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NURSING GRAND THEORY

NURSING GRAND THEORY
MYRA LEVINE: CONSERVATION MODEL

Student Names:

INTRODUCTION

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Conserving means keeping together, intact.

Conservation describes how complex systems continue to function despite facing challenges.

Individuals are able to confront obstacles, adapt accordingly & maintain their uniqueness.

This requires strength and good health in order to confront disability.

However, integrity & the conservation laws hold in all situations (Erickson, Tomlin & Swain, 2014).

The purpose of the conservation model is to improve the physical and emotional wellbeing of a person 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 (Alligood & Tomney, 2015).

Proposed that the nurses use the principles of conservation of:

  • Client Energy
  • Personal integrity
  • Structural integrity
  • Social integrity

A conceptual model with three nursing theories –

  • Conservation
  • Redundancy
  • Therapeutic intention

*

CONSERVATION MODEL

Nursing intervention is a conservation activity.

Conservation of energy is the main concern.

Guides nurses to focus on the influences & responses at the organismic level.

Goals of the model accomplished through the conservation of energy, structure, personal & social integrity.

Patients have different adaptive responses based on personal factors like gender, age & illness.

A patient in the conservation phase has been able to adapt to health challenges using very small effort.

Focuses on promoting adaptation & maintaining wholeness using the conservation principle.

The goal of Levine’s Conservation Model is to improve the physical and emotional wellbeing of a person, by considering the four domains of conservation she set out. By proposing to address the conservation of energy, structure, and personal and social integrity, this theory helps guide nurses in the provision of care that will help maintain and promote the health of the patient (Erickson, Tomlin & Swain, 2014).

*

CONSERVATION MODEL

The purpose of the conservation model is to improve the physical and emotional wellbeing of a person 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 nurses are seen as part of the environment and uses skill, knowledge, and compassion to assist each client to confront environmental challenges in resolving problems.

Effectiveness of interventions is determined by maintenance of client integrity.

Through conservation, individuals confront obstacles, adapt, and maintain their uniqueness. The goal of conservation is health. Focus of conservation is keeping together the wholeness of the individual. Stresses nursing interactions and interventions are based on the conservation principles. Nursing interventions are based on conservation of the client’s integrity in each of the conservation domains (Meleis, 2013).

*

PRINCIPLES

Principle of the conservation of:

Client Energy

Personal integrity

Structural integrity

Social integrity

Conservation of energy refers to balancing energy input and output to avoid excessive fatigue. It includes adequate rest, nutrition and exercise.

Conservation of personal integrity recognizes the individual as one who strives for recognition, respect, self-awareness, selfhood, and self-determination. It involves acknowledging and preserving patient’s space needs

Conservation of structural integrity refers to maintaining or restoring the structure of body preventing physical breakdown and promoting healing. It includes assisting patients in ROM exercise and the preservation of patient’s personal hygiene.

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. Nursing care should help the individual to preserve his or her place in a family, community, and society (Roy, 2014).

*

CONCEPTS

Wholeness (holism): “wholeness emphasizes a sound, organic, progressive, mutuality between diversified functions and parts within an entirety”; wholeness is integrity.

Adaptation: “process of change whereby the individual retains his integrity within the realities of his internal and external environment”; conservation is the outcome.

Conservation: “the way complex systems are able to continue to function even when severely challenged”

Wholeness is the singular, yet integrated response of the individual to forces in the environment.

Adaptation is the process of change and integration of the organism in which the individual retains integrity or wholeness. It is possible to have degrees of adaptation.

Conservation includes joining together and is the product of adaptation including nursing intervention and patient participation to maintain a safe balance (Sitzman & Eichelberger, 2011).

*

LEVINE’S THEORY IN NURSING

Nursing involves engaging or interacting with human beings.

The interaction requires proper communication while delivering care.

The quality of the interaction will have an impact on the patient in terms of recovery.

This should promote adaptation and at the same time enhancing wholeness.

Nursing is the human interaction relying on communication, rooted in the organic dependency of the individual human being in his relationships with other human beings (Meleis, 2013).

*

LEVINE’S THEORY IN HEALTH

Disease is “unregulated & undisciplined change”.

It must be stopped or else death will ensue.

Health is the avenue of return to the daily activities compromised by ill health.

The encroachment of the disability is completely set aside and the individual is free to operate without encountering constraints.

It is a return to selfhood.

Health is the pattern of adaptive change of the whole being. It should be noted that it is not only the insult or the injury which is repaired, but also the individual him/herself.

Health is not only the healing of an afflicted part, but a return to normalcy (Roy, 2014).

