Myra Estrin Levine’s

Conservation Model
Prepared by: Merlyn C. Tayo
BCNG 501A - Theoretical Framework for Nursing Practice
Philippine Women’s University
 Objectives
● Describe the historical background of the development of
Levine’s model for health
● Define Levine’s major concepts and four principles of
conservation
● Present the relationship between Levine’s model and
concepts in nursing’s metaparadigm
● Provide an example of Levine’s model in a clinical
practice
● Evaluation of the Conservation Model
Who is Myra Estrin Levine?
➢ Born Myra Estrin
December 12, 1920
Chicago, Illinois
➢ Died March 20, 1996 (aged 75)
Evanston, Illinois
➢ Nationality American
➢ Occupation Nurse, Author, Theorist
➢ Known for Conservation Model of
Nursing, Nursing Theorist
 Education
Diploma in Nursing from Master of Science from
Cook County Hospital Wayne University
School of Nursing

1944 1962

1949 1992

Bachelor of Science in Granted an honorary

Nursing from University of doctorate by Loyola
Chicago University in Chicago
 Professional Career
Private Duty Nurse Director of Drexel Home for Academic career in four
Civilian Nurse - US Army Older Adults - Chicago schools of nursing in
Chicago

1944-45 1950-51 1963-87

1947-50
1951-62

Preclinical instructor of
Surgical Supervisor -
Physical Sciences for
University of Chicago Clinics
Nurses - Cook County
& Henry Ford Hospital in
Hospital School of Nursing
Detroit
 Distinctions & Awards:
● A charter fellow of the American Academy of Nursing(1973)
● An honorary membership in the American Mental Health Aid to Israel
(1976)
● Honorary Recognition from the Illinois Nurses' Association
● Member of Sigma Theta Tau (Alpha Beta Chapter, Loyola University)
● Enlisted in Who's Who in American Women (1977-1988)
● Enlisted in Who's Who in American Nursing (1987)
● Elected fellow in the Institute of Medicine of Chicago (1987-1991)
● First recipient of the Elizabeth Russel Belford Award for excellence in
teaching from Sigma Theta Tau (1977)
● Received recognition from the Alpha Lambda Chapter of Sigma Theta Tau
in 1990 for her exceptional contribution to nursing.
 Published Books & Articles
● 1969: Introduction to Clinical Nursing (1st Edition)
● 1971: Renewal for Nursing
● 1973: Introduction to Clinical Nursing (2nd
Edition)
● Her paper entitled "Trophicognosis: An Alternative
to Nursing Diagnosis," can be found in the
American Nurses' Association publication
Exploring Progress in Medical-Surgical Nursing
Practice, New York, 1966, vol. 2.
 Theory Overview
Myra Estrin Levine’s conservation model believes nursing
intervention is a conservation activity, with energy
conservation as a fundamental concern, she proposed 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, personal and social integrity of the
individual.
 CONSERVATION
OF SOCIAL
INTEGRITY

