Levin's Four Conservation Principles Myra Estrine Levine

Levin's Four Conservation Principles

Myra Estrine Levine This page was last updated on November 6, 2010

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Introduction Born in Chicago 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 & 1989 Received honorary doctorate from Loyola University in 1992 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 country SON Visiting professor at Tel Aviv university in Israel Conservational model Goal: To promote adaptation and maintain wholeness using the principles of conservation Model guides the nurse to focus on the influences and responses at the organismic level Nurse accomplishes the goal of model through the conservation of energy, structure and personal and social integrity Adaptation Every individual has a unique range of adaptive responses The responses will vary by heredity, age, gender or challenges of illness experiences Example: The response to weakness of cardiac muscle is an increased heart rate, dilation of ventricle and thickening of myocardial muscle While the responses are same, the timing and manifestation of organismic responses will be unique for each individual pulse rate) An ongoing process of change in which patient maintains his integrity within the realities of environment Achieved through the "frugal, economic, contained and controlled use of environmental resources by individual in his or her best interest" Wholeness Exist when the interaction or constant adaptations to the environment permits the assurance of integrity Promoted by use of conservation principle Conservation The product of adaptation "Keeping together "of the life systems or the wholeness of the individual Achieving a balance of energy supply and demand that is with in the unique biological realities of the individual Nursing’s paradigm Person A holistic being who constantly strives to preserve wholeness and integrity A unique individual in unity and integrity, feeling, believing, thinking and whole system of system Environment Competes the wholeness of person Internal Homeostasis Homeorrhesis External Preconceptual Operational Conceptual Internal Environment Homeostasis: A state of energy sparing that also provide the necessary baselines for a multitude of synchronized physiological and psychological factors A state of conservation Homeorrhesis: A stabilized flow rather than a static state Emphasis the fluidity of change within a space-time continuum Describe the pattern of adaptation, which permit the individual’s body to sustain its well being with the vast changes which encroach upon it from the environment External Environment Preconceptual: Aspect of the world that individual are able to intercept Operational: Elements that may physically affects individuals but not perceived by hem: radiation, micro-organism and pollution Conceptual: Part of person's environment including cultural patterns characterized by spiritual existence, ideas, values, beliefs and tradition Person and environment Adaptation Organismic response Conservation 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 A change in behavior of an individual during an attempt to adapt to the environment Help individual to protect and maintain their integrity They co-exist They are four types: 1. Flight or fight: An instantaneous response to real or imagined threat, most primitive response 2. Inflammatory: response intended to provide for structural integrity and the promotion of healing 3. Stress: Response developed over time and influenced by each stressful experience encountered by person 4. Perceptual: Involves gathering information from the environment and converting it in to a meaning experience Nine models of guided assessment Vital’s 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 Assumption 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 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) form previous time. Theories must be logical in nature. Levine’s idea about nursing care are organized in such a way as to b sequential and logical. they can be used to explain the consequences of nursing action Theories should be relatively simple yet generalizable. Levine’s theory is easy to use . It’s major elements are easily comprehensible and the relation ship have the potential for being complex but are easily manageable Certain isolated aspect of the theory are the generalizable i.e. those related to the conservational principles Theories can be the bases for hypotheses that can be tested. Levine’s idea can be tested Hypothesis can be derived from them . The principle of conservation are specific enough to be testable Levine’s work & Characteristics of theory 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 have not yet been widely researched ,it is hard o 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 setting 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 Conservational Principle Conservation of energy Conservation of structural integrity Conservation of personal integrity Conservation of social integrity 1. Conservation of energy Refers to balancing energy input and output to avoid excessive fatigue includes adequate rest, nutrition and exercise Example: Availability of adequate rest Maintenance of adequate nutrition 2. Conservation of structural integrity Refers to maintaining or restoring the structure of body preventing physical breakdown And promoting healing Example: Assist patient in ROM exercise Maintenance 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: Recognize and protect patient’s space needs 4. Conservation of social integrity An individual is recognized as some one who resides with in a family, a community ,a religious group, an ethnic group, a political system and a nation Example: Position patient in bed to foster social interaction with other patients Avoid sensory deprivation Promote patient’s use of news paper, magazines, radio. TV Provide support and assistance to family Health Health is a wholeness and successful adaptation It is not merely healing of an afflicted