CONSERVATION MODEL

MYRA ESTRIN LEVINE

April Beresford, RNHeidi Ertman, RN

Latrice Garner, RNMary Jacobs, RN

Maureen Koval, RN

MYRA E. LEVINE

"Ethical behavior is not the display of one's moral rectitude in times of crisis," says nurse Myra Levine.“It is the day-to-day expression of one's commitment to other persons and the ways in which human beings relate to one another in their daily interactions.” - Levine (1977)

WHY NURSES USE THEORY TO GUIDE THEIR PRACTICE:o A nursing theory provides the theoretical

foundation of the profession.o Theory defines what nursing is, what it does, and

the goals or outcomes of nursing care.o Nursing is the synthesis of many theories.o Our group identified with Levine’s Conservation

Model because it focuses on conserving an individual's wholeness. It addresses an individual from birth to death and aims to maintain an equilibrium conducive to health.

PURPOSE:The purpose of this project is to describe

the use of a conceptual nursing model, Levine’s Conservation Model.

THEORY OVERVIEWMyra Estrin Levine proposed four principles of conservation. The process by which conservation is achieved is adaptation and the desired outcome is integrity or wholeness. Adaptation includes responses based on past experiences (historicity), specific to the need (specificity), and with a variety of levels of possible response (redundancy). The principles of conservation relate to the conservation of energy, structural integrity, personal integrity, and social integrity of the individual.

LEVINE’S NURSING MODEL:OBJECTIVES

o Describe the historical background of the development of Levine’s model for health

o Define Levine’s three major concepts and four principles of conservation

o Present the relationship between Levine’s model and concepts in nursing’s metaparadigm

o Provide an example of Levine’s model in a clinical practice

o Evaluation of the Conservation Model

HISTORICAL BACKGROUND AND MOTIVATION FOR DEVELOPMENT

OF CONSERVATION MODEL Myra Estrin Levine (1920-1996) was born in Chicago, Illinois. Levine

developed an interest in nursing because her father was frequently ill and

required nursing care on many occasions. Levine did not desire to make a nursing

model or theory. Her model developed from the organizational structure she

developed for teaching medical surgical nursing students (Stafford,1996).

According to Tomey and Alligood (2006, p. 288). “The Four Conservation

Principles of Nursing” was the first statement of the conservation principles. The

theory was completed in 1973.

Levine’s education background includes (Current Nursing, 2009):

o ADN: Cook county school of nursing, Chicago,1944

o BSN: University of Chicago, 1949

o MSN: Wayne State University, Detroit, 1962

Her major accomplishments are (Current Nursing, 2009):

o Publication: An Introduction to Clinical Nursing, 1969,1973, and 1989

oHonorary doctorate from Loyola University in 1992

EDUCATIONAL BACKGROUND

AND ACCOMPLISHMENTS

PHILOSOPHIC VALUES AND KNOWLEDGE DEVELOPMENT

Mrs. Levine's values were shaped by the many areas of nursing she

worked in, and the ways she visualized teaching changes, improving a

patients care, and mostly how nurses can impact patient healing through

conservation. Her nursing career included many different areas of nursing:

oPrivate Duty nurse (1944)

o Civilian nurse in the U.S. Army (1945)

oDirector of nursing at Drexel Home in Chicago (1950 to 1951)

o Academic Education Bryan Memorial Hospital in Lincoln,

Nebraska (1951), Cook County School of Nursing (1963 to

1973), Rush University (1974-1977), and University of Illinois

(1962, 1963, 1977 to 1987).

o Chairperson of Clinical Nursing at Cook Country School of

Nursing (1963-1967)

oVisiting professor at Tel Aviv University in Israel (1974 and

1982)

More historical back ground can be found in Tomey and

Alligood (2006, pp. 227-229). Her accomplishments are many,

and express the road she traveled in developing the Conservation

Model.

MANY TEACHERS INFLUENCED THE CONSERVATION MODEL

Mrs. Levine’s study of theory started with Badland’s: specific causation

and multiple factors, and gives credit to Florence Nightingale, according to

Alligood and Tomey (Alligood and Tomey, 2006, p. 229 [as cited in Levine,

1992, p.42]), “guardian activity” of observation used by nurses to “save

lives and increase health and comfort", it was a large contribution in to the

thinking aspect of the Conservation model.

