MYRA ESTRIN LEVINE

The Conservation Model

 BIOGRAPHY
1920 – Myra Estrin Levine was born in Chicago, the first child of three siblings.
Her involvement throughout her father’s persistent gastrointestinal illness contributed to her interest in and
devotedness to nursing.
1944 – received her diploma in nursing from the Cook County School of Nursing
1949 – BS in Nursing from the University of Chicago
1969 - Master’s of Science in Nursing was granted to her from Wayne State University in Detroit
She was a private duty nurse in 1944,
civilian nurse in the U.S. Army in 1945,
preclinical instructor in the physical sciences at Cook County from 1947 to 1950,
director of nursing at Drexel Home in Chicago from 1950 to 1951,
surgical supervisor at both the University of Chicago Clinics from 1951 to 1952, and the Henry Ford Hospital in
Detroit from 1956 to 1962.
 BIOGRAPHY
In 1951, Levine also became a clinical instructor at Bryan Memorial Hospital in Lincoln, Nebraska, and administrative
supervisor at the University of Chicago.
 Levine also worked as a chairperson of clinical nursing at her alma mater, the Cook County School of Nursing, from
1963 to 1967.
She managed to work her way up the academic ranks at Loyola University from 1967 to 1977 and the University of
Illinois from 1962 to 1963 and from 1977 to 1987.
She coordinated the graduate nursing program in oncology at Rush University from 1974 to 1977.
Levine was a director of the Department of Continuing Education at Evanston Hospital from March to June 1974 and a
consultant to the department from July 1974 to 1976.
She was also a professor of Humanistic Studies at the University of Illinois from 1981 to 1987.
In 1987, she became a Professor Emerita, Medical-Surgical Nursing, at the University of Illinois at Chicago.
She was also a visiting associate professor at Tel Aviv University in Israel in 1974. She was also a visiting professor at
Recanati School of Nursing, Ben Gurion University of the Negev, at Beer Sheva, Israel, from March to April 1982.
 THEORY DESCRIPTION AND DISCUSSION
 THE 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.
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.
1. 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; Maintenance of adequate nutrition

2. 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

3. 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

4. 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.
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.
Adaptation is achieved through the “frugal, economic, contained, and controlled use of
environmental resources by the individual in his or her best interest”.

Wholeness is based on Erikson’s 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 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
Conservation, on the other hand, is the product of adaptation.
Conservation describes the way complex systems are able to continue to function even when severely
challenged.
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.
The primary focus of conservation is keeping together of the wholeness of the individual. Although nursing
interventions may deal with one particular conservation principle, nurses must also recognize the influence
of other conservation principles.
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.
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.
 NURSING PROCESS

1. Assessment- The collection of facts, by way of interviews and observation with the patient
(considering conservation principles)
2. Trophicognosis- The application of nursing diagnoses which will provide the collected facts with
meaning in the context of the patient's circumstance
3. Hypotheses- The application of interventions that aim to maintain the patient's wholeness and
promote their adaptation in the current situation
4. Interventions- The use of interventions will test the nurse's hypotheses
5. Evaluation- Assessment of the client's responses to imposed interventions
 APPLICATION OF THE NURSING PROCESS IN LEVINE’S
CONSERVATION MODEL

• Assessment- The nurse will observe and speak with the patient, in conjunction with medical reports, results
and diagnostic studies to gather information- referred to as the collection of provocative facts.
• Patients will be assessed for challenges to their external and internal environments that may impede their
ability to achieve complete wellness and health. Areas focused on which may present such challenges are:
• Energy Conservation- the balance between energy expenditure and the client's energy supply
• Structural Integrity- the defense system for the body
• Personal Integrity- the client's sense of self-worth, independence and validation
• Social Integrity- how well one can be part of a social system (family, community, etc.) 
• Judgement- Taking the provocative facts of the client's situation and organizing them in a way
that makes sense and adds meaning to the patient's circumstances, in order to decide patient
needs and possible nursing interventions. Using these judgments to decide about a patient's needs
is referred to as trophicognosis.
• Hypotheses- Using his or her formed judgment, the nurse will speak with the client regarding
these judgments with the client. Hypothesizing about the problem and its solution will eventually
form a care plan for the patient.
• Interventions- With the aim of promoting wholeness and adaptation, the nurse tests his/her
hypothesis via direct care. These interventions aim to address the four areas of wellness (energy
conservation, structural integrity, personal integrity and social integrity).
• Evaluation- Evaluation of the interventions aimed at supporting the nurse's hypotheses seek to
assess the client's response to the interventions. The evaluation considers both supportive
outcomes (providing comfort to the client) and therapeutic outcomes (improving the client's
sense of wellness)
 ASSUMPTIONS AND ASSERTIONS

• 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
 ASSUMPTIONS AND ASSERTIONS
• 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
 NURSING METAPARADIGM

Nursing
• Nursing is “Human Interaction “
• The nurse participates actively in every patient’s environment and much of what she does supports his adjustments as he
struggles in the predicament of illness.
• Goal: to promote adaptation and maintain wholeness

Person
• Is the unique individual in unity and integrity, feeling, believing, thinking, and whole.
• Integrity means the person has freedom of choice and movement, sense of identity and self-worth.
• Systems of systems, and its wholeness expresses the organization of all the contributing parts.

