LEWINE’S THEORY

 INTRODUCTION:- Myra Estrin Levine (1920-1996) was born in Chicago ,

Illinois . she was the oldest of three children. She had one sister and one brother
with whom she shared a close, loving relationship. She was also fond of her this
might father , who was a hardware man. He was often ill and frequently
hospitalized with gastrointestinal problems. She believed that this might have been
the reason why she had a great interest in nursing.
 Levin graduated from the cook country school of nursing in 1944 and obtained her
BS in nursing from the university of Chicagoin 1949.
 Following graduation , Levine worked as a private duty nurse, as civilian nurse for
the US army , as a surgical nursing supervisor, and in nursing administration.
 After earning an MS in nursing at wayne state university in 1962
 She authored 77 published articles which included “An introduction to clinical
nursing “ with multiple publication years on 1969 , 1973 &1989.
 She also received an honorary doctorate from Loyola University in 1992.
 She died on 1996.
 Levine told other that she did not set out to develop a “nursing theory” but had
wanted to find a way to teach the major concepts in medical- surgical and attempt
to teach associate degree students a new approach for daily nursing activities.
levine also wished to move away from nursing education practices that were
strongly procedurally oriented and refocus on active problem solving and
individualized patient care.

COMPOSITION OF CONSERVATION MODEL:-

 Levine’s conservation model is focused in promoting adaptation and
maintaining wholeness using the principles of conservation . the model
guides the nurse focus on the influences and responses at the organismic
level. The nurse accomplishes the goal of the model through the
conservation of energy , structure, and personal and social integrity.

[Link] 2. WHOLENESS [Link]

 1. ADAPTATION

Adaptation is the process of change , and conservation is the outcome of adaptation . adaptation
is the process whereby the patient maintains integrity within the realties of the environment.

 Every individual has a unique range of adaptive responses.

 The responses will vary by heredity, age ,gender or challenges of illness
experience.
 Example : the responses 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
environment resources by individual in his or her best interest.
2. Wholeness

Levine stated that “ the unceasing interaction of the individual organism with its environment
does represent an ‘open and fluid” system , and a condition of health, wholeness, exists when the
interaction or constant adaptation to the environment, permit ease --- the assurance of
integrity….in all the dimensions of life.

3. Conservation
‘the product of adaptation . conservation is from the Latin word
conservation, meaning “ to keep together”. “conservation describes
the way complex systems are able to continue to function even
when severely challenged. “through conservation , individual are
able to confront obstacles, adapt accordingly, and maintain their
uniqueness. “ the goal of conservation is health and the strength to
confront disability” as …”the rule of conservation and integrity
hold “ in all situation in which nursing is requires.”

The primary focus of conservation is keeping together of the wholeness of the individual.

Although nursing interventions may deal with one particular conservation principle, nurses must
also recognize the influence of other conservation principle (Levine1990).

NURSING PARADIGM:-
PERSON:- the person is a holistic being who constantly strives to preserve wholeness and
integrity and one “who is sentient , thinking , future – oriented, and past- aware.” The wholeness
(integrity) of the individual demands that the “individual life person is also described as a unique
individual in unity and integrity, feeling, believing , thinking and whole system of system.

ENVIRONMENT:-The environment completes the wholeness of the individual .the individual

has both an internal and external environment

HOMEOSTASIS

INTERNAL

ENVIRONMENT

HOMEORRHESIS

PERCEPTUAL

EXTERNAL OPERATIONAL
ENVIRONMENT

CONCEPTUAL
3. HEALTH:-LEVINE (1991) clarified what she meant by health as: the avenue of return to
the daily activities compromised but ill health. It is not only the insult or the injury that is
repaired but the person himself .it is not merely the healing of an affiliated part . it is rather a
return to self hood ,where the encroachment of the disability can be set aside entirely, and the
individual is free to pursue once more his or her own interests without constraint.”

* disease is “unregulated and undisciplined change and must be stopped or death will ensure.”

4. NURSING:-Nursing involves engaging in “human interaction” “the nurse enters into a

partnership of human experience where sharing moments in time ---some trivial, some dramatic
—leaves its mark forever on each patient. the goal of nursing is to promote adaptation and
maintain wholeness.

5. PERSON AND ENVIRONMENT :- person and the environment become congruent over
time. It is the fit of the person with his or her predicament of time and space . the specific
adaptive responses make conservation possible occur on many levels ;molecular , physiologic,
emotional, psychologic, and social.

