wholeness, Levine supported the testing of vari-
ables that represent a single integrity. For example,
Lane and Winslow (1987) focused on energy con-
servation, whereas Roberts, Fleming, and (Yeates)
Giese (1991) focused on energy conservation and
structural integrity. To be true to the model, inves-
tigators can explain their findings within the
framework and consider how the findings support
the goal of promoting adaptation and maintaining
wholeness.
Because the model supports understanding and
description, both qualitative and quantitative ap-
proaches are appropriate to develop the model and
theories derived from the model. The qualitative
approach helps to explain how the patient experi-
ences the challenges to their internal and external
environments. The quantitative approach helps to
test the relationships between the variables, and, in
some cases, provides for the testing of causal mod-
els. These predictive models help clinicians alter the
environments to promote adaptation and maintain
wholeness.
Combining qualitative and quantitative (mixed
methods) approaches to the study concepts using
Levine’s model helps to preserve the art and the sci-
ence of nursing. Interactions with patients are both
predictive and creative. Qualitative research helps
to provide a way for the nurses to repeatedly share
the creative aspects of their work. Qualitative data
helps to explain the quantitative data and provides
a more holistic perspective regarding the data expe-
rience.
Several investigators have contributed signifi-
cant research to the support and expansion of the
Conservation Model as a model for nursing prac-
tice. Theories developed from the model will pro-
vide propositions from which hypotheses can be
developed and tested. Following is a summary of
several of the conclusions of research using the
Conservation Model as a framework.
- Responding to involuntary urges was as efficient
as, and resulted in less perineal damage than,
sustained breath holding during the second
stage of labor (Yeates & Roberts, 1984). There
were no differences in the mean duration of the
second stage of labor between the two groups. - Interventions that are employed as a course of
routine rather than based on individual needs
actually increase the physiological burden of
healing following birth and act as a significant
threat to the psychological adjustments of the
postpartum period (Fleming, 1988).- Conservation of energy can be maintained by
placing the infant skin to skin on the mother’s
chest, covered with a warm blanket (Newport,
1984). - Ludington (1990) found that simple skin-to-
skin contact was effective in reducing activity
and state-related energy expenditure in the new-
born of 34 to 36 weeks’ gestation. - There is no significant difference in energy
expenditure between basin, tub, or shower
bathing 5 to 17 days postmyocardial infarction
(Winslow, Lane, & Gaffney, 1985). The differ-
ences that did exist were related more to subject
variability than the type of bathing. The experi-
mental group had significantly lower oxygen
consumption than did the control group. - Age, arterial pressure on bypass, and body tem-
perature on the first and third postoperative days
best predicts delirious patients (Foreman, 1989).
Acutely confused patients were differentiated
best from those not confused by 10 variables
representing all four conservation principles. - Higgens (1998) found that fatigue was present
in ventilator patients 100 percent of the time
and that fatigue and depression were signifi-
cantly correlated. Despite the fact that sleep dis-
turbances were present and nutrition was
compromised, there were no significant rela-
tionships with fatigue. - Schaefer’s (1991b; Schaefer & Shober-Potylycki,
1993) research supports the finding that the ex-
perience of fatigue in congestive heart failure is
an experience that affects one’s whole sense of
being. - Mefford (1999) developed a theory of health
promotion for preterm infants derived from
Levine’s Conservation Model. She examined the
relationship of nursing caregiving to health out-
comes of infants. Although the proposed models
were not supported, findings revealed that an in-
crease in the level of consistency of nursing care-
giving decreased the age at which health was
achieved, and an increase in the level of consis-
tency in nursing caregiving also reduced re-
source utilization.
Winslow (personal communication, October 14,
1993) indicated that an important outcome of her104 SECTION II Evolution of Nursing Theory: Essential Influences