INTRODUCTION:-

Born in Chicago, raised with a sister and a brother with whom she shared a close
loving relationship
Also very fond of her father who was often ill and frequently hospitalized with GI
problem. This was the reason of choosing nursing as a career

Also called as Renaissance women-highly principled, remarkable and committed to

patient's quality of care.
Died in 1996.

EDUCATIONAL ACHIEVEMENT:-
 Diploma in nursing: Cook county SON, Chicago, 1944
 BSN: University of Chicago, 1949
 MSN: Wayne State University, Detroit, 1962
 Publication: An Introduction to Clinical Nursing, 1969,1973 and 1989
 Received honorary doctorate from Loyola University in 1992

THEORY DEVELOPMENTAL HISTORY:-

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.

ACHIEVEMENTS:-
 Clinical experience in OT technique and oncology nursing
 Civilian nurse at the Gardiner General Hospital
 Director of nursing at Drexel home in Chicago
 Clinical instructor at Bryan Memorial Hospital in Lincoln, Nebraska
 Administrative supervisor at University of Chicago
 Chairperson of clinical nursing at Cook County SON

Nursing Theory: The Conservation Model

Levine’s conservation model believes nursing intervention is a conservation
activity, with energy conservation as a fundamental concern, four conservation
principles of nursing. It guides nurses to concentrate on the importance and
responses at the level of the person. Nurses fulfill the theory’s purpose by
conserving energy, structure, and personal and social integrity.

Every patient has a different array of adaptive responses, which vary based on
personal factors, including age, gender, and illness. The fundamental concept of
Myra Estrin Levine’s theory is conservation. When an individual is in a phase of
conservation, it means that the person can adapt to the health challenges with the
slightest amount of effort. The core of Levine’s Conservation Model is to improve
a person’s physical and emotional well-being by considering the four domains of
conservation she set out. By proposing to address the conservation of energy,
structure, and personal and social integrity, this nursing theory helps guide nurses
in providing care that will help maintain and promote the health of the patient.

What is the Conservation Model?

The core of the conservation model is to improve a person’s physical and

emotional well-being by considering the four domains of conservation she set
out. 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. Levine
(1989) proposed the following four principles of conservation
 COMPONENTS OF CONSERVATION MODEL:

A)Adaptation:
Characteristics:
-Historicity: Adaptations are grounded in history and await the challenges to which
they respond.
-Specificity: Individual responses and their adaptive pattern varies on the base of
specific genetic structure
-Redundancy: Safe and fail options available to the individual to ensure continued
adaptation
-Organismic response:
General Information
1. To survive, a person must adapt to the environment.
2. Individuals can choose several ways of adapting to the environment; this is called
redundancy.
3. The levels of redundant choices are part of the person's organismic: response; some
responses are immediate, whereas others are long-term.
4. Levine identifies four levels of organismic response:
  fight or flight response,
 inflammatory response,
 response to stress,
 sensory response

Fight or flight response:

1. Is the most primitive response to a real or perceived threat.
2. Causes the individual either to stay and face the threat or to run from it.

Inflammatory response:
1. Is a mechanism that protects a person from a hostile environment.
2. Maintains the body's structural integrity and promotes healing.
Response to stress:
1. Is a nonspecific bodily response in which all systems within the individual adapt (for
example, the psychological and social responses to limb amputation)
2. Is based on Hans Selye's stress theory, or general adaptation syndrome.

Sensory response:
1. Is based on a person's perceptual awareness; causes use of the senses.
2. Is used to gather information from the environment for self-protection

B) Wholeness:
Exist when the interaction or constant adaptations to the environment permits the
assurance of integrity
Promoted by use of conservation principle
.

C)Conservation

Conservation includes joining together and is the product of adaptation, including

nursing intervention and patient participation to maintain a safe balance.
PRINCIPLES OF LEVINS THEORY IN NURSING

 The conservation of energy of the individual.

 The conservation of the structural integrity of the individual.
 The conservation of the personal integrity of the individual.
 The conservation of the social integrity of the individual.
“The conservation principles do not, of course, operate singly and in isolation from
each other. They are joined within the individual as a cascade of life events,
churning and changing as the environmental challenge is confronted and resolved
in each individual’s unique way. The nurse as a caregiver becomes part of that
environment, bringing to every nursing opportunity his or her own cascading
repertoire of skill, knowledge, and compassion. It is a shared enterprise, and each
participant is rewarded.” (Levine, 1989)

Conservation of energy refers to balancing energy input and output to

avoid excessive fatigue . It includes adequate rest, nutrition, and exercise.

Examples: Availability of adequate rest; Sustenance of adequate nutrition

Conservation of Structural Integrity

Conservation of structural integrity refers to maintaining or restoring the

body’s structure, preventing physical breakdown, and promoting healing.

Examples: Assist patient in ROM exercise; Preservation of patient’s personal

hygiene

Conservation of Personal Integrity

Conservation of personal integrity recognizes the individual as one who strives

for recognition, respect, self-awareness, selfhood, and self-
determination .Example: Acknowledge and preserve patient’s space needs

Conservation of Social Integrity

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 .Example: Help the individual to preserve his or her
place in a family, community, and society.

