Levin's Four Conservation Principles

Introduction

• Theorist - Myra Estrine Levine
• 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
• 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
• Died in 1996

Major Concepts of Conservational model

• Goal of the model is 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
• 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

Nursing’s 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 individual’s 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

• Vital’s 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

Characteristics of theory

• The concept of illness adaptation, using interventions, and the evaluation of nursing interventions are interrelated.
• Concepts are sequential and logical and can be used to explain the consequences of nursing action.
• Levine’s theory is easy to use and elements are easily comprehensible.
• Levine’s idea can be tested and hypothesis can be derived from them.
• The principle of conservation are specific enough to be testable
• Levine’s idea have not yet been widely researched.
• Levine's theory has been applied in surgical settings.
• Levine’s ideas are 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 patient’s 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 patient’s space needs

4. Conservation of social integrity

• An individual is recognized as someone 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 patient’s 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

• To promote wholeness, realizing that every individual requires a unique and separate cluster of activities

The individual integrity is his abiding concern and it is the nurse’s responsibility to assist him to defend and to seek its realization

Nursing Process

• Assessment
• Trophicognosis
• Hypothesis
• Interventions
• Evaluation

Conservational models

• Conservational model provides the basis for development of two theories
• Theory of redundancy
• Theory of therapeutic intention

Theory of redundancy

• Untested, speculative theory that redefined aging and everything else that has to do with human life
• Aging is diminished availability of redundant system necessary for effective maintenance of physical and social well being

Theory of therapeutic intention

• Goal: To seek a way of organizing nursing interventions out of the biological realities which the nurse has to confront

• Therapeutic regimens should support the following goals:
• Facilitate healing through natural response to disease
• Provide support for a failing auto regulatory portion of the integrated system
• Restore individual integrity and well being

Limitation

• 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 don’t match, this mismatch will be an area of conflict.
• The major limitation is the focus on individual in an illness state and on the dependency of patient.

Research Highlights

• 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 Levine’s conservational model that can be used to guide neonatal nursing practice.

References

1. Timber BK. Fundamental skills and concepts in Patient Care, 7th edition, LWW.
2. George B. Julia , Nursing Theories- The base for professional Nursing Practice , 3rd ed. Norwalk, Appleton & Lange.
3. Wills M.Evelyn, McEwen Melanie (2002). Theoretical Basis for Nursing Philadelphia. Lippincott Williams& wilkins.
4. Meleis Ibrahim Afaf (1997) , Theoretical Nursing : Development & Progress 3rd ed. Philadelphia,  Lippincott.
5. Taylor Carol,Lillis Carol (2001)The Art & Science  Of Nursing Care 4th ed. Philadelphia,  Lippincott.
6. Potter A Patricia, Perry G Anne (1992) Fundamentals Of Nursing –Concepts Process & Practice 3rd ed. London Mosby Year Book.
7. Vandemark L.M. Awareness of self & expanding consciousness: using Nursing theories to prepare nurse –therapists Ment Health Nurs. 2006 Jul; 27(6) : 605-15
8. Reed PG, The force of nursing theory guided- practice. Nurs Sci Q. 2006 Jul;19(3):225
9. 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.

THANK YOU