1991), long-term ventilator patient (Higgins, 1998;
Delmore, 2003), and older adult and elderly pa-
tients (Cox, 1991; Foreman, 1991, 1996; Hirschfeld,
1976), including the frail elderly patient (Happ,
personal communication, January 31, 1995;
Roberts, Brittin, Cook, & deClifford, 1994).
The model has been used as a framework for
wound care (Cooper, 1990), managing respiratory
illness (Dow & Mest, 1997; Roberts, Brittin, Cook,
& deClifford, 1994), managing sleep in the patient
with a myocardial infarction (Littrell & Schumann,
1989), developing nursing diagnoses (MacLean,
1989; Taylor, 1989), practicing enterostomal ther-
apy (Neswick, 1997), assessing for changes in
bladder function in posthysterectomy women
(O’Laughlin, 1986). It has also been used for devel-
oping plans of care for women with chronic illness
(Schaefer, 2002), care of intravenous sites (Dibble,
Bostrom-Ezrati, & Rizzuto, 1991), skin care (Burd
et al., 1994), developing day room admission
(Clark, Fraaza, Schroeder, & Maddens, 1995), and
care of patients undergoing treatment for cancer
(Webb, 1993), and as an approach to the assess-
ment and design of interventions to support staff
nurses through change (Jost, 2000). Universities
and colleges are considering continued and new use
of the model as the framework for undergraduate
(Grindley & Paradowski, 1991) and graduate pro-
grams (Schaefer, 1991b).
Current work on the model is in process in the
areas of community health. The following is a brief
summary of beginning clarification of the model’s
use in community-based care.
Modified for Use in
Community-Based Care
The principles of community health nursing that
are fundamental to community-based care can be
practiced in any setting. This discussion focuses on
community-based care using Levine’s Conserva-
tion Model to provide a foundation for the future
of nursing practice and to dispel the myth that the
model is inappropriate for the community.
The focus of health in the community is based
on the assumption that community-based care is
often informed by the one-on-one care provided to
individuals. Using Levine’s Conservation Model,
community was initially defined as “a group of peo-
ple living together within a larger society, sharing
common characteristics, interests, and location”
(National League for Nursing Self Study Report,
1978). Clark (1992) provides examples of the use of
the conservation principles with the individual,
family, and community as a testament to the
model’s flexibility/universality.
The approach to community begins with the
collection of facts and a thorough community as-
sessment (provocative facts). The internal environ-
ment assessment directs the nurse to examine the
patterns of health and disease among the people of
the community and their use of programs available
to promote a healthy community. The assessment
of the external environment directs the nurse to ex-
amine the perceptual, operational, and conceptual
levels of the environment in which the people live.
The perceptual environment incorporates those
factors that are processed by the senses. On a com-
munity basis these factors might include an assess-
ment of:- how the media affects the health of the people;
- how the quality of the air influences health pat-
terns and housing development; - the availability of nutritious and affordable
foods throughout the community; - noise pollution; and
- relationships among the community’s subcul-
tures.
The operational environment would encourage
a more detailed assessment of the factors in the en-
vironment that affect the individual’s health but are
not perceived by the people. These might include
surveillance of communicable diseases, assessment
for the use of toxins in industry, disposal of waste
products, consideration for exposure to radiation
from electrical lines, and examination of buildings
for asbestos, lead, and radon.
The conceptual environment focuses the assess-
ment on the ethnic and cultural patterns in the
community. An assessment of types of houses of
worship and health-care settings might be included.
In this area, the effect of the communities external
to the one being assessed would be addressed in
order to determine factors that may influence the
function of the target community.
The novice nurse will benefit from using the
conservation principles to guide continued assess-
ment to assure a thorough understanding of the
community. When considering energy conserva-
tion, areas to assess might include:102 SECTION II Evolution of Nursing Theory: Essential Influences