*

LEVINE’S THEORY IN PATIENT

A patient is a holistic being who constantly strives to preserve wholeness & integrity.

It is an individual who is sentient, thinking, future-oriented & past-aware.

The wholeness or integrity of the individual demands that the individual life has meaning only in the context of social life.

Person/patient is the unique individual in unity and integrity, feeling, believing, thinking, and whole (Sitzman & Eichelberger, 2011).

*

LEVINE’S THEORY IN ENVIRONMENT

The environment completes the wholeness of the individual.

Environment includes both the internal and external environment.

Focus is given to the three aspects of external environment drawn upon Bates’ (1967) classification which are:

  • The operational environment consists of the undetected natural forces which impinge on the individual.
  • The perceptual environment consists of information that is recorded by the sensory organs.
  • The conceptual environment is influenced by language, culture, ideas, and cognition (Alligood & Tomney, 2015).

*

RELATIONSHIP BETWEEN CONCEPTS

Conservation of energy is based on nursing interventions to conserve energy through a deliberate decision as to the balance between activity and the person’s available energy.

Conservation of structural integrity is the basis for nursing interventions to limit the amount of tissue involvement.

Conservation of personal integrity is based on nursing interventions that permit the individual to make decisions for himself or herself or to participate in the decisions.

Conservation of social integrity is based on nursing interventions to preserve the client’s interactions with family and the social system to which they belong.

The relationships between the concepts serves as the basis for nursing interventions. All nursing interventions are based on careful and continued observation over time (Erickson, Tomlin & Swain, 2014).

*

USEFULNESS OF THE THEORY

Mefford (2004) based her theory of health promotion for preterm infants on Levine’s conservation model.

Used to develop a nursing undergraduate program at Allentown College of Saint Francis de Sales in Center Valley, Pennsylvania.

A concept analysis was published using Levine’s conservation model to refine the concept of creativity for nursing practice.

Used in the graduate program at Allentown College of Saint Francis de Sales in Center Valley, Pennsylvania as the framework for development of the content of the graduate nursing courses.

Neswick (1997) suggested Levine’s model as the theoretic basis for enterostomal therapy (ET) nursing. She found Levine’s framework useful because of its holistic approach.

The four conservation principles of Levine’s model were used in the emergency department at the Hospital of the University of Pennsylvania as an organizing framework for nursing practice.

Strenghthened communication

Improved nursing care

Used in the directing of nursing care of children

Conservation of personal and social integrity important in healing ill children

Levine’s (1973) model has been useful in nursing education. For example, it was used to develop a nursing undergraduate program at Allentown College of Saint Francis de Sales in Center Valley, Pennsylvania, where it was deemed to be compatible with the mission and philosophy of the college. It was also used in the graduate program at the same school as the framework for development of the content of the graduate nursing courses. The emergency department at the Hospital of the University of Pennsylvania used the four conservation principles of Levine’s model as an organizing framework for nursing practice. It was believed that use of the model strengthened communication and improved nursing care in the hospital through an atmosphere of collaboration among disciplines. The conservation principles were also found to be useful in directing nursing practice in the care of children. The concept of adaptation and the four conservation principles were particularly relevant, and conservation of personal and social integrity was especially important to the healing of the ill child. A concept analysis was published using Levine’s conservation model to refine the concept of creativity for nursing practice. Mefford (2004) based her theory of health promotion for preterm infants on Levine’s conservation model. Neswick (1997) suggested Levine’s model as the theoretic basis for enterostomal therapy (ET) nursing. She integrated the four conservation principles into wound and ostomy care. The principles that she found useful are energy, structure, personal integrity, and social integrity. She found Levine’s framework useful because of its holistic approach (Meleis, 2013).

*

TESTABILITY

Piccoli and Galvao (2005) investigated methods of assessing and preparing perioperative nursing patients, focusing on Levine’s four conservation principles.

The Canadian Association of Critical Care Nursing, which published the abstract of Vandall-Walker, Jensen, and Oberle (2006), cited Levine in their investigation of nursing support of family members of critically ill adults.

Conserving the cognitive integrity of hospitalized elderly was the focus of a research study by Foreman (1991). In that study, 71 participants were administered several cognitive measures by an interview process. The researchers stated that the four conservation principles were supported in their study. The model has been the guide for qualitative studies to understand clients in their whole state. Extracted from: Schaefer, K. & Pond, B. (1993). Levine’s conservation model: A framework for nursing practice (pp. 134–149). Philadelphia: Davis.

Schaefer (1991b) reported a case study of a patient with congestive heart failure and found the model “pragmatic and parsimonious in studying the subject” (p. 130).

