CONSERVATION MODEL FOR NURSING (ADAMU SILAS, CHUKWUELUE LILIAN, OKECHUKWU JOYCE)

CONSERVATION MODEL FOR NURSING (ADAMU SILAS, CHUKWUELUE LILIAN, OKECHUKWU JOYCE)

MYRA ESTRIN LEVINE 

INTRODUCTION and BIOGRAPHY 

The nursing profession is continuously evolving and dynamic. Ever since Florence Nightingale started writing her notes on nursing, more theories and models about the nursing profession flourished during the last decade; one of these is Myra Levine’s Conservational Theory which was completed on 1973. 

Myra Estrin Levine (1920-1996) was born in Chicago, Illinois. She was the oldest of three children. She had one sister and one brother. Levine developed an interest in nursing because her father (who had gastrointestinal problems) was frequently ill and required nursing care on many occasions. Levine graduated from the Cook County School of Nursing in 1944 and obtained her BS in nursing from the University of Chicago in 1949. Following graduation, Levine worked as a private duty nurse, as a civilian nurse for the US Army, as a surgical nursing supervisor, and in nursing administration. After earning an MS in nursing at Wayne State University in 1962, she taught nursing at many different institutions (George, 2002) such as the University of Illinois at Chicago and Tel Aviv University in Israel. She authored 77 published articles which included “An Introduction to Clinical Nursing” with multiple publication years on 1969, 1973 & 1989. She also received an honorary doctorate from Loyola University in 1992. She died on 1996. 

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).

MAJOR CONCEPTS

Over the years, nurses (like Myra Levine) have developed various theories that provide different explanations of the nursing discipline. Like her Conservation Model, all theories share four central or major concepts: person, environment, nursing and health. In addition to this, Levine’s Model also discussed that person and environment merge or become congruent over time, as it will be discussed below.

       I.            The person is a holistic being who constantly strives to preserve wholeness and integrity and one “who is sentient, thinking, future-oriented, and past-aware.” The wholeness (integrity) of the individual demands that the “individual life has meaning only in the context of social life” (Levine, 1973, p. 17). The person is also described as a unique individual in unity and integrity, feeling, believing, thinking and whole system of system.

    II.            The environment completes the wholeness of the individual. The individual has both an internal and external environment.

The internal environment combines the physiological and pathophysiological aspects of the individual and is constantly challenged by the external environment. The internal environment also is the integration of bodily functions that resembles homeorrhesis rather than homeostasis and is subject to challenges of the external environment, which always are a form of energy.

Homeostasis is a state of energy sparing that also provides the necessary baselines for a multitude of synchronized physiological and psychological factors, while homeorrhesis is a stabilized flow rather than a static state. The internal environment emphasizes the fluidity of change within a space-time continuum. It 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.

The external environment is divided into the perceptual, operational, and conceptual environments. The perceptual environment is that portion of the external environment which individuals respond to with their sense organs and includes light, sound, touch, temperature, chemical change that is smelled or tasted, and position sense and balance. The operational environment is that portion of the external environment which interacts with living tissue even though the individual does not possess sensory organs that can record the presence of these factors and includes all forms of radiation, microorganisms, and pollutants. In other words, these elements may physically affect individuals but are not perceived by the latter. The conceptual environment is that portion of the external environment that consists of language, ideas, symbols, and concepts and inventions and encompasses the exchange of language, the ability to think and experience emotion, value systems, religious beliefs, ethnic and cultural traditions, and individual psychological patterns that come from life experiences.

 III.            Health and disease are patterns of adaptive change. Health is implied to mean unity and integrity and “is a wholeness and successful adaptation”. The goal of nursing is to promote health. Levine (1991, p. 4) clarified what she meant by health as: “… the avenue of return to the daily activities compromised by ill health. It is not only the insult or the injury that is repaired but the person himself or herself… It is not merely the healing of an afflicted part. It is rather a return to self hood, where the encroachment of the disability can be set aside entirely, and the individual is free to pursue once more his or her own interests without constraint.” On the other hand, disease is “unregulated and undisciplined change and must be stopped or death will ensue”.

