Levine’s nursing theory provides a cognitive approach that can facilitate the nursing jobs in developing and framing interventions that are widespread or comprehensive in nature for better and more effective curative objectives and results. The Conservation theory propounded by Myra E. Levine born in Chicago in the late 1960s was greatly inspired to choose nursing as her career due to her father’s ill health. The model emphasizes the adaptive nature of human beings towards their environment. Application of the conservation model provides a platform for nursing care standards.
A Levine’s model is a conceptual model rather than a theory as it includes a set of relatively abstract and general concepts that reflect a common interest in the nursing discipline. It provides a distinctive structure that guides the nurses on how to observe and interpret the nursing issues it defines each meta paradigm including people, environment, health and nursing in a detailed and descriptive manner (Fawcett J, 2005).
Levine’s Conservation Model was constructed to aid medical surgical nursing based on the firm belief that medical practices should be completely based on conservation principles. Such principles can be promoted by encouraging bed rest, maintaining pressure care areas, preservation of privacy. All the four principles of Conservation, energy, social, personal and structural integrity are highly compatible with the Wound Management Practices as they are testable and specific in nature.
Levine’s model is popular among nursing practices as it provides a scientific approach for the implications of nursing practices and interventions. Right from the extension of clinical practices to the administration part such principles of conservation are perfectly applicable. They help in the anticipation and prediction of all related areas of nursing practices and help in the construction of an organized framework.
The major utility of the model revolves around the fact that an interface between an individual and his environment is constantly maintained which can certainly be useful for rendering off contemporary nursing practices. (Martsolf and Mickley, 1998). The model is based on four main principles of conservation of energy that balances input and output energy to avoid unnecessary fatigue and stress, personal integrity helps in restoring self-confidence, integrity and sense of belongingness and identity, structural integrity prevents physical breakdown and enhances and speeds up the healing process, lastly, social integrity creates awareness among the patients that they are social human beings, all four together facilitate in the nursing care decision making (Langer VS, 1990).
Most of the nurses prefer to adopt the Conservational Model as it extends a scientific and research-oriented approach (Leach J M). Through the Conservation model, nurses are able to deliver high-quality remedial measures for critically ill patients in a less stressful and protective manner. The principles are apt in the treatment of a patient’s wound, ostomy and continence problems (Neswick RS, 1997).
The model’s prime focal point is adaptation and wholeness. It is based on the belief that every individual has a unique range of responses which may vary due to a natural change in age, or because of distinct factors like gender, heredity or health experiences. The patient is able to adapt himself to the changing environment maintaining his integrity through the controlled use of environmental resources which further promotes the ‘wholeness’ of the model.
The nursing paradigm of the conservation theory includes ‘Person’, who is holistic striving to sustain integrity and wholeness. An individual who has a distinct identity in feeling, believing, thinking, analyzing, perceiving etc. the paradigm also entails ‘Environment’, both internal and external. The Homeostasis internal environment provides a base for synchronized physiological and psychological factors while Homeorrhesis internal environment describes the pattern of adjustments. On the other hand, the external environment includes conceptual, operational and conceptual viewpoints.
The interface between the ‘person’ and the ‘environment’ is maintained through adaptation, organismic response and conservation. Another paradigm to the theory is ‘Health’, which comprises of both wholeness and adaptation which not only means healing of an inflicted body part but the ability of the individual to restart his normal life course without constraints. ‘Nursing’ is taken as human interaction, a profession that relies on effective communication and building healthy personal relationships with others.
The characteristics of the conservation theory reflect on the varied ways of looking at the phenomenon, a comprehensive viewpoint of nursing care, heading in a sequential and logical manner. The theory is simple, easy to use and provides the base for a hypothesis that can be tested. It is most effective in acute care settings. The conservation theory is based on the assumption that nurses have the potential to create an environment that is most suitable for quicker healing.
All human beings are unique in sensing, reflecting, reasoning, understanding, strategizing etc; they are agents who act deliberately to achieve specific goals and objectives. Every individual possesses an adaptive ability based on his personal experiences that help in generating unique messages. A human being is a social animal and constantly interacts with his environment and society. All that is needed is the nursing profession to deal with the emerging demands of self-care.
The conservational model involves two main theories, the theory of redundancy which redefines all aspects of human life and the therapeutic theory finds out ways to organize the nursing intrusions which have to be confronted in medical practices. It also adds up to healing through natural response restores integrity, ensures comfort and stimulates the physiological process.
Levine’s model can also be used as a theoretical tool for wound management to add on to the best nursing practices engrossing wholeness and health keeping the cost within reasonable limits.
