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Introduction

The nursing profession is undergoing dynamic and continuous evolution. During the last decade, many theories concerning the nursing career thrived following nursing notes writing initiated by Florence Nightingale (Tomey & Alligood, 2006). Conservational Theory formulated by Myra Levine in 1973 is among these emergent theories. She was born in Chicago, Illinois and lived between 1920 and 1996. Her interest in the nursing career resulted from her ill father who always needed nursing care. Levine graduated in 1944 from Cook County School of Nursing with a diploma and in 1949, acquired an SB from the University of Chicago and later on in 1962 obtained a Master’s of Science in nursing from Wayne State University (Yeager, 2002).

Levine has had a varied nursing career. Clinically, she worked on private duty as a nurse, surgical supervisor, U.S. Army nurse, and nursing director. She held faculty positions at Loyola University, University of Illinois, Chicago, Cook County School of Nursing and Rush University. Levine also filled visiting professorship in Israel at Recanati School of Nursing, Tel-aviv University and Ben Gurion University of Negev. Levine has been honored by the Illinois Nurses Association and is a charter fellow in the American Academy of Nursing. She was the first to receive the Sigma Theta Tau’s Elizabeth Russell Belford Award for teaching excellence. Furthermore, Loyola University, Chicago, granted her an honorary doctorate in 1992 (Yeager, 2002).

Background of the Theorist

Levine did not intend to develop a theory when she began writing ideas about nursing. In fact, over two years following the initial publication of Introduction to Clinical Nursing, she started referring to her work as a theory but still preferred its identity as a conceptual model. She states that she wanted to find a way of generalizing the content in the attempt to avoid a procedurally oriented educational process (Levine, 1973). Her interest was to help nurses to come to the realization that every nurse-patient contact results into a puzzle regarding nursing care, which needs an individual solution. Levine Myra’s work has advanced over the years, with the latest theory update published in 1989 and further discussions in 1990 and 1991 (Pond, & Schaefer, 1991).

Levine believes that entry into the healthcare system is related to renouncing some measure of personal independence.  Designating a client who has entered a healthcare system causes a state of dependency. She supports the term suffering due to the fact that patient means sufferer while dependency is related with suffering. Suffering makes a person to aside independence to accept another person’s services. The challenge of the nurse is providing appropriate care while upholding the integrity of the individual, honoring the care placed in the by the patient, and encouraging participation of the individual in his/her care. The patient’s trust and dependence last as long as there is a need for nurse’s services. The goal of the nurse is always to impart strength and knowledge to enable the individual to regain independence. Levine intention is for the dependency to be temporary (Levine, 1973).

In her writings, Levine credits the works of scientists upon which she built her work. She drew her discussion on physiological mechanisms upon Cannon’s description of flight and flight response. The stress theories of Selye provided additional information on protection from hazards of living. She also drew some of her work from upon Gibson’s perception systems concerning the way people get involved in collecting information from their environment to help in moving safely through these environments. The discussions of Erikson regarding the environmental influence on development provided a further expansion of Levine’s information on person-environment interaction. The description of three types of environment by Bate was also useful. Levine drew the concept of adaptation upon the works of Dubos and Cohen (Sitzman, & Eichelberger, 2009).

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Focus of the Model

Levine’s Conservational Model focuses on promotion of adaptation and maintenance of wholeness by the use of conservation principles. The model guides the nurse in focusing on the responses and influences at the level of organisms. The nurse achieves the models goals by conserving structure, energy, as well as social and political integrity. Besides, conservation, adaptation and wholeness are other critical concepts to the use of the model. Adaptation refers to the process of change, and its outcome is conservation. It is a practice where the patient upholds integrity in the environmental realities. Achievement of adaptation is via prudent economic and controlled environmental resources utilization at his interest (Levine, 1973).

Levine bases wholeness on the Erikson’s account of wholeness being an open system. Erikson states that, wholeness provides an emphasis of sound, natural and progressive harmony between differentiated parts and functions in total with the boundaries being unstable and open. On the other hand, Levine states that as an organism continue to interact with its environment, an open and fluid system is created while as a state of comprehensive health occurs when this interaction permit ease-the integrity assurance….in all life’s dimensions. This continuous, dynamic and open interaction between the external and the internal environment provides holistic thought foundation, viewing the being as a whole (Levine, 1973).

Adaptation brings about conservation. Conservation explains the functionality of complex systems on severe, challenging situations. Conservation enables individuals to face difficulty, adjust as necessary, and uphold their uniqueness. The primary objective of conservation is wellness and ability to face disability as the conservation and integrity principles hold in all situations requiring nursing. The focus of conservation is to keep the individual’s wholeness together. Though some nursing interventions can handle a specific conservation rule, nurses ought to acknowledge that there are conservational rules other than those of adaptation. (Levine, 1973).

