INTRODUCTION:

The conservation model is an esoteric model of nursing created by Myra Levine in 1989. It is
based around the physical concept of conservation of energy, combined with the psycho-social
aspects of the individual's needs. She postulated that 3 main principles operate together to
facilitate healing, namely the conservation of the structural integrity of the individual, the
conservation of the personal integrity of the individual, and the conservation of the social
integrity of the individual. She believed that these 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 caregiver becomes part of that environment,
bringing to every nursing opportunity his or her own cascading repertoire of skill, knowledge,
and compassion. It is shared enterprise and each participant is rewarded.” [1] It is not clear
what extent her ideas have been adopted, but critics suggest that her model focuses too heavily
on the patient's current needs and desires, to the detriment of their longer-term medical
treatment.

BACKGROUND OF THE THEORIST: Myra Estrine Levine (1920- 1996) was born in
Chicago,llinois. Levine's developed interest in nursing because her father (who had
gastrointestinal problem) was frequently ill and required nursing care in many occasions. Levine
graduated from the Cook County School of Nursing in 1944 and obtained her BS in nursing from
University of Chicago, 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, s 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 Loyolo University in 1992. she
died on 1996.The conservation model is an esoteric model of nursing created by Myra Levine in
1989. It is based around the physical concept of conservation of energy, combined with the
psycho-social aspects of the individual's needs. She postulated that 3 main principles operate
together to facilitate healing, namely the conservation of the structural integrity of the
individual, the conservation of the personal integrity of the individual, and the conservation of
the social integrity of the individual. She believed that these 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 caregiver becomes part of that
environment, bringing to every nursing opportunity his or her own cascading repertoire of skill,
knowledge, and compassion. It is shared enterprise and each participant is rewarded.”[1] It is
not clear what extent her ideas have been adopted, but critics suggest that her model focuses
too heavily on the patient's current needs and desires, to the detriment of their longer term
medical treatment.
COMPOSITION OF CONSERVATION MODLE:
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.

The key component are Adaptation, Wholeness and Conservation....

Adaptation- adaptation consists of how a patient adapts to the realities of their new health
situation- the better a patient can adapt to changes in health, the better they are able to
respond to treatment and care.

Wholeness - the concept of wholeness maintains that a nurse must strive to address the client's
external and internal environments. This allows the client to be viewed as a whole person, and
not just an illness.

Conservation -the product of adaptation; “Conservation describes the way complex systems are
able to continue to function even when severely challenged”.[4] Conservation allows individuals
to effectively respond to the changes their body faces, while maintaining their uniqueness as a
person.

CONSERVATIONAL MODEL:
The core of the conservation model is to improve the physical and emotional wellbeing of a
person 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:

 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.

CONSERVATIONAL MODEL GOAL:
1. To promote adaptation and maintain wholeness using the principles of
conservation

2. Model guides the nurse to focus on the influences and responses at the
organismic level

3. Nurse accomplishes the goal of model through the conservation of energy,

structure and personal and social integrity.

"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

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 structure of body

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.

Major Concepts of Levine’s Conservation Model

In this section, we will define the nursing metaparadigm and the major concepts of the theory:

Environment

The Environment completes the wholeness of the individual. Environment includes both the
internal and external environment.

1. Internal environment

Homeostasis is a state of energy sparing that also provides the necessary baseline for a
multitude of synchronized physiological and psychological factors.

Homeorrhesis is a stabilized flow rather than a static state.

2. External environment

The operational environment consists of the undetected natural forces and that 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.

Person

Person is the unique individual in unity and integrity, feeling, believing, thinking, and whole.

 Individuals continuously defend their wholeness in constant interaction with

their environments and choose the most economical, frugal, energy-sparing options
available to safeguard their integrity.

 A person is a holistic being, who is sentiment, thinking, future-oriented and past-

aware. It

 A holistic being who has open and fluid boundaries that co-exist with the
environment.

 He is "whole"

 A unified social being

 "Whole" not only in the physical aspect but also with regards to psychosocial-
cultural and spiritual aspects

 A person is a sense of identity and worth.

 A unique individual in unity and integrity, feeling, believing, thinking and whole
system of system.

Health

Health is the pattern of adaptive change of the whole being.

 Health of being "whole" not just the absence of illness or disease.

 Is determined by 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.

 Not merely healing of an afflicted part, it is return to daily activities, selfhood and
the ability to once more pursue by an individual, his or her own interest without
constraints.
  Health can be socially determined (through their interaction with the significant
others). Failure in doing so is a negative scenario.

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.

 Is a human interaction designed to promote wholeness through adaptation

 Nursing care is both supportive and therapeutic (to achieve maximum level of
adaptation).

 Promote wholeness through the use of the four conservation principles.

 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.

 The major area of concern for nurses in maintenance of a person's wholeness.

Adaptation

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.

Three Concepts of Adaptation

Historicity

Adaptation is a historical process, responses are based on past experiences, both personal and
genetic

Specificity

Adaptation is also specific. Each system has very specific responses. The physiologic responses
that “defend oxygen supply to the brain are distinct from those that maintain the appropriate
blood glucose levels.” (Levine, 1989)

Redundancy

Although the changes that occur are sequential, they should not be viewed as linear. Rather,
Levine describes them as occurring in “cascades” in which there is an interacting and evolving
effect in which one sequence is not yet completed when the next begins.
Organismic response is a change in the behaviour of a patient during an attempt to adapt to the
environment. These responses help the patient protect and maintain his or her integrity. There
are four types of these responses:

Fight or flight, which is an instantaneous response to real or imagined threat. It is the most
primitive response.

