The four conservation principles of nursing

Grand Nursing Theory Based on Interactive Process

Biography — Early & Family Life

Myra Levine was born in 1920 in Chicago, IL (“Myra Estrin Levine,” 2016)

First of three children

Her father’s “persistent gastrointestinal illness” sparked her interest in pursuing a career in nursing

Myra Levine died on March 20, 1996, at age 75

(Gonzalo, 2019)

Biography — Education

Graduated from Cook County School of Nursing

Obtained BSN from the University of Chicago in 1944

Obtained MSN from Wayne State University in Detroit in 1962

Earned honorary doctorate from Loyola University in 1992

(“Myra Estrin Levine,” 2016)

Biography — Nursing Career

Oncology nurse at Gardiner General Hospital in Chicago

Became Director of Nursing Drexel Home in Chicago

Clinical instructor at Bryan Memorial Hospital in Lincoln, NE (“Myra Estrin Levine,” 2016)

Surgical supervisor at the University of Chicago and Henry Ford Hospital in Detroit (Gonzalo, 2019)

Chairperson of clinical nursing at Cook County School of Nursing (“Myra Estrin Levine,” 2016)

Chronological order

Biography — Publications, Awards, & Honors

Works: “The Pursuit of Wholeness,” “For Lack of Love Alone,” “Adaptation and Assessment: A Rationale for Nursing Intervention,” “The Four Conservation Principles of Nursing,” & “Introduction to Clinical Nursing”

Charter fellow of the American Academy of Nursing in 1973

Honorary recognition from the Illinois Nurses’ Association

Member of Sigma Theta Tau at Alpha Beta Chapter

Elected fellow in the Institute of Medicine of Chicago

First recipient of the Elizabeth Russel Belford Award for excellence in teaching from Sigma Theta Tau in 1977

(Gonzalo, 2019)

Best known for “The Four Conservation Principles of Nursing,” the others were preliminary works

She never planned on developing a nursing theory, she worked as a consultant for different hospitals and nursing schools and came up with an organizational structure for teaching med-surg nursing which was the basis for theory development

Philosophical Underpinnings

Understanding the era in which Myra Levine matured helps give background to her theory

Healthcare was based on authoritarianism and physician decisions were not questioned

Nurses were taskers, operating without a scientific origin

(Toon, 2014)

-In noting pioneers in nursing, it is suitable to recall the era in which theorists such as Myra Levine matured. In Levine’s case it is helpful to recall the era in sociological terms, cultural terms and recall the available technology and the discipline of medicine and how nurses ‘fit’ at the time. The environment of her maturation and development became the underpinning of her career and her Theory of Conservation for Nursing.

-nurses were primarily seen as the ‘handmaidens’ of doctors; neither patients nor nurses were anticipated to question a physicians perspective or decision

Philosophical Underpinnings Continued

Social revolution evolved in the 1960’s to early 1970’s

Intellectual development was blossoming

Myra Levine had many different roles (clinical instructor, supervisor, chairperson) (Myra Estrin Levine, 2019).

Definitions of “nursing science” were vague

Theorists began applying biological, medical, and social sciences to nursing (Aita VA, 1995)

Levine had incorporated the conservation of energy, structure, personal, and social integrity into a theory that guided nurses in the provision of care that promotes health through environment, predictably, and illuminates the fact that humans are greater than the sum of their parts, that human response is predictable, that humans are unique, are capable of assessing conditions, situations and objects, and drawing an understanding of those perceptions. Further, Levine extrapolated that humans are self-determinate (even during periods of stress and emotion and that they will formulate their own opinions via reflection (Four Conservation Principals, 2016).

Philosophical Underpinnings Continued

Levine’s focus was on influences and responses, energy supply and demand

Her theory allows for the enhancement of health by working with the patient instead of ‘on’ the patient (Frauman and Rasch, 1995)

Theory was built responsively to her era

Based on patient care perspective and scientific perspective (Myra Levine’s Remarks, 1995)

-Levine’s focus was on influences and responses, energy supply and demand- and the patient outcome when that patient is acted upon and exists with structural, personal, and social integrity and is capable of conservation of energy. Her theory incorporated and explained homeostatic and homeorhetic states of existence and the fluidity of adaptation

-Levine’s theory is the antithesis of authoritarianism and is principally and philosophically balanced to allow healing.

-The fact remains that Levine’s esoteric theory began to develop in a time when a patient’s ‘need to know’ about their care or disease process(es) was nearly nil and physicians were a rarified group and usually authoritarian. It appears that Levine’s theory was built responsively to her era of medical understanding and practice. She developed the highly adaptive model of care that was responsive to the patient’s specific context/need and less focused on medical procedures and standard interventions.

