WHAT IS THEORY??

An explanation of an event that has been supported by consistent, repeated

experimental results and has therefore been accepted by most.

-Mr. Manish BijalwanM. Sc Nursing 1st yr

SCON

LEVINE’S THEORY

TITLE AND CONTENT• Theorist view

• Levine’s theory

• Key concept

• Principles

• Conceptual framework

• Major concepts

• Sources

• Assumptions

• Metaparadigm

• Nursing process

• Acceptance of theory in nursing

• Application of theory

• Limitations

• Research highlights

• Further development

OBJECTIVES• To differentiate between meaning of theory and

model.

• To outline about the theorist.

• To describe the main concept of theory.

• To draw, describe and follow the Levine's conservation model.

• To identify the importance and acceptance of theory in nursing.

• To apply the theory in nursing process

• To criticize the theory

THEORIST VIEW

LEVINE’S THEORY• Do not want to develop a nursing theory

• Finding out a way to teach major concepts of medical surgical nursing

• Keeping herself away from procedure oriented nursing education practices

• Focusing on active problem solving and individualized care

KEY CONCEPT

“Conservation” 

KEY CONCEPTWhen a person is in a state of conservation, it

means that individual adaptive responses conform change productively, and to the

least expenditure of effort, while preserving optimal function and identity. 

PRINCIPLE OF LEVINE’S THEORY

1. Conservation of energy

2. Conservation of structural integrity

3. Conservation of personal integrity

4. Conservation of social integrity

PRINCIPLE OF LEVINE’S THEORY

1. Conservation of energy• Balance between energy input and output to avoid

fatigue. • Each person requires a balance of energy but there are

factors when the person and the environment that may cause depletion of energy.

• Replacement, prevention of energy drainage, and promotion of physical, psychological and emotional balance should also be done to conserve energy.

PRINCIPLE OF LEVINE’S THEORY

2. Conservation of structural integrity• Maintain or restore the structure of body

preventing physical breakdown and promoting healing.

• Nurses are responsible to promote healing as well as protect the patient from external factors that may contribute to physical breakdown.

PRINCIPLE OF LEVINE’S THEORY

3. Conservation of personal integrity• Recognition of an individual as one who strives for

recognition, respect, self awareness, selfhood and self determination.

• Achieved through appreciating the patient's effort towards recovery, helping the patient regain his self-esteem and body-image.

• Less conservation can lead to decline in sense of self worth. 

• The client needs to be respected, provided with privacy, encouraged and psychologically supported.

PRINCIPLE OF LEVINE’S THEORY

4. Conservation of social integrity• “A man is not an island” • Every one of us belongs to a unit, a group or

a society. • These are our support systems that we need

to belong to. • It involves the presence and recognition of

human interaction particularly client's significant others and those who comprise his support system

CONCEPTUAL FRAMEWORK

“LEVINE’S CONSERVATION MODEL”

LEVINE’S CONSERVATION MODEL

• GOAL: To promote adaptation and maintain wholeness using the principles of conservation

wholeness

Conservation of structural integrity

Conservation of personal integrity

Conservation of social ingrity

Conservation of energy

LEVINE’S CONSERVATION MODEL

• Guides the nurse to focus on the influences and responses at the organismic level.

• The Nurse accomplishes the goal of model through the conservation of energy, structure and personal and social integrity

MAJOR CONCEPTS

Adaptation

Wholeness

Conservation

"Change is the life process and Adaptation is the method of change.“

– Adaptation is a means for a person to live harmoniously with his internal and external environment conquering challenges that might threaten his well-being.

– In time, we experience certain obstacles and challenges that poses a threat to our health.

– We undergo change for us to adapt and be in a mutual relationship with both our internal and external environment.

Adaptation

• Historicity– Adaptive responses and abilities to adapt to

changes are also based from past experiences.• Specificity

– Adaptive patterns can be genetic to the individual as well as influenced by social and cultural factors.