Conservation is the primary concept of Levine’s Theory. An individual is at a conservation condition if the adaptive responses suits in changing to productivity with the little effort, while maintaining maximum identity and function. Levine Myra described Four Conservational Principles that focus on conservation of wholeness of an individual. She supported nursing as a human interaction and proposed the four principles relating to integrity and unity of individuals. Its outline consists of energy, personal integrity, social and structural integrity.

Conservation of energy: Every individual requires an energy balance there are internal and external environmental factors that may cause energy depletion. Conservation is the balancing of energy input and output in order to avoid excess fatigue through exercise, nutrition and enough rest.

Conservation of Structural Integrity: A person has to cover his/her structural integrity to function; preserving the body’s anatomical structure. Conservation of structural integrity refers to maintenance and restoration of the body’s structure to promote healing and prevent physical breakdown. For example, maintaining the patient’s personal hygiene and assisting in ROM exercise.

Conservation of Personal Integrity: Everyone has a sense of identity and self worth. Conservation of personal integrity recognizes an individual’s strive for respect, recognition, self-determination, selfhood and self-awareness. For example, recognition and protection of space requirements of patients.

Conservation of social Integrity: This involves the availability and appreciation of human interaction especially with the patient critical environment. An individual is recognized as someone who lives within a religious group, family, ethnic group and a community. For example, positioning of the patient in bed to foster social interaction and avoiding sensory deprivation (Pond, & Schaefer, 1991).

Metaparadigm Concepts

1. Person

The “person” is a holistic being who continuously struggles to maintain the integrity and wholeness. The wholeness emphasizes on the importance of social life in the life of an individual. Furthermore, the person is regarded as a distinctive being in integrity and unity, thinking, believing, feeling and the whole system of systems.

1. Environment

The environment makes individual’s wholeness complete. The internal environment merges the individual’s patho-physiological and the physiological features and is continuously threatened by the external environment. It is the incorporation of bodily functions similar to homeorrhesis as opposed to homeostasis. It is subject to obstacles from the external environment through energy form. Homeostasis refers to a condition of sparing energy that gives the essential baselines for a several synchronized psychological and physiological factors. Homeorrhesis refers to a stabile flow of as opposed to a stationary state.  Internal environment puts emphasis on the dynamism of transformation within a specific space and time. It describes the adaptation pattern that allows the body of an individual in order to preserve its well-being from the immense changes from the surrounding.

The outside environment consists of the conceptual, perceptual and operational environments. The perceptual environment is the external setting to which persons respond with their organs of sense comprises of sound, light, temperature, feel, smelled and tasted chemical change, position, and balance. The conceptual environment is the outside environment that comprises of symbols, ideas, language, and concepts and interventions and includes language exchange, value systems, and the ability to experience and comprehend feeling, cultural and ethnic traditions, religious beliefs, and private psychological patterns originating from life. The operational environment is the external environment that interacts with living tissue despite the fact that the individual lacks sensory organs for recording the existence of such factors and encompasses all sort of pollutants, radiations and microorganisms.

1. Health

The patterns of adaptive change are health and disease. Health implies integrity and unity. It is a successful adaptation to the surrounding whether favorable or not. The primary objective of nursing is to advance health. Levine means health by the avenue to return to the day-to-day activities interfered by ill health. It not only repairs the injury but also the individual himself or herself. It refers to healing of the afflicted part as well as restoring the individual to selfhood and setting aside the disability encroachment entirely. The individual regains freedom to pursue his/her interests without any constraint. On the contrary, disease refers to an uncontrolled and undisciplined alteration that ought to be prevented otherwise death will occur.

1. Nursing

Nursing entails taking part in the aforementioned human interactions. The nurse engages in human experience that leaves a permanent mark on every patient. The objective of nursing is to maintain wholeness and promote adjustment to the surrounding constraints (health). Nursing promotes wholeness by appreciating that each person requires a distinctive and separate group of activities. Since the abiding concern of the individual is integrity, it is the duty of the nurse to assist the patient in its defense and realization. The accomplishment of this nursing goal is by the application of the conservation principles: personal, social, structure, and energy integrity.

The specific adaptive responses that assist in conservation occur on molecular, emotional, psychologic, physiologic and social levels. Historicity, specificity and redundancy are the three factors that form the foundation of these adaptive responses.

Historicity refers to the notion that the basis for adaptive responses is partially personal and generic t history. Every person is made up of both personal and generic history that give rise to adaptive responses.

Specificity: This refers to the fact that every system making up a human being has distinct response initiated by stimulus pathways. Responses are task-oriented, and their stimulation is via specific stressors. Responses stimulated in multiple ways are synchronized and occur in a flow of complementary reactions.

Redundancy: This describes the perception that different pathway may take over should a particular system or pathway fail to ensure adaptation. This is useful when the response is corrective. Conversely, redundancy can be detrimental, such as when autoimmune situations cause an individual’s immune system to fight previously health body tissue (Pond, & Schaefer, 1991).

