MYRA LEVINE’S CONSERVATION MODEL

INTRODUCTION

The nursing activities and actions that are deliberately designed for caring for patients,
potential patients, or people at risk(or families, or communities) are grouped under nursing
therapeutics. Theorists have described and discussed nursing therapeutics and two images
have emerged-one is Levine’s proposed actions for conservation of energy and the second is
Orem’s proposed strategies to enhance self care.

ABOUT THE THEORIST

Myra Estrin Levine (1920-1996) was born in Chicago, Illinois. She was the oldest of three
children. . 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.

Levine told others that she did not set out to develop a “nursing theory” but had wanted to
find a way to teach the major concepts in medical-surgical nursing and attempt to teach
associate degree students a new approach for daily nursing activities. Levine also wished to
move away from nursing education practices that were strongly procedurally oriented and
refocus on active problem solving and individualized patient care (George, 2002).

THEORY DESCRIPTION

The central questions Levine addressed are:

 What are the ways in which nursing care is delivered?

 What are the goals of nursing actions?
 Why are nursing actions provided?

To answer these questions, Levine conceptualised the methods of nursing as conservation of

patient resources as alteration of environment to fit the resources as an extension of the
patient’s perceptual system until his own system is healed. These questions address nursing
therapeutics and to a lesser degree a perspective of health.

The central idea in her theory is energy conservation which is a universal concept. The
impetus for Levine’s conceptualisation appears to be her attempt to separate the domains of
medicine and nursing her first published work focussed on proposing” trophicognosis” as a
new label for nursing diagnosis and “plan of action” for nursing interventions.

THEORITICAL SOURCES/ PHILOSOPHICAL UNDERPINNINGS OF THE THEORY

Levine’s theory was based on Nightingale’s idea that ‘the nurse creates an environment in
which healing occurs Levine’s theory was formulated upon the studies based on various
studies. She borrowed information from various other disciplines. She drew from the works
of Tilich on the unity principle of life, Bernad on internal environment, Cannon on the theory
of homeostasis, and Waddington on the concept of homeorrhesis. Beland’s (1971)
presentation of ‘special causation and multiple factors ‘also influenced her. Levine also
learned various historical view points of diseases and general peoples view point about
diseases

THE CONSERVATION MODEL

The three major concepts of conservation model are

 Wholeness(holism)
 Adaptation
 Conservation.

The main goal is to promote adaptation and maintain wholeness using principles of
conservation

WHOLENESS – Anglo Saxon word ‘hal’

Levine quotes Erickson, who states ‘wholeness’ emphasizes a sound ,organic

,progressive ,mutually between diversified functions and parts with in an entity, the
boundaries of which are open and fluent”. She believed Erickson’s definition set up an
option of exploring the parts of the whole to understand the whole.

ADAPTATION

“Adaptation is a process of change where the individual retains his integrity within the
reality of his internal and external environment”. Conservation is the outcome

Levine (1991) speaks of three characteristics of adaptation

 Historicity
The characteristics of individual responses are rooted in history and are
waiting for a suitable time to respond
 Specificity
“Every species has fixed patterns of responses uniquely, designed to ensure
success on essential life activities, which ensures historicity and specificity
  Redundancy

Fail-safe options available to individuals to ensure adaptation like trauma,

age,disease and environmental conditions

Failed redundancy

This can occur either due to physiological or psychological functions

CONSERVATION

Meaning

The word conservation is derived from a Latin word ‘Conservatio’ meaning ‘to
keep together ’(Levine 1973)

Definition

According to Levine (1990) “Conservation describes the complex systems which

are able to continue to function even when severely challenged ”

Types of Conservation Principle

 The Principle of conservation of energy

 The Principle of conservation of personal integrity
 The Principle of conservation of structural integrity
 The Principle of conservation of social integrity

METAPARADIGM

NURSING

Levine states Nursing as a human interaction and Nursing Practice is based on a

nurse’s unique knowledge of nursing and other disciplines adjunctive to nursing
knowledge

PERSON

A Person is a holistic being, with integrity

HEALTH

Health is socially determined by the ability to function in a reasonably normal

manner. Health can change with time and for individuals

ENVIRONMENT
According to Levine, Nurse can relate the internal environment as the physiological and
pathophysiological aspects of the patient. Levine uses Bate’s (1967) definition of external
environment and suggests the following three levels

 Perceptual Level

The level where environment is intercepted and interpreted with sense organs

 Operational Level

The level where men physically perceive some even though they cannot do it directly