Mock and colleagues (2007) stated that the model “provided a useful framework” (p. 509) for their investigation of nursing interventions to manage fatigue in cancer patients.

Levine’s (1990) Conservation Model has guided research studies internationally.

Schaefer and Potylycki (1993) used Levine’s model to study fatigue in patients with congestive heart failure with a focus on client adaptation

Leach (2006) studied wound management in Australia using Levine’s four principles and found that the model contributed to health and wholeness of the client and assisted in cost-effective care (Meleis, 2013).

*

PARSIMONY

The model is fairly parsimonious.

Has many concepts with unspecified relationships and unstated assumptions.

According to Levine (1991), redundancy of the domains makes it simple to configure interventions by providing multiple means. However, when domain redundancy is lost by the seriousness of disease, the options for intervention are limited.

This makes it difficult for practitioners and researchers using the model to configure ways in which the model will be used or studied and to derive the theoretical structures that proceed from the model.

The model is fairly parsimonious whereby four conservation principles comprise the model. These principles are succinctly stated.

There are 15 concepts which are addressed by Levine’s model and 5 working assumptions covering both the individual and nursing care.

This model also requires some knowledge of the environment to which the patient is responding. In every stage, an assessment must be made to determine how effectively the patient is responding (Sitzman & Eichelberger, 2011).

*

VALUE IN EXTENDING NURSING SCIENCE

This model has value in guiding education and in implementing practice

Levine’s Conservation Model has provided 4 defining principles that are sufficiently universal to allow research and practice in a large number of situations.

The concept of holism was proposed at an early stage in nursing’s scientific history and has made an important difference in the care of clients.

Levine’s (1973) Conservation Model has impacted the discipline of nursing in education, practice, and research, providing four defining principles that are sufficiently universal to allow research and practice in a large number of situations.

The concept of holism, although not unique to this model, was proposed at an early stage in nursing’s scientific history and has made an important difference in the care of clients.

This model has value in guiding education and in implementing practice. It helps to fulfill the spirituality, goals, and values of both the client and nurse. Nurses use it in diverse clinical settings, such as psychiatric care, acute care, and community nursing. Several chapters and books by the author and associates, and numerous journal articles have been generated by this model (Alligood & Tomney, 2015).

*

ASSUMPTIONS

Each individual is an active participant in interactions with the environment.

The individual is a sentient being.

Change is the essence of life.

Change is unceasing as long as life goes on. Change is characteristic of life.

The decisions for nursing intervention must be based on the unique behavior of the individual patient.

Every man is a unique individual, and as such he requires a unique constellation of skills, techniques and ideas designed specifically for him.

 

*

REFERENCES

Alligood, M. & Tomney, A. (2015). Nursing Theory: Utilization & Application. St. Louis: Mosby.

Erickson, H., Tomlin, E. & Swain, M. (2014). Modeling and Role Modeling: A Theory and Paradigm for Nursing. Columbia: R.L Bryan.

Meleis, A. (2013). Theoretical Nursing: Development and Progress. London: Lippincott Williams & Wilkins.

Roy, C. (2014). Generating middle Range Theory: From Evidence to Practice. New York: Springer.

Sitzman, K. & Eichelberger, L. (2011). Understanding the Work of Nurse Theorists: A Creative Beginning. Burlington. Jones and Bartlett.

The purpose of the conservation model is to improve the physical and emotional wellbeing of a person 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 (Alligood & Tomney, 2015).

Proposed that the nurses use the principles of conservation of:

  • Client Energy
  • Personal integrity
  • Structural integrity
  • Social integrity

A conceptual model with three nursing theories –

  • Conservation
  • Redundancy
  • Therapeutic intention

*

Focuses on promoting adaptation & maintaining wholeness using the conservation principle.

The goal of Levine’s Conservation Model is to improve the physical and emotional wellbeing of a person, by considering the four domains of conservation she set out. By proposing to address the conservation of energy, structure, and personal and social integrity, this theory helps guide nurses in the provision of care that will help maintain and promote the health of the patient (Erickson, Tomlin & Swain, 2014).

*

The purpose of the conservation model is to improve the physical and emotional wellbeing of a person 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 nurses are seen as part of the environment and uses skill, knowledge, and compassion to assist each client to confront environmental challenges in resolving problems.

Effectiveness of interventions is determined by maintenance of client integrity.

Through conservation, individuals confront obstacles, adapt, and maintain their uniqueness. The goal of conservation is health. Focus of conservation is keeping together the wholeness of the individual. Stresses nursing interactions and interventions are based on the conservation principles. Nursing interventions are based on conservation of the client’s integrity in each of the conservation domains (Meleis, 2013).

