M.

Sc DEGREE COURSE IN NURSING

ADVANCED NURSING PRACTICE

UNIT – VI
Philosophy and Theories of Nursing

Myra Levines Conservation Theory

DR. T.JAYADEEPA
VICE PRINCIPAL
MYRA LEVINES
 INTRODUCTION

• Myra Estrin Levine (1920-1996) was born in Chicago, Illinois.

• She was the oldest of three children. She had one sister and
one brother.
• Levine developed an interest in nursing because her father
(who had gastrointestinal problems) was frequently ill and
required nursing care on many occasions.
• Levine graduated from the Cook County School of Nursing in
1944 and obtained her BS in nursing from the University of
Chicago in 1949.
• Following graduation, Levine worked as a private duty nurse,
as a civilian nurse for the US Army, as a surgical nursing
supervisor, and in nursing administration
• After earning an MS in nursing at Wayne State University in
1962, she taught nursing at many different institutions
(George, 2002) such as the University of Illinois at Chicago
and Tel Aviv University in Israel.
• She authored 77 published articles which included “An
Introduction to Clinical Nursing” with multiple publication
years on 1969, 1973 & 1989.
• She also received an honorary doctorate from Loyola
University in 1992. She died on 1996.
 COMPOSITION OF CONSERVATION MODEL

• Levine’s Conservation Model is focused in promoting

adaptation and maintaining wholeness using the principles of
conservation. The model guides the nurse to focus on the
influences and responses at the organismic level. The nurse
accomplishes the goals of the model through the
conservation of energy, structure, and personal and social
integrity (Levine, 1967). The conservation is fundamental to
the outcomes expected when the model is used, Levine also
discussed two other important concepts critical to the use of
her model – adaptation and wholeness.
ADAPTATION WHOLENESS CONSERVATION
 Adaptation

• Adaptation is the process of change, and conservation is

the outcome of adaptation. Adaptation is the process
whereby the patient maintains integrity within the realities of
the environment (Levine, 1966, 1989a). Adaptation is
achieved through the “frugal, economic, contained, and
controlled use of environmental resources by the individual
in his or her best interest”
 Wholeness

• Wholeness - Levine (1973, p. 11) stated that “the unceasing

interaction of the individual organism with its environment

does represent an ‘open and fluid’ system, and a condition of

health, wholeness, exists when the interaction or constant

adaptations to the environment, permit ease - the assurance

of integrity…in all the dimensions of life.”

 Conservation
• Conservation, on the other hand, is the product of
adaptation. Conservation is from the Latin word
conservation, meaning “to keep together”. “Conservation
describes the way complex systems are able to continue to
function even when severely challenged.”Through
conservation, individuals are able to confront obstacles,
adapt accordingly, and maintain their uniqueness. “The goal
of conservation is health and the strength to confront
disability” as “... the rules of conservation and integrity hold”
in all situation in which nursing is requires”.
 Conservation

•The primary focus of conservation is keeping together of the

wholeness of the individual.
•Although nursing interventions may deal with one particular
conservation principle, nurses must also recognize the
influence of other conservation principles (Levine, 1990).
MAJOR CONCEPTS
 PERSON
• The person is a holistic being who constantly strives to
preserve wholeness and integrity and one “who is sentient,
thinking, future-oriented, and past-aware.” The wholeness
(integrity) of the individual demands that the “individual life
has meaning only in the context of social life” (Levine, 1973,
p. 17). The person is also described as a unique individual in
unity and integrity, feeling, believing, thinking and whole
system of system.
 ENVIRONMENT

• The environment completes the wholeness of

the individual. The individual has both an

internal and external environment.

 INTERNAL
ENVIRONMENT

HOMEOSTASI HOMEORRHESIS
S
 PERCEPTUAL

EXTERNAL
OPERATIONA
ENVIRONMENT
L

CONCEPTUAL
 HEALTH
• Health and disease are patterns of adaptive change. Health is implied to mean unity

and integrity and “is a wholeness and successful adaptation”. The health is: “… the

avenue of return to the daily activities compromised by ill health. It is not only the insult

or the injury that is repaired but the person himself or herself… It is not merely the

healing of an afflicted part. It is rather a return to self hood, where the encroachment of

the disability can be set aside entirely, and the individual is free to pursue once more

his or her own interests without constraint.” On the other hand, disease is “unregulated

and undisciplined change and must be stopped or death will ensue”. disease is

“unregulated and undisciplined change and must be stopped or death will ensue”.
 NURSING
• Nursing involves engaging in “human interactions” (Levine,
1973, p.1). “The nurse enters into a partnership of human
experience where sharing moments in time—some trivial, some
dramatic—leaves its mark forever on each patient”. The goal of
nursing is to promote adaptation and maintain wholeness.
(health).
 PERSON AND ENVIRONMENT

• Person and The Environment become congruent over time. It

is the fit of the person with his or her predicament of time and

space. The specific adaptive responses make conservation

possible occur on many levels; molecular, physiologic,

emotional, psychologic, and social.

