LEVINES FOUR CONSERVATION PRINCIPLES

Myra Estrine Levine

This page was last updated on 15-01-2010
---------------------------------------------------------------Introduction

Born in Chicago, raised with a sister and a brother with whom she shared a close loving
relationship

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

Also called as renaissance women-highly principled, remarkable and committed to

patients quality of care

Died in 1996

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

Nursings 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 individuals 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:

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

Vitals 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

Levines 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.

Levines 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.

Levines theory is easy to use .

Its 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.

Levines idea can be tested

Hypothesis can be derived from them .

The principle of conservation are specific enough to be testable

Levines 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 Levines 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 Levines 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 .

Levines 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
2. Conservation of structural integrity

Refers to maintaining or restoring the structure of body preventing physical breakdown

And promoting healing

Example:
Assist patient in ROM exercise
Maintenance of patients personal hygiene
3. Conservation of personal integrity

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

Example:
Recognize and protect patients space needs
4. Conservation of social integrity

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 patients 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
o To promote wholeness, realizing that every individual requires a unique and
separate cluster of activities
o The individual integrity is his abiding concern and it is the nurses responsibility
to assist him to defend and to seek its realization
o Human being make decision through prioritizing course of action

o Human being must be aware and able to contemplate objects, condition and
situation
o Human being are agents who act deliberately to attain goal
o Adaptive changes involve the whole individual
o A human being has unity in his response to the environment
o Every person possesses a unique adaptive ability based on ones life experience
which creates a unique message
o There is an order and continuity to life change is not random
o A human being respond organismically in an ever changing manner
o 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
o A human being is a social animal
o A human being is an constant interaction with an ever changing society
o Change is inevitable in life
o Nursing needs existing and emerging demands of self care and dependant care
o Nursing is associated with condition of regulation of exercise or development of
capabilities of providing care
Nursing Process
o Assessment
o Trophicognosis
o Hypothesis
o Interventions
o Evaluation
Nursing Process
Assessment

o Collection of provocative facts through observation and interview of challenges to

the internal and external environment using four conservation principles
o Nurses observes patient for organismic responses to illness, reads medical reports.
talks to patient and family
o Assesses factors which challenges the individual
Trophicognosis
o Nursing diagnosis-gives provocative facts meaning
o A nursing care judgment arrived at through the use of the scientific process
o Judgment is made about patients needs for assistance
Hypothesis
o Planning
o Nurse proposes hypothesis about the problems and the solutions which becomes
the plan of care
o Goal is to maintain wholeness and promoting adaptation
Interventions
o Testing the hypothesis
o Interventions are designed based on the conservation principles
o Mutually acceptable
o Goal is to maintain wholeness and promoting adaptation
Evaluation
o Observation of organismic response to interventions
o It is assesses whether hypothesis is supported or not supported
o If not supported, plan is revised, new hypothesis is proposed
Conservational models

o Conservational model provides the basis for development of two theories

Theory of redundancy

Theory of therapeutic intention

Theory of redundancy
o Untested ,speculative theory that redefined aging and everything else that has to
do with human life
o Aging is diminished availability of redundant system necessary for effective
maintenance of physical and social well being
Theory of therapeutic intention
o Goal: To seek a way of organizing nursing interventions out of the biological
realities which the nurse has to confront
o Therapeutic regimens should support the following goals:
o Facilitate healing through natural response to disease
o Provide support for a failing auto regulatory portion of the integrated system
o Restore individual integrity and well being
Theory of therapeutic intention
o Provide supportive measure to ensures comfort
o Balance a toxic risk against the threat of disease
o Manipulate diet and activity to correct metabolic imbalance and stimulate
physiological process
o Reinforce usual response to create a therapeutic changes
Uses
o Critical, acute or long term care unit
o Neonates, infant and young children, pregnant young adult and elderly care unit
o Primary health care

o OT
o Community setting
Utility of Theory
o Nursing research
o Nursing education
o Nursing administration
o Nursing practice
Nursing research
o Principles of conservation have been used for data collection in various researches
o Conservational model was used by Hanson et al.in their study of incidence and
prevalence of pressure ulcers in hospice patient
o Newport used principle of conservation of energy and social integrity for
comparing the body temperature of infants who had been placed on mothers
chest immediately after birth with those who were placed in warmer
Nursing education
o Conservational model was used as guidelines for curriculum development
o It was used to develop nursing undergraduate program at Allentown college of
St.Francis de sales, Pennsylvania
o Used in nursing education program sponsored by Kapat Holim in Israel
Nursing administration
o 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
o McCall developed an assessment tool for data collection on the basis of four
conservational principles to identify nursing care needs of epileptic patients
o Family assessment tool was designed by Lynn-Mchale and Smith for families of
patient in critical care setting