• Redundancy– if one system or pathway, is unable to ensure

adaptation, then another pathway may be able to take over and complete the job

Adaptation

Wholeness

– Wholeness is not merely being healthy or the absence of disease.

– completeness of a person in all aspects of human existence.

– A person is whole if he is emotionally, psychologically, spiritually, morally, physically and socially stable and capable.

– According to Levine, wholeness exists when the interactions or constant adaptations to the environment permit the assurance of integrity.

Conservation

"Conservation is about achieving a balance of energy supply and demand that is within the unique biological realities of the individual"

Through nursing care and nursing interventions

the patient's personal integrity, social integrity, structural integrity and energy can be conserved.

promote optimum health.

SOURCES1. Florence Nightingale:

– Nightingale provided great attention to energy conservation and recognized the need for structural integrity.

– Levine relates Nightingale’s discussion of social integrity to Nightingale’s concern for sanitation, which she says implies an interaction between the person and the environment.

SOURCES2. Irene Beland:

– Myra’s teacher and thesis advisor. – Beland influenced her thinking about nursing as a

compassionate art and rigid intellectual pursuit– Levine also credited Beland for the theory of

specific causation and multiple factors.

SOURCES3. Feynman (1965)

– provided support for Myra’s position that conservation was a natural law, arguing that the development of theory cannot deny the importance of natural law

4. Bernard (1957)– identification of the interdependence of bodily

functions

SOURCES5. Waddington (1968)

– emphasized the dynamic nature of the internal milieu, and termed it as “homeophoresis.”

6. Selye (1956)

7. Wolf (1961)

8. Goldstein (1963)

9. Dubos (1965)

10.Gibson (1966)

11.Bates (1967)

SOURCES

12.Levine’s personal experiences– Hospitalization– “the experience of wholeness is universally

acknowledged."

SOURCES

• The nurse creates an environment in which healing could occur.

• A human being is more than the sum of the part.

• Human beings respond in a predictable way.

• Human beings are unique in their responses.

• Human beings know and appraise objects, condition and situation.

• Human being senses reflects reason and understand.

ASSUMPTIONS

• Human being action are self determined even when emotional.

• Human beings are capable of prolonging reflection through such strategists raising questions.

• Human being make decision through prioritizing course of action

• Human being must be aware and able to contemplate objects, condition and situation

• Human being are agents who act deliberately to attain goal

ASSUMPTIONS

• Adaptive changes involve the whole individual

• A human being has unity in his response to the environment

• Every person possesses a unique adaptive ability based on one’s life experience which creates a unique message

• There is an order and continuity to life change is not random

• A human being respond organismically in an ever changing manner

ASSUMPTIONS

• A theory of nursing must recognized the importance of detail of care for a single patient with in an empiric framework that successfully describe the requirement of the all patient

• A human being is a social animal

• A human being is an constant interaction with an ever changing society

• Change is inevitable in life

ASSUMPTIONS

• Nursing needs existing and emerging demands of self care and dependent care

• Nursing is associated with condition of regulation of exercise or development of capabilities of providing care

ASSUMPTIONS

• PERSON– A person is a holistic being that has open and fluid

boundaries that co-exist with the environment.– He is "whole“, not only in the physical aspect but also

with regards to psychosocial-cultural and spiritual aspects

– Individuals continuously defend their wholeness in constant interaction with their environments

METAPARADIGM

• HEALTH– State of being "whole" not just the absence of illness or

disease but the ability to function in a reasonably normal manner 

– It is culturally determined and influence by ethos and beliefs. 

– Health is wholeness and successful adaptation. – Failure in doing so is a negative scenario. 

METAPARADIGM

• ENVIRONMENT– Where the person is constantly and actively

involved. – It is where we live our lives.  – It pertains to the • internal (physiologic)• external environment (perceptual, operational, and

conceptual). 

METAPARADIGM

• NURSING– It is a human interaction designed to promote

wholeness through adaptation – Promote wholeness through the use of the four

conservation principles. – Nursing care is both supportive and therapeutic – Realizing that every individual requires a unique and

separate cluster of activity. – Individual integrity is his abiding concern and it is the

nurse's responsibility to assist him to defend and to seek its realization.

