Testing a Theory of Health Promotion for Preterm Infants Based on Levine's Conservation Model of Nursing

Article excerpt


Neonatal nurses play an essential role in supporting preterm infants during their critical adaptation to extrauterine life. The study's purpose was to test a middle range Theory of Health Promotion for Preterm Infants based on Levine's Conservation Model of Nursing, which is well suited to the needs of these fragile patients. Structural equation modeling was used in an ex post facto study design with a convenience sample of 235 preterm infants. Testing and refinement of a path diagram produced a complete mediation model in which consistency of nursing caregivers during the hospital stay completely mediated the effects of physiologic immaturity at birth on the age at which initial health was attained. Predetermined criteria for good model fit were met. The study supported utility of the middle range Theory of Health Promotion for Preterm Infants as a framework to guide neonatal nursing practice and research and highlighted the importance of consistent nursing caregivers to promote health in preterm infants.

Keywords: Consistency of caregivers, Levine's Conservation Model, neonatal intensive care nursing preterm infants, structural equation modeling theory testing

Preterm infants face unique challenges during their adaptation to extrauterine life due to immaturities in many major organ systems. This adaptation can take weeks or even months to complete, especially if an infant is extremely preterm, and complications arising during the transition to extrauterine life can lead to long-term disabilities for surviving infants. Because neonatal nurses play an essential role in supporting preterm infants and dieir families through this critical postnatal transition, theoretical frameworks to guide planning and delivery of holistic neonatal nursing care need refinement and testing. The purpose of this study was to perform an exploratory test of a middle range Theory of Health Promotion for Preterm Infants based on Levine's Conservation Model of Nursing.

Theoretical Framework

Using Levine's Conservation Model to view the plight of die preterm infant in the Neonatal Intensive Care Unit, Mefford (2004) developed and described a middle range Theory of Health Promotion for Preterm Infants. This theory proposes that die crisis event of a preterm birth creates environmental challenges for both the infant and the family and survival of both the infant and the family system requires rapid and ongoing engagement with die process of adaptive change. According to Levine (1996), "There must be a bridge which allows ready movement from one environmental reality to another. Adaptation is the bridge. Adaptation is the process by which individuals 'fit' the environments in which they five" (p. 38). In Levine's model, die goal of this adaptive change is the conservation of health, a term which is linguistically analogous to the terms wholeness, integrity, and unity (Levine, 1991). In Levine's view, "The internal environment and the external environment are joined through adaptive patterns, and the individual's wholeness is a function of their harmonious interaction" (Levine, 1996, p. 38). The goal of nursing care in Levine's model is conservation of health and wholeness via therapeutic and supportive nursing interventions guided by four conservation principles: conservation of energy, conservation of structural integrity, conservation of personal integrity and conservation of social integrity (Levine, 1967).

A preterm infant is both physically small and structurally immature presenting the risk for injury with transition from intrauterine to extrauterine life (a threat to structural integrity). Preterm physiologic systems also are not completely developed. This physiologic immaturity is pervasive, yielding immaturities in various cellular biochemical and metabolic pathways and suboptimal functioning of major organ systems including the lungs, heart and gastrointestinal tract (threats to the balance of energy). …