Theory of Myra Estrin Levine

INTRODUCING THE THEORIST

Myra Levine has been called a Renaissance women-highly principled, remarkable and
committed to what happens to the patient’s quality of life. She was a daughter, sister, wife,
friend, educator, and administrator, student of humanities, scholar, enabler, and confidante.
She was amazingly intelligent, opinionated, quick respond, loving, caring, trustworthy and
global in her vision of nursing.
Levine was born in Chicago and was raised with a sister and brother with whom she
shared a close, loving relationship. She was also very fond of her father who was a hardware
man. He was often ill and frequently hospitalized with gastrointestinal problems. She thinks
that this might have been why she had such a great interest in nursing. Her mother was very
supportive of Levine’s choice to be a nurse.
Levine began attending the University of Chicago but choose to attend Cook County
School of Nursing when she could no longer afford the university. Being in nursing school
was a new experience for her; she called it a “great adventure”. She received her diploma
from Cook County in 1944. She later receive her Bachelor of Science degree from the
University of Chicago in 1949 and her Master of Science in nursing from Wayne State
University in 1962
Aside from her husband and children, education was Levine’s primary interest,
although she had clinical experience in the operating room and in oncology nursing. She was
a civilian nurse at the Gardiner General Hospital, director of nursing at Drexel Home in
Chicago, clinical instructor at Bryan memorial Hospital in Lincoln, Nebraska and
administrative supervisor at University of Chicago Clinics and Henery Ford Hospital in
Michigan.
She was chairperson of clinical nursing at cook county school of nursing and faculty
member at Loyola University Rush University and University of Illinois. She was visiting
professor at Tel Aviv University in Israel and Recanti School of nursing at Ben Gurion
University of Negev in beer Sheeva, Israel. She was professor emeritus in medical surgical
nursing, university of Chicago; a charter fellow of American association of nurses. she
received the Elizabeth Russell Belford Award as distinguished educator. She received an
honorary doctorate from Loyola University in 1992.

INTRODUCING THE THEORY

Levine views nursing as a dynamic, purposeful process. Her definition includes a
description of what nursing is, how it accomplishes its purpose, and what its purpose is. She
believes nursing is a discipline, the basis of which is people’s dependence on their
relationship with other people. This discipline includes nursing interventions to support or
promote the patient’s adjustments. Further she states that the essence of nursing is human
interaction.

ASSUMPTIONS: Levines theory makes assumptions about:

1. the condition in which the patient enters the health care setting.
 2. the responsibilities of the nurse in the situation and as each relates to nurse patient
interactions.
3. the function of nurse in the situation.
These assumptions provide the structure and definition to this theory of nursing.
CONDITION:
Levine has limited the focus of her theory to those patients entering the health care system in
a state of illness or altered health. This limitation is consistent with her original intention to
provide rationale for performing nursing activities.
RESPONSIBILITIES:
The assumptions regarding the responsibilities of the nurse interacting with the patient holds
the nurse accountable for recognizing the patient’s organismic response to an altered health
state. Organismic response is change in behaviour or change in level of functioning exhibited
by the patient adapting or attempting to adapt the environment.
The environment is viewed broadly by Levine and encompasses both internal and external
environment. The internal environment deals with the body and its functioning and external
environment is composed of three dimensions:
 perceptual ,referring to the five senses
 operational, referring to forces,conditions,nonperceiveable elements
 conceptual, encompassing thought processes, emotions and social processes.

LEVELS OF ORGANISMIC RESPONSE:

1. response to fear
2. inflammatory response
3. response to stress
4. sensory response

FUNCTIONS OF NURSE:
1. Intervening to promote the patient’s adaptation to the state of illness.
2. Evaluating the intervention as being supportive or therapeutic.
Supportive nursing interventions help to maintain the patient’s present state of altered health
and to prevent further health deterioration. Nursing interventions that promote healing and
restoration of health referred to a therapeutic intervention.

CONSERVATION PRINCIPLES:
Levine has identified four conservation principles that serve as the foundations for all nursing
interventions. The goal this theory is to restore person’s health by conserving energy,
structural integrity, personal integrity and social integrity. The four conservation principles
are:
1. Conservation of energy refers to balancing energy output and input to avoid excessive
fatigue.i.e. adequate rest, nutrition and exercise.
2. Conservation of structural integrity refers to the restoration of structure of the body.i.e
prevention of physical breakdown and promotion of healing.
3. Conservation of personal integrity refers to maintains the patient’s sense of identity
and self worth,i.e. acknowledgement of uniqueness.
 4. Conservation of social integrity refers to the acknowledgement of the patient as a
social being. It involves the recognition and presence of human interaction.

