FOUR CONSERVATION PRINCIPLES OF NURSING Theorist: MYRA ESTRIN LEVINE

Born: Chicago I!!inois in "#$% &ie': (os)ice o* the North Shore at E+anston (os)ita! in "##,-

N.rsing E'.cation (istor/

Myra Levine developed an interest in nursing due to her fathers GI problems. She obtained a diploma in nursing at Cook County School of Nursing in !"". She obtained her #achelor of Science in Nursing at $niversity of Chicago in !"!% and got her Master of Science in Nursing at &ayne State $niversity in !'(.

Career Mi!estones in N.rsing Pro*ession an' Science

Levine had en)oyed a varied career. *er nursing e+perience included staff nursing% administrative and teaching supervision% clinical instruction% and direction of nursing services.

P.0!ishe' Artic!e
*er paper entitled ,-rophicognosis. /n /lternative to Nursing 0iagnosis%, can be found in the /merican Nurses1 /ssociation publication Exploring Progress in Medical-Surgical Nursing Practice% Ne2 3ork% !''% vol. (.

&istinctions1A2ar's

/ charter fello2 of the /merican /cademy of Nursing4 !567 /n honorary membership in the /merican Mental *ealth /id to Israel 4 !5'7 *onorary 8ecognition from the Illinois Nurses1 /ssociation Member of Sigma -heta -au 4/lpha #eta Chapter% Loyola $niversity7 9nlisted in &ho1s &ho in /merical &omen 4 !55: !;;7 9nlisted in &ho1s &ho in /merican Nursing 4 !;57 9lected fello2 in the Institute of Medicine of Chicago 4 !;5: !! 7 <irst recipient of the 9li=abeth 8ussel #elford /2ard for e+cellence in teaching from Sigma -heta -au 4 !557 #oth the first and second editions of her book% Introduction to Clinical Nursing% received /merican >ournal of Nursing 4/>N7 #ook of the 3ear a2ards and her !5 book% 8ene2al for Nursing 2as translated to *ebre2 /2arded *onorary 0octorate of *umane Letters from Loyola $niversity of Chicago 4 !!(7

E3trac.rric.!ar Acti+ities
Levine 2as an active leader in the /merican Nurses /ssociation and the Illinois Nurses1 /ssociation. / dynamic speaker% she 2as a fre?uent presenter on programs% 2orkshops% seminars and panels% and a prolific 2riter regarding nursing and education. /lthough she never intended to develop theory% she provided an organi=ational structure for teaching medical:surgical nursing and a stimulus for theory development. ,-he <our Conservation @rinciples of Nursing, 2as the first statement of the conservation principles. Ather preliminary 2ork included ,/daptation and /ssessment. / 8ationale for Nursing Intervention%, ,<or Lack of Love /lone%, and ,-he @ursuit of &holeness., -he first edition of the book 2as published in !56. /fter2ards% Levine presented the conservation principles at nurse theory conferences% some of 2hich have been audiotaped% and at the /llento2n College of St. <rancis de Sales Conferences in /pril !;".

In*!.entia! Beings
Levines theory dre2 from many other peoples ideas and vie2points. She learned historical vie2points of diseases and the 2ay people think about disease changes over time from #eland1s presentation of the theory of specific causation and multiple factors. Levine used >ames 9. Gibson1s definition of perceptual systems% 9rik 9rikson1s differentiation bet2een total and 2hole% *ans Selye1s stress theory% and M. #ates1 models of e+ternal environment.Burt Goldstein% Sir /rthur Sherrington% and 8ene 0ubos 2ere also influential in her 2ork.Martha 8ogers 2as her first editor.

Characteristics o* the Theor/

. Levines 2ork is categori=ed as a conceptual model of nursing and is an e+ample of the 2orks of those often referred to as the grand theories in nursing 2hich are comprehensive and tend to include ma)or concepts 2ith 2hich nursing is concerned. Levines model possesses clarity. -he model has numerous termsC ho2ever% Levine 2as able to ade?uately define them. Levine also used deductive logic in developing her model 2hich can be used to generate research ?uestions. She integrated theories and concepts from the humanities and the sciences and used this information to analy=e nursing practice situations and described nursing skills and activities 2ith the underlying belief that people are dependent on their relationships 2ith other people. It interrelates concepts in such a 2ay as to create a different 2ay of looking at a particular phenomenon. Ideas about nursing% the concepts of illness% adaptation% nursing interventions% and evaluation of nursing interventions are )oined together and synthesi=ed in such a 2ay that the vie2point of nursing care changes% gro2s and evolves. It has logical nature. Levines ideas about nursing are organi=ed in such a 2ay as to be se?uential and logical. -hey can be used to e+plain the conse?uences of nursing actions. -here are no apparent contradictions in her ideas. / simple yet generali=able theory. Levines theory is easy to use. Its ma)or elements are easily comprehensible% and the relationships have the potential for being comple+ but are easily manageable. Levines ideas can be tested. *ypotheses can be derived from them. -he principles of conservation are specific enough to be testable. <or e+ample% it is possible to test if physiological structure is being supported or improved% thus testing the principle of conservation of structural integrity. Levines ideas can be used by practitioners to guide and improve their practice. @aula 9. Cra2ford:Gamble successfully applied Levines theory to a female patient undergoing surgery for the traumatic amputation of fingers. Levines ideas seem to be consistent 2ith other theories% la2s and principles% particularly those from the humanities and sciences% and many ?uestions are left unans2ered 2hich 2ould be 2orthy of investigation. Levine1s theory for nursing focuses on one person : the patient. In utili=ing this theory the nurse is concerned 2ith the patients family andFor significant others only to the point that they influence or have an offer on the patient1s progress. Nursing is human interaction.