-The bedrock for her logic was crafted by both the era and her unique understanding of what needed to improve in nursing, both from a patient care perspective and from a scientific perspective.

Analysis — Introduction

Purpose of the conservation model is to improve the physical and emotional wellbeing of a person by considering the four domains of conservation

Client Energy

Personal integrity

Structural integrity

Social integrity

Nursing’s role in conservation is to help the person with the process of “keeping together” the total person through the least amount of effort

A conceptual model with three nursing theories

Conservation

Redundancy

Therapeutic intention

(Alligood & Tomney, 2015)

Analysis — Conservation Model

Focuses on promoting adaptation & maintaining wholeness using the conservation principle

Goal: to improve the physical and emotional wellbeing of a person

By proposing to address the conservation of energy, structure, and personal and social integrity, this theory helps guide nurses in the provision of care that will help maintain and promote the health of the patient

(Erickson, Tomlin, & Swain, 2014)

Analysis — Conservation Model Continued

Nursing’s role in conservation is to help the person with the process of “keeping together” the total person through the least amount of effort

Nurse is seen as part of the environment and uses skill, knowledge, and compassion to assist each client to confront environmental challenges in resolving problems

Effectiveness of interventions is determined by maintenance of client integrity

(Erickson, Tomlin, & Swain, 2014)

Analysis — Principles

Conservation of energy refers to balancing energy input and output to avoid excessive fatigue

Includes adequate rest, nutrition and exercise

Conservation of personal integrity recognizes the individual as one who strives for recognition, respect, self-awareness, selfhood, and self-determination

Involves acknowledging and preserving patient’s space needs

(Roy, 2014)

Analysis — Principles Continued

Conservation of structural integrity refers to maintaining or restoring the structure of body preventing physical breakdown and promoting healing

Includes assisting patients in ROM exercise and the preservation of patient’s personal hygiene

Conservation of social integrity exists when a patient is recognized as someone who resides within a family, a community, a religious group, an ethnic group, a political system, and a nation

Nursing care should help the individual to preserve his or her place in a family, community, and society

(Roy, 2014)

Analysis — Concepts

Wholeness is the singular, yet integrated response of the individual to forces in the environment

Adaptation is the process of change and integration of the organism in which the individual retains integrity or wholeness. It is possible to have degrees of adaptation

Conservation includes joining together and is the product of adaptation including nursing intervention and patient participation to maintain a safe balance

(Sitzman & Eichelberger, 2011)

Analysis — Levine’s Theory in Nursing

Nursing is the human interaction relying on communication, rooted in the organic dependency of the individual human being in his relationships with other human beings (Meleis, 2013)

Analysis — Levine’s Theory in Health

Health is the pattern of adaptive change of the whole being

It should be noted that it is not only the insult or the injury, which is repaired, but also the individual him/herself

Health is not only the healing of an afflicted part, but a return to normalcy (Roy, 2014)

Analysis — Levine’s Theory in Patient

Person/patient is the unique individual in unity and integrity, feeling, believing, thinking, and whole (Sitzman & Eichelberger, 2011)

Analysis — Levine’s Theory in Environment

Focus is given to the three aspects of external environment drawn upon Bates’ (1967) classification which are:

The operational environment consists of the undetected natural forces which impinge on the individual

The perceptual environment consists of information that is recorded by the sensory organs

The conceptual environment is influenced by language, culture, ideas, and cognition

(Alligood & Tomney, 2015)

Analysis — Relationship Between Concepts

The relationships between the concepts serves as the basis for nursing interventions

All nursing interventions are based on careful and continued observation over time

(Erickson, Tomlin & Swain, 2014)

Analysis — Usefulness of Theory

Levine’s (1973) model has been useful in nursing education

Used to develop a nursing undergraduate program at Allentown College of Saint Francis de Sales in Center Valley, PA

Deemed to be compatible with the mission and philosophy of the college

Also used in the graduate program at the same school as the framework for development of the content of the graduate nursing courses

(Meleis, 2013)

Analysis — Usefulness of Theory

The ED at the Hospital of the University of Pennsylvania used the four conservation principles of Levine’s model as an organizing framework for nursing practice

Believed that use of the model strengthened communication and improved nursing care in the hospital through an atmosphere of collaboration among disciplines

The conservation principles were also found to be useful in directing nursing practice in the care of children

The concept of adaptation and the four conservation principles were particularly relevant and especially important to the healing of the ill child

(Meleis, 2013)

Analysis — Usefulness of Theory

A concept analysis was published using Levine’s conservation model to refine the concept of creativity for nursing practice

Mefford (2004) based her theory of health promotion for preterm infants on Levine’s conservation model

Neswick (1997) suggested Levine’s model as the theoretic basis for enterostomal therapy (ET) nursing

Integrated the four conservation principles into wound and ostomy care.