Inflammatory, which is a response intended to provide for structural integrity and the
promotion of healing.

Stress, which is a response developed over time and influenced by each stressful experience the
patient encounters.

Perceptual, which involves gathering information from the environment and converting it into a
meaning experience.

Levine’s theory includes nine models of guided assessment:

1. vital signs

2. body movement and positioning

3. ministration of personal hygiene needs

4. pressure gradient system in nursing interventions

5. nursing determination in provision of nutritional needs

6. pressure gradient system in nursing

7. local application of heat and cold

8. administration of medicine

9. establishing an aseptic environment

Conservational model provides the basis for development of two theories:

1. Theory of Redundancy: aging is the diminished availability of a redundant

system necessary for effective maintenance of physical and social well-being.

2. Theory of Therapeutic Intention: Organizing nursing intervention to facilitates

 healing through natural response, provide support, restore individual integrity and well-
being.

Assumptions

The following are the major assumptions of The Conservation Model.

Assumptions About Individuals

Each individual “is an active participant in interactions with the environment… constantly
seeking information from it.” (Levine, 1969)

The individual “is a sentient being and the ability to interact with the environment seems
ineluctably tied to his sensory organs.”

“Change is the essence of life and it is unceasing as long as life goes on. Change is characteristic
of life.” (Levine, 1973)

Assumptions About Nursing

“Ultimately the decisions for nursing intervention must be based on the unique behaviour of
the individual patient.”

“Patient-centred nursing care means individualized nursing care. It is predicated on the reality of
common experience: every man is a unique individual, and as such he requires a unique
constellation of skills, techniques and ideas designed specifically for him.” (Levine, 1973)

Relationships

Conservation of energy is based on nursing interventions to conserve through a deliberate

decision as to the balance between activity and the person’s available energy.

Conservation of structural integrity is the basis for nursing interventions to limit the amount of
tissue involvement.

Conservation of personal integrity is based on nursing interventions that permit the individual
to make decisions for himself or participate in the decisions.

Conservation of social integrity is based on nursing interventions to preserve the client’s

interactions with the family and the social system to which they belong.

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

UTILITY OF THEORY:
  Nursing research: Principal of conservation have been used for data collection in
various research

 Nursing education: This model is used as guideline for curriculum development.

 Nursing administration: It is used as assessment guide for data collection and

development of comprehensive nursing care plan.

 Nursing practice: It has been used for nursing practice in different setting.

NURSING PROCESS ACCORDING TO LEVINE'S MODEL:

Nursing process:

 Assessment : Collection of provocative facts through observation and interview

of challenges to the internal and external using four conservation principal.

 Trophicgnosis : Nursing diagnosis based on patient's need through the use of

scientific process.

 Hypothesis: Nurse formulate goal to maintain wholeness and promoting

adaptation.

 Intervention: It is designed on conservational principal.

 Evaluation: Observation of organismic response to intervention.

EXAMPLE:

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 has no hygiene.

ASSESMENT :

 Challenges to the internal environment weight loss, nausea, loss of reproductive

ability

 Challenges to external environment is abusive husband, unhygienic condition at

home
  Energy conservation: weight loss, nausea, pain.

 Structural integrity: threatened by surgical procedure, inability to pass urine.

 Personal Integrity: unable to give birth to more children

 Social integrity: Strained relationship with husband.

TROPHICOGNOSIS :

 Inadequate nutritional status

 pain

 potential for wound and bladder infection

 need to learn self-catheterization

 Decreased self-worth

 potential for abuse

HYPOTHESIS:

 Nutritional consultation

 Teaching and return demonstration of urinary self-catheterization

 Care of surgical wound

 Exploring concern regarding hysterectomy

INTERVENTION:

Energy conservation

 Provide medication for pain and nausea

 Allowing rest period

Structural integrity

 Administration antibiotic for wound

 Teaching self-catheterization

Personal integrity
  Exploring her feeling about uterus removal while respecting her privacy

Social integrity

 Asses potential abuse from husband

 Support to the family

Orgasnismic respose

 Controlled pain

 Abdominal wound healing

 Improved appetite, weight gain

 Clean urinary self-catherization

 Assistance from husband

CRITIQUING OF THEORY:
 She values the holistic approach to all individual, well or sick.
  Values patients participation in nursing care

 Comprehensive content in depth

 Provides direction of nursing research, education, administration and practice.

 Logically congruent

 Shows high regards to adjacent discipline to develop theoretical basis for nursing.

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 responds in a predictable way

 Human being is unique in their responses

 Human being knows and appraise objects, condition and situation

 Human being sense, reflects, reason and understand

 Human being action are self-determined even when emotional

 Human being is 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 responds organismically in an ever-changing manner

 A theory of nursing must recognize 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 a 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 of providing care

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 and on the

dependency of the patient.

CONCLUSION: To summarize, Levine expressed the view that within the nurse-patient
relationship a patient’s state of health is dependent on the nurse-supported process of
adaptation. This guides nurses to focus on the influences and responses of a client to promote
wholeness through the Conservation Principles. The goal of this model is to accomplish this
through the conservation of energy, structural, personal and social integrity. The goal of nursing
is to recognize, assist, promote, and support adaptive processes that benefit the patient.