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Running head: Myra Levines Conservation Model

Myra Levines Conservation Model


Laura K. Martin
Southeastern Louisiana University

Running head: Myra Levines Conservation Model

Myra Levines Conservation Model


Myra Levines Conservation Model was initially developed not with the intent to become
a theory in nursing. According to Stafford, Levine provided an organizational structure for
teaching medical-surgical nursing and a stimulus for theory development (Schaefer, 2010a).
Levine developed this model using the inductive reasoning techniques, borrowing information
from other disciplines while still retaining the basics of nursing. Her first statement of the
conservation principles was in The Four Conservation Principles in Nursing in 1969 (Schaffer,
2010a). Levine (1973) titled the first chapter of her textbook for medical-surgical nursing
Introduction to Patient-Centered Care and acknowledged that patient-centered care was
individualized patient care. She believed that scientific knowledge provides avenues for
dialogue among human beings but does not substitute for the basic relationships that they must
build with one another. Levine (1973) stated, Nursing knowledge, thoroughly grounded in
modern scientific concepts, allows for a sensitive and productive relationship between the nurse
and the person entrusted to her care (p.1). Nursing interventions must be founded not only on
the scientific body of knowledge that is available, but also in recognizing the holistic response of
the individual. This response indicated the nature of adaption taking place. When interventions
influenced adaptation favorably, then the nurse is acting in a therapeutic sense. When nursing
intervention cannot alter the course of adaption by maintaining current status or failing to prevent
deterioration, the nurse is acting in a supportive sense (Levine, 1973). The model is clear in
language, can be applied to all areas of nursing practice, and can serve as a framework to guide
the beginning nursing student, has the depth for to support the DNP in developing and testing
theory, and can guide the nurse researcher. For these reasons, this model was explored.

Running head: Myra Levines Conservation Model

The goal of Levines Conservation Model is to promote adaptation and maintain


wholeness using the principles of conservation (Schaefer, 2010b). Adaptation is the process of
change whereas conservation is the outcome of that adaptation. Adaptation is the process of
maintaining integrity within the realities of the environment. Every individual is one of a kind
and has a unique range of adaptive responses. Conservation of the integrity of the person is
essential to ensuring health and for providing strength to confront disability (Levine, 1991). In
the treatment of illness the importance of conservation is the focus on the reclamation of
wholeness, of health. Levine (1991) stated Every nursing act is dedicated to the conservation,
or keeping together, of the wholeness of the individual (p.3). Each individual has an internal
and an external environment (Schaefer, 2010b). The internal environment consists of the
physiological and pathophysiological aspects of the person and is constantly challenged by the
external environment. There are three sources of environmental challenges (Schaefer, 2010b).
The perceptual environment includes aspects of the environment which is perceived through the
senses. The operational environment is not directly perceived and may include pollutants,
radiation, and microorganisms. The conceptual environment includes cultural patterns including
language, spiritual beliefs and can shape beliefs and behavior.
Levine (1973) delineated four conservation principles of nursing which provide the
structure for understanding a wide variety of nursing activities. Conservation of energy requires
a balance of energy and a constant renewal of energy to maintain life processes (Schaefer,
2010a). Processes such as healing and aging provide challenges to energy. Conservation of
structural integrity recognizes the ability to sustain wholeness as well as to overcome insult and
injury and to restore structure and function (Levine, 1996). The defense of wholeness is healing.
The nurse guides adaptation to new circumstances for those who are left disabled. Conservation

Running head: Myra Levines Conservation Model

of personal integrity is the recognition of the self which is the unique way we use to define
ourselves to ourselves (Levine, 1996, p. 40). This is the defensive mode that insures the safety
of the private self. Dependency, even when brief, threatens personal integrity and creates stress
and anxiety. Social integrity is defined by the communities that surround the person such as
family, friends, workplace, school, religion and cultural heritage. Many behaviors are prescribed
by these communities and health is defined in the context of communities. Social problems are
not left behind when the individual enters the health care system.
Myra Levine defined nursing as a human interaction (Levine, 1973). She stated It is a
discipline rooted in the organic dependency of the individual human being on his relationships
with other human beings (Levine, 1973, p. 1). The goal of nursing is to promote adaptation and
to promote health, which is described as wholeness. This is accomplished through the
application of the conservation principles in practice: conservation of energy, conservation of
structural integrity, conservation of personal integrity, and conservation of social integrity. The
nurse must consider the individuals internal and external environments. Levine stated, The
holistic approach to nursing depends upon recognition of the integrated response of the
individual arising from the internal environment, and the interaction which occurs with the
external environment (Levine, 1973, p. 12). The nurse actively participates in the patients
environment and supports adaptations. Therefore, nursing intervention must not only be founded
on scientific knowledge, but also on the recognition of the context of the holistic response.
Levine described organismic responses for which the nurse is responsible for responding to the
request for healthcare. These responses include: response to fear (flight or fight), inflammatory
response, response to stress, perceptual response (Schaefer, 2010b). These responses assist the
individuals protect and maintain integrity. The nurse uses creative abilities and the scientific

