LEVINE’S FOUR CONSERVATION PRINCIPLES

Myra Estrine Levine

Introduction

Educational Achievement

• Diploma in nursing:-Cook county SON, Chicago, 1944

• BSN:-University of Chicago,1949

• MSN:-Wayne state University, Detroit, 1962

• Publication:-An Introduction to Clinical Nursing, 1969,1973 & 1989

• Received honorary doctorate from Loyola University in 1992

Achievements

• Clinical experience in OT technique and oncology nursing

• Civilian nurse at the Gardiner general hospital

• Director of nursing at Drexel home in Chicago

• Clinical instructor at Bryan memorial hospital in Lincoln, Nebraska

• Administrative supervisor at university of Chicago

• Chairperson of clinical nursing at cook country SON

• Visiting professor at Tel Aviv university in Israel

Conservational model

• Goal: To promote adaptation and maintain wholeness using the principles of conservation

• Model guides the nurse to focus on the influences and responses at the organismic level

• Nurse accomplishes the goal of model through the conservation of energy, structure and personal and social integrity

Adaptation

• Every individual has a unique range of adaptive responses

• The responses will vary by heredity, age, gender or challenges of illness experiences

• Example: The response to weakness of cardiac muscle is an increased heart rate, dilation of ventricle and thickening of myocardial muscle

• While the responses are same, the timing and manifestation of organismic responses will be unique for each individual pulse rate)

• An ongoing process of change in which patient maintains his integrity within the realities of environment

• Achieved through the "frugal, economic, contained and controlled use of environmental resources by individual in his or her best interest"

Wholeness

• Exist when the interaction or constant adaptations to the environment permits the assurance of integrity

• Promoted by use of conservation principle

Conservation

• The product of adaptation

• "Keeping together "of the life systems or the wholeness of the individual

• Achieving a balance of energy supply and demand that is with in the unique biological realities of the individual

Nursing’s paradigm

Person

• A holistic being who constantly strives to preserve wholeness and integrity

• A unique individual in unity and integrity, feeling, believing, thinking and whole system of system

Environment

• Competes the wholeness of person

•  Internal

• Homeostasis

• Homeorrhesis

• External

• Preconceptual

• Operational

• Conceptual

Internal Environment

• Homeostasis: A state of energy sparing that also provide the necessary baselines for a multitude of synchronized physiological and psychological factors

• A state of conservation

• Homeorrhesis: A stabilized flow rather than a static state

• Emphasis the fluidity of change within a space-time continuum

• Describe the pattern of adaptation, which permit the individual’s body to sustain its well being with the vast changes which encroach upon it from the environment

External Environment

• Preconceptual: Aspect of the world that individual are able to intercept

• Operational: Elements that may physically affects individuals but not perceived by hem: radiation, micro-organism and pollution

• Conceptual: Part of person's environment including cultural patterns characterized by spiritual existence, ideas, values, beliefs and tradition

Person and environment

• Adaptation

• Organismic response

• Conservation

Adaptation

Characteristics

Historicity: Adaptations are grounded in history and await the challenges to which they respond

Specificity: Individual responses and their adaptive pattern varies on the base of specific genetic structure

Redundancy: Safe and fail options available to the individual to ensure continued adaptation

Organismic response

• A change in behavior of an individual during an attempt to adapt to the environment

• Help individual to protect and maintain their integrity

• They co-exist

• They are four types

Nine models of guided assessment

• Vital’s signs

• Body movement and positioning

• Ministration of personal hygiene needs

• Pressure gradient system in nursing interventions

• Nursing determination in provision of nutritional needs

• Pressure gradient system in nursing

• Local application of heat and cold

• Administration of medicine

• Establishing an aseptic environment

Assumption

• The nurse creates an environment in which healing could occur

• A human being is more than the sum of the part

• Human being respond in a predictable way

• Human being are unique in their responses

• Human being know and appraise objects ,condition and situation

• Human being sense ,reflects, reason and understand

• human being action are self determined even when emotional

• Human being are capable of prolonging reflection through such strategists raising questions

• Human being make decision through prioritizing course of action

• Human being must be aware and able to contemplate objects, condition and situation

• Human being are agents who act deliberately to attain goal

• Adaptive changes involve the whole individual

• A human being has unity in his response to the environment

• Every person possesses a unique adaptive ability based on one’s life experience which creates a unique message

• There is an order and continuity to life change is not random

• A human being respond organismically in an ever changing manner

• A theory of nursing must recognized the importance of detail of care for a single patient with in an empiric framework that successfully describe the requirement of the all patient

• A human being is a social animal

• A human being is an constant interaction with an ever changing society

• Change is inevitable in life

• Nursing needs existing and emerging demands of self care and dependant care

• Nursing is associated with condition of regulation of exercise or development of capabilities of providing care

Levine’s work & Characteristics of theory

• Theories can interrelate concepts in such a way as to create a different way of looking at a particular phenomenon

• The concept of illness adaptation, using interventions, and the evaluation of nursing interventions are interrelated .they are combined to look at nursing care in a different way (more comprehensive view incorporating total patient care) form previous time.