 Conceptual Level

The environment is constructed from cultural patterns,characterised by a spiritual existence

and mediated by the symbols of language,thought and history

OTHER CONCEPTS

ORGANISMIC RESPONSE

The capacity of an individual to adapt to his or her environmental condition is called as

organismic response.it has four divisions

Fight or flight

This is the most primitive type where the individual perceives that he is threatened even if
threat is not actually present.A patient in such a state responds by being very alert to the
response of his hospitalisation

Inflammatory response

This response uses available energy to remove or to keep out unwanted irritants or
pathogens.it drains away patients energy

Response to stress

This is predictable,non-specifically ind ed organismic changes. it is characterised by

irreversibility and infuluences the way the patients behave to the nurse

Perceptual awareness
This response occurs only when the individual experiences the world around him.this is
information seeking

 TROPHICOGNOSIS

Levine recommended trophicognosis as an alternative to nursing diagnosis and it is a

scientific method to reach a nursing care judgement

 HOMEOSTASIS

Stable state normal alterations in physiological parameters in response to environmental

changes; an energy sparing state ,a state of conservation

 MODES OF COMMUNICATION

The many ways information, needs and feelings are transmitted among the
patient,family,nurses and other health care workers

 THERAPEUTIC INTERVENTION

Interventions that influence adaptation in a favourable way, enhancing the adaptive responses
available to the person

ASSUMPTIONS

 The person is viewed as a holistic being

 Human beings respond in a singular but integrated fashion
 Each individual responds wholly and completely to every alteration in his or her life
pattern
 Individuals cannot be understood out of the context of their environment
 Ultimately decisions for nursing care are based on the unique behaviour of the
individual patients
 Patient centred care means individualized nursing care
 Every self sustaining system monitors its own behaviour by conserving the use of
resources required to define its unique identity
 The nurse is responsible for recognizing the state of altered health and the patients
organismic responses to the altered health
 Nursing is a unique contributor to patient care

THE MODEL

Energy conservation is dependent on the free exchange of energy with the internal and
external environment to maintain the balance of energy supply and demand
Conservation of structural integrity is dependent on an intact defence system (immune
system)that supports healing and repair to preserve the structure and the function of the
whole being

The conservation of personal integrity acknowledges the individual as one who strives for
recognition, recognition, respect, self awareness’s, humaneness, self-hood and self-
determination

The conservation of social integrity recognizes the individual as a social being who functions
in a society that helps to establish boundaries of self. The value of an individual is recognized
and it also recognizes that the individual resides with-in a family, a community, a religious
group, an ethnic group, a politic group and a country

The outcome of nursing involves assessment of organismic responses

ORGANISMIC RESPONSE

The capacity of an individual to adapt to his or her environmental condition is called as

organismic response. It has four divisions

Fight or flight

This is the most primitive type where the individual perceives that he is threatened even if
threat is not actually present. A patient in such a state responds by being very alert to the
response of his hospitalisation

Inflammatory response

This response uses available energy to remove or to keep out unwanted irritants or pathogens.
It drains away patients energy

Response to stress

This is predictable, on-specifically induced organismic changes. it is characterised by

irreversibility and influences the way the patients behave to the nurse

Perceptual awareness

This response occurs only when the individual experiences the world around him. This is
information seeking

These organismic responses are redundant in the sense that they co-exist.the four responses
help individuals to protect and maintain their integrity. They are integrated by their cognitive
abilities, the wealth of previous experiences, the ability to define relationships and strength of
their adaptive abilities
Nurses use the scientific process and creative abilities to provide nursing care to the
patient.The nursing process incorporates these abilities thereby improving the care of the
patient

APPLICATIONS

Nursing research

 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

Nursing education

 Conservational model was used as guidelines for curriculum development

  It was used to develop nursing undergraduate program at Allentown college of St.
Francis de Sales, Pennsylvania
 Used in nursing education program sponsored by Kapat Holim in Israel
 Nursing administration
 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
 McCall developed an assessment tool for data collection on the basis of four
conservational principles to identify nursing care needs of epileptic patients
 Family assessment tool was designed by Lynn-Mchale and Smith for families of
patient in critical care setting

Nursing practice

 Conservational model has been used for nursing practice in different settings
 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
 Pond used conservation model for guiding the nursing care of homeless at a clinic,
shelters or streets

In the community

 Using Levine’s model community was defined as “ a group of people living

together within a larger society, sharing common characteristics, interests and
location”(National league for self study report in 1978)