 IV.            Nursing involves engaging in “human interactions” (Levine, 1973, p.1). “The nurse enters into a partnership of human experience where sharing moments in time—some trivial, some dramatic—leaves its mark forever on each patient” (Levine, 1977, p. 845). The goal of nursing is to promote adaptation and maintain wholeness (health).

The goal of nursing is to promote wholeness, realizing that every individual requires a unique and separate cluster of activities. The individual’s integrity is his/her abiding concern and it is the nurse’s responsibility to assist the patient to defend and to seek its realization. The goal of nursing is accomplished through the use of the conservation principles: energy, structure, personal, and social integrity.

COMPOSITION OF CONSERVATION MODEL

Levine’s Conservation Model is focused in promoting adaptation and maintaining wholeness using the principles of conservation. The model guides the nurse to focus on the influences and responses at the organismic level. The nurse accomplishes the goals of the model through the conservation of energy, structure, and personal and social integrity (Levine, 1967). Although conservation is fundamental to the outcomes expected when the model is used, Levine also discussed two other important concepts critical to the use of her model – adaptation and wholeness.

Adaptation is the process of change, and conservation is the outcome of adaptation. Adaptation is the process whereby the patient maintains integrity within the realities of the environment (Levine, 1966, 1989a). Adaptation is achieved through the “frugal, economic, contained, and controlled use of environmental resources by the individual in his or her best interest” (Levine, 1991, p. 5).

Wholeness is based on Erikson’s (1964, p. 63) description of wholeness as an open system: “Wholeness emphasizes a sound, organic, progressive mutuality between diversified functions and parts within an entirety, the boundaries of which are open and fluid.” Levine (1973, p. 11) stated that “the unceasing interaction of the individual organism with its environment does represent an ‘open and fluid’ system, and a condition of health, wholeness, exists when the interaction or constant adaptations to the environment, permit ease—the assurance of integrity…in all the dimensions of life.” This continuous dynamic, open interaction between the internal and external environment provides the basis for holistic thought, the view of the individual as whole.

Conservation, on the other hand, is the product of adaptation. Conservation is from the Latin word conservatio, meaning “to keep together” (Levine, 1973). “Conservation describes the way complex systems are able to continue to function even when severely challenged.” (Levine, 1990, p. 192). Through conservation, individuals are able to confront obstacles, adapt accordingly, and maintain their uniqueness. “The goal of conservation is health and the strength to confront disability” as “... the rules of conservation and integrity hold” in all situation in which nursing is requires” (Levine, 1973, pp. 193- 195). The primary focus of conservation is keeping together of the wholeness of the individual. Although nursing interventions may deal with one particualr conservation principle, nurses must also recognize the influence of other conservation principles (Levine, 1990).

ASSUMPTIONS

·         Myra Levine’s Model also discusses other assertions and assumptions:

·         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

·         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

·         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

·         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

·         Nursing needs existing and emerging demands of self care and dependant care

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

APPLICATIONS

Ø  Nursing education

·         Conservational model was used as guidelines for curriculum development

·         It was used to develop nursing undergraduate program at Allentown college of St. Francis de Sales, Pennsylvania

·         Used in nursing education program sponsored by Kapat Holim in Israel

·         Nursing administration

·         Taylor (n.d.) described an assessment guide for data collection of neurological patients which forms basis for development of comprehensive nursing care plan and thus evaluate nursing care

·         McCall (n.d.) developed an assessment tool for data collection on the basis of four conservational principles to identify nursing care needs of epileptic patients

·         Family assessment tool was designed by Lynn-Mchale and Smith (n.d.) for families of patient in critical care setting

Ø  Nursing practice

·         Conservational model has been used for nursing practice in different settings

·         Bayley (n.d.) discussed the care of a severely burned teenagers on the basis of four conservational principles and discussed patient’s perceptual, operational and conceptual environment

·         Pond (n.d.) used conservation model for guiding the nursing care of homeless at a clinic, shelters or streets.

REFERENCES

Websites:

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.

Leach, M.J. (n.d.) Wound management: Using Levine’s Conservation Model to guide practice. Vol. 52, Issue No. 8. Retrieved from: http://www.o-wm.com/article/6024 on July 2009.

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.

Books:

Añonuevo, C. A., et al. (2005). Theoretical foundations of nursing. University of the Philippines Open University: Quezon City, Philippines.

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

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.

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