She continued to modify her Conceptual Model throughout her career based

on her continued education, work experience and advances in scientific

principles.

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), as quoted from nursingtheories,

[blog,2009,(03)].

THE THREE MAJOR CONCEPTS OF THE

CONSERVATION MODEL• Wholeness (Holism)

• Adaptation

• Conservation

WHOLENESSo To understand the whole person, one must first

understand the parts of the whole.

o Levine used Erickson’s description of wholeness as an open system (Levine, 1969).

o Levine believed that humans respond in “ an integrated, singular fashion to environmental changes” (Levine 1966).

ADAPTATION“Adaptation is the process of change whereby

the individual retains his integrity within the realities of his internal and external environment” (Levine, 1973).

o All adaptations vary in degree, and not all are successful.

o Conservation is the outcome.o Adaptation has three characteristics

o Historicityo Specificityo Redundancy

CONSERVATION“Conservation describes the way complex systems are

able to continue to function even when severely challenged (Levine, 1973).

o The primary goal of conservation is maintaining wholeness and uniqueness.

o Nursing actions reflecting this model are directed at helping the client conserve:o * Energy * Personal Integrityo * Structural Integrity * Social Integrity

GLOBAL CONCEPTS IN THE NURSING PROFESSIONo Human Being: Each person has freedom of choice,

identity, and self-worth. Each person expresses themselves as a summary of all contributing parts.

o Health: Defined in social contexts; the ability to function within reasonable limits. Health is more than the absence of disease, and changes with time.

o Environment: Not just the place a person lives, but also the situation. There is an internal and an external environment, and both contribute to accommodation.

GLOBAL CONCEPTS IN THE NURSING PROFESSION“The goal of nursing is to promote adaptation and

maintain wholeness” (Levine 1971). o Nursing is not a series of specific tasks but is a

human interaction. o It is based on knowledge and scientific reasoning,

but is an art that each person practices in a unique manner based on each client’s needs.

Each one of the global concepts of nursing has the ability to add to wholeness or to detract from it.

INTERPRETATION & INFERENCE

IMPLICATIONS & CONSEQUENCES

EVALUATION OF NURSING MODEL

o Myra Levine’s conservation model focuses on promoting adaptation and maintaining wholeness using the principles of conservation.

o According to Levine (1973) “human beings conserve their bodies’ incredible ability to adapt to environmental stimuli” (Schaefer & Pond, 1994, p.53).

ORIGINS Levine’s Conservation Model is clearly influenced

by other disciplines. It is not unique to nursing. It has elements of the physical sciences as evidenced by the principle of energy conservation. The social sciences are represented in the concept of the perseveration of personal integrity. The influence of humanities is reflected by the concept of how a person’s social system is part of their environment and all forms of environment have an influence on the person.

ORIGINS Levine’s Conservation model was developed as an

organizational framework for teaching medical surgical nursing. It was not intended to be a nursing theory (Schaefer, 2006, p.228).

LEVINE’S THEORY AND ITS UNIQUENESS TO NURSINGo The conservation principles are used by the nurse

to identify interventions and to maintain wholeness for the patient (Schaefer & Pond, 1994, p.53).

o This theory is influenced by a person’s wholeness and their ability to adapt and respond to different environmental challenges.

FOUR GLOBAL CONCEPTSThis model adequately describes the four global

concepts:o Human beingo Environmento Healtho NursingAll of these concepts represent the factors that

influence individuals and their ideas about their own health and how they view healthcare in general which can influence the individual’s treatment goals and outcome.

APPLICATIONSo A theory deals with one or more specific concepts

and is usually derived from a conceptual model (Kearney-Nunnery, 2005).

o Levine’s Conservation model is a general guide of systems and statements and uses broad concepts in a logical, organized form that can be used in different settings. “Conservation principles as a framework are not limited to nursing care in the hospital but can be generalized and used in every environment, hospital, or community (Levine, 1990, 1991)” (Schaefer, 2006, p.233).

APPLICATIONS This model has been used in varied areas of

nursing. “Conservation principles have been used as frameworks for numerous practice settings in cardiology, obstetrics, gerontology, acute care (neurology), pediatrics, long-term care, emergency care, primary care, neonatology, critical care areas, and in the homeless community” (Savage & Culbert, 1989; Schaefer & Pond, 1991).