Running head: Myra Levines Conservation Model

process to provide care (Schaefer, 2010a). The term nursing diagnosis is replaced by
trophicognosis which is a judgment based on the facts of the patients predicament.
In an Convocation address at Loyola University in 1992, Myra Levine was described as a
Renaissance woman who was highly principled, remarkable, and committed to what happens to
the patients quality of life (as cited in Schaefer, 2010b, p.83). Levine was born in Chicago in a
home filled with love and warmth. She had two siblings with whom she was close and she also
enjoyed a close relationship with her parents. Her father was a hardware man who was often ill
and hospitalized with gastrointestinal problems. Levines mother was devoted to caring for her
father whilst he was ill which was why Levine developed such a great interest in nursing
(Schaefer, 2010b). Levine received her diploma from the Cook County School of Nursing in
Chicago in 1944. She earned her Bachelor of Science degree from University of Chicago in
1949 and a Master of Science degree in nursing from Wayne State University in 1962. In 1992
she received an honorary doctorate from Loyola University.
Myra Levine had a rich and varied career. Her experiences included private duty nursing,
civilian nursing in the U.S. Army, director of nursing at Drexel Home, and surgical supervisor.
She enjoyed had a rich academic career as well. She worked as a preclinical instructor and held
positions ranging from faculty member, department chairperson, and graduate nursing program
coordinator in several universities and schools of nursing (Schaefer, 2010a, 2010b). Levine was
a visiting professor at Tel Aviv University in Israel and Recanati School of Nursing at Ben
Gurion University of the Negev in Beer Sheva, Israel (Schaefer, 2010b). She also served as the
director of the Department of Continuing Education at Evanston Hospital.
Levine developed her model as a starting point to provide the whys of nursing activities
(Fawcett, 1991). She understood that the serious study of any discipline required a theoretical

Running head: Myra Levines Conservation Model

baseline to provide substance and meaning. She did not underestimate the importance of
technical skills and in fact stated that technical skills are the silent language of the nurse and
without them all of the book knowledge is useless (Levine, 1973, p. xi). Newman stated
Levines attention to the theoretical basis for nursing came at a time when nursing was
recognizing the need for substantive knowledge (as cited in Fawcett, 1991). She spoke out
against the growing functionalism in nursing with a reorientation to the wholeness of each
patient (Fawcett, 1991). Levine (1973) stated, effective human interaction remains basic to the
nursing role, and it emphasizes that the whole man is the focus of nursing intervention in health
and sickness, in tragedy and joy, in hospitals and clinics and in the community (Levine, 1973, p.
vii). She was concerned with expanding technology being blamed for the many ills of society.
Levine viewed technology as tools that expanded the resources for renewed well-being. She
stated nursing practitioners can learn to use the technology as tools, instruments that expand and
enlarge the human interaction that is essential to the nurse-patient exchange (pp. vii-viii).
Myra Levine was influenced by a variety of sciences and individuals whose knowledge
and teachings were certainly applicable to both the science and art of nursing. Among those
influences were Koch and Pasteur, Selye, Hippocrates (environmental interactions), Tillich
(holism), Bernard (interdependence of bodily functions), Cannon (homeostasis), Waddington
(homeorhesis) (Levine, 1973; Schaefer, 2010b). She acknowledged the scientific knowledge of
the modern world and that nursing knowledge is grounded in modern scientific concepts (Levine,
1973). Levine (1991) stated that nursing cannot ignore any discipline that deals with human
beings. Every science that contributes to the knowledge of the human condition is a fit subject
for the nurse theorist. However all of this adjunctive theory must be used correctly.

