Evidence-Based Practice

Preterm infants face unique challenges due to immaturities in many

major organ systems. Because neonatal nurses play an essential How Do
role in supporting preterm infants and their families through their criti Chronic
cal postnatal transition, theoretical frameworks to guide planning and
delivery of holistic neonatal nursing care need refinement and testing.
The purpose of the study by Mefford and Alligood (2011) was to per
form an exploratory test of a middle range theory of health promotion
for preterm infants based on Levine’s conservation model of nursing.
More than 130 babies who met the criteria were included in the
study. Analysis of the data supported the applicability of the theory
to this population, which, in turn, supports the assumption that the
role of the nurse is essential in facilitating infant survival. One of the
most central findings indicated that consistency of the nurse was an
essential component in infant improvement.
IMPLICATIONS
Mathematical models such as those used in the analysis of the data in
this study can be useful in determining the interrelationships between
the variables of preterm infant characteristics, nursing roles and ac
tions, and infant health outcomes. The study demonstrates the value
of nursing, which may have previously only been known intuitively to
nurses and their clients. Using a theoretical model or framework such
as that of Levine’s conservation model of nursing anchors the study
and the knowledge it provides in a broader context.

Conditions and Disabilities Interact

in Clients Accessing Health Care Services?

Among the greatest challenges in health care is meeting the needs
of those with multiple chronic conditions. In this study, Gulley,
Rasch, and Chan (2011) used the Medical Expenditure Panel Sur
vey data to examine differences in health status, service use, and
access to care among and between working-age adults reporting
disabilities and/or one or more chronic conditions. More than half
of working-age people with disabilities reported having more than
one chronic condition. Among those with ADL or instrumental ADL
limitations, 35% reported four or more chronic conditions at a time.
They found considerable variability in access problems and service
use. However, disability consistently predicted higher emergency
department use, higher hospitalization rates, and greater access
problems.
IMPLICATIONS
The overall prevalence of chronic conditions among the U.S. working
age population, coupled with the high concentration of multiple chronic
conditions among those with disabilities, underscores the importance
of reforming health care delivery systems to provide person-centered
care over time. New policy-relevant measures that transcend diag
nosis are required to track the ongoing needs for health services that
these populations present. Nurses are often the health care provid
ers who have the most contact with clients who have disabilities and
chronic health conditions. Knowledge of the interface between these
two characteristics and the complexity of the health care delivery sys
tem places nurses in an ideal position to assist clients in obtaining the
care they need at the most appropriate facilities and cost