The theorist

 Born in Chicago, first child in a family of 3

siblings,
 Her experiences during her father’s frequent
illnesses contributed to her interest in and
dedication to nursing.
 1944- Diploma- cook County School of
Nursing
 1949- B.S. in Nursing from the University of
Chicago
 1962- M.S. in Nursing Wayne State University
Career

 Private duty Nurse, civilian nurse for the U.S. army,

surgical supervisor, Director of Nursing
 Faculty Positions:
 Loyola University, Cool County School of Nursing,
Rush University, University of Illinois, Chicago.
 Professor Emerita, Medical Surgical Nursing,
University of Illinois, Chicago.
 Visiting Professorship
 Israel: Tel Aviv University and Recanati School of
Nursing, Ben Gurion University of Negev
Honors and Awards
 1973- Charter Fellow in the American
Academy of Nursing
 1976-Honorary membership in the American
Mental Health Aid to Israel
 1977- honorary recognition by the Illinois
Nurses Association.
 1992- Granted: Honorary Doctorate, by
Loyola University, Chicago
 First recipient of : Sigma Theta Tau’s Elizabeth
Russell Belford Award for Teaching excellence.
Introducing...
MYRA ESTRIN
Major Concepts and
definitions:
 Holistic- (quotes Erikson) “ wholeness
emphasizes a sound, organic, progressive,
mutuality between diversified functions and
parts within an entirety, the boundaries of which
are open and fluent.”
 Holism- “ human beings are more than and
different from the sum of their parts”
 Integrity- from the latin word integer meaning
“one” integrity means being in control with one’s
life.
Nursing:

 Nursing is a human interaction, “ when

nursing intervention influences adaptation
favourably, or toward renewed social well
being, then the nurse is acting in a
therapeutic sense, when the response is
unfavourable, the nurse adds supportive care.
The goal of nursing is to promote wholeness.
Person

 Is who we know ourself to be,

or a sense of identity.
Health

 Is socially determined. It is
predetermined by Social groups
and is not just the absence of
pathological conditions
 Change is characteristic of life,
and adaptation is the method of
change.
Environment

 Is the context in which we live our lives. It is

not a positive backdrop, we are active
participants in it.
 Composed of Internal and external
environments

 (to be elaborated in the conservation

principles)
 Assumptions
 An underlying assumption of Levine’s model is that
the nurse creates an environment in which healing
can occur and adaptation is promoted. Individuals
are constantly interacting with an external
environment; consequently, they adapt and preserve
their energy and integrity in accordance with that
environment. However, when an individual can no
longer maintain that energy and integrity, health is
adversely affected. This environment pertains not
only to the external milieu, but also to the
individual’s internal environment.
The conservation theory...
 Theoretical Sources:
 1. Beland’s theory of specific causation and
multiple factors- the way people think about
disease changes over time.
 2. James E. Gibson-definition of perceptual
systems
 3. Erik Erikson- differentiation between total
and whole
 4. Hans Selye- Stress theory
 5. M. Bates- Models of external environment
 Martha Rogers: her first editor
conservation
 Conservation- is from the latin word
meaning conservation meaning to
keep together. “conservation
describes the way complex systems
are able to continue to function even
when severely challenged. Through
conservation, individuals are able to
confront obstacles and adapt
accordingly while maintaining their
uniqueness.
Conservation

 The goal of conservation is

health
 The primary focus of
conservation is on the
integrity of “oneness” of the
individual
Conservation principles:

 a conceptual model of
nursing that focuses on
conservation of the
person's wholeness.
Adaptation

 Adaptation is the process by which people

maintain their wholeness or integrity as they
respond to environmental challenges.
 Adaptation, according to Levine,is a process of
change whereby the individual retains his
integrity within the realities of his environment.
It is 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. (shoes)
Environment

 Environment: is: “where we are constantly

and actively involved. The person and his
relationship with his environment is what
counts.
 Levine views the environment to which an
individual adapts as being both internal and
external.
Environment: Internal

 The INTERNAL ENVIRONMENT is the

physiological and pathophysiological aspects
of the patient. It is the integration of bodily
functions that resembles a stabilized flow
(homeorrhesis) rather than a static state
(homeostasis) and is subject to challenges of
the external environment, which always are a
form of energy.
Environment: External

