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Myra Levines Conservation Theory

Introduction to Theorist
1920

1996

Myra Estrin Levine


(Group A,
2011)

Education
Diploma in
Nursing
Bachelor of
Science in
Nursing
Master of
Science in
Nursing
Honorary
Doctorate

1944
Cook County School of Nursing,
Chicago
1949
University of Chicago
1962
Wayne State University, Detroit
1992
Loyola University, Chicago
(Group A,
2011)

Experience
Life
Experience
Clinical
Experience
Administrati
ve
Experience
Educational
Experience

Child during Great Depression


Young adult during WWII
Oncology nurse
Civilian nurse at Gardiner General
Hospital
Director of Nursing at Drexel Nursing
Home
Administrative Supervisor at
University of Chicago
Clinical Instructor at Bryan Memorial Hospital
Chairperson of clinical nursing at Cook County School
of Nursing
Visiting professor at Tel Aviv University in Israel
Seventy-seven published articles

(Meleis, 2012
and Group A,

Beliefs
Theory should influence practice
Acceptable use of adjunct science
Conservation came from physics

Patients give up independence when


they enter health-care environment
and should regain it when they leave
(Levine, 1989,
Levine, 1990, and
Levine, 1996)

Theory Beginnings
Began as nursing curriculum
Gives rationale behind nursing actions
Goals:
Teach problem solving skills
Teach individualized patient care
Avoid procedure-oriented methods
(Group A,
2011)

Conservation Theory
Internal environment
adapts to
external environmental cues
through conservation
so that
person maintains integrity

(Levine, 1969, Levine, 1989,


Levine, 1990, Levine 1996
Levine, 1996)

Internal Environment
Energy

Social
Integrit
y

Perso
n

Structu
ral
Integrit
y

Persona
l
Integrit
y

(Levine, 1996)

External Environment
Perceptu
al

Concept
ual

Operatio
nal

Can be
sensed

Can be
thought
about

Interacts with
tissues
without
person being
aware

light, sound

language,
symbols

Radiation,
microorganis
ms

(Levine, 1989)

Adaptation
Process of interacting with
environment
Process of change or of life
Can be equated with
Homeostasis
Stability
Equilibrium
Balance
(Levine, 1989
and Levine,

Three Parts of Adaptation


Historicity
Refers to
persons
genetic
makeup
Happens at
the cellular
level

Specificity

Redundancy

There is a
system to
deal with
each task
Biologic
systems
model
Interacting
sequences
of events

Person
displays
multiple
responses
to
dysfunction
Multiple
systems
deal with
threat
(Levine, 1989
and Levine,
1996)

Types of responses
Fight or flight
Quick response to threat or perceived threat
Inflammatory-immune
Restores physical wholeness (healing)
Stress
Integrated response of person
Perceptual awareness
Focusing on specific aspects of environment

(Levine, 1989)

Conservation
Product of adaptation
Is how a system sustains itself even
when challenged
Can be equated with a thermostat
Negative feedback systems
Efficient use of energy

Goal of conservation is health

(Levine, 1989,
Levine, 1990, and
Levine, 1996)

Principles of Conservation
Protects functional
integrity
Pacing activities to
restore function

Physical healing
Physiologic activities

Conservati
on of
Energy

Conservati
on of
Structural
Integrity

Conservati
on of
Social
Integrity

Conservati
on of
Personal
Integrity

Ability to function in
groups
Self
Self is developed in
family and society

Recognition of self
Protection of personal
space
(Levine, 1990 and Levine,

Integrity
Same root as health and whole
Independence
Control over own life

(Levine, 1990
and Levine,

Internal
Environmen
t

Adaptation

External
Environmental
Cues
Conservati
on

Integrity
(Levine, 1969, Levine, 1989,
Levine, 1990, Levine 1996
Levine, 1996)

Nurses Role in Supporting


Adaptation
Therapeutically
Encourages favorable adaptation

Supportively
Maintains status quo cannot prevent
decline

(Levine, 1969)