part ,it is return to daily activities, selfhood and the ability of the individual to pursue once more his or her own interest without constraints Disease: It is unregulated and undisciplined change and must be stopped or death will ensue Nursing "Nursing is a profession as well as an academic discipline, always practiced and studied in concert with all of the disciplines that together from the health sciences" The human interaction relying on communication ,rooted in the organic dependency of the individual human being in his relationships with other human beings Nursing involves engaging in "human interactions" Goal of Nursing To promote wholeness, realizing that every individual requires a unique and separate cluster of activities The individual integrity is his abiding concern and it is the nurse’s responsibility to assist him to defend and to seek its realization 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 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 Process Assessment Trophicognosis Hypothesis Interventions Evaluation Nursing Process 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 organismic 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 through the use of the scientific process Judgment is made about patient’s needs 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 organismic response to interventions It is assesses whether hypothesis is supported or not supported If not supported, plan is revised, new hypothesis is proposed Conservational models Conservational model provides the basis for development of two theories Theory of redundancy Theory of therapeutic intention Theory of redundancy Untested ,speculative theory that redefined aging and everything else that has to do with human life Aging is diminished availability of redundant system necessary for effective maintenance of physical and social well being Theory of therapeutic intention Goal: To seek a way of organizing nursing interventions out of the biological realities which the nurse has to confront Therapeutic regimens should support the following goals: Facilitate healing through natural response to disease Provide support for a failing auto regulatory portion of the integrated system Restore individual integrity and well being Theory of therapeutic intention Provide supportive measure to ensures comfort Balance a toxic risk against the threat of disease Manipulate diet and activity to correct metabolic imbalance and stimulate physiological process Reinforce usual response to create a therapeutic changes Uses Critical, acute or long term care unit Neonates, infant and young children, pregnant young adult and elderly care unit Primary health care OT Community setting 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 patient 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 warmer Nursing education Conservational model was used as guidelines 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 streets Nursing process according to Levine’s model Mrs. MN, a wife of an abusive husband, underwent a radical hysterectomy. Post operatively has pain ,weight loss, nausea and inability to empty bladder .Patient has history of smoking and stays in house which is less than sanitary Assessment Challenges to the internal env:-weight loss, nausea, loss of reproductive ability Challenges to the external env:-abusive husband, insanitary condition in 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 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 Interventions Energy conservation Provide medication for pain and nausea Allowing rest period Structural integrity Administrating antibiotic for wound, Teaching self catheterization Personal integrity Exploring her feeling about uterus removal while respecting her privacy Social integrity Assess potential abuse form husband Support to the family Organismic response Controlled pain Abdominal wound healing Improved appetite ,weight gain Clean urinary self catheterization Assistance from husband Critiquing the theory She values the holistic approach to all individual, well or sick Values patient’s participation in nursing care Comprehensive content in depth 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 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. Research Highlights A theory of health promotion for preterm infants based on conservational model of nursing. Nursing science quarterly,2004 Jul,17 (3) The article describes a new middle range theory of health promotion for preterm infants based on Levine’s conservational model that can be used to guide neonatal nursing practice. Summary Introduction to the theorist Conservational model Concept of the model Adaptation Wholeness Conservation Conservation principles Nursing process Assessment Trophicogosis Hypothesis Interventions Evaluation Theory of redundancy Theory of therapeutic intention Utility of theory Nursing research Nursing education Nursing administration Nursing practices References Timber BK. Fundamental skills and concepts in Patient Care, 7th edition, LWW. George B. Julia , Nursing Theories- The base for professional Nursing Practice , 3rd ed. Norwalk, Appleton & Lange. Wills M.Evelyn, McEwen Melanie (2002). Theoretical Basis for Nursing Philadelphia. Lippincott Williams& wilkins. Meleis Ibrahim Afaf (1997) , Theoretical Nursing : Development & Progress 3rd ed. Philadelphia, Lippincott. Taylor Carol,Lillis Carol (2001)The Art & Science Of Nursing Care 4th ed. Philadelphia, Lippincott. Potter A Patricia, Perry G Anne (1992) Fundamentals Of Nursing –Concepts Process & Practice 3rd ed. London Mosby Year Book. Vandemark L.M. Awareness of self & expanding consciousness: using Nursing theories to prepare nurse –therapists Ment Health Nurs. 2006 Jul; 27(6) : 605-15 Reed PG, The force of nursing theory guided- practice. Nurs Sci Q. 2006 Jul;19(3):225 Cheng MY. Using King's Goal Attainment Theory to facilitate drug compliance in a psychiatric patient. Hu Li Za Zhi. 2006 Jun;53(3):90-7. Delaune SC,. Ladner PK, Fundamental of nursing, standard and practice, 2nd edition, Thomson, NY, 2002.