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LEVINE’S FOUR CONSERVATION PRINCIPLES
Myra Estrine Levine
This page was
last updated on
16-03-09
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Introduction
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Born in Chicago, raised with a sister and a brother
with whom she shared a close loving relationship
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Also very fond of her father who was often ill and
frequently hospitalized with GI problem. This was the reason of choosing nursing as a career
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Also called as renaissance women-highly principled,
remarkable and committed to patient’s quality of care
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Died in 1996
Educational Achievement
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Diploma in
nursing:-Cook county SON, Chicago, 1944
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BSN:-University of Chicago,1949
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MSN:-Wayne
state University, Detroit, 1962
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Publication:-An
Introduction to Clinical Nursing, 1969,1973 & 1989
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Received honorary
doctorate from Loyola University in 1992
Achievements
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Clinical experience in
OT technique and oncology nursing
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Civilian nurse at the
Gardiner general hospital
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Director of nursing at
Drexel home in Chicago
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Clinical instructor at
Bryan memorial hospital in Lincoln, Nebraska
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Administrative
supervisor at university of Chicago
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Chairperson of clinical
nursing at cook country SON
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Visiting professor at
Tel Aviv university in Israel
Conservational model
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Goal: To
promote adaptation and maintain wholeness using the
principles of conservation
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Model guides the nurse
to focus on the influences and responses at the
organismic level
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Nurse accomplishes the
goal of model through the conservation of
energy, structure and personal and social integrity
Adaptation
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Every individual has a
unique range of adaptive responses
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The responses will vary
by heredity, age, gender or challenges of illness
experiences
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Example: The response
to weakness of cardiac muscle is an increased heart
rate, dilation of ventricle and thickening of myocardial
muscle
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While the responses are
same, the timing and manifestation of organismic
responses will be unique for each individual pulse rate)
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An ongoing process of
change in which patient maintains his integrity within
the realities of environment
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Achieved through the
"frugal, economic, contained and controlled use of
environmental resources by individual in his or her best
interest"
Wholeness
Conservation
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The product of
adaptation
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"Keeping together "of
the life systems or the wholeness of the individual
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Achieving a balance of
energy supply and demand that is with in the unique
biological realities of the individual
Nursing’s paradigm
Person
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A holistic being who
constantly strives to preserve wholeness and integrity
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A unique individual
in unity and integrity, feeling, believing, thinking
and whole system of system
Environment
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Preconceptual
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Operational
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Conceptual
Internal Environment
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Homeostasis:
A state of energy sparing that also provide the
necessary baselines for a multitude of synchronized
physiological and psychological factors
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A state of
conservation
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Homeorrhesis: A
stabilized flow rather than a static state
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Emphasis the fluidity
of change within a space-time continuum
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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
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Preconceptual: Aspect
of the world that individual are able to intercept
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Operational: Elements
that may physically affects individuals but not
perceived by hem: radiation, micro-organism and
pollution
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Conceptual: Part of
person's environment including cultural patterns
characterized by spiritual existence, ideas, values,
beliefs and tradition
Person and environment
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Adaptation
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Organismic response
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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
1. Flight or
fight: An instantaneous response to real or
imagined threat, most primitive response
2. Inflammatory:
response intended to provide for structural
integrity and the promotion of healing
3. Stress:
Response developed over time and influenced by
each stressful experience encountered by person
4.
Perceptual: Involves gathering information
from the environment and converting it in to a meaning
experience
Nine models of guided
assessment
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Vital’s signs
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Body movement and
positioning
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Ministration of
personal hygiene needs
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Pressure gradient
system in nursing interventions
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Nursing determination
in provision of nutritional needs
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Pressure gradient
system in nursing
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Local application of
heat and cold
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Administration of
medicine
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Establishing an aseptic
environment
Assumption
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The nurse creates an
environment in which healing could occur
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A human being is more
than the sum of the part
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Human being respond in
a predictable way
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Human being are unique
in their responses
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Human being know and
appraise objects ,condition and situation
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Human being sense
,reflects, reason and understand
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human being action are
self determined even when emotional
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Human being are capable
of prolonging reflection through such strategists
raising questions
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Human being make
decision through prioritizing course of action
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Human being must be
aware and able to contemplate objects, condition and
situation
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Human being are agents
who act deliberately to attain goal
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Adaptive changes
involve the whole individual
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A human being has unity
in his response to the environment
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Every person possesses
a unique adaptive ability based on one’s life experience
which creates a unique message
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There is an order and
continuity to life change is not random
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A human being respond
organismically in an ever changing manner
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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
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A human being is a
social animal
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A human being is an
constant interaction with an ever changing society
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Change is inevitable in
life
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Nursing needs existing
and emerging demands of self care and dependant care
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Nursing is associated
with condition of regulation of exercise or development
of capabilities of providing care
Levine’s work &
Characteristics of theory
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Theories can
interrelate concepts in such a way as to create a
different way of looking at a particular phenomenon
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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.
