APPLICATIONOF

APPLICATION OFLEVINE
LEVINE
THEORY
THEORY
 NURSING
 “nursing is a profession as well as
an academic discipline,always
practiced and studied in concert with
all of the disciplines that together
from the health sciences”
 The human interaction relying on
communication ,rooted in the
organic dependency of the
individual human being in his
relationships with other human
beings
 Nursing involves engaging in
“human interactions”
GOAL OF NURSING
 To promote wholeness,
realizing that every individual
requires a unique and separate
cluster of activities

 The individual integrity is his

abiding concern and it is the
nurse’s responsibility to assist
him to defend and to seek its
realization
 NURSING PROCESS
 Assessment

 Trophicognosis

 Hypothesis

 Interventions

 Evaluation
 NURSING PROCESS

Assessment
 Collection of provocative
facts through observation
and interview of
challenges to the internal
and external environment
using four conservation
principles
CONT.....
 Nurses observes patient
for organismic responses
to illness,reads medical
reports,talks to patient
and family

 Assesses factors which

challenges the individual
 NURSING PROCESS
 TROPHICOGNOSIS
 Nursing diagnosis-gives provocative facts
meaning
 A nursing care judgment arrived at through the
use of the scientific process
 Judgment is made about patient’s needs for
assistance
NURSING PROCESS
 Hypothesis
 Planning
 Nurse proposes hypothesis about the problems
and the solutions which becomes the plan of care
 Goal is to maintain wholeness and promoting
adaptation
NURSING PROCESS

Interventions
 Testing the hypothesis
 Interventions are designed based on the
conservation principles
 Mutually acceptable
 Goal is to maintain wholeness and promoting
adaptation
 NURSING PROCESS

Evaluation
 Observation of organismic response to
interventions
 It assesses whether hypothesis is supported or not
supported
 If not supported,plan is revised,new hypothesis is
proposed
APPLICATION OF
CONSERVATION PRINCIPLES
TO CLINICAL PRACTICES
 PATIENT
 Mr. Rajiv , admitted with medical diagnosis of
hypertension and peripheral vascular disease.
CONSERVATION OF ENERGY
 Mr. Rajiv reports he cannot walk more than ½
block without resting because of pain in his leg.
 He must climb three steps to enter his house and
can usually do so without difficulty.
 He lives in a two story house but has a bedroom
on the first floor.
CONT........
 VITAL SIGNS are within normal limits- Mr. Rajiv
says that as he takes his antihypertension medicine
and limits the salt in his diet, his blood pressure is
controlled.

 CHEST X-ray clear

 LAB values: only abnormal level is cholestrol at 260

CONT......
 Mr. Rajiv reports he takes care of himself and
hires someone to come in to clean his house and
do his laundry once a week. He states he aets two
meals a day and he cooks for himself.
 He has to get up at least once a night to void.
 His bowels are usually regular- sometimes he is
constipated.
CONSERVATION OF STRUCTURAL INTEGRITY

 Medical diagnosis of peripheral vascular disease

is consistent with Mr. Rajiv’s description of
difficulty walking and indicates impairement of
his vascular system.
 Mr. Rajiv reports that his left leg either hurts or
“feels strange” most of the time. Pedal pulse on
the left are dimnished.
CONT.....
 History of smoking ½ pack per day for 40
years- stopped smoking 10 years ago and
report his breathinh is better since then.
 Reports arthritis in both hands; physical
examination indicates arthritic nodules distal
joints of index finger.
 Mr. Rajiv reports pain in proximal joints of
both thumbs and that this has weakened his
grip strength. He can fully close each hand.
CONSERVATION OF PERSONAL INTEGRITY

 89 year old male

CONSERVATION OF SOCIAL INTEGRITY
 Widower , lives alone
 Believes in GOD but doesnot “get out to temple
much anymore. It’s just too much effeort.”
 Has three living children- all are in their 60s and
live out of state.
 Mr. Rajiv states they call and write regularly and
each visits once or twice a year.
CONT....
 He has neighbours on either side of him who
“keep an eye out.” one of these neighbours likes
to cook and regularly brings food over.
NURSING DIAGNOSIS
 Pain related to arthritis in hands and peripheral
vascular disease in legs.
 Limited mobility associated with pain and
peripheral vascular disease.
 DESIRED OUTCOME :
 Able to continue to care for self and live in own
home.
PLANNING
 Pain control using prescribed medication and
possible physical therapy to support continued
function.
 Support for medical workup that could result in
recommendation of vascular surgery- provide
appropriate education and opportunity for
questions and discussion.
CONT.....
 Explain all test in level of detail he desires.
 Be sensitive to how detail he really wants.
IMPLEMENTATION

Conservation of Energy:

 Increase the servings of fruits and vegetables to at

least five daily to help assure regularity of his
bowels.

 Arrange his bath and other care activities to allow

rest before and after his physical therapy.
CONT.....

Conservation of Structural Integrity

 work with physician and patient to establish an

effective plan of analgesia to decrease his pain-
help him accept that the pain will not totally
disappear.
CONT....

Conservation of Personal and Social Integrity

 Encourage him to keep up the good work.

EVALUATION
 Can he walk with more comfort?

 Can he use his hands for activities of daily living

and desired recreation?

 Is he ready to resume independence?

NURSING PROCESS ACCORDING TO
LEVINE’S MODEL
 NURSING CARE OF MRS.SITA WITH
LEVINE’S MODEL
 Mrs. Sita, a wife of an abusive husband,
underwent a radical hysterectomy.
 Post operatively has pain ,weight loss,nausea and
inability to empty bladder .
 Patient has history of smoking and stays in house
which is less than sanitary.
 ASSESSMENT

 Challenges to the internal env:-weight

loss,nausea, loss of reproductive ability

 Challenges to the external env:-abusive husband,

insanitary condition in home

 Energy conservation:-weight loss,nausea ,pain

CONT....
 Structural integrity:-threatened by surgical
procedure,inability to pass urine

 Personal integrity:-not able to give birth to more

children

 Social integrity:-Strained relationship with

husband
 TROPHICOGNOSIS
 Inadequate nutritional status
 Pain
 Potential for wound and bladder infection
 Need to learn self catheterization
 Decreased self worth
 Potential for abuse
HYPOTHESIS

 Nutritional consultation
 Teaching and return demonstration of urinary
self catheterization
 Care of surgical wound
 Exploring concern regarding hysterectomy
 INTERVENTIONS
 Energy conservation
 Provide medication for pain and nausea
 Allowing rest period
 Structural integrity
 Administrating antibiotic for wound,
 Teaching self catheterization
 Personal integrity
 Exploring her feeling about uterus removal while respecting her
privacy
 Social integrity
 Assess potential abuse form husband
 Support to the family
EVALUATION
Is she hving Is her abdominal
pain? wound healing?

Can she perform

Is she gaining
clean self
weight? catheterisation?

Is her relationship
with her husband
ORGANISMIC RESPONSE
 Controlled pain
 Abdominal wound healing
 Improved appetite ,weight gain
 Clean urinary self catheterization
 Assistance from husband