Organismic response refers to an individual’s behavior change in an attempt to suit the surrounding. It helps the individual in protecting and maintaining the integrity. There are four types of organismic responses. These include flight or fight, which is an immediate reaction to imagined or real danger, inflammatory response, which is a response for providing structural integrity and healing promotion, stress, which refers to reactions developed for a long time and affected by uncomfortable experience and finally, perceptual response which, involves gathering environmental information and converting it into a meaningful experience.

Theories Generated from the Nursing Model

Levine Myra’s Conservational Model offers the foundation for creation of two theories namely: Theory of Redundancy and Theory of Therapeutic Intention. The redundancy theory is an untested and tentative theory that redefines aging, and all other things relating to human life. Aging refers to decreased availability of redundant system that is vital for efficient preservation of social and physical well-being. The goal of the Theory of Therapeutic Intention is to look for a means of fashioning nursing interventions beyond the biological realities that nurses confront (Pond, & Schaefer, 1991).

Model’s Contribution to Nursing Research and Practice

In nursing research, conservation principles have been applied in collecting data for many researches. Hanson et al. used the conservation model to study the prevalence and incidence of pressure ulcers among hospice patients. Newport also used the principle of social integrity and conservation of energy to compare body temperatures of infants placed in a warmer with those put on mother’s chest soon after delivery. In nursing practice, there is evidence of the use of Conservation Model in different settings. Bayley used the four conservational principles in discussing the care of severely burnt teenagers. Bayley also discussed the patient’s perceptual, conceptual and operational environments. Pond used the Levine’s Conservational Model to guide nursing care of the homeless in streets, shelters or clinic (Tomey & Alligood, 2006).

Strengths and Weaknesses of the Model

The strength of the conservation model is its ability to integrate the person, environment and health with the nursing profession. This has clearly brought out the role of the nurse in restoring the patient’s state of health to enable him/her to resume the daily activities by managing the adaptive responses. The other strength in this model is the use of unique and extensive vocabulary. Levine provided adequate definitions to minimize confusion on the meaning of her ideas. The careful word selection provides clarity to the reader. The first weakness of the conservation model is its focus on illness rather than health. The theory does not support illness prevention and health promotion strategies. The principle of energy conservation only applies in bedside patient care but not in cases where there is a need for energy utilization like in paralyzed patients. The principle of conservation of structural integrity does not apply to cases where the patient seeks to compromise the structural integrity to gain psychological satisfaction and physical beauty. The nurse can also find it challenging to practice conservation of personal integrity if the patient is psychologically impaired or incapacitated, for instance, comatose and suicidal patients. The final limitation is the conservation of social integrity that can be impracticable in the absence of significant others like the case with abandoned children.

Research Study with the Using the Conservational Model

Mock et al. used the Levine’s Conservation Model in their study on mitigation of fatigue among cancer patients. The researchers used the model to provide an organizational structure for their study, to provide guidance on hypothesis development and testing and help in placing the research findings within the science context. The findings of this research found the conservation model to be useful in the inquiry on the impacts of exercise on physical functioning and fatigue in cancer patients. The four principles of conservation guided in developing exercise intervention, identifying salient outcomes for patients and selecting appropriate tools for measuring study variables. The model was also useful in analyzing and interpreting data, in association to the conservation rules (Mock et al., 2007).

Conclusion

In nurse-patient relationship, Levine believes that a patient’s status of wellness depends on the process of adaptation supported by the nurse. The Levine’s Conservation Model leads nurses to concentrate on the impacts and responses to a patient in order to uphold wholeness via these conservation principles. The model helps in the accomplishment of this focus through the conservation of energy, structure, personal integrity and social integrity. Overall nursing goal it to recognize, help, promote and support the processes of adaptation that benefit the patient.

References

Levine, M. E. (1973). Introduction to Clinical Nursing. F. A. Davis Company: Philadelphia, PA. 

Mock, V., Hall, S., Bositis, A., Tillery, M., Belcher, A.,  Krumm, S.,  McCorkle, R., & Wald, F. 

(2007). Using a Conceptual Model in Nursing Research - Mitigating Fatigue in Cancer Patients. J Adv Nurs, 58(5), 503–512. 

Pond, J. B., & Schaefer, K. M. (1991). Levine’s Conservation Model: A Framework of Nursing 

Practice. F.A. Davis Company: Philadelphia, PA.

Sitzman, K. & Eichelberger, L.W. (2009). Understanding the Work of Nurse Theorists: A 

Creative Beginning. Retrieved November 9, 2011 from http://nursing.jbpub.

com/sitzman/artGallery.cfm 

Tomey, A. M. & Alligood, M. R. (2006). Nursing Theorists and their Work. (6th ed.). Elsevier 

Health Sciences. 

Yeager, S. (2002). Overview of Nurse Theorist: Myra Levine’s Conservation Model. Retrieved 

November 9, 2011 from: http://www4.desales.edu/~sey0/levine.html