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Theories must be
logical in nature.
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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
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Theories should be
relatively simple yet generalizable.
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Levine’s theory is easy
to use .
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It’s major elements are
easily comprehensible and the relation ship have the
potential for being complex but are easily manageable
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Certain isolated aspect
of the theory are the generalizable i.e. those related
to the conservational principles
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Theories can be the
bases for hypotheses that can be tested.
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Levine’s idea can be
tested
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Hypothesis can be
derived from them .
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The principle of
conservation are specific enough to be testable
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Levine’s work &
Characteristics of theory
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Theories contribute to
and assist in increasing the general body of knowledge
within the discipline through the research implemented
to validate them.
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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
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Theories can be
utilized by the practitioner to guide and improve their
practice.
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Paula E.Crawford-gamble
:-successfully applied Levine’s theory to the female
patient undergoing surgery for the traumatic amputation
of the fingers
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These ideas lend
themselves to use in practice particularly in acute care
setting
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Theories must be
consistent with other validated theories, laws and
principles but will leave open unanswered questions that
need to be investigated .
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Levine’s ideas seem to
be consistent with other theories, laws and principles
particularly those from the humanities and sciences
Conservational Principle
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Conservation of energy
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Conservation of
structural integrity
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Conservation of personal
integrity
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Conservation of social
integrity
1. Conservation of
energy
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Refers to balancing
energy input and output to avoid excessive fatigue
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includes adequate
rest, nutrition and exercise
Example:
availability of
adequate rest
Maintenance of
adequate nutrition
2. Conservation of
structural integrity
Example:
Assist patient in ROM
exercise
Maintenance of
patient’s personal hygiene
3. Conservation of
personal integrity
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Recognizes the
individual as one who strives for recognition,
respect, self awareness, selfhood and self
determination
Example:
Recognize and protect
patient’s space needs
4. Conservation of
social integrity
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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
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Position patient in
bed to foster social interaction with other patients
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Avoid sensory
deprivation
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Promote patient’s use
of news paper, magazines, radio. TV
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Provide support and
assistance to family
Health
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Health is a wholeness
and successful adaptation
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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
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Disease: It is
unregulated and undisciplined change and must be stopped
or death will ensue
Nursing
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"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"
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The human interaction
relying on communication ,rooted in the organic
dependency of the individual human being in his
relationships with other human beings
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Nursing involves
engaging in "human interactions"
Goal of Nursing
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To promote wholeness,
realizing that every individual requires a unique and
separate cluster of activities
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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
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Assessment
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Trophicognosis
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Hypothesis
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Interventions
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Evaluation
Nursing Process
Assessment
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Collection of
provocative facts through observation and interview of
challenges to the internal and external environment
using four conservation principles
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Nurses observes patient
for organismic responses to illness, reads medical
reports. talks to patient and family
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Assesses factors which
challenges the individual
Trophicognosis
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Nursing diagnosis-gives
provocative facts meaning
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A nursing care judgment
arrived at through the use of the scientific process
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Judgment is made about
patient’s needs for assistance
Hypothesis
Interventions
Evaluation
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Observation of
organismic response to interventions
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It is assesses whether
hypothesis is supported or not supported
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If not supported, plan
is revised, new hypothesis is proposed
Conservational models
Theory of redundancy
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Untested ,speculative
theory that redefined aging and everything else that has
to do with human life
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Aging is diminished
availability of redundant system necessary for effective
maintenance of physical and social well being
Theory of therapeutic intention
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Goal: To seek a way of organizing nursing
interventions out of the biological realities which the
nurse has to confront
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Therapeutic regimens should support the following
goals:
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Facilitate healing through natural response to
disease
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Provide support for a failing auto regulatory portion
of the integrated system
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Restore individual integrity and well being
Theory of therapeutic intention