Nursing practice
o Conservational model has been used for nursing practice in different settings
o Bayley discussed the care of a severely burned teenagers on the basis of four
conservational principles and discussed patients perceptual, operational and
conceptual environment
o Pond used conservation model for guiding the nursing care of homeless at a
clinic, shelters or streets
Nursing process according to Levines 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
o Challenges to the internal env:-weight loss, nausea, loss of reproductive ability
o Challenges to the external env:-abusive husband, insanitary condition in home
o Energy conservation:-weight loss, nausea ,pain
o Structural integrity:-threatened by surgical procedure, inability to pass urine
o Personal integrity:-not able to give birth to more children
o Social integrity:-Strained relationship with husband
Trophicognosis
o Inadequate nutritional status
o Pain
o Potential for wound and bladder infection
o Need to learn self catheterization
o Decreased self worth
o Potential for abuse
Hypothesis

o Nutritional consultation
o Teaching and return demonstration of urinary self catheterization
o Care of surgical wound
o Exploring concern regarding hysterectomy
Interventions
Energy conservation
o Provide medication for pain and nausea
o Allowing rest period
Structural integrity
o Administrating antibiotic for wound,
o Teaching self catheterization
Personal integrity
o Exploring her feeling about uterus removal while respecting her privacy
Social integrity
o Assess potential abuse form husband
o Support to the family
Organismic response
o Controlled pain
o Abdominal wound healing
o Improved appetite ,weight gain
o Clean urinary self catheterization
o Assistance from husband
Critiquing the theory

o She values the holistic approach to all individual, well or sick

o Values patients participation in nursing care
o Comprehensive content in depth
o Provides direction of nursing research , education, administration and practice
o Logically congruent
o Shows high regard to adjunctive disciplines to develop theoretical basis for
nursing
Limitation
o Limited attention can be focused on health promotion and illness prevention.
o 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 will be an area of conflict.
o The major limitation is the focus on individual in an illness state and on the
dependency of patient.
Research Highlights
o A theory of health promotion for preterm infants based on conservational model
of nursing. Nursing science quarterly,2004 Jul,17 (3)
The article describes a new middle range theory of health promotion for preterm infants
based on Levines conservational model that can be used to guide neonatal nursing
practice.
Summary
o Introduction to the theorist
o Conservational model
o Concept of the model
o Adaptation
o Wholeness
o Conservation

o Conservation principles
o Nursing process

Assessment

Trophicogosis

Hypothesis

Interventions

Evaluation

o Theory of redundancy
o Theory of therapeutic intention
o Utility of theory

Nursing research

Nursing education

Nursing administration

Nursing practices

References
o Timber BK. Fundamental skills and concepts in Patient Care, 7th edition, LWW.
o George B. Julia , Nursing Theories- The base for professional Nursing Practice ,
3rd ed. Norwalk, Appleton & Lange.
o Wills M.Evelyn, McEwen Melanie (2002). Theoretical Basis for Nursing
Philadelphia. Lippincott Williams& wilkins.
o Meleis Ibrahim Afaf (1997) , Theoretical Nursing : Development & Progress 3rd
ed. Philadelphia, Lippincott.
o Taylor Carol,Lillis Carol (2001)The Art & Science Of Nursing Care 4th ed.
Philadelphia, Lippincott.

o Potter A Patricia, Perry G Anne (1992) Fundamentals Of Nursing Concepts

Process & Practice 3rd ed. London Mosby Year Book.
o Vandemark L.M. Awareness of self & expanding consciousness: using Nursing
theories to prepare nurse therapists Ment Health Nurs. 2006 Jul; 27(6) : 605-15
o Reed PG, The force of nursing theory guided- practice. Nurs Sci Q. 2006
Jul;19(3):225
o 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.
o Delaune SC,. Ladner PK, Fundamental of nursing, standard and practice, 2nd
edition, Thomson, NY, 2002.