INT RUCT TION

PSYCHOSOCIAL

RIT AL
BEING

EG UR
ST RVA

Y
OF NSE
CO

INTERVENTION:
THERAPEUTIC/
CLIENT’S ADAPTIVE PHYSICAL
RESPONSE
SUPPORTIVE BEING
N
GY
TIO
NS NER
VA
ER
E
OF

PHYSIOLOGICAL
C O

BEING
CONSERVATION
OF PERSONAL
INTEGRITY
 =
ENERGY

STRUCTURAL WHOLE SOCIAL

INTEGRITY PERSON INTEGRITY

PERSONAL
INTEGRITY
 Distinctions
Major Concepts
Theory & Awards: Model
of Conservation
Overview
Environment
● Internal environment combines the physiological and
pathophysiological aspects of the individual and is
constantly challenged by the external environment. It
consist of homeostasis and homeorrhesis.
● External environment is divided into the operational,
perceptual, and conceptual environments.
Person
● A unique individual in unity and integrity, feeling,
believing, thinking and whole system of system.
● A holistic being who has open and fluid boundaries that
coexist with the environment. He is a whole being who is
conserved and integral. An example is a patient’s anxiety
is still present despite the alleviation of pain.
Health Distinctions & Awards:
Theory Overview
● Health is the pattern of adaptive change of the whole
being.
● A state of wholeness and not just an absence of disease
and successful adaptation and not merely healing of an
affected part.
● Ability to function normally and able to return to daily
activities, self-hood, and ability to pursue one's interest
without constraints.
Nursing Distinctions & Awards:
Objectives
● Nursing is the human interaction relying on
communication, rooted in the individual human being’s
organic dependency in his relationships with other
human beings.
● The goal of nursing is to promote wholeness. 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).
 Concepts
Theoryof Adaptation
Distinctions & Awards:
Overview
Historicity
● Adaptation is a historical process. Responses are based on
past experiences, both personal and genetic.
Specificity
● Refers to the individual responses and their adaptive
pattern.
Redundancy
● The options available to the patient to ensure continued
adaptation.
 Organismic
Distinctions Response
& Awards:
Objectives
● 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.
 The Four Conservation Principles
Conservation of Energy
● It refers to balance between energy expenditure and
conservation. Patient activity is dependent on energy
balance.
Conservation of Structural Integrity
● It refers to maintaining or restoring the structure of body
preventing physical breakdown and promoting healing.
 Distinctions
Conservation ofTheory & Awards:
Overview
Personal Integrity
● Individual strives for recognition, respect, self awareness,
self-hood and self-determination.
Conservation of Social Integrity
● An individual is recognized as someone who resides and
interacts with in a family, a community, academe, a
religious group, an ethnic group, a political system and a
nation.
 Distinctions
Nine Models
Theory & Awards:
of Guided
Overview
Assessment
● vital signs
● body movement and positioning
● ministration of personal hygiene needs
● pressure gradient system in nursing interventions
● nursing determination in provision of nutritional needs
● pressure gradient system in nursing
● local application of heat and cold
● administration of medicine
● establishing an aseptic environment
Use of the Nursing
Distinctions Process
& (Levine)
Awards:
Objectives
Process Application of the Process

Assessment Collection (through observation and interview) of challenges

to the internal and external environments.

Trophicognosis Nursing diagnosis that gives the provocative facts meaning.

Hypotheses Direct the nursing interventions with the goal of maintaining

wholeness and promoting adaptation.

Interventions Test the hypotheses.

Evaluation Observation of organismic response to interventions.

 Assumptions
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 behavior of the individual patient.”

● “Patient-centered 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)
 Application to Practice
Distinctions & Awards:
Objectives
Scenario:
Mona is a 32-year-old woman who is currently on her 3rd
trimester and was married for 5 years. She considers herself
healthy, except that she was diagnosed with fibromyalgia at
age of 26 and been treating it with Amitriptyline (Elavil)
25mg nightly and exercise. When she got pregnant, she
stopped taking the medicine and used relaxation, warm
baths, and stretching to help her sleep and to control the
muscular discomfort associated with FM with limited
success.
 PROCESS APPLICATION OF THE PROCESS

❖ Challenges to Mona’s Internal Environment

➢ She rates her pain level as 7 on a scale of 0 to 10.
➢ Due to fatigue, she is more likely to eat fast food to cut preparation
❖ Challenges to Mona’s External Environment
➢ Perceptual - affected by her high level of pain and fatigue
➢ Operational - assessment reveals that she is bothered by the summer
➢ Conceptual - her concerns about being able to manage labor
❖ Energy
Assessment ➢ fatigue serves as a clue to an alteration in function, she also reports
dyspepsia
❖ Personal Integrity
➢ frustrated by the return of her FM symptoms which could affect L & D
❖ Structural Integrity
➢ reports lower back pain which is making it difficult for her to sleep
❖ Social Integrity
➢ challenging her ability to go through a natural delivery
 PROCESS APPLICATION OF THE PROCESS