CRITICAL COMPONENTS: Critical components of Levine’s theory of nursing are:

1. the patient is the predicament of illness.
2. the patient’s environment includes the nurse.
3. the nurse must recognize the organismic manifestation of the patient’s adaptation
to illness.
4. the nurse must make an intervention in the patient’s environment based on the
four conservation principles and must evaluate the intervention as therapeutic or
supportive.
Conservation Therapeutic/Supp Rationale
principle ortive
1. Mrs.H is put on a Energy Supportive Limits the
stretcher with her expenditure of
head elevated. energy.
2. Given an inj.of Energy/Structural Supportive/  To relieve
morphine. integrity Therapeutic pain and to
reduce
energy
expenditure
 Decreased
pain reduces
the oxygen
needs of the
body.
3.Mr.H is to receive oxygen . a) structural a) a) maintain an
she is given choice of how integrity supportive/therap adequate oxygen
she prefer to receive it, by b) personal eutic supply to reduce
nasal canula or face mask. integrity b) supportive labored breathing
b) maintain
individuality and
autonomy

4. Mr. H husband Social integrity Supportive Provide Mrs.H with

accompanies her to ccu. a support system
during transfer
process

The nurse observes Mrs. response to nursing interventions to determine how she is adjusting
to her altered state of health. Mrs .H chest pain is subsiding and her shorteness of breath is
relieved with the administration of oxygen via nasal cannula. Mrs .H is settling into the
coronary care unit with her husband at her side. Based on these and other observations the
nurse decides what further nursing interventions are needed.
THE COMPOSITION OF CONSERVATION MODEL
As an organization framework for nursing practice , the goal of conservation model is
to promote adaptation and maintain 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 goal of the model through the conservation of energy, structure and
personal and social integrity. Interventions are provided in order to improve the patients
condition or comfort when change in the condition is not possible. The outcomes of the
interventions are assessed through the organismic response.
Although Levine defines two concepts critical to the use of her model – adaptation and
wholeness.-conservation is fundamental to the outcomes expected when the model is used.
Conservation is therefore handled as the third major concept of the model. Using the model in
the practice requires that the nurse understands the commonplaces of health person ,
environment, and nursing.
COMPONENTS OF THEORY
ADAPTATION
Adaptation is the concept of change, conservation is the outcome of adaptation.
Adaptation is the process whereby the patient maintains integrity within the realities of the
environment. Adaptation is achieved through the frugal economic , contained and controlled
use of environmental resources by the individual in his or her best interest. In her view: The
environmental “ fit” that underscores the successful adaptation suggests that every species has
fixed patterns of response uniquely designed to ensure success in essential life activities,
demonstrating that adaptation is both historical and specific.
However, tremendous opportunities for individual accommodations are locked into
the gene structure of each species, every individual is one of kind. The response will vary
based on heredity age, gender or challenges of illness experience.
For example, the response to weakness of the cardiac muscles is an increased heart
rate, dilation of ventricle, and thickening of the myocardial muscle. While the response is
same the timing and the manifestation of the organismic response will be unique for each
individual.
CONSERVATION
Conservation is the product of adaptation and is a common principle underlying many
of the basic sciences. Conservation is critical to understanding an essential element of human
life.
Implicit in the knowledge of conservation is the fact of wholeness , integrity ,unity –all the
structures that are being observed , conservation of the integrity of a person is essential to
ensuring health and providing strength to confront disability, the importance of conservation
in the treatment of illness is precisely focused on the reclamation of the wholeness of health,
every nursing act is dedicated to the conservation or keeping together the wholeness of the
individual.
Individuals are continuously defending their wholeness to keep together the life system.
Individuals defend themselves in constant interaction with the environment, the most frugal
and energy sparing options that safeguard their integrity. Conservation seeks to achieve a
balance of energy supply and demand that is within the unique biological capabilities of
individual.
Maintaining the proper balance involves the nursing interventions coupled with the patient’s
participation to assure the activities within the safe limits of the patient’s ability to participate.
Although energy cannot be directly observed, the consequences of energy exchanges are
predictable, recognizable and manageable.
WHOLENESS
Wholeness emphasis a sound, organic, progressive mutuality between diversified
functions and parts within an entirely , the boundaries of which are open and fluid. Levine
stated that “ the unceasing interaction or constant adaptation 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 individual as a whole.