 The EXTERNAL ENVIRONMENT is divided

into the:
 Perceptual environment
 Operational environment
 Conceptual environment
The PERCEPTUAL ENVIRONMENT

 is that portion of the external environment

which individuals respond to with their sense
organs and includes light, sound, touch,
temperature, chemical change that is smelled
or tasted, and position sense and balance.
The OPERATIONAL ENVIRONMENT

 is that portion of the external environment

which interacts with living tissue even though
the individual does not possess sensory
organs that can record the presence of these
factors and includes all forms of radiation,
microorganisms, and pollutants.
The CONCEPTUAL ENVIRONMENT

 is that portion of the external environment

that consists of language, ideas, symbols, and
concepts and inventions and encompasses
the exchange of language, the ability to think
and experience emotion, value systems,
religious beliefs, ethnic and cultural
traditions, and individual psychological
patterns that come from life experiences.
Organismic response

 The capacity of the individual to adapt to his

environmental condition

 Divided into 4 levels of integration

 Fight or flight
 Inflammatory response
 Response to stress
 Perceptual response
 The 4 conservation
Principles
 CONSERVATION OF ENERGY

 CONSERVATION OF SOCIAL INTEGRITY

 CONSERVATION OF PERSONAL INTEGRITY

 CONSERVATION OF STRUCTURAL INTEGRITY

CONSERVATION OF ENERGY

 is a natural law found to hold everywhere in the

universe for all animate and inanimate entities.
Nursing intervention is based on balancing the
individual’s energy input with energy output.
The individual requires a balance of energy and
a constant renewal of energy to maintain life
activities.
 Conservation of energy has long been used in
the nrsing practice:e.g. providing care that
makes the least additional demand possible.
CONSERVATION OF STRUCTURAL
INTEGRITY
 focuses attention on restoring structural
integrity and healing. Nursing intervention is
based on limiting the amount of tissue
involvement in infection and disease, by early
detection of functional changes and by
nursing interventions;
 e.g. prevention of pressure ulcers
 CONSERVATION OF PERSONAL
INTEGRITY

 focuses attention on the patient as a

person. Nursing intervention is based
on helping the individual to preserve
his or her identity and selfhood.
 CONSERVATION OF SOCIAL
INTEGRITY
 focuses attention on the individual's place in
his or her family, community, and society. Self
worth and a sense of Identity is important.
 Nursing intervention is based on helping the
individual to preserve his or her place in a
family, community, and society. The nurse’s
goal is always to impart knowledge and
strength so that the individual can resume a
private life.
 Summary of the conservation
principles
 conservation of energy — balancing energy output and
input to avoid excessive fatigue  
 conservation of structural integrity — maintaining or
restoring the body structure by preventing physical
breakdown and promoting healing
 conservation of personal integrity — maintaining or
restoring the patient’s sense of identity and self-worth
and…acknowledging uniqueness      
 conservation of social integrity — fostering awareness
that the patient…is a social being who interacts with others
in their social environment.
The principles applied
in the Nursing
Process...
Assessment

 Principles of
conservation used as
guides in assessing
 Conservation of Energy

 primary focus: identifying the areas of energy

expenditure that are related to the suffering that
brought the patient into contact with the nurse.
Information about the balance on energy input and
output is also important.
 Data would include: Vital signs, Lab values related to
uptake and use of oxygen and nutrients, activities of
daily living, nutrition, exercise, elimination, menstrual
cycles...
 any aspect of living that requires energy.
 Conservation of Structural
Integrity:
 would relate to information about injury and
disease processes.

 Data would include: lab values that reflect the

immune/inflammatory response, direct
observation of wounds, and any visible
indication of disease, and information from
the patient about symptoms that are not
observable.
 Conservation of personal
Integrity
 – needs to be collected very carefully...
 Levine warns about the threat to the self of the patient
that can be created if the nurse seeks a too thorough
investigation of the self of that patient.
 Guideline: use only those generalizations that actually
make a difference in the choice of treatment plans.
 To assist in maintaining independence, assessment
needs to be limited to those portions of the self that the
patient is willing to share, and is capable of sharing.
 Conservation of Social
Integrity
 includes information about others who have
influenced the person’s identification of self