*

Conservation of energy refers to balancing energy input and output to avoid excessive fatigue. It includes adequate rest, nutrition and exercise.

Conservation of personal integrity recognizes the individual as one who strives for recognition, respect, self-awareness, selfhood, and self-determination. It involves acknowledging and preserving patient’s space needs

Conservation of structural integrity refers to maintaining or restoring the structure of body preventing physical breakdown and promoting healing. It includes assisting patients in ROM exercise and the preservation of patient’s personal hygiene.

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. Nursing care should help the individual to preserve his or her place in a family, community, and society (Roy, 2014).

*

Wholeness is the singular, yet integrated response of the individual to forces in the environment.

Adaptation is the process of change and integration of the organism in which the individual retains integrity or wholeness. It is possible to have degrees of adaptation.

Conservation includes joining together and is the product of adaptation including nursing intervention and patient participation to maintain a safe balance (Sitzman & Eichelberger, 2011).

*

Nursing is the human interaction relying on communication, rooted in the organic dependency of the individual human being in his relationships with other human beings (Meleis, 2013).

*

Health is the pattern of adaptive change of the whole being. It should be noted that it is not only the insult or the injury which is repaired, but also the individual him/herself.

Health is not only the healing of an afflicted part, but a return to normalcy (Roy, 2014).

*

Person/patient is the unique individual in unity and integrity, feeling, believing, thinking, and whole (Sitzman & Eichelberger, 2011).

*

Focus is given to the three aspects of external environment drawn upon Bates’ (1967) classification which are:

  • The operational environment consists of the undetected natural forces which impinge on the individual.
  • The perceptual environment consists of information that is recorded by the sensory organs.
  • The conceptual environment is influenced by language, culture, ideas, and cognition (Alligood & Tomney, 2015).

*

The relationships between the concepts serves as the basis for nursing interventions. All nursing interventions are based on careful and continued observation over time (Erickson, Tomlin & Swain, 2014).

*

Levine’s (1973) model has been useful in nursing education. For example, it was used to develop a nursing undergraduate program at Allentown College of Saint Francis de Sales in Center Valley, Pennsylvania, where it was deemed to be compatible with the mission and philosophy of the college. It was also used in the graduate program at the same school as the framework for development of the content of the graduate nursing courses. The emergency department at the Hospital of the University of Pennsylvania used the four conservation principles of Levine’s model as an organizing framework for nursing practice. It was believed that use of the model strengthened communication and improved nursing care in the hospital through an atmosphere of collaboration among disciplines. The conservation principles were also found to be useful in directing nursing practice in the care of children. The concept of adaptation and the four conservation principles were particularly relevant, and conservation of personal and social integrity was especially important to the healing of the ill child. A concept analysis was published using Levine’s conservation model to refine the concept of creativity for nursing practice. Mefford (2004) based her theory of health promotion for preterm infants on Levine’s conservation model. Neswick (1997) suggested Levine’s model as the theoretic basis for enterostomal therapy (ET) nursing. She integrated the four conservation principles into wound and ostomy care. The principles that she found useful are energy, structure, personal integrity, and social integrity. She found Levine’s framework useful because of its holistic approach (Meleis, 2013).

*

Levine’s (1990) Conservation Model has guided research studies internationally.

Schaefer and Potylycki (1993) used Levine’s model to study fatigue in patients with congestive heart failure with a focus on client adaptation

Leach (2006) studied wound management in Australia using Levine’s four principles and found that the model contributed to health and wholeness of the client and assisted in cost-effective care (Meleis, 2013).

*

The model is fairly parsimonious whereby four conservation principles comprise the model. These principles are succinctly stated.

There are 15 concepts which are addressed by Levine’s model and 5 working assumptions covering both the individual and nursing care.

This model also requires some knowledge of the environment to which the patient is responding. In every stage, an assessment must be made to determine how effectively the patient is responding (Sitzman & Eichelberger, 2011).

*

Levine’s (1973) Conservation Model has impacted the discipline of nursing in education, practice, and research, providing four defining principles that are sufficiently universal to allow research and practice in a large number of situations.

The concept of holism, although not unique to this model, was proposed at an early stage in nursing’s scientific history and has made an important difference in the care of clients.

This model has value in guiding education and in implementing practice. It helps to fulfill the spirituality, goals, and values of both the client and nurse. Nurses use it in diverse clinical settings, such as psychiatric care, acute care, and community nursing. Several chapters and books by the author and associates, and numerous journal articles have been generated by this model (Alligood & Tomney, 2015).

*

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