Health
• Socially determined by the ability to function in a reasonably normal manner
• Predetermined by social groups and it is not just an absence of pathological conditions
• Health is also determined – it is not an entry on its own, but rather a definition imparted by the ethos and beliefs of the
groups to which individuals belong

Environment

Environment completes the wholeness of the individual
Levine’s model explains into two parts: internal and external environment
•Internal Environment

Combines the physiological and pathophysiological aspects of the individual and is constantly
challenged by the external environment. 

Homeostasis – state of energy- sparing that also provides the necessary baselines for a multitude of
synchronized physiological factors.

Homeorhesis – is a stabilized flow rather than a static state
•External Environment
Perceptual environment – the aspect of the world that the patient is able to intercept.

Operational environment – contains elements that may physically affect patients, but not perceived by
them.

Conceptual environment – part of the patient’s environment that includes cultural, patterns
characterized by spiritual existence, ideas values, beliefs, 1 tradition. 
concepts of patient and environment
Levine’s Conservation Model discussed that the way in which the person and the
environment become congruent over time. It is the fit of the person with his or her
predicament of time and space. The specific adaptive responses make conservation possible
occur on many levels; molecular, physiologic, emotional, psychologic, and social. These
responses are based on three factors: historicity, specificity and redundancy.
Adaptation
1. Historicity – states that adaptations are grounded in history and await the challenges
to which they respond.
2. Specificity – refers to the individual responses and their adaptive pattern, which varies
on the basis of specific genetic structure. 
3. Redundancy – explains the options available to the patient to ensure continued
adaptation.
Organismic response – is a change in the behavior 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:
1. Fight or flight, which is an instantaneous response to real or imagined threat. It is
the most primitive response.
2. Inflammatory, which is a response intended to provide for structural integrity and
the promotion of healing.
3. Stress, which is a response developed over time and influenced by each stressful
experience the patient encounters.
4. Perceptual, which involves gathering information from the environment and
converting it into a meaning experience.
Conservation
 ANALYSIS AND CRITIQUE
• Simplicity - although the four conservation principles appear simply initially, they contain subconcepts and
multiple choices. Nevertheless, this model is still one of the simpler one's develop.
• Generality - this four conservation principles can be used in all nursing context.
• Accessibility - Levine used deductive logic to develop her model, which can be used to generate research
question. As she lived her conservation concept, she verified the use of inductive reasoning to further
develop and inform her model (M. Levine, personal communication, May 17, 1989.)
• Clarity - Levine's model posseses clarity. ( Fawcett 2000) states "Levine's Conservation Model provides
nursing with a logically congruent, holistic view of the person". George (2002) affirms "this theory direct
nursing actions that lead to favorable outcomes. The model has numerous item terms; however, Levine
adequately defines them for clarity.
 APPLICATION TO PRACTICE, RESEARCH, EDUCATION

Practice:
 Used in variety of settings, from critical care, acute care, long-term care, community care, homeless, patients with
burns, cervical cancer, chronic pain, congestive heart failure, and epilepsy; emergency room, intensive care nursery,
pediatrics, peri-operative nursing, smoking cessation (as cited by George, 2008) and geriatric nursing where majority
of the elderly patients will have some problems in at least two of the conservation models (Bautista, 2008).
 Conservation of Energy: Make sure the patient receives enough rest to provide them the energy they need for everyday
tasks.
 Conservation of structural integrity: Due to CHF (congestive heart failure) and frailty, the patient is at a significant risk
of becoming immobile, so the nurse will need to implement treatments to prevent pressure ulcers.
 Conservation of personal integrity: The nurse will take action to help the patient achieve the highest level of personal
care independence feasible (for example, by collaborating with a physiotherapist or occupational therapist) since she is
aware that the patient wants to maintain a sense of independence.
 Conservation of social integrity: The nurse can talk about measures for getting the patient to interact with other
patients in the long-term care facility with the interdisciplinary team (such as activity/recreation aides).
 APPLICATION TO PRACTICE, RESEARCH,
EDUCATION
• Education:
 Provides a student friendly nursing theory.
 Provided an organizational structure for teaching Medical-Surgical Nursing and stimulus for theory development.
• Research:
 Enhances the foundation of nursing practice and nursing education.
1. Studies conducted by Wong (1989) and Winslow, Lane, and Gaffney (1985) support the importance of energy
conservation for patients with myocardial infarctions  
2. Pappas (1990)investigated the relationship between nursing care and anxiety in patients with sexually transmitted
diseases and found significant relationships between constructs of nursing and components of anxiety.
3. Foreman (1987)found that variables that represented the four conservation principles were more important in
combination than separately when used to diagnose confusion in hospitalized erderly patients.
4. MacLean (1987) used the principles of conservation of energy and conservation of structural integrity in identifying
cues that nurses use to diagnose activity intolerance.
 IMPORTANCE OF THEORY

• Her theory is based on employing conservation principles to encourage adaptation and maintain completeness.
The model instructs the nurse to focus on the factors that have an impact on and how the organisms react. The
nurse completes the model's objectives by conserving energy, maintaining order and maintaining both her
personal and societal integrity.
• 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.
• She defined nursing as a caring profession that helps people and social groups achieve, maintain, and recover
health. If this is not possible, nurses assist people in passing away with dignity.
• She also interacts with people while providing nursing care. According to Levine, the purpose of nursing is to
foster completeness while understanding that every person needs a different set of activities to reach wholeness.
 GOODS BA?
• GROUP 4
• LEONARDO DULA
• JANICA DULOS
• MELVIN EBIO
• ANGELA ESPILOY
• EZRA ESQUILONA
THANK YOU!