(. 6.

".

D.

'.

5.

;.

!.

E.

Le+ine4s )oint 5Ma6or 7 8e/ Conce)ts9

LEVINE:S CONSERVATION T(EORY an' ITS CONCEPTS

Levines Conservation Theory 2as developed because she believed that nursing revolves around controlling and preserving the energy resources of the patient. / big factor in the development of this theory 2as her strong physical science background. &ith this background she influenced the practice of nursing through the attainment of the nursing goal% promoting GwholenessH.

MA;OR CONCEPTS

PERSON

/ holistic beingInot only in the physical needs% but also the psychosocial% cultural and spiritual aspectsI2ho constantly strives to preserve 2holeness and integrity Ane 2ho is sentient% thinking% future:oriented% and past:a2are / uni?ue individual in unity and integrity% feeling% believing% thinking and 2hole system of system. / holistic being 2ho has open and fluid boundaries that coe+ist 2ith the environment. *e is a 2hole being 2ho is conserved and integral. /n e+ample is a patients an+iety is still present despite the alleviation of pain.

ENVIRONMENT

@lays an important role in completing the individuals 2holeness. &here the individual lives her life.

-he individual has both an internal and e+ternal environment.

a. internal environment combines the physiological and pathophysiological aspects of the individual and is constantly challenged by the e+ternal environment. b. external environment is divided into the perceptual% operational% and conceptual environments. o perceptual environment : individuals respond to 2ith their sense organs and includes light% sound% touch% temperature% chemical change that is smelled or tasted% and position sense and balance. o operational environment : interacts 2ith living tissue even though the individual does not possess sensory organs that can record the presence of these factors and includes all forms of radiation% microorganisms% and pollutants. In other 2ords% these elements may physically affect individuals but are not perceived by the latter. o conceptual environment : consists of language% ideas% symbols% and concepts and inventions and encompasses the e+change of language% the ability to think and e+perience emotion% value systems% religious beliefs% ethnic and cultural traditions% and individual psychological patterns that come from life e+periences.

In'i+i'.a!s res)on' to the en+iron<enta! cha!!enges 0/ <eans o* *o.r integrate' )rocesses:

. Fight-or-flight mechanism - most primitive response. *ospitali=ation% illness and ne2 e+periences triggers a response . /n individual may turn a2ay ,flight, or face his condition ,fight, to assure his safety and 2ell:being. (. Inflammator -immune response : a 2ay of healing% a defense mechanism to protect self from insult in a hostile environment. $ses available energy to remove or keep out un2anted irritants or pathogens. 9nvironmental control is important. 6. Stress response: according to Selye% stress response syndrome is a predictable non:specifically induced organismic changes. Characteri=ed by irreversibility and influences the 2ay patients respond to nursing care. ". Perceptual a!arenessIinformation seeking response used by the individual to seek and maintain safety for himself. Includes the basic orienting% synaptic% auditory% visual% and taste:smell systems.

N"RSIN#

Involves engaging in Ghuman interactionsH : rooted on the organic dependency of an individual as 2ell as communications 2ith other human beings. -he goal of nursing is to promote 2holeness. -he nurse enters into a partnership of human e+perience 2here sharing moments in timeIsome trivial% some dramaticIleaves its mark forever on each patient 4Levine% !55% p. ;"D7. G&holenessH can be achieved through the use of supportive and therapeutic aspect of caring. / profession as 2ell as an academic discipline that al2ays should be studied and practiced along 2ith other health sciences. *uman interaction is the focus of nursing./ nurse should have the follo2ing goals. . 8eali=e that every individual re?uires a uni?ue and separate cluster of activities (. /ssist the person 4his sole concern7 to defend and to seek its reali=ation 6. Make decision through prioriti=ing course of action ". #e a2are and able to contemplate ob)ects% condition and situation D. Involve the 2hole individual

Nurses should also use the nursing process in giving care to their patients.