As per the case undertaken, a patient was currently discharged who was on Gastro Intestinal unit (GI). The patient’s case history revealed that she was admitted in her 50s suffering from adenocarcinoma pancreas, recovered from laprosectomy due to cancer, problem in the gall bladder, bile duct and duodenum, antiphospholipid antibody, DVT, HTN, and cardiomyopathy. Lost a pregnancy in the 1980s. The patient is undergoing extreme pain, is fearful and anxious.
The interventions provided in the above case were Morphine IV to release the pain. The client had PRN Percocet, continuous vomiting, so was intervened through gravel. The patient is insulin dependant diabetic, CBS QID, IV antibiotics Vital signs QID Foley catheter-, draining dressing and wound drainage- serosanguinous small amount mobile within assist, DAT, unable to ambulate with physiotherapist because of pain.
For the treatment of the patient, Levine’s Conservation Model was applied to provide the best wound management and nursing care. The following procedure was adopted as per the model intervention:
- Firstly Assessment is to be carried out which includes a collection of facts through observation, interviews related to the internal and external environment based on the four principles of the Conservation Model. Nurses are supposed to observe the patients identify organismic responses to illness and the factors that affect the patient.
- Secondly, Trophicognosis is conducted to diagnose the provocative facts in a patient. A scientific and systematic study is applied so as to a nursing care judgment plan about the patient’s needs, assistance and requirements depending upon the data collected and interpreted.
- The third step includes the declaration of the hypothesis which involves detailed planning; the hypothesis proposed by the nurse determines the future course of action or in other words, it helps in drafting the nursing plan which highlights all the problems and their supportive remedial measures. The key points of Levine’s Conservation model adaptation and wholeness should be the focal areas of the nursing plan.
- The fourth step of the nursing process aims to pinpoint the interventions required for the cure of the patient by testing the hypothesis. The interventions designed are in accordance with the conservation principles emphasizing the main areas of adaptation and wholeness, which are mutually acceptable by all.
- The last procedure is the evaluation of the entire process including meticulous observations of the organismic responses to the jotted interventions, assessing whether the hypothesis is appropriate or not and finally reframing the hypothesis if found unsuitable with the nursing plan.
As per the case study, the following nursing process in accordance with Levine’s Conservational model was followed:
Assessments
- Challenges to Internal Environment: weight loss, nausea, pain, anxiety, increased blood pressure
- Challenges to External Environment: unhealthy family relations, unhygienic conditions at home, lack of care
- Energy Conservation: weight loss, nausea, pain, high blood pressure, diabetes
- Structural integrity: unable to ambulate with physiotherapist because of pain, QID Foley catheter, threatened by surgical procedure
- Personal Integrity: lost a baby, absence of duodenum
- Social Integrity: Unhealthy family terms
Trophicognosis
Inadequate Nutritional Status
Pain
Wound and Bladder infection
Draining dressing
Need to learn self-catheterization
Feeling Low
Decreased self-confidence
Hypothesis
Nutritional Consultation
Care of Surgical Wound
Exploring concerns regarding diabetes, Blood Pressure, OID Foley Catheterization
Interventions
Energy Conservation
Providing medication for pain and nausea, BP, Diabetes
Allowing rest period
Physical Intervention
For energy conservation, during wound management as in this case, nurses may select wound treatments that restore skin integrity and help in the reduction of energy consumption which would benefit in less expenditure and less pain and trauma. For the assessments of such energy effects, the nurse needs to constantly measure the energy discharge.
Structural Integrity
Supervising antibiotic for Wound
OID Foley Catheterization
A change in the structure affects functions. To achieve the hypothesis stated in the process constant healing and repair needs to be undertaken. The nurses if through their analyses are able to identify the disease in the initial stages then tissue destruction can be controlled which promotes structural integrity.
Personal Integrity
Exploring her feelings about cancer and other problems interfaced while respecting her privacy as well.
Personal integrity includes self-identity and privacy. Protecting patient’s privacy, possessions, respecting personal choices are a part of personal integrity. Constant knowledge and support should be imparted by the nurses so that the patient is able to live an independent life.
Social Integrity
Assessing the support of the family
Social Integrity includes the support of family and friends. It includes all aspects related to different cultures, religions, education, status, lifestyle etc.
Organismic response
Controlled Pain
Wound Healing
Improved Nutrition
Support from family and relatives
Critiquing the Theory
A holistic approach to all individuals
Patients involvement in nursing care
The direction of nursing research, tools and techniques
Logical congruency
Evaluation
The application of the model does help in the treatment of the patient, enabling them to adapt to the environment and ensuring comfort and confidence in the family as well.
Limitations
A very little emphasis is given to actual health promotion and prevention of the disease. It all depends upon the judgment and perception of the nurse about the patient’s participation in the nursing plan, however, if the intervention developed by the nurse is inappropriate, the whole plan has to be reframed resulting in wastage of resources, time and cost as well leading to increase in stress and anxiety levels of the patient. The dependency of the patient is completely ignored.