.
 (Fig: Conservation Model)

ASSUMPTION:-
The nurse creates an environment in which healing could occur.
A human being is more than the sum of the parts
Human beings respond in a predictable way
Human beings are unique in their responses
Human beings know and appraise objects, condition and situation
Human beings sense, reflects, reason and understand
Human beings action are self determined even when emotional
Human beings are capable of prolonging reflection through such strategists raising
questions
Human beings make decision through prioritizing course of action
Human beings must be aware and able to contemplate objects, condition and situations
Human beings are agents who act deliberately to attain goal.
Adaptive changes involve the whole individual. A human beings 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 responds organismically in an ever changing manner
A theory of nursing must recognized the importance of detailed of care for a single
patient within an empiric framework that successfully describes the requirement of the
all patients
A human being is a social animal
A human being has constant interaction with an ever changing society
Change is inevitable in life.
 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

LEVINE’S MODEL AND THE FOUR CONCEPTS OF THE

NURSING METAPARADIGM:-
 Person:

The person is a holistic being who constantly strives to preserve wholeness and integrity
and one who is sending thinking, future oriented and past aware. The wholeness of the
individual demands that the individual life has meaning only in the context of social life.

The person is also described as a unique individual in unity and integrity, feeling,
believing, thinking and whole system of system.

 Environment:
Is internal (within a person, such as the body's response to bacteria)
Is external (consisting of three parts: perceptual environment, to which a person
responds by using the five senses-sight, sound, smell, taste, and touch; operational
environment, such as pollutants or radiation, to which a person responds physically;
and conceptual environment, including past experiences and future ideas, to which a
person responds through traditions, beliefs, or values
Includes the nurse

 Health:
Is described by Levine as a pattern of adaptation or change and is viewed as a
continuum.
Involves adapting by degrees - that is, gradually rather than by extremes

Maintains a person's unity and integrity.

 Nursing:
Is a discipline based on the dependence of people and their relationships with
others.
Involves human interaction to promote the wholeness of a dependent person and to
assist the person in adapting to a state of health.

Requires skills and scientific knowledge when interacting with a patient.

 Entails active participation in every aspect of a patient's internal and external
environment.
Uses each of the conservation principles to identify areas of intervention
Consists of observing the patient, planning and performing appropriate
interventions, and evaluating their effectiveness.
Assumes that the nurse and the patient participate together in the patient's care.
Recommends TROPHICOGNOSIS as an alternative to nursing diagnosis.
Focuses on only one patient at a time and concentrates on the present, with the
patient in an altered state of health.

NURSING PROCESS According to Levine’s Theory:-

Assessment
Trophicognosis
Hypothesis
Interventions
Evaluation

Assessment:
Collection of provocative facts through observation and interview of challenges to the
internal and external environment using four conservation principles
Nurses observes patient for organism responses to illness, reads medical reports. talks
to patient and family
Assesses factors which challenges the individual

Trophicognosis:
Nursing diagnosis-gives provocative facts meaning.
A nursing care judgment arrived at use of the scientific process.
Judgment is made about patient's need for assistance.

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
Interventions:
Testing the hypothesis
Interventions are designed based on the conservation principles
Mutually acceptable
Goal is to maintain wholeness and promoting adaptation

Evaluation:
Observation of organism response to interventions
It assesses whether hypothesis is supported or not supported
If not supported, plan is revised, new hypothesis is proposed

APPLICATION OF LEVINE MODEL NURSING PROCESS:-

Mrs. Mona, a wife of an abusive husband, underwent a radical hysterectomy. Post
operatively had pain, weight loss, nausea and inability to empty bladder. Patient had
history of smoking and stayed in house which had no hygiene.

Nursing Process Levine Conservation Model

Assessment  The internal environment: weight
loss, nausea, loss of reproductive
ability.
 The external environment of abusive
husband, unhygienic condition at
home.
 Energy conservation: weight loss,
nausea, pain.
 Structural integrity: Threatened by
surgical procedure, inability to pass
urine.
 Personal integrity: Not able to give
birth to more children.
  Social integrity: Strained
relationship with husband.

Trophicognosis/ Diagnosis  Inadequate nutritional status

 Pain
 Potential for wound and bladder
infection
 Need to self esteem
 Decreased self worth
 Potential for abuse

Hypothesis  Nutritional consultation

 Teaching regarding care of
urinary catheterization
 Care of surgical wound
 Exploring concern regarding
hysterectomy

Intervention Energy conservation

 Provide Medication for pain and
nausea
  Allow rest period
Structural integrity
 Administrating antibiotic for
Wound
Personal integrity
 Exploring her feeling about
uterus removal while respecting
her privacy
Social integrity
 Assess potential abuse room
husband
 Support to the family

LEVINE'S WORK & CHARACTERISTICS OF THEORY:-

Theories can interrelate concepts in such a way as to create a different way of looking
at a particular phenomenon.
The concept of illness adaptation, using interventions, and the evaluation of nursing
interventions are interrelated. They are combined to look at nursing care in a different
way (more comprehensive view incorporating total patient care)
Theories must be logical in nature. . Levine's idea about nursing care is organized in
such a way as to be sequential and logical. They can be used to explain the
consequences of nursing action.
Theories should be relatively simple yet generalized.
Levine's theory is easy to use.
Its major elements are easily comprehensible and the relationship has the potential for
being complex but is easily manageable.