Running head: Myra Levines Conservation Model

Levines influences in nursing included Florence Nightingale for her focus on


observation, discussion of social integrity, and concern for sanitation, which implied interaction
between the person and the environment (Schaefer, 2010b). Irene Beland was an influence due
to her view of nursing as a compassionate art as well as rigid intellectual pursuit. Myra Levine
was proud that Martha Rogers was her first editor (Schaefer, 2010a).
Myra Levine received numerous honors for her contributions to nursing including,
charter fellow of the American Academy of Nursing (1973), honorary member of American
Mental Health Aid to Israel (1976), and honorary recognition from the Illinois Nurses
Association (1977) (Schaefer, 2010a, p. 226). She also received the first Elizabeth Russell
Belford Award for excellence in teaching from Sigma Theta Tau. Both editions of her text,
Introduction to Clinical Nursing, received the American Journal of Nursing Book of the Year
award. Levines book, Renewal for Nursing, was translated into Hebrew. She was listed in
Whos Who in American Women from 1977-1988 and in Whos Who in American Nursing in 1987
(Schaefer, 2010a). She was elected fellow of the Institute of Medicine of Chicago and was
recognized by the Lambda Chapter of Sigma Theta Tau for her outstanding contributions to
nursing in 1990 (Schaefer, 2010a). Levine was a leader in the American Nurses Association and
in the Illinois Nurses Association. She remained active in theory development following
retirement in 1987 and encouraged continued research about her theory (Levine, 1996). Levine
was a frequent speaker at programs, workshops, seminars and panels. She was also a prolific
writer regarding nursing and education with many books and journal articles in print.
Levine valued a holistic approach to the care of all people whether well or sick (as cited
in Schaefer, 2010a). Schaefer and Pond (1991) provided examples of the Conservation Theory
in practice. These included examples for the care of children, emergency care, ambulatory care

Running head: Myra Levines Conservation Model

of the homeless, chronic pain management, care of the patient with congestive heart failure, and
care of the burn patient. Levines model provided a thoughtful guide to nursing practice in
wound management in order to improve wound healing and promote individual well-being and
quality of life (Leach, 2006). An assessment of families of the critically ill has been devised
based upon the model in order to meet the holistic needs of these families and to enhance
comprehensive patient-family care (Lynn-McHale & Smith, 1991). Neswick (1997) examined
the model for enterostomal (ET) nursing and determined that the conservation principles provide
a basis for comprehensive and holistic ET nursing.
Grindley and Paradowski (1991) describe using Levines model to develop undergraduate
and graduate nursing programs in nursing at Allentown College of Saint Francis de Salles in
Center Valley, Pensylvania. A curriculum for the undergraduate students was developed which
reflected both the requirements of the college and that supported Levines conservation
principles. The conservation principles provide the basic organizing theme with the emphasis on
holistic care. One of the greatest strengths of using this model has been its adaptability
(Grindley & Paradowski, 1991). It has stood the test of time and the impact of technology.
Rather than limiting the graduate student to a single model, each course contains at least one
objective of Levines Model. In concert with Levines philosophy, a strong background in
research and physiology is required. Students learn about Levines conservation principles yet at
the same time how other nurses view a specific concept.
The Conservation Principles have served as a useful approach for bringing sound science
to nursing through research (Levine, 1996). Schaefer (1991) stated that Levines Conservation
Model provides an appropriate framework to study phenomena related to nursing. It can serve as
a useful guide for both quantitative and qualitative research (Schaefer, 1991). Mefford and

Running head: Myra Levines Conservation Model

Alligood (2011) used Levines Conservation Model to test a theory of health promotion for
preterm infants. The model was used to study fatigue in patients with congestive heart failure
(Schaefer & Potylycki, 1993). Mock et al. (2007) used Levines model as a framework for
investigation of the effects of fatigue in cancer patients. Levines Conservation Model has
usefulness in for nursing service administration as the structure of nursing care plan and for
providing guidelines for staff development at Alverno Health Care Facility in Clinton, Iowa
(Fawcett, 1991). The care plan is organized according to the conservation principles and
contains a summary of the patients trophicognosis. The model has been used to identify process
and outcome criteria for the nursing care of patients with cardiovascular problems (Fawcett,
1991). Conservation principles have been used to set goals and to use as a frame of reference for
commonly recurring nursing problems for patients with neurologic problems (Fawcett, 1991).
Fawcett (1991) stated, A hallmark of Levines Conservation Model is the accurate use of
knowledge from what Levine called adjunctive disciplines (p. 41). She has used the knowledge
from scholars of other disciplines appropriately when developing her model. There is a lack of
major limitations which suggests that the model may be an effective guide for nursing actions
(Fawcett, 1991). Levine (1996) acknowledged that the science principles from adjunctive
disciplines had increased exponentially since she first developed the model 30 years prior and
she believed that this growth of knowledge would continue. She expected this growth in
knowledge to only increase the research possibilities for the model. According to Stafford the
philosophical, ethical, and spiritual implications of the model are research challenges yet to be
realized (Stafford 2010a, p. 233).
As an employee in a hospital setting within a larger healthcare system, Myra Levines
Conservation Model can be appropriately applied in both the hospital as well as clinic settings.