 Again, the kind and amount of data

collected in this area has to be constructed
carefully, with due sensitivity to the needs of
the person to maintain privacy.
Diagnosis:

 she suggests trophicognosis: which is a nursing

care judgement that is arrived at through the
use of the scientific method. (not adopted by
the nurses)
 The nursing Diagnosis : focuses on the cause
of the patient’s suffering—what has put him or
her in the predicament of need—and on the
areas in which adaptation needs to be
supported in order to achieve conservation and
integrity.
Outcomes:

 Goal of returning the patient to a

state of independence as early
and efficiently as possible
Planning:

 no specific structure,
 Focus: what the nurse needs to do to aid the
patient to regain independence, as quickly
and as fully as possible.
Implementation:

 Guided by the 4 conservation

principles...
Conservation of Energy:

Balancing energy input with

output

 Input: example improved nutrition

 Output: example: Activity
changes ( bed rest)
 Conservation of structural
Integrity:
 based on limiting the amount
of tissue involvement in
infections and disease.
 Example: appropriate positioning to prevent
decubiti, dressing changes etc.
 Conservation of Personal
Integrity:
 based on helping the person preserve his or
her identity and selfhood.

 Example: deciding to protect the patient’s

private self by being careful to collect only
data that would influence the patient’s plan of
care, and proceeding with the design of
treatment plans that take individual
characteristics into account.
 Conservation Social
Integrity:
 based on helping the patient to preserve his
or her place in a family, society and
community.
 May include: Teaching the family about the
patient’s care needs or teaching persons with
colostomies how to handle food and fluid
intake and how to change the ostomy bag in
a manner that helps to minimize its being
evident to those they meet.
Evaluation:

 Evaluate to know if the person’s suffering

has been alleviated and that he or she is
willing and capable of no longer being
dependent. The evaluation data focus on
the effectiveness of adaptation in
achieving conservation and integrity in the
4 areas of conservation.
Critique...
Researchability

 All in all: Levine’s model served as an

excellent beginning. Its contribution has
added a great deal to the overall
improvement of the and development of the
Nursing Knowledge.
 Fawcett says: “more systematic evaluations
of the use of the model in various clinical
situations are needed.”
Clarity

 Levine’s model possesses clarity...

 Fitzaptrick and Whall believe Levine’s work

to be consistent internally and externally.
Simplicity

 Although the 4 conservation

principles initially appear simple,
they contain subcontents and
multiple variables.
Generality-

 the 4 conservation Principles

can be used in all nursing
contexts
Empirical Precision

 Levine used deductive logic to

develop her model, which can
be used to generate research
questions.
Strengths

 Universality: her concepts apply to all human

beings wherever they may be.
 She also indicates when nursing is needed—it
is needed by the person in a predicament of
illness who is willing to become dependent in
relation to that predicament.
 Thus the use of this work is not limited to any
given setting but may be used wherever there
is a nurse and a patient.
Strengths

 Careful use of words:

 Careful use of terminology provides clarity to the
reader
 Provides clear connections to the works of
others9adjunct disciplines) and helps readers
understand how these works can be used in a way
specific to nursing.
Her stress on the wholeness of the person and the
importance of integrity is very useful.
Limitation

 Despite the comprehensiveness and wide

application of Levine’s theory, the model is
not without limitation.

 The need for each nurse to create his or her

own assessment tool to use Levine’s
conservation principles...
 Limitations
 Levine’s conservation model focuses on illness as
opposed to health; thus, nursing interventions are
limited to addressing only the presenting condition
of an individual. Hence, nursing interventions under
Levine’s theory have a present and short-term focus
and do not support health promotion principles,
even though health promotion is an essential
component of current nursing practice. Thus,
Levine’s model does not add support to the use of
interventions that prevent ulcer occurrence and
reoccurrence in susceptible individuals.
 Summary

 Myra Levine’s theory has evolved from a

publication whose initial intention was the
organization of medical-surgical nursing content
to facilitate student learning.
 Her theory interrelates the concepts of
adaptation, conservation, and integrity
 Adaptation is the process by which conservation
occurs.
 Human Beings are in constant interaction with
their environments.
 It is this Interaction that creates the need for
Adaptation...
 As the environment changes, the person
must adapt...
 Successful Adaptation will achieve the best fit
with the environment and will do so in a
manner that conserves energy, structural
integrity, personal integrity, and social
Integrity.
 The purpose of Conservation is
Health or Integrity—the
wholeness of the person.