Nursing Process in hospital setting

Assessment Trophicognosis Hypothesis Interventions Evaluation

Collection of Nursing diagnosis Direct nursing Testing the Observation
provocative that gives interventions with hypothesis of organismic
facts through provocative facts the goal of response to
observation and meaning. The maintaining Use for direct interventions
and interview nurse arranges wholeness and care.
of challenges these in a way that promoting Interventions It is assesses
to the internal provides meaning adaptation .nurse should be based whether
and external to the patient’s seeks validation on the hypothesis is
environment progress of patient’s conservation supported or
problems with the principles .the not supported
Example- patient and the interventions
support systems. should not be If not
-organismic Then the imposed but supported,
responses to hypothesis can be should be plan is
illness proposed mutually revised, new
accepted thus hypothesis is
maintaining
-Lab reports wholeness and proposed
promote
Patient family adaptation

-Patient
environment

Nursing Process in community setting

Assessment Trophicognosis Hypothesis Interventions Evaluation

Collection of Community Directs the nurse Testing the Observation of
provocative diagnosis that to promote hypothesis organismic
facts through gives provocative interventions response to
observation facts and with wholeness Interventions interventions
and interview meaning. The of the should be based
of challenges nurse arranges community on the Observation of
to the internal these in a way members .nurse conservation organismic
and external that provides seeks validation principles response to
environment meaning to the of patient’s interventions
patient’s progress problems with Example- When
Example- the patient and shelter for It assesses
the support abused women is whether
-observation systems. Then provided, hypothesis is
the hypothesis structural supported or not
-Review of can be proposed integrity of the supported
census data community is to
Example- be maintained If not supported,
-statistics Providing shelter while preserving plan is revised,
to the abused the energy, new hypothesis
-Wind shield women will personal and is proposed
assessment reduce morbidity social integrity
associated with of the women Example-
continuous abuse who chooses the Expected
shelter outcome of
provision of
shelter for
abused women
should be a
reduction of
women who
visits
emergency
room with
reports of abuse
 or suspected
abuse

CRITIQUE

Clarity

Filtzpatrick and Whall believe that Levine’s work is both externally and internally valid.
Fawett states that Levine’s conservation model provides nursing with a logically congruent,
logistic and holistic view of the person

Simplicity

Even though various sub-concepts are involved, it is one of the simpler models than many
other theories.

Generality

Levine,s theory can be generalised to various settings

Empirical Precision

Deductive logic was used to develop the concept,but later inductive method was used to
develop her model. The theory is easily testable

Derivable Consequences

The model has its importance in nursing practice even in the twenty first century

SUMMARY

To summarize, Levine expressed the view that within the nurse-patient relationship a
patient’s state of health is dependent on the nurse-supported process of adaptation. This
guides nurses to focus on the influences and responses of a client to promote wholeness
through the Conservation Principles. The goal of this model is to accomplish this through the
conservation of energy, structural, personal and social integrity. The goal of nursing is to
recognize, assist, promote, and support adaptive processes that benefit the patient.
 REFERENCES

Book References

George, J. B. Nursing theories: Base for professional nursing. 5th ed. Pearson Education.
2003,p-97-102

Johnson B.M,Webber P.B.An Introduction To Theory And Reasoning In Nursing.3rd ed

Philadelphia:Lippincott Publishers;2010;p-138-140

Parker, M. E. Nursing theories and nursing practice. F. A. Davis Company: Philadelphia,

PA.;2007.p-94-108

Tomey, A. M. & Alligood, M. R. 2006. Nursing theorists and their work. 6th ed.. Elsevier
Health Sciences,p- 227-335

Online References

Leach, M.J. (n.d.) Wound management: Using Levine’s Conservation Model to guide
practice. Vol. 52, Issue No. 8. Retrieved from: http://www.o-wm.com/article/6024 on July
2009.

Sitzman, K. & Eichelberger, L.W. (2009). Understanding the work of nurse theorists: A
creative beginning. Retrieved from http://nursing.jbpub.com/sitzman/artGallery.cfm on July
2009. Jones and Bartlett Publishers.

Yeager, S. (2002). Overview of nurse theorist: Myra Levine’s conservation model. Retrieved
from: http://www4.desales.edu/~sey0/levine.html on July 2009.
 ADVANCE NURSING PRACTICE

A SEMINAR ON THE CONSERVATION MODEL

BY MYRA .E. LEVINE

SUBMITTED TO

PROF.SHEELA PAVITHRAN

DEPT. OF MEDICAL SURGICAL

NURSING

AMRITA COLLEGE OF NURSING

SUBMITTED BY

MS PRIYA MARY PAULOSE

M.Sc NURSING- 1ST YEAR

AMRITA COLLEGE OF NURSING-AIMS.2011