Running head: Myra Levines Conservation Model

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The model, by design, is a patient-centered model, which is now acclaimed as the answer to costeffective care (Schaefer, 2010b). The nursing care delivery model at Ochsner Health System is
said to be patient-centered, however care delivery continues to be process and system oriented
rather than patient oriented. In a time of value based purchasing we must put the patient at the
center of our care in order to survive. The language of Levines Model is clear with a logically
holistic view of the person which can be translated into any area of practice. It can serve as a
sound reference in my practice of educating staff, ensuring competency, in examining processes
and procedures within the system, as well as communicating with staff and leadership the
meaning of patient-centered care. The model can also serve as a framework for research in the
practice setting demonstrated by the variety of research utilizing this model. These research
findings may be applied and validated or new research can be conducted with this model as a
theoretical framework. Just as Levine valued the contributions of other disciplines with this
model, the interdisciplinary team could benefit as well. It is my belief that the conservation
principles could be of value for team members such as respiratory therapy; physical, speech, and
occupational, therapies; dietetics; and pastoral care among others. Due to the clarity of the
language, the focus and the goals of the model can be clearly communicated across disciplines.
Study of Levines Model has been consistent with my talents and goals. This provides a
framework which is not only patient-centered, but is truly applicable to any setting and can be
clearly communicated to any person in the healthcare setting. I have been stimulated by learning
about this model and look forward to using this theory as a framework and reference point for
continued practice. In a video excerpt featuring Myra Levine, she stated that she wanted nurses
to use her model in a way that made sense to them (FITNEinc, 2011). If nurses chose to use it in
a way that she would not, it did not make any difference as long as they learned in the process.

Running head: Myra Levines Conservation Model

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References
Fawcett, J. (1991). Analysis and evaluation of Levines conservation model. In M.E. Schaefer &
J.B. Pond (Eds.), Levines conservation model: A framework for nursing practice (pp. 1343). Philadelphia: F.A. Davis.
FITNEinc. (2011, October 3). The nurse theorists Myra Levine promo [YouTube]. Retrieved
from http://www.youtube.com/watch?v=C8tJUjDDKKw
Grindley, J., & Paradowski, J.M. (1991). Developing an undergraduate program using Levines
model. In M.E. Schaefer & J.B. Pond (Eds.). Levines conservation model: A framework
for nursing practice (pp.199-208). Philadelphia: F.A. Davis.
Leach, M.J. (2006). Wound management: Using Levines conservation model to guide practice.
Ostomy Wound Management, 52(8). Retrieved from http://www.owm.com/content/wound-management-using-levine%E2%80%99s-conservation-modelguide-practice

Levine, M.E. (1973). Introduction to clinical nursing (ed. 2). Philadelphia: F.A. Davis.
Levine, M.E. (1991). The conservation principles: A model for health. In K.M. Schaefer & J.B.
Pond (Eds.). Levines conservation model: A framework for nursing practice (pp. 1-11).
Philadelphia: F.A. Davis.
Levine, M.E. (1996). The conservation principles: A retrospective. Nursing Science Quarterly
9(1), 38-41.
Lynn-McHale, D., & Smith, A. (1991). Comprehensive assessment of families of the critically
ill. AACN Clinical Issues 2(2), 195-209.
Mefford, L.C., & Alligood, M.R. (2011). Testing a theory of health promotion for preterm infants
based on Levines conservation model of nursing. The Journal of Theory Construction in
Nursing, 15(2), 41-47.

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Mock, V., St. Ours, C., Hall, S., Bositis, A., Tillery, M., Belcher, A., Krumm, S., & McCorkle, R.
(2007). Using a conceptual model in nursing research mitigating fatigue in cancer
patients. Journal of Advanced Nursing 58(5), 503-512. doi: 10.1111/j.13652648.2007.04293.x
Neswick, R.S. (1997). Myra E. Levine: A theoretical basis for ET nursing. Journal of WOCN,
24(1), 6-9.
Schaefer, K.M. (2010a). The conservation model. In M.R. Alligood & A.M. Tomey (Eds.),
Nursing theorists and their work (pp. 225-241), Maryland Heights, MO: Mosby Elsevier.
Schaefer, K.M. (2010b). Myra Levines conservation model. In M.E. Parker & M.C. Smith
(Eds.), Nursing theories & nursing practice (3rd ed.) (pp. 83-103), Philadelphia: F.A.
Davis.
Schaefer, K.M. (1991). Developing a graduate program in nursing: Integrating Levines
philosophy. In K.M. Schaefer & J.B. Pond (Eds.), Levines conservation model: A
framework for nursing practice (pp. 209-217). Philadelphia: F.A. Davis
Schaefer, K.M., & Pond, J.B. (1991). Levines conservation model: A framework for nursing
practice. (pp.209-217). Philadelphia: F.A. Davis.
Schaefer, K.M., & Potylycki, M.J.S. (1993). Fatigue associated with congestive heart failure: use
of Levines conservation model. Journal of Advanced Nursing, 18, 260-268.

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