Interventions based on principles of


conservation
Conservation
of energy

Conservation
of Structural
Integrity

Conservation
of Personal
Integrity

Conservation
of Social
Integrity

Timing,
spacing, and
restriction of
interventions

Limit injury

Maintain
Privacy

Include support
system in
treatment plan

Measured
through vital
signs, blood
gases, patient
behavior

Proper
positioning and
range of
motion
exercises

Respect
patients desire
to withhold
information

Assist with
coping
behaviors

Help them
adjust to
health-care
environment

(Levine,, 1989
and Levine

Example
Bed bath conserves energy and promotes
structural integrity
The nurse also must look at personal integrity
(privacy) and social integrity (visitors present)
Can intervention be timed differently or done
in a way to encourage conservation principles
in ALL areas?

(Levine, 1990)

Internal environment
adapts to
external environmental cues
through conservation
so that
person maintains integrity

(Levine, 1969, Levine, 1989,


Levine, 1990, Levine 1996
Levine, 1996)

Critique of Theory

(Meleis, 2012)

Purpose

Describes rationale for nursing actions


Written for hospital-based nursing, but can apply to
all patient-care situations

(Group A,
2011 and

Concepts
Person
Viewed holistically
As having integrity

Environment
Internal and external
Internal environment adapts
External environment is manipulated

Health
Fitting into external environment through adaptation
Integrity
Wholeness

Nursing
Duty is to promote wholeness and adaptation
Uses conservation principles to plan interventions
Must use thorough observation and scientific method to arrive at nursing actions.

Definitions
Specific definitions already covered in detail
Internal environment
External environment
Adaptation
Conservation
Integrity

Multiple definitions derived from Latin/Greek roots


Author was very careful in word selection
Patient vs. client
Integrity
(Levine, 1991
and Levine,
1996)

Relationships
Concepts are well related
Patients internal environment adapts to external
environmental cues through conservation so that
person maintains integrity

(Levine, 1969, Levine, 1989,


Levine, 1990, Levine 1996
Levine, 1996)

Structure
Concepts are divided into subcomponents
All concepts move toward end goalintegrity
Does not lie in a linear fashion, rather ongoing
process of events
No internal diagram
Has been depicted as mandala art

Assumptions
Assumptions are implicit
Values a patient-centered approach
Patient is to be viewed as a whole
Patient interacts with environment
Nurse is provider of care
Nurse is an active participant in patients environment
Disease is a disruption which must be adapted to
(Glass, 1989)

Clarity and Simplicity


Well organized, easy to read, flows logically
All concepts are divided and clearly defined
Language is consistent throughout
Succeeds in giving nurse rationale for
interventions

Generalizability
Broad purpose
Theory applies to all people.
Used with multiple patient populations
Used in multiple settings

Importance
Supported with empirical data
Results can be generalized to other populations
Forward-looking theory for time written
Many writings address current issues
noncompliant patients (Levine, 1970)
(Levine, 1969)

healthcare costs

May be able to look at issues in a renewed light


(Levine, 1969, and Levine,

Contributions to Nursing/Healthcare
Provided nursing with a systematic
way to view patient holistically and
intervene accordingly
Advocated for use of scientific process
in nursing
Now calledEvidence Based
Practice

Application to Care for


Fatigue
According to Levine, fatigue is a manifestation of the
body trying to heal itself.
Effects of exercise on fatigue during cancer treatment
Conservation principles addressed and measured during
treatment
Theory of Conservation determined to be effective model for
study design

Description of fatigue in congestive heart failure


patients
Fatigue described by patients
Nursing interventions developed based on Conservation
principles to foster adaptation and maintain wholeness of
patient
(Mock et. al., 2007 and
Schaefer & Shober,
1993)

Nurse Consistency
Effect of nurse consistency during
NICU stay on patient outcomes
(Mefford & Alligood, 2011)
Consistent nurse more familiar with
patients unique patterns of adaptation
and tailor interventions accordingly
Consistency has positive impact on
length of stay and patient outcomes

Translates to other areas of care


(Mefford & Alligood,
2011)

Personal Evaluation
Overall like theory and viewing patient
holistically
Being familiar with theory has allowed insight
into patient behavioral reactionsand allowed
improved interventions
Reminds nurse to care for the person