APPLICATIONS“Use of an appropriate conceptual model facilitates the design and testing of theory-based interventions and the development of science to support nursing practice”(Mock et al, 2007, p. 512).

PUTTING THE CONSERVATION MODEL TO WORK

You are a labor and delivery nurse working for a local hospital. You are caring for a teenager who is about to deliver her first child. In the room are her boyfriend, her mother, and her best friend. She is quiet and is not making eye contact with care staff, and her family members are watching television. You sit down next to the bed and ask the patient if there is anything she needs and she replies “no” but your gut instinct tells you there’s more to the picture. Your assessment skills tell you there is a great potential here for problems.

You ask the patient how she feels about becoming a mother. She tells you she is scared. In further conversation, she tells you she is not planning to go back to school because she is embarrassed and afraid of social rejection. She did not take any birthing classes or childcare education. She is afraid of pain during active labor, and has questions about pain control options. She says her mother and her boyfriend have been supportive, but also voices concern about taking care of her mother, who has a physical disability.

ASSESSING THE SITUATION

o Is this patient demonstrating wholeness?

o Is this patient demonstrating adaptation?

o Is this patient demonstrating conservation?

WHOLENESSWow. This patient has issues, right? Let’s look at

the pieces here. Levine states we have to look at all of the little pieces to see the whole person. In order to understand our patient, we have to assess her lifestyle, social integration, spirituality, self-image, family dynamic, environment, cultural identity, and anything else she feels may contribute to her identity. We get a few hints of that in our initial conversation.

ADAPTATIONHow well is your patient adapting? Before you say

“poorly” look at what you can build on. Adaptation is not a “pass or fail” but can vary in degree. Consider environment, organismic response, and trophicognosis in your response. This is a new situation for your patient. How is she relating this to past experiences? What does she perceive as a challenge? What does she not perceive as a challenge or a goal?

CONSERVATIONLevine describes conservation as “… the way

complex systems are able to continue to function even when severely challenged” (1990). Is your patient conserving energy? Is she conserving structural (physical) integrity? Is she conserving her personal integrity? Is she preserving social integrity? How could you, as a nurse, promote these principles?

PUTTING THE MODEL TO WORK Promoting wholeness: Talk with your patient about what roles for her

are important, discuss what parts of her identity have been fragmented. What is she proud of? What is she missing? What are her goals?

Promoting adaptation: Although your patient has not been to prenatal education and has dropped out of school, she has spent time gathering baby supplies and has stopped hanging out with unsupportive friends. Build on this. Encourage her and tell her about other community resources available to her. Help her explore all of her options and consider her preferences.

Promoting conservation: Provide her with pain control options, encourage physical rest. Encourage her to advocate for her needs and allow her to carry out her social roles during her hospital stay by involving friends and family there to support her, if that is what she desires.

Using Levine’s Conservation Model to guide our nursing practice takes conscious effort, but has the potential to help our patients reach a higher state of health, which is the ultimate goal of nursing practice.

REFERENCESAlligood, M.R.,& Tomey, A.M.(2006). Myra Estrin

Levine :The conservation model. Y. Alexopoulos, & K. Hebberd (Eds.), Nursing theorists (pp. 726 – 742).St. Louis, MO: Mosby

Chitty, K. (2007). Professional Nursing Concepts &Challenges. St. Louis, Missouri: Saunders. George, J.

Current Nursing. (n.d.). Nursing theories: Levine’s four conservation principles. Retrieved from http://currentnursing.com on July 2009.

Dalida D. N207 Blogger (2009). Myra Levine’s Conservation Theory. University of the Philippines Open University

Retrieved from http://nursingtheories.blogspot.com

George, J. B. (2001). Nursing theories: Base for professional nursing. (5th ed). Pearson Education.

Levine, M. E. (1992). Nightingale redux. In B.S. Barnum (Ed.), Nightingale’s notes on nursing (pp. 39-43). Philadelphia: J.B. Lippincott.

Schaefer, K.M. (2006). Nursing Theorists and Their Work. In Y.Alexopaoulos (Ed. “Et al”), Myra Estrin Levine: The Conservation Model (pp. 227-243). St. Louis, Missouri: Mosby Elsevier.

Schaefer, K.M. & Pond, J.B. (1994). Levine’s Conservation Model as a Guide to Nursing Practice. Nursing Science Quarterly, 7, 53-54. doi: 10.1177/089431849400700204