$E%&T$

/ state of 2holeness and not )ust an absence of disease and successful adaptation and not merely healing of an affected part. /bility to function normally and able to return to daily activities% self:hood% and ability to pursue one1s interest 2ithout constraints.

8EY CONCEPTS

The Fo.r Conser+ation Princi)!es

-he nurse has to promote conservation of energy% structural integrity% personal integrity and social integrity of the client.

I- Conser+ation o* Energ/

It refers to balance bet2een energy e+penditure and conservation. @atient activity is dependent on energy balance. Illness increases energy demand% and that increased energy demand can be measured by the level of fatigue. 9nergy is measured in everyday nursing practice via body temperature% blood gases% pulse% and blood pressureC fluctuations determine either energy e+penditure or conservation. -he balance is brought by proper rest% ade?uate hydration% inhaling of clean air% proper nutrition and e+ercising.

II- Conser+ation o* Str.ct.ra! Integrit/

<ocused on preserving the anatomical structure of the body and preserving healing 8efers to maintaining or restoring the structure of body preventing physical breakdo2n and promoting healing Changes in structure ultimately affect function% that structural integrity may be compromised by pathophysiological processes% and that healing restores.structural integrity. -herefore% to regain structure and function% the body needs to restore structural integrity through repair and healing Nursing Intervention aims in helping the individual to prevent skin breakdo2n and limiting the amount of tissue involvement in infectious disease. 9+amples include. a. Maintenance of clean% dry% 2rinkle free linen.

b. 8egular turning of patient side to side every ( hours to patients 2ho are bedridden. c. d. @erform 8AM e+ercise Maintenance of patients personal hygiene

III- Conser+ation o* Persona! Integrit/

/ client is a person 2ith dignity% sense of identity and self:2orth. Individual strives for recognition% respect% self a2areness% self:hood and self: determination. Individuals re?uire privacy and are responsible for their o2n decisions. Illness and hospitali=ation compromise personal integrity% self:identity% and self: respect @ersons integrity is compromised 2hen the individual becomes dependent. Nursing interventions include protecting and respecting patient privacy% possessions% and defense mechanisms and supporting personal choice. 9+amples include. a. 9+pression of patients feelings b. Involvement of patient in plan of care% c. <ocus on self aspect by not comparing to others d. 8einforce positive traits e. @romote sociali=ation in such a 2ay he can developed positive self:esteem. f. 8ecogni=e and protect patients space needs

IV- Conser+ation o* Socia! Integrit/

/n individual is recogni=ed as someone 2ho resides and interacts 2ith in a family% a community% academe% a religious group% an ethnic group% a political system and a nation Individuals recogni=e social responsibilities% traditional customs and spiritual group. Individual behavior is influenced by the ability to relate to various social groups% families often are affected by an individuals illness% and hospitali=ation results in social isolation. Nursing Intervention. *elping the individual to preserve his or her place in the family% community and society. 9+amples include. a. In the case of a pregnant 2omen scheduled for caesarean operation%her support system is very important both before and after the operation. b. @osition patient in bed to foster social interaction 2ith other patients c. /void sensory deprivation d. @romote patients use of ne2s paper% maga=ines% radio. -J e. @rovide support and assistance to family

=The #oal of the in'ivi'ual is conservation or preserving an integrate' an' (alance !hole>5Le+ine "#?@9

STRENGT(S AN& LIMITATIONS

Strengths

Jalues the holistic approach to all individual% 2ell or sick

Jalues patients participation in nursing care Comprehensive content% in:depth Scientific principles are emphasi=ed. @rovides direction of nursing research % education% administration and practice Logically congruent

Sho2s high regard to ad)unctive disciplines to develop theoretical basis for nursing

Li<itations

Limited attention can be focused on health promotion and illness prevention. 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 dont match% this mismatch 2ill be an area of conflict. -he ma)or limitation is the focus on individual in an illness state and on the dependency of patient.

LEVINE 7 NURSING 5APPLICATION IN NURSING PRACTICE E&UCATION 7 RESEARC(9

APPLICATION

A- NURSING PRACTICE $sed in variety of settings% from critical care% acute care% long:term care% community care% homeless% patients 2ith burns% cervical cancer% chronic pain% congestive heart failure% and epilepsyC emergency room% intensive care nursery% pediatrics% peri:operative nursing% smoking cessation 4as cited by George% (EE;7 and geriatric nursing 2here ma)ority of the elderly patients 2ill have some problems in at least t2o of the conservation models 4#autista% (EE;7.

. #ayley 4n.d.7 discussed the care of severely burned teenagers on the basis of four conservation principles and discussed patients perceptual% operational and conceptual environment. (. @ond 4n.d.7 used conservation model for guiding the nursing care of homeless at a clinic% shelters or streets. $sed 2ith patients across the lifespan% from the neonate to the elderly patient. $sed as a frame2ork for many purposes% such as 2ound care% development of nursing diagnoses% care of intravenous sites% and care of patients undergoing cancer treatment. Influences the interventions undertaken by nurses% 2ith them recogni=ing that the interventions should be related to the adaptive path2ays% 2hile remembering that each path2ay is influenced by historicity% specificity% and redundancy.