❖ Inadequate nutrition based on frequent fast food meals

❖ Lower back pain related to normal pregnancy changes and
fibromyalgia
Tropicognosis ❖ Lack of restful sleep related to lower back pain and indigestion
❖ Inadequate self-esteem related to fear of not being able to fulfill her
role as a mother
❖ Anxiety related to anticipated discomfort during delivery
 PROCESS APPLICATION OF THE PROCESS

❖ Alteration in sleep position will improve the quality of Mona’s

sleep.
❖ Exploring comfort options for her lower back pain will result in
improved comfort and more restful sleep.
❖ Identifying challenges related to delivery will help to reduce her
anxiety.
Hypotheses ❖ Reviewing the expected changes post delivery will help Mona
anticipate when she might need assistance because of her FM.
❖ Discussing ways to parent in the context of FM will improve her
self-esteem as a new mother.
❖ Referring Mona for a nutritional consult will help her meet her
nutritional needs and control her indigestion during her last
trimester
 PROCESS APPLICATION OF THE PROCESS

❖ Energy Conservation
➢ Nutritional consultation and restful sleep, low dose of Elavil
❖ Structural Conservation
➢ Improving Mona’s nutrition will support the healing process needed
after delivery of her child.
❖ Personal Integrity
➢ Reassure Mona that she can be a good mother even with the FM
Nursing
➢ Refer to Lactation Consultant to help her with breastfeeding
Interventions ➢ Recommend to have some help after delivery of her baby to get rest
❖ Social Integrity
➢ It is recommended that Mona’s husband join her for the last several
health visits before birth so that he is included in the discussions and
planning for the baby
➢ To maintain her social integrity, she will want to maintain a balance
in her life so that her sense of being is not stressed.
PROCESS APPLICATION OF THE PROCESS

❖ In response to the above interventions, the nurse will observe for the
following organismic responses:
➢ Reduced lower back pain and restful sleep
➢ Controlled dyspepsia
➢ Normal hemoglobin and hematocrit
➢ No protein in her urine
➢ Average weight gain of 1 pound per week until delivery
Evaluation ➢ Meeting with her husband and a lactation consultant
➢ Reports that she has made arrangements for her mother (or other
support person) to spend 2 weeks with her after the baby is born. Her
sister will then spend a week so that she will have help for 3 weeks.
➢ Discomfort controlled during delivery
➢ Successful delivery of a healthy child
➢ Expresses excitement about becoming a new mother
 Distinctions
Analysis ofTheory & Awards:Model
Overview
the Conservation
● Although there are many concepts similar to that of other
nursing theories, Levine’s energy conservation concept
makes it unique in guiding nursing actions.
● The concept of conservation, adaptation, and integrity
can be applied to any age group since every individual
needs to expand and reserve bodily energy.
 Distinctions
Theory & Awards:
Overview
● Levine’s operational definition of homeostasis is in
question since to achieve homeostasis; the body is
continuously using energy; thus, her statement that
homeostasis is energy sparing state is quite vague in
nature. Rewording might be helpful in this part of her
model.
● Borrowed concepts from Bates regarding Levine’s view of
the environment were not translated into how it affects
the individual. The necessity of connecting incorporated
concepts is crucial when developing a model for nursing
to be applied to human care. The operational
environment consists of the undetected natural forces and
that impinge on the individual.
 Distinctions
Theory & Awards:
Strengths
Overview
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
 Distinctions & Awards:
Objectives
Limitations
✘ Limited attention can be focused on health promotion
and illness prevention. Nurse has the responsibility for
determining the patient 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.
 Distinctions
Theory & Awards:
References
Overview
● Parker, M. E. (2010). Nursing Theories & Nursing Practice.
(3rd Ed.) F. A. Davis Company: Philadelphia, PA.
● https://nurseslabs.com/myra-estrin-levine-the-conservation-
model-of-nursing/
● http://myra-levine-4conservationprinciples.blogspot.com/
● http://lormacollegesnursinginformatics2018.blogspot.com/20
18/07/conservation-model-for-nursing-adamu.html
● https://nursing-theory.org/theories-and-models/levine-four-c
onservation-principles.php
Thank you!