RESPONSES BASED ON THREE
FACTORS
 Historicity

Historicity refers to the notion that adaptive responses are

partially based on personal and genetic past history. Each

individual is made up of a combination of personal and

genetic history, and adaptive responses are the result of

both
 Specificity

• Specificity refers the fact that each system that makes up a

human being has unique stimulus-response pathways.
Responses are stimulated by specific stressors and are
task oriented. Responses that are stimulated in multiple
pathways tend to be synchronized and occur in a cascade
of complimentary (or detrimental in some cases) reactions
 Redundancy

• Redundancy describes the notion that if one system or

pathway, is unable to ensure adaptation, then another
pathway may be able to take over and complete the job.
This may be helpful when the response is corrective (e.g.,
the use of allergy shots over a lengthy period of time to
diminish the effects of severe allergies by gradually

desensitizing the immune system).

CONSERVATION MODEL
 Conservation of energy
• Conservation of energy: Refers to balancing energy input
and output to avoid excessive fatigue. It includes adequate
rest, nutrition and exercise.
Examples: Availability of adequate rest; Maintenance of
adequate nutrition
 Conservation of structural integrity
• Conservation of structural integrity: Refers to maintaining or
restoring the structure of body preventing physical
breakdown and promoting healing.
Examples: Assist patient in ROM exercise; Maintenance of
patient’s personal hygiene
 Conservation of personal integrity

• Recognizes the individual as one who

strives for recognition, respect, self
awareness, selfhood and self
determination. Example: Recognize
and protect patient’s space needs
 ASSUMPTIONS

1. 1. Human being are agents who act deliberately to attain goal

2. Adaptive changes involve the whole individual

3. A human being has unity in his response to the environment

4. Every person possesses a unique adaptive ability based on

one’s life experience which creates a unique message

k. 5. There is an order and continuity to life change is not random

 ASSUMPTIONS contd……...

6. A human being respond organismically in an ever changing

manner

7. A human being is an constant interaction with an ever

changing society

8. A human being is a social animal

 Nursing Process

• Assessment

• Trophicognosis (nursing diagnosis)

• Hypothesis

• Interventions

• Evaluation
 Nursing Process

• Assessment:
• Internal environment: weight loss, nausea, loss of
reproductive ability .
• External environment : abusive husband, unhygienic
condition at home.
• 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.
 Nursing Process

• Trophicognosis:
• Inadequate nutritional status.

• Pain

• Potential for wound and bladder infection.

• Need to learn self cateterization.

• Decreased self worth.

• Potential for abuse.

 Nursing Process
• Hypothesis:

• Nutritional consultation.
• Teaching and return demonstration of urinary self
catheterization.
• Care of surgical wound.

• Exploring concern regarding hysterectemy.

 Nursing Process
Interventions:

•Energy conservation: provide medication for pain and nausea.

•Allowing rest period.
•Structural integrity:
•Administrating antibiotic for wound.
•Teaching self catherization
•Personal integrity:
•Exploring her feeling about uterus removal while respecting her privacy.
•Social integrity:
•Assess potential abuse from husband.
•Support to family.
 Nursing Process

• Organismic Response:

• Controlled pain

• Abdominal wound healing.

• Improved appetite & weight gain.

• Clean urinary self catheterization.

• Assistance from husband.

• How to apply this theory in to practice?
 Levine's Theory

USES:
- Critical, acute, or long term care unit.
-Neonates, infant and young children, pregnant, young adult,
& elderly care unit
-Primary health care.

-Operation Theatre.
-Community setting.
 Limitation of Levine's Theory

• Limited attention can be focused on health promotion and

illness prevention.
• The major limitation is focused on individual in an illness state
& on the dependency of patient.
• If the patient,s ability to participate in the care & perception of
nurse about the ability of patient participation is mismatched
then area of conflict arises.
 CONCLUSION

• Levine’s theory is Logical in nature.

• Relatively simple yet generalized.
• Easy to use.
• Levine’s idea can be tested.
• Conservational principle is specific enough to be tested.
• Guide & improve the practice
 REFERENCE
1.Alligood, A., & Marriner-Tomey, A., (2002). Nursing Theorists
and Their Work. (5th Ed.). St. Louis: Mosby.

2. Basavanthappa, BT. (2007). Nursing Theories. New

Delhi: Jaypee Brothers Publishers.
3. McEwen, M. & Wills, E. (2014). Theoretical basis for
nursing. (4th ed.). Philadelphia: Wolters Kluwer. Lippincott
Williams & Wilkins
4.Paraska, K., & Clark, C. (2012). Health promotion in
nursing practice. Burlington, MA: Jones & Bartlett
Publisher .