/pplied in rendering comprehensive nursing care incorporated in the nursing process.

Scenario. / 5D year old man currently staying in a long term care facility. *e has a history of congestive heart failure and generali=ed 2eakness. Currently he states that he has been feeling GdepressedH due to his inability to do his o2n personal care. *e also states that he misses his old friends in the community.

The n.rse co.!' .se the *o.r )rinci)!es o* conser+ation to a''ress his nee's as *o!!o2s:

. Conser+ation o* Energ/: 9nsure the patient has enough rest periods to provide the energy needed for activities of daily living.

(. Conser+ation o* str.ct.ra! integrit/: -he patient is at high risk for immobility due to C*< and 2eakness% so the nurse 2ill need to put interventions in place for prevention of pressure ulcers.

6. Conser+ation o* )ersona! integrit/: -he nurse recogni=es that the patient 2ants to maintain a sense of independence% so she 2ill take steps to have the patient achieve as high a level of independence as possible 2ith personal care 4i.e. 2orking together 2ith a physiotherapist F occupational therapist7.

". Conser+ation o* socia! integrit/: -he nurse can facilitate the maintenance of old friendships by contacting the family and asking if they 2ould be able to take him out on social leave. /lso% the nurse can discuss 2ith the interdisciplinary team 4i.e. activity F recreation aides7 2ays of having the patient form ne2 connections 2ith other patient 2ithin the long term care facility.

B- NURSING E&UCATION

@rovides a student friendly nursing theory. -his reflects simple yet complete and concise nursing theory. $sed as a curriculum model and is a part of both undergraduate and graduate curricula 4Marriner:-omey K /lligood% (EE'7. @rovided an organi=ational structure for teaching Medical:Surgical Nursing and stimulus for theory development. 4#asavanthappa% (EE57. She aimed to move a2ay from a procedurally oriented educational process and instead sought to teach the ma)or concepts of medical surgical nursing as generali=ed content. $sed to develop nursing undergraduate program at /llento2n college of St. <rancis de Sales% @ennsylvania and Bapat*olim in Israel.

C- NURSING RESEARC(

9nhances the foundation of nursing practice and nursing education. *ypotheses have been developed from Levines theory% and research has been conducted to test these hypotheses 4George% (EE;7.

. Studies conducted by &ong 4 !;!7 and &inslo2% Lane% and Gaffney 4 !;D7 support the importance of energy conservation for patients 2ith myocardial infarctions. (. @appas 4 !!E7 investigated the relationship bet2een nursing care and an+iety in patients 2ith se+ually transmitted diseases and found significant relationships bet2een constructs of nursing and components of an+iety. 6. <oreman 4 !;57 found that variables that represented the four conservation principles 2ere more important in combination than separately 2hen used to diagnose confusion in hospitali=ed erderly patients. ". MacLean 4 !;57 used the principles of conservation of energy and conservation of structural integrity in identifying cues that nurses use to diagnose activity intolerance.

Use' 0/ <an/ researchers as a conce)t.a! *ra<e2orA-

. Mefford 4(EE"7 used Levines conservation model to describe a middle range theory of health promotion for preterm infants% in order to assure that the holistic nursing care needs of infant and family 2ere met. (. Schaefer and Shober used Levines Conservation Model to provide ?uantitative and ?ualitative data on fatigue associated 2ith congestive heart failure 4Schaefer and Shober% !!67. 6. Leach used Levines model to guide the practice of 2ound management 4Leach% (EE'7. ". Gagner:-)ellesen% 3urkovich% and Gragert 4(EE 7 found that music therapy and other independent therapeutic nursing interventions could increase patient comfort and facilitate conservation of energy 4aiding in healing as described in the Conservation Model7. D. Conservation model 2as used by *anson et al.in their study of incidence and prevalence of pressure ulcers in hospice patients. '. Ne2port 4n.d.7 used principle of conservation of energy and social integrity for comparing the body temperature of infants 2ho had been placed on mothers chest immediately after birth 2ith those 2ho 2ere placed in 2armer.

Princi)!es o* conser+ation ha+e 0een .se' *or 'ata co!!ection in +ario.s research st.'ies:

. -aylor described an assessment guide for data collection of neurological patients 2hich forms the basis for the development of comprehensive nursing care plans and thus effective nursing care. (. McCall developed an assessment tool for data collection on the basis of our conservation principles to identify nursing care needs of epileptic patients. 6. <amily assessment tool 2as designed by Lynn:Mchale and Smith for families of patient in critical care setting.