• Theories must be logical in nature.

• Levine’s idea about nursing care are organized in such a way as to b sequential and logical. they can be used to explain the consequences of nursing action

• Theories should be relatively simple yet generalizable.

• Levine’s theory is easy to use .

• It’s major elements are easily comprehensible and the relation ship have the potential for being complex but are easily manageable

• Certain isolated aspect of the theory are the generalizable i.e. those related to the conservational principles

• Theories can be the bases for hypotheses that can be tested.

• Levine’s idea can be tested

• Hypothesis can be derived from them .

• The principle of conservation are specific enough to be testable

• Levine’s work & Characteristics of theory

• Theories contribute to and assist in increasing the general body of knowledge within the discipline through the research implemented to validate them.

• Since Levine’s idea have not yet been widely researched ,it is hard o determine the contribution to the general body of knowledge with in the discipline

• Theories can be utilized by the practitioner to guide and improve their practice.

• Paula E.Crawford-gamble :-successfully applied Levine’s theory to the female patient undergoing surgery for the traumatic amputation of the fingers

• These ideas lend themselves to use in practice particularly in acute care setting

• Theories must be consistent with other validated theories, laws and principles but will leave open unanswered questions that need to be investigated .

• Levine’s ideas seem to be consistent with other theories, laws and principles particularly those from the humanities and sciences

Conservational Principle

• Conservation of energy

• Conservation of structural integrity

• Conservation of personal integrity

• Conservation of social integrity

1. Conservation of energy

• Refers to balancing energy input and output to avoid excessive fatigue

• includes adequate rest, nutrition and exercise

Example:

availability of adequate rest

Maintenance of adequate nutrition

• Refers to maintaining or restoring the structure of body preventing physical breakdown And promoting healing

• Recognizes the individual as one who strives for recognition, respect, self awareness, selfhood and self determination

• An individual is recognized as some one who resides with in a family, a community ,a religious group, an ethnic group, a political system and a nation

Example:

• Position patient in bed to foster social interaction with other patients

• Avoid sensory deprivation

• Promote patient’s use of news paper, magazines, radio. TV

• Provide support and assistance to family

Health

• Health is a wholeness and successful adaptation

• It is not merely healing of an afflicted part ,it is return to daily activities, selfhood and the ability of the individual to pursue once more his or her own interest without constraints

• Disease: It is unregulated and undisciplined change and must be stopped or death will ensue

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

• Collection of provocative facts through observation and interview of challenges to the internal and external environment using four conservation principles

• Nurses observes patient for organismic responses to illness, reads medical reports. talks to patient and family

• Assesses factors which challenges the individual

• 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

• Planning

• Nurse proposes hypothesis about the problems and the solutions which becomes the plan of care

• Goal is to maintain wholeness and promoting adaptation

• Testing the hypothesis

• Interventions are designed based on the conservation principles

• Mutually acceptable

• Goal is to maintain wholeness and promoting adaptation

• Observation of organismic response to interventions

• It is assesses whether hypothesis is supported or not supported

• If not supported, plan is revised, new hypothesis is proposed

Conservational models

• Conservational model provides the basis for development of two theories

  • Theory of redundancy

  • Theory of therapeutic intention

Theory of redundancy

• Untested ,speculative theory that redefined aging and everything else that has to do with human life

• Aging is diminished availability of redundant system necessary for effective maintenance of physical and social well being

Theory of therapeutic intention

• Goal: To seek a way of organizing nursing interventions out of the biological realities which the nurse has to confront

• Therapeutic regimens should support the following goals:

• Facilitate healing through natural response to disease

• Provide support for a failing auto regulatory portion of the integrated system

• Restore individual integrity and well being

Theory of therapeutic intention

• Provide supportive measure to ensures comfort

• Balance a toxic risk against the threat of disease

• Manipulate diet and activity to correct metabolic imbalance and stimulate physiological process

• Reinforce usual response to create a therapeutic changes

Uses

• Critical, acute or long term care unit

• Neonates, infant and young children, pregnant young adult and elderly care unit

• Primary health care

• OT

• Community setting

Utility of Theory

• Nursing research

• Nursing education

• Nursing administration

• Nursing practice

• Principles of conservation have been used for data collection in various researches

• Conservational model was used by Hanson et al.in their study of incidence and prevalence of pressure ulcers in hospice patient

• Newport used principle of conservation of energy and social integrity for comparing the body temperature of infant’s who had been placed on mother’s chest immediately after birth with those who were placed in warmer