HEALTH , PERSON , ENVIORNMENT AND NURSING
Health and disease are patterns of adaptive changes . from a social perspective health
is the ability to function in social roles. Health is culturally determined. “ it is not an entity,
but rather a definition imparted by the ethos and beliefs of the groups to which the individual
belongs”. Health is a individual responses that may change over time in response to new
situations, new life challenges and aging or in response to social political, economic and
spiritual factors. Health is implied to mean unity and integrity.
Levine’s discussion of the person includes recognition that the person is defined to
certain degree. Levine rejected the notion that energy can be manipulated and transferred
from one human to another as a therapeutic touch. Yet a person is affected by a presence of
another relative to his or her personal space boundaries. Admittedly , some of this is defined
based on cultural ethos ,yet what is it about the “bubble” that results in a specific organismic
response? It may be that the energy involved in the interaction is nit clearly defined. Levine
encourage creativity such as therapeutic touch but rejected activities that are not scientifically
sound.
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 external environment includes those factors that impinge on and challenge the
individual. The environment as described by Levine was adapted from the following three
levels of environment identified by Bates.
The perceptual environment includes the aspects of the world that individuals are able
to seize or interpret through the senses. The individual “ seeks, selects and tests information
from the environment in the context of his or her definition of himself and so defends his or
her safety, identity and in larger sense his purpose.”
The operational environment includes factors that may physically affect individual but
are not directly perceived by them such as radiation , micro-organisms and pollution.
The conceptual environment includes the cultural patterns characterized by spiritual
existence and mediated by language, thought and history. Factors that affect behaviour- such
as norms, values and beliefs-are also part of the conceptual environment.
CONSERVATION MODEL
Energy conservation is dependent on the free exchange of energy with the internal and
external environment to maintain balance of energy supply and demand. Conservation of
structural integrity is dependent on an intact defense system that supports healing and repair
to preserve the structure and function of the whole being.
The conservation of personal integrity acknowledges the individual as one who strives
for recognition , respect , self-awareness, humanness, self –hood and self –determination.
The conservation of social integrity recognizes the individual as a social being who functions
in a society that helps to establish boundaries of the self. The value of the individual is
recognized , but it is also recognized that individual resides within a family, a community , a
religious group, an ethnic group , a political system and a nation.
The outcome of nursing involves the assessment of organismic responses. The nurse is
responsible for responding to a request for health care and for recognizing altered health. An
organismic response is chsnge in behaviour or change in the level of functioning during an
attempt to adapt to environment. The organismic responses are intended to maintain the
patient’s integrity. According to Levine , the levels of organismic response include:
1) Response to fear ( flight / fight response ) : This is the most primitive response. It is
the physiological and behavioral readiness to respond to a sudden and unexpected
environmental change; it is an instantaneous response to real or imagined threat.
2) Inflammatory response : This is the second level of response to provide for structural
integrity and the promotion of healing. Both are defenses against noxious stimuli and
initiation of healing.
3) Response to stress : This is the third level of response , which is developed over time
and influenced by each stressful experience encountered by the patient. If the
experience is prolonged , the stress can lead to damage to the systems.
4) Perceptual response : This is the fourth level of response. It involves gathering
information for the environment and converting it to a meaningful experience.
The organismic responses are redundant in that sense that coexist. The four responses help
individuals protect and maintain their cognitive abilities, the wealth of previous experiences ,
the ability to define relationships and the strength of their adaptive abilities.
Nurses use scientific process and creative abilities to provide nursing care to the patient. The
nursing process incorporates these abilities , thereby improving the care of patient.

USE OF NURSING PROCESS ACCORDING TO LEVINE

Process Application of process
Assessment Collection of provocative facts through observation and interview
of challenges to internal and external environment.
Trophicognosis Nursing diagnosis that gives the provocative facts a meaning.
Hypotheses Direct the nursing intervention with the goal of maintaining
wholeness and promoting adaptation. Nurses seek validation of the
patient’s problems with the patients or support persons.
Interventions Test the hypotheses
Evaluation Observation of organismic response to interventions.