The principles that she found useful were energy, structure, personal integrity, and social integrity

Found Levine’s framework useful because of its holistic approach

(Meleis, 2013)

Analysis — Testability

Levine’s Conservation Model has guided research studies internationally

Schaefer and Potylycki (1993) used Levine’s model to study fatigue in patients with congestive heart failure with a focus on client adaptation

Leach (2006) studied wound management in Australia using Levine’s four principles and found that the model contributed to health and wholeness of the client and assisted in cost-effective care

(Meleis, 2013)

Analysis — Parsimony

The model is fairly parsimonious whereby four succinctly stated conservation principles comprise the model

15 concepts addressed by Levine’s model and 5 working assumptions, covering both the individual and nursing care

Model requires some knowledge of the environment to which the patient is responding

In every stage, an assessment must be made to determine how effectively the patient is responding

(Sitzman & Eichelberger, 2011)

Analysis — Value in Extending Nursing Science

Levine’s (1973) Conservation Model has impacted the discipline of nursing in education, practice, and research, providing four defining principles that are sufficiently universal to allow research and practice in a large number of situations

The concept of holism, although not unique to this model, was proposed at an early stage in nursing’s scientific history and has made an important difference in the care of clients

(Alligood & Tomney, 2015)

Analysis — Value in Extending Nursing Science Continued

This model has value in guiding education and in implementing practice. It helps to fulfill the spirituality, goals, and values of both the client and nurse

Nurses use it in diverse clinical settings, such as psychiatric care, acute care, and community nursing

Several chapters and books by the author and associates, and numerous journal articles have been generated by this model

(Alligood & Tomney, 2015)

Analysis — Assumptions

Each individual is an active participant in interactions with the environment.

The individual is a sentient being.

Change is the essence of life.

Change is unceasing as long as life goes on. Change is characteristic of life.

The decisions for nursing intervention must be based on the unique behavior of the individual patient.

Every man is a unique individual, and as such he requires a unique constellation of skills, techniques and ideas designed specifically for him.

References

Aita VA. (1995). Toward improved practice: Formal prescriptions and informal expressions of compassion in American nursing during the 1950s. Retrieved from CINAHL Complete database. (Accession No. 109873162)

Alligood, M. & Tomney, A. (2015). Nursing Theory: Utilization & Application. St. Louis: Mosby.

Erickson, H., Tomlin, E. & Swain, M. (2014). Modeling and Role Modeling: A Theory and Paradigm for Nursing. Columbia: R.L Bryan.

Four conservation principles. (2016). Retrieved November 15, 2019, from Nursing Theory website: http://nursing-theory.org/theories-and-models/levine-four-conservation-principles.php

Frauman, A. C., & Rasch, R. (1995). Myra Levine, at last a clear voice of reason. Journal of Nursing Scholarship, 27(4), 261. Retrieved from Clio Hosting database.

References

Gonzalo, A. (2019). Myra Estrin Levine: The conservation model of nursing. Retrieved from https://nurseslabs.com/myra-estrin-levine-the-conservation- model-of-nursing/

King, M. (1995). Myra Levine's remarks. The Journal of Nursing Scholarship, 27(3), 174. Retrieved from Clio Hosting database.

Meleis, A. (2013). Theoretical Nursing: Development and Progress. London: Lippincott Williams & Wilkins.

Myra Estrin Levine - Nursing theorist. (2016). Retrieved from https://nursing-theory.org/nursing-theorists/Myra-Estrine-Levine.php

Roy, C. (2014). Generating middle Range Theory: From Evidence to Practice. New York: Springer.

Sitzman, K. & Eichelberger, L. (2011). Understanding the Work of Nurse Theorists: A Creative Beginning. Burlington. Jones and Bartlett.

References

Toon, E. (2014). The machinery of authoritarian care: Dramatising[sp] breast cancer treatment in 1970s Britain. Social History of Medicine, 27(3), 557-576. https://dx.doi.org/10.1093%2Fshm%2Fhku003

What's in the name (autobiography & characteristics of theory) [Blog post]. (2011). Retrieved from Myra Estrin Levine: Four Conservation Principles website: http://myra-levine-4conservationprinciples.blogspot.com/