METAPARADIGM

• Assessment– Nurses observes patient for organismic

responses to illness– builds rapport with the patient and explaining to

him his needs for assistance and evaluates results for diagnostics.

– Assesses factors which challenge both in the internal and external environment of the patient.

LEVINE’S THEORY & NURSING PROCESS

• Assessment– Assesses for:• Balance of energy supply and demand (Energy

conservation)• Body's defense system or immunity ( Structural

integrity)• Person's sense of self-worth (Personal Integrity)• Person's ability to participate in the society (Social

Integrity)

LEVINE’S THEORY & NURSING PROCESS

• Trophicognosis / Judgment – Nursing diagnosis gives meaning to assessments

/ data collected– Judgment is made about patient’s needs for

assistance

LEVINE’S THEORY & NURSING PROCESS

• Hypothesis – Planning– Nurse proposes hypothesis about the problems and the

solutions which becomes the plan of care– Goal is to maintain wholeness and promoting adaptation

LEVINE’S THEORY & NURSING PROCESS

• Interventions – To tests the hypothesis– Interventions are designed based on the conservation principlesand the model

LEVINE’S THEORY & NURSING PROCESS

• Evaluation – Evaluating the response of the client with the

interventions to determine whether the goals were met or not.

– It assesses whether hypothesis is supported or not supported

– If not supported, the plan is revised, a new hypothesis is proposed

LEVINE’S THEORY & NURSING PROCESS

ACCEPTANCE OF LEVINE’S

CONSERVATION MODEL

IN NURSING

As A Ward Nurse By: Alvir B. Nombrefia, RN St. Jude Family Hospital

• Talking to a 70 yrs old patient with a chief complaint of difficulty of breathing and chest pain diagnosed with congestive heart failure.

• As part of care plan, along with pharmacological treatment such as diuretics and anti anginal drugs and dependent nursing actions he added some initiative actions to alleviate his condition. – to promote better respiration, lessen cardiac workload– To assist patient with respect to maintain their personal integrity.

APPLICATION OF THEORY

• Conservation of energy is not applicable in all cases like mania, where the utilization of energy has more importance.

• Conservation of structural integrity also has limitation like in case of aesthetic surgeries.

• Conservation of personal integrity require knowledge, information, but it is limited in case of comatose, psychologically impaired patients.

LIMITATIONS OF THEORY

• Conservation of social integrity: when the client has no significant others like family members. Abandoned children, psychiatric patients who are unable to interact, unresponsive clients like unconscious individuals,• The nurse is the one to assess the patient's capability to participate with the care.• Independence fosters self worth.

LIMITATIONS OF THEORY

• 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.

RESEARCH HIGHLIGHTS

• CLARITY

• SIMPLICITY

• GENERALITY

• EMPIRICAL PRECISION

• DERIVABLE CONSEQUNCES

FURTHER DEVELOPMENT

• Alligood, M., and A. Tomey. Nursing Theory: Utilization and Application. 2nd Ed. Mosby Inc, Missouri, 2002.

• Tomey, A. M. & Alligood, M. R. (2006). Nursing theorists and their work. (6th ed.). Elsevier Health Sciences.

• Levine, M. E. (1973). Introduction to clinical nursing. F. A. Davis Company: Philadelphia, PA. 

• Parker, M. E. (2001). Nursing theories and nursing practice. F. A. Davis Company: Philadelphia, PA. 

• Schaefer, K. M., Pond, J. B., et al. (1991). Levine’s conservation model: A framework of nursing practice. F.A. Davis Company: Philadelphia, PA

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

BIBLIOGRAPHY

• 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. 

• http://currentnursing.com/nursing_theory/Levin_four_conservation_principles.html

• http://www.hrmuae.com/esol/emrates/images/Nursing.Theories.and.Nursing.Practice.3HAXAP.pdf

• www.plu.edu/~lynchpd/doc/n526-orem.ppt

BIBLIOGRAPHY