ASSUMPTIONS AND VALUES OF CONSERVATION MODEL :

Assumptions
1) The person is viewed as a holistic being: “the experience of wholeness is the
foundation of all human enterprises”
 2) Human beings respond in a singular yet integrated fashion.
3) Each individual responds wholly and completely to every alteration in his or her life
pattern.
4) Individuals cannot be understood out of the context of their environment.
5) Ultimately , decisions for nursing care are based on the unique behaviour of the
individual patient. A theory of nursing must recognize the importance of unique detail
of care for a single patient within an empiric framework which successfully describes
the requirements of all patients.
6) Patient centered care means individualized nrsing care. It is predicted on the reality of
common experience: every man is a unique individual and such requires a unique
constellation of skills, techniques, ideas designed specially for him.
7) Every self sustaining system monitors its own behaviour by conserving the use
resources required ti define its unique identity.
8) The nurse is responsible for recognizing the state of altered health and patient’s
organismic response to altered health.
9) Nursing is a unique contributor to patient care.
10) The patient is in an altered state of health. A patient is one who seeks health care
because of a desire to remain healthy or one who identifies a known or possible risk
behavior.
11) A guardian –angel activity assumes that the nurse accepts responsibility and shows
concern based on knowledge that makes it possible to decide on the patient’s behalf
and in his /her best interest.
Values
1) All nursing actions are moral actions.
2) Two moral imperatives are the sanctity of life and the relief of suffering.
3) Ethical behaviour is the day to day expression of one’s commitment to other persons
and the ways in which human beings relate to one another in their daily interactions.
4) A fully informed individual should make decisions regarding life and death in
advance of the situations. These decisions are not the role of health care providers or
families.
5) Judgements by nurse or doctors about the quality of life are inappropriate and should
not be used as a basis for the allocation of care.
6) Persons who require the intensive interventions of critical care units enter with a
contract of trust. To respect trust . .….is a moral responsibility.

LEVINE’S THEORY AND THE NURSING PROCESS

Levine’s theory for nursing parallels many elements of nursing process. According ti
Levine ,the nurse must observe the patient , decide on an appropriate intervention , perform it
and then evaluate its usefulness in helping the patient. Levine’s theory assumes the nurse and
patient will participate together in the patient’s care. However, the nursing process
emphasizes more mutuality between the patient and the nurse than is implied in the levine’s
theory.
In levine’s theory the patient is assumed to be an a dependent position , which may
restrict the patient’s ability to participate in data gathering, planning , implementing or all
three phases of nursing process. As a result this dependent position , the patient is in need of
nursing assistance to help in adapting to a state of health. The nurse assumes responsibility for
determining the extent to which the patient is able to participate in his or her care. The nursing
process, on the other hand, does not necessarily assume the client in dependent position.

