts, and nursing process to give nurses a foundation
and Culbert (1989) used the Conservation Model for nursing activities. These models are not part of
to establish a plan of care for infants. Dever (1991) the Conservation Model. The Conservation Model
based her care of children on the Conservation Model. is addressed in the Introduction and in Chapter 10
Roberts, Fleming, and Yeates-Giese (1991) designed of the introductory text. The teachers’ manual that
interventions for women in labor based on the Con- accompanies the text remains a timely source of edu-
servation Model. Mefford (2000; Mefford & Alligood, cational principles that may be helpful to both begin-
2011a, 2011b) tested a Middle Range Theory of Health ning and seasoned teachers (Levine, 1971c).
Promotion for Preterm Infants based on Levine’s Although the text is labeled introductory, beginning
Conservation Model of nursing and found a signifi- students would have benefited from a background in
cant inverse relationship between the consistency of physical and social sciences to use it. An emphasis of
the caregiver and the age at which the infant achieved scientific principles in the second edition bridged this
health, and an inverse relationship between the use gap. Evidence supporting the model has been integrated
of resources by preterm infants during the initial hos- successfully into undergraduate and graduate curricula
pital stay and the consistency of caregivers. Cooper (Grindley & Paradowski, 1991; Schaefer, 1991a).
(1990) developed a framework for wound care focus-
ing on structural integrity while integrating all the Research
integrities. Leach (2007) published a white paper on Levine’s Model has been successfully used to develop
use of the Conservation Model to guide wound care nursing knowledge (Schaefer & Pond, 1991). However,
practices. Webb (1993) used the Conservation Model Fawcett (1995) states that to establish credibility, “more
to provide care for patients undergoing cancer treat- systematic evaluations of the use of the model in vari-
ment. Roberts, Brittin, and deClifford (1995) and ous clinical situations are needed, as are studies that
Roberts, Brittin, Cook, and deClifford (1994) used test conceptual-theoretical-empirical structures di-
the Conservation Model to study the boomerang pil- rectly derived from or linked with the conservation
low technique effect on respiratory capacity. Jost principles” (p. 208). Many research questions can be
(2000) used the model to develop an assessment of generated from Levine’s model (Radwin & Fawcett,
the needs of staff during the experience of change. 2002; Schaefer, 1991b). Graduate students and clinical
Conservation principles have been used as a researchers have used the conservation principles as a
framework for numerous practice settings in cardiol- framework to guide their research (Ballard, Robley,
ogy, obstetrics, gerontology, acute care (neurology), Barrett, et al., 2006; Cox, 1988; Gagner-Tjellesen,
pediatrics, long-term care, emergency care, primary Yurkovich, & Gragert, 2001; Mefford, 2000; Mefford &
care, neonatology, critical care, and in the homeless Alligood, 2011a, 2011b; Moch, St. Ours, Hall, et al.,
community (Savage & Culbert, 1989; Schaefer & 2007). Ballard and colleagues used the model to frame
Pond, 1991). their phenomenological study of how participants re-
constructed their lives with paraplegia. They found that
Education structural integrity, along with all the other integrities,
Levine (1973) wrote Introduction to Clinical Nursing was used as a basis for defining their new lives.
as a textbook for beginning students. It introduced One of the most important questions to be asked
new material into the curricula. She presented an about the model is: What are the human experiences