Certain isolated aspect of the theory is the generalized i.e. those related to the
conservational principles.
Theories can be the basis for hypothesis that can be tested.
Levine's idea can be tested Hypothesis can be derived from them.
The principle of conservation is specific enough to be tested
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 idea has not yet been widely researched, it is hard to determine the
contribution to the general body of knowledge with in the discipline.
Theories can be utilized by the practitioner to guide and improve their practice.
Paula E. Crawford-gamble: - successfully applied Levine's theory to the female patient
undergoing surgery for the traumatic amputation of the fingers.
These ideas lend themselves to use in practice, particularly in acute care settings
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

UTILITY OF THEORY:-
 Nursing research
 Nursing education
 Nursing administration
 Nursing practice

Nursing research:
Principles of conservation have been used for data collection in various researches
Conservational model was used by Hanson et al.in their study of incidence and
prevalence of pressure ulcers in hospice patients.
Newport used principle of conservation of energy and social integrity for comparing
the body temperature of infant's who had been placed on mother's chest immediately
after birth with those who were placed in the warmer.

Nursing education:
Conservational model was used as guideline 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 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 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 for families of
patient in critical care setting

Nursing practice:
Conservational model has been used for nursing practice in different settings
Bayley 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 used conservation model for guiding the nursing care of homeless at a clinic,
shelters or It streets

STRENGTHS:-
Values the holistic approach to all individual, well or sick
Values patient's participation in nursing care
Comprehensive content, in-depth
Scientific principles are emphasized.
Provides direction of nursing research, education, administration and practice
Logically congruent
Shows high regard to adjunctive disciplines to develop theoretical basis for nursing

LIMITATION:-
Limited attention can be focused on health promotion and illness prevention.
Nurse has the responsibility for determining the patient’s ability to participate in the
care and if the perception of nurse and patient about the patient ability to participate in
care don't match, this mismatch will be an area of conflict.
The major limitation is the focus on individual in an illness state and on the
dependency of patient.

SUMMARY:-
The central concept of Levine's theory is conservation. When a person is in a state of
conservation, it means that individual has been able to effectively adapt to the health
challenges, with the least amount of effort.
JOURNAL:-
Thomaz, Mouchrek, Silva, et all (2013) and Cheng, Goggins, Thompson, et all (2008)
conducted a study. This study was conducted with a case study. Ten children with cancer
who experienced chemotherapy due to mucositis was participated in this study. Nursing
process was applying by Levine Conservation Theory for one month at National Referal
Hospital in Jakarta. Case studies are carried out by applying the nursing process
according to Levine's Conservation Theory, which consists of trophicognosis, hypothesis,
nursing intervention and evaluation. Data analysis within cases and across cases is
conducted by content analysis related to Levine's evaluation model.

This study aimed to explore the nursing process that was given to children experiencing
chemotherapy-induced mucositis using Levine's Conservation Theory.

Ten clients of children with cancer who experienced chemotherapy due to mucositis was
participated in this study.

Data were collected using physical assessment, medical chart reviews, interviews patient
family members, and observing the patient during hospitalization at National Referral
Hospital in Jakarta, Indonesia.

Findings Shows that the mean age of respondents was 6.5±0, 8years with mean year
living with cancer was 1.3±0, 2 years. Most of the patients had leukemia, 80% had severe
mucositis, and 90% received chemotherapy with high mucosatoxic types.

The results of this case study showed that before intervention 8 clients experienced
energy conservation problems, 10 clients experienced structural integrity problems, 3
clients experienced personal and social integrity problems. After one month intervention
using Levine's conservation model, there has been a better change in the patient's
condition, this has been proven with only 2 people experiencing problems related to
energy conservation and structural integrity. Meanwhile, patients who experienced
problems related to personal integrity also declined, from 3 to 2 patients. On the other
hand, there has been no change in patients who experience problems related to social
integrity.

This case study shows that the Levine conservation model can be used in the nursing
process in children with mucositis to maintain energy conservation and structural
integrity.
CONCLUSION:-
According to Levine's theory, every patient has a unique range of adaptive responses,
which vary based on the individual circumstances of the patient including age, gender,
and illness. The responses are the same, but the timing and manifestation of organismic
responses will be unique for each patient's pulse rate.

BIBLIOGRAPHY:-
1. Basheer. P. Shebeer, khan Yaseen. S. “A Concise Text Book of Advanced nursing
practice 2019, 4th edition, 1000 Bangalore, EMMESS Medical Publishers. Page No -
431-437.