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Provide supportive measure to ensures comfort
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Balance a toxic risk against the threat of disease
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Manipulate diet and activity to correct metabolic
imbalance and stimulate physiological process
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Reinforce usual response to create a therapeutic
changes
Uses
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Critical, acute or long term care unit
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Neonates, infant and young children, pregnant young
adult and elderly care unit
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Primary health care
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OT
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Community setting
Utility of Theory
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Nursing research
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Nursing education
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Nursing administration
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Nursing practice
Nursing research
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Principles of conservation have been used for data
collection in various researches
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Conservational model was used by Hanson et al.in
their study of incidence and prevalence of pressure
ulcers in hospice patient
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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
Nursing education
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Conservational model
was used as guidelines for curriculum development
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It was used to develop nursing undergraduate program
at Allentown college of St.Francis de sales, Pennsylvania
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Used in nursing education program sponsored by Kapat
Holim in Israel
Nursing administration
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Taylor described an assessment guide for data
collection of neurological patients which forms basis
for development of comprehensive nursing care plan and
thus evaluate nursing care
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McCall developed an assessment tool for data
collection on the basis of four conservational
principles to identify nursing care needs of epileptic
patients
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Family assessment tool was designed by Lynn-Mchale
and Smith for families of patient in critical care
setting
Nursing practice
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Conservational model has been used for nursing
practice in different settings
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Bayley discussed the care of a severely burned teenagers on the basis of four conservational principles and
discussed patient’s perceptual, operational and
conceptual environment
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Pond used conservation model for guiding the nursing
care of homeless at a clinic, shelters or streets
Nursing process according to Levine’s
model
Mrs. Mona, 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
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Challenges to the internal env:-weight loss, nausea,
loss of reproductive ability
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Challenges to the external env:-abusive husband,
insanitary condition in home
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Energy conservation:-weight loss, nausea ,pain
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Structural integrity:-threatened by surgical
procedure, inability to pass urine
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Personal integrity:-not able to give birth to more
children
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Social integrity:-Strained relationship with husband
Trophicognosis
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Inadequate nutritional status
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Pain
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Potential for wound and bladder infection
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Need to learn self catheterization
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Decreased self worth
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Potential for abuse
Hypothesis
Interventions
Energy conservation
Structural integrity
Personal integrity
Social integrity
Organismic response
Critiquing the theory
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She values the holistic approach to all individual, well or sick
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Values patient’s participation in nursing care
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Comprehensive content in depth
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Provides direction of nursing research , education,
administration and practice
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Logically congruent
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Shows high regard to adjunctive disciplines to
develop theoretical basis for nursing
Limitation
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Limited attention can be focused on health promotion
and illness prevention.
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Nurse has the responsibility for determining the
patient ability to participate in the care ,and if the
perception of nurse and patient about the patient
ability to participate in care don’t match, this
mismatch will be an area of conflict.
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The major limitation is the focus on individual in an
illness state and on the dependency of patient.
Research Highlights
Summary
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Adaptation
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Wholeness
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Conservation
References
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Timber BK. Fundamental skills and concepts in Patient
Care, 7th edition, LWW.
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George B. Julia , Nursing Theories- The base for
professional Nursing Practice , 3rd ed. Norwalk,
Appleton & Lange.
-
Wills
M.Evelyn, McEwen Melanie (2002). Theoretical Basis for
Nursing Philadelphia. Lippincott Williams& wilkins.
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Meleis Ibrahim Afaf (1997) , Theoretical Nursing :
Development & Progress 3rd ed. Philadelphia, Lippincott.
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Taylor Carol,Lillis Carol (2001)The Art & Science Of
Nursing Care 4th ed. Philadelphia, Lippincott.
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Potter A Patricia, Perry G Anne (1992) Fundamentals Of
Nursing –Concepts Process & Practice 3rd ed. London
Mosby Year Book.
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Vandemark L.M. Awareness of self & expanding
consciousness: using Nursing theories to prepare nurse
–therapists Ment Health Nurs. 2006 Jul; 27(6) : 605-15
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Reed
PG, The force of nursing theory guided- practice. Nurs
Sci Q. 2006 Jul;19(3):225
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Cheng
MY. Using King's Goal Attainment Theory to facilitate
drug compliance in a psychiatric patient. Hu Li Za Zhi.
2006 Jun;53(3):90-7.
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Delaune SC,. Ladner PK, Fundamental of nursing, standard
and practice, 2nd edition, Thomson, NY, 2002.
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