In the above case supportive as well as therapeutic interventions were applied to prevent deterioration of health, aggravate the healing process and restore health and energy through various observations and their corresponding interventions. In this case, it is also observed that a combination of appropriate primary dressings and compression therapy may result in better results.
Apart from the above analysis, many past types of research have supported the implementation of the conservation Model. So far there has been numerous evidence where the implication of Levine’s conceptual model including the four main principles has been applied as the best nursing alternative. In a study conducted by Piccoli M; Galvão CM(2001), a sample of 30 patients including both males and females was undertaken who had already been subjected to surgery.
The objective of the study was to identify a nursing diagnosis of the patients during the pre-operative visits. The implementation of Levine’s model confirmed the nursing diagnosis infection risk up to 100%. The theoretical framework of the model helped the nurses to chalk out a preventive and infection control care plan.
The Levine’s Conservation Model of nursing is also selected by many medical practitioners for neonatal intensive care nursing to render a holistic care treatment to the infant as well as the family members. Mefford LC (2004) identified that premature infants face a lot of difficulty in survival in the extrauterine environment, not only this; even the family goes through a tough time. Thus, the use of Levine’s conservation models facilitates the nursing care procedure
Studies have also highlighted the wholeness concept of Levine’s Conservation Model. It is observed that when the family of the client enters the critical care unit, a significant amount of stress is born by them with numerous kinds of diversified needs.
At such critical times, dysfunctional behaviour may lead to unsuccessful management (Lynn-McHale DJ; Smith A, 1991). In a study conducted by the authors, Smith and Lynn a complete family assessment tool based on Myra Levine’s Principles of Conservation was prepared for the enhancement of patient and family care and reassuring families that they are an imperative part of their relatives’ care and recovery. The model helps the nursing practices by individual assessment and helping in the accomplishment of the holistic needs of families.
In a study conducted by Schaefer KM; Shober Potylycki MJ (1993), a descriptive approach based on the Conservation model was framed to provide data in regard to fatigue-related with congestive heart failure, both quantitative and qualitative analyses were adopted. Qualitative data featured the principle of personal integrity while quantitative data reflected on the other three principles of energy conservation, structural and social integrity. Tiredness and exhaustion were the major causes of fatigue resulting due to stress, physical activity and diseases. The findings were deducted as per Levine’s model including the holistic approach for nursing implications for fruitful results.
To further strengthen the importance of the Levine’s Conservation model, research conducted by Mock V; St Ours C; Hall S; Bositis A; Tillery M; Belcher A; Krumm S; McCorkle R(2007), guided the investigation of an exercise intervention to lessen the cancer-related fatigue via the theoretical frameworks to build an organizing framework for their studies. The Levine Conservation Model provided a useful tool to investigate the effects of exercise on fatigue and physical functioning in cancer patients. The four conservation principles aided in chalking out the exercise intervention and exploring the corresponding effects of the interventions.
The model also helped in selecting the appropriate instruments to measure study variables along with the analysis and interpretation of the data collected as per the four main model principles of energy, structural, personal and social integrity. The findings of the study stated that the use of the conceptual model aided in the designing and testing of theory-based interventions and augmenting the support services rendered to the nursing discipline as a whole.
Personal reflections of Levine’s Conservation model help to analyze that the four conservation principles address the integrity of the individual right from his conception, the birth stage till the last stage of his life. All body changes including each and every activity performed by the individual involve a specific amount of energy consumption which is most imperative for the functioning of the body. Hence, every activity must show deep respect and integrity adopting the structural wholeness of the individual for his better health and well being. Each individual has a distinct identity and chooses and conducts every activity as per the individual capacity and potential, also affected by the social system to which an individual is constantly exposed too.
In spite of all the advantages of the Conservational model, the crisis has pointed out the shortcomings which hinder the wholesome affectivity. The model is regarded as short term intervention which doe not support health promotion principles. Further, the model has no evidence so far in curing ulcer formations (Leach J M,). Levine’s claims that energy can be measured in everyday nursing practice, however, the validity and reliability of the indicators are unclear.
Still, the conservation model provides a thought-provoking basis for positive outcomes. In the words of Myra Levine, “Ethical behaviour is not the display of one’s moral rectitude in times of crisis,” (Levine M, 1977, p 846). The attitude of the person reflects his deep commitment towards the respect and individuality of a person. It’s an expression through which human beings relate with others in their normal core of day to day life. Scientific and technical knowledge is essential but it is incomplete till nursing is adopted as a humanitarian province. (Levine E M, 1999).
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