LEVINE’S WORK AND CHARACTERSTICS OF THEORY

1) Theories can interrelate concepts in such a way as to create a different way of
looking at a particular phenomenon.
In considering Levine’s ideas about nursing , the concepts of illness , adaptation , nursing
intervention and evaluation of nursing interventions are interrelated in just that way. They are
combined to look at nursing care in different ways from previous time.
2) Theories must be logical in nature.
Levine’s ideas about nursing are organized in such a way as to be sequential and logical. They
can be used to explain the consequences of nursing actions. There are no contradictions in her
ideas.
3) Theories should be relatively simple yet generalizable
Levine’s theory is easy to use. Its major elements are easily comprehensible and the
relationships have the potential for being complex but are easily manageable. Perhaps certain
aspects of the theory are generalizable, i.e. those related to the conservation principles, but the
interaction of these relationships are currently not generalizable. The major factor
contributing to this lack of generability is the limited amount of research done using the
theoretical base.
4) Theories can be the basis for hypotheses that can be tested
Levine’s ideas can be tested. Hypotheses can be derived from them. The principles of
conservation are specific enough to be testable.
E.g. it is possible to test if physiological structure is being supported or improved , thus
testing the principle of conservation of structural integrity . however, more sophisticated
research techniques would be needed to test if the patient’s social integrity is being supported
or ignored.
5) Theories contribute to and assist in increasing the general body of knowledge
within the discipline through the research implemented to validate them
Since Levine’s ideas have not yet been widely researched it is hard to determine a
contribution to general body of knowledge within the discipline.
6) Theories can be utilized by practitioners to guide and improve their practice.
Levine’s ideas can be used by practitioners to guide and improve their practice. Paule E.
Crawford-Gamble successfully applied Levine’s theory to a female patient underlying surgery
for the traumatic amputation of fingers. These ideas lend themselves to use in practice,
particularly in the acute care setting.
7) Theories must be consistent with other validated theories , laws and principles but
will leave open unanswered questions that need to be investigated
Levine’s ideas seem to be consistent with other theories , laws and principles, particularly
those from the humanities and sciences and many questions are left unanswered which would
be worthy of investigation.
Since Levine’s ideas meet four of the seven criteria for theory, one might consider them as
frame work of nursing. Levine herself does not refer to her ideas as either a theory or
concepts.
APPLICATIONS
The model’s universality is supported by model’s use in a variety o situations and
patient’s condition across the lie span. A growing body of research is providing support for
the development of scientific knowledge related to model.
USE OF CONSERVATIO MODEL IN PRACTICE
The model has been used to guide patient care in settings such as critical care, acute
care , emergency room, primary care , in the operating room, long term care, homeless and in
the community.
This model has been used with a variety of patients across the life span, including the
neonate, infant, young child, pregnant women, young adult, long term ventilator patient and
older adult and elderly patient.
This model has been used as a framework for wound care, managing respiratory illness,
managing sleep in patient with myocardial infarction, developing nursing diagnosis, assessing
changes in bladder function in post hysterectomy women. It has been used for developing
intravenous sites, skin care ,developing day room admission and care of patients undergoing
treatment for cancer.
Current work on the model is in progress in the areas of community health. The
following is a brief summary of beginning clarification of model’s use in community based
care.
MODIFIED FOR USE IN COMMUNITY –BASED CARE
The principles of community based care can be practiced in any settings. The
discussion focuses on community based care using Levine’s conservation model to provide a
foundation for the future of nursing practice and to dispel the myth that the model is
inappropriate for the community.
The focus of health in the community is based on the assumption that the community
based care is often informed by the one-on –one care provided to individuals . using Levine’s
conservation model , community was initially defined as “ a group of people living together
within a larger society, sharing common characteristics, interests and location.”
The approach to community begins with the collection of facts and a thorough
community assessment. The internal environmental assessment directs the nurse to examine
the patterns of health and disease among the people of the community and their use of
programes available to promote a healthy community.the assessment of external environment
directs the nurse to examine the perceptual environment, operational and conceptual levels of
environment in which the people live.
The perceptual environment incorporates those factors that are processed by the senses . on
community basis these factors might include an assessment of :
 How the media affects the health of the people
 How the quality of air influences health patterns and housing development
 The availability of nutritious and affordable foods throughout the community
 Noise pollution
 Relationships among the community subcultures
The operational environment would encourage a more detailed assessment of the factors
in the environment that affect the individual’s health but are not perceived by the people.
These might include surveillance of communicable diseases, assessment for the use of
 toxins in the industry, disposal of waste products, consideration for exposure to radiation
from electrical lines and examination of buildings for asbestos, lead and radon.
The conceptual environment focuses the assessment on the ethnic and cultural patterns
in the community. An assessment of types of houses of worship and health care settings
might be included in this area the effect of communities external to the one being
assessed would be addressed in order to determine factors that may influence the
function of the target community.
The novice nurse will benefit from using the conservation principles to guide continued
assessment to assure a thorough understanding of the community.
When considering energy conservation ,areas to assess might include:
I. Hours of employment
II. Water supply
III. Community budget
IV. Food sources
An assessment of structural integrity might include:
I. City planning
II. Availability of resources
III. Transportation
IV. Traffic patterns
V. Public services
Assessment of personal integrity might include:
I. Community identity
II. Mission of government
III. Political environment
Assessment of social integrity might include:
I. Recreation
II. Social services
III. Opportunities for employment

USE OF CONSERVATION MODEL IN RESEARCH

“ Nurses are constantly testing what they propose will work in their practice based on
what they know”. This continuous testing expands what is known about practice and offers
new insights to improve the practice of nursing.
Levine maintained that research is critical to the development of a scientifically sound
body of knowledge for nursing. She felt that the conservation principles offer an approach to
nursing that is scientific, research oriented and universal in practice. She said that research
should focus on the maintenance of wholeness and interaction between the internal and
external environment of the individuals. For the purpose of discovery and contrary to the
notion of wholeness, Levine supported the testing of variables that represent a single integrity.
E.g Lane and Winslow focused on energy conservation, whereas Roberts ,Fleming and
Giese focused on energy conservation and structural integrity. To be true to the model,
investigators can explain their findings support the goal of promoting adaptation and
maintaining wholeness.
Because the model supports understanding and description , both qualitative and
quantitative approaches are appropriate to develop the model and theories derived from the
model. The qualitative approaches helps to explain how the patient experiences the challenges
to their internal and external environments. The quantitative approach helps to test the
relationships between the variables and in some cases , provides for testing of the causal
models. These predictive models help clinicians alter the environments to promote adaptation
and maintain wholeness.
Combining qualitative and quantitative approaches to the study concepts using
Levine’s model helps to preserve the art and science of nursing. Interactions with patients are
both predictive and creative. Qualitative research helps to provide a way for nurses to
repeatedly share the creative aspects of their work. Qualitative data helps to explain the
quantitative data and provides a more holistic perspective regarding the data experience.
Several investigators have contributed significant research to support and explanation
of the conservation model as amodel for nursing practice. Theories developed from the model
will provide propositions from which hypotheses can be developed and tested.
Following are the several conclusions of research using the conservation model as a
framework:
1) Responding to the involuntary urges was as efficient as , and resulted in less perineal
damage than, sustained breath holding during the second stage of labor. There were no
differences in the mean duration of the second stage of labor between the two groups.
2) Interventions that are employed as a course of routine rather than based on individual
needs actually increase the physiological burden of healing following birth and act as a
significant threat to the psychological adjustments of postpartum period.
3) Conservation of energy can be maintained by placing the infant skin to skin on the
mother’s chest , covered with a warm blanket.
4) Ludington found that simple skin to skin contact was effective in reducing activity and
state related energy expenditure in the mew born of 34 to 36 weeks of gestation.
5) There is no significant difference in energy expenditure between basin ,tub or shower
bathing 5 to 17 days post myocardial infarction. The differences that did exist were
related more to subject variability than the type of bathing. The experimental group
had significantly lower oxygen consumption than did the control group.
6) Age , arterial pressure on bypass and body temperature on the first and third
postoperative days best predicts delirious patients. Acutely confused patients were
differentiated best from those not confused by 10 variables representing all four
conservation principles.
7) Higgens found that fatigue was present in ventilator patients 100 % of the time and
that fatigue and depression were significantly correlated. Despite the fact that sleep
disturbances were present and nutrition was compromised, there were no significant
relationships with fatigue.
8) Schaefer’s research supports the finding that the experience of fatigue in congestive
heart failure is an experience that affects one’s whole sense of being.
9) Mefford developed a theory of health promotion for preterm infants derived from
Levine’s conservation model. She examined the relationship of nursing caregiving to
health outcomes of infants. Although the proposed models were supported , findings
revealed that an increase in the level of consistency of nursing care giving decreased
the age at which health was achieved and an increase in the level of consistency in
nursing caregiving also reduced resource utilization.
In general , the studies support that energy can be conserved with the nursing interventions
and can be measured through the assessment of organismic responses. The patients inherently
conserve their own energy when confronted with the environment challenges. The second
important findings is that attention to conservation principles explains the organismic
response of confusion better than does any single principle alone. This supports the
assumption and that using the conservation principles to guide interventions will promote
adaptation and maintain wholeness.
Investigators are encouraged to continue their excellent work with Levine’s model.
New investigators are encouraged to consider the conservation model as basis for study and to
test the propositions developed from the theories discussed later in this chapter. It is only with
continued research that scientific basis for nursing will be developed.

USE OF CONSERVATION MODEL IN 21ST CENTURY

Nurses of future will continue to build on the basic principles of nursing established
by Florence Nightingale. Nightingale was a visionary woman who knew that nurse should be
prepared professionals in institutions of higher education. Levine’s conservation model and
the theories developed from the model provide basis for the future of professional nursing.
The model includes the assessment, identification of problems, development of hypotheses
about the problem, identification, selection and application of an intervention and an
evaluation of the response.
The intervention is provided based on the assumptions that if the intervention attends to the
conservation of energy, structural, personal and social integrities, the patient will return to
wholeness. The model includes three major concepts that are critical to understanding the
health care delivery systems of future: adaptation, wholism and conservation.
BIBLIOGRAPHY
1. Julia. George, Nursing Theories,3rd edition, Published by United States of America,
pp.182-189