Responses based on three factors

HISTORICITY

SPRCIFICITY

REDUNDANCY
CONSERVATION MODEL:-
1. Conservation of energy:-
 Refers to balancing energy input and output to avoid excessive [Link]
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
 Examples: 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 sp ace needs

4. Assumption :- a. the nurse creates an environment in which healing could occur

b. a human being is more than the sum of the part .
c. human being are unique in their response
d. human being response in a predictable way.
e. human being know and appraise objects , condition and situation.
f. human being sense , reflects, reason and understand .

g. human being action are self determined even when emotional .

h. human being are capable of prolonging reflection through such strategies raising
question.
i. human being make decision through prioritizing course of action.
j. human being must be aware and able to contemplate objects, condition and situation .
k. human being are agents who act deliberately to attain goal.
l. adaptive changes involve the whole individual.
m. a human being has unity in his response to the environment .
n. every person possesses a unique adaptive ability based on one’s life experience which
creates a unique message .
o. there is an order and continuity to life change is not random.
p. a human being respond organismically in ever changing manner.
 q. a theory of nursing must recognized the importance of detail of care for a single patient
with in an empiric frame work that successfully describe the requirement of the all
patient.
r. a human being is a social animal.
s. a human being is an constant interaction with an ever changing society.
t. 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.
GOAL OF NURSING :-
 To promote wholeness, realizing that every individual requires a unique and
separate cluster of activities.
 The individual integrity is his aiding concern and it is the nurse’s responsibility
to assist him to defend and to seek its realization.

LEVINES THEORY AND NURSING ASSESSMENT

It includes the following:-

ASSESSMENT TROPHICOGENOSIS HYPOTHESIS

EVALUATION INTERVENTION

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.
  The nurse assesses for physiological and patho physiological challenges to
the internal environment and the factors in the perceptual, operational,
and conceptual levels of the external environment that challenge the
individual.

TROPHICOGNOSIS:- (diagnosis)
 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 need for assistance

HYPOTHESIS:-
 Direct the nursing intervention with the goal of maintaining
wholeness and promoting adaptation, nurses seek validation of the
patients problem with the patients or support persons.
 The Nurses proposes hypothesis about the problems and the
solutions such as these and becomes the plan of care.
 Goal is to maintain wholeness and promoting adaptation .

INTERVENTION:-

 Testing the hypotheses. Nurse use hypotheses to direct care.

 The nurses tests proposed hypotheses and designs based on the
conversation principles: conversation of energy, structural
integrity and social integrity.
 Intervention are not required but are determined to be mutually
acceptable. The expectation is that this approaches will
maintain wholeness and promotes adaptation.
EVALUATION:-
 Observation of organism response to interventions, the outcome of hypothesis-testing is
evaluated are supported or not supported.
 Consequences of care are either therapeutic or supportive.
 Therapeutic measures improve the sense of well being.
 Supportive measures provide comfort when the downward course of illness can not be
influenced.
 If the hypotheses are not supported. The plan is revised an d new hypotheses are
proposed.
CASE STUDY

 MRS. JOHNES IS A 45YRS OLD women with breast cancer, she has been admitted to
the hospital for a bilateral mastectomy . Mrs. Jones is married, but in the process of
getting a divorce, she is the mother of 2 children and has not been in the work forces out
of the home for several years.

Levine’s theory Example

Assessment  Personal integrity :-body image disturbance;

inability to care for children.
 Structural integrity:- wound healing, weakness.
 Social integrity:- potentially strained relationship
with society.
Trophocgnosis  Pain
 Mobility
 Wound management
 Potential low self esteem

Hypothesis  Teaching : wound care, follow up treatment.

 Explore needs to help with children
 MSW consult for divorce and cancer support group
intervention  Explore body image
 Disciss the need for assistance at home
 Provide privacy dignity and respect
 Wound care
 Nutritional care
 Labs
 Concurrent treatment
 Physiological response to concurrent treatment
 Pain managemen t
 Allow for frequent rest periods

Evaluation  Fight/flight:- are vital signs

Acceptable: assess for effective coping mechanism
 Inflammatory response:- is the wound
healing :review and assess labs
 Response to stress :- assess nutritional intake: review
interactions with significant others
 Perceptual awareness:- how is the patient adapting
to her new body configuration: is she seeking
knowledge for follow up care?
Levine’s work and characteristics of the theory
1. Theoriews can interrelate concepts in such a way to create a different
way a looking at a different at a particular phenonmenon. Levine’s
has incorporated concepts of adaptation, conversation, integrity in a way
that provides a different nursing views.
2. Theories must be logical in nature:- levine’s work is logical. Onewe
thought or idea flows from the previous one and into the next.
3. Theories should e relatively simple and generalizable; there are only
three concepts in levine’s theory. This is the essence of simplicity. The
theory is “generalizable as it can be used in any setting with any human
being who is suffering and willing to seek assistance from a nurse.
4. Theories can be the basis for hypotheses that can be testes.
 Levines idea can be tested.
 Hypotheses can be derived from them.
 Researchers been conducted to test these hypothesese.
5. Theories contribute to and assist in increasing the general body of
knowledge within the discipline through the research implemented
to validate them.
 Research has been conducted using levines theory that you have
contributed to the general body of knowledge.
6. Theories can be used by the practitioner to guide and improve their
practice.
 Levine’s developed her work to teach nursing students. she had
a practice- oriented approach in doing so.
 Areas of nursing practice that have been reported in literature
include the homeless; patient with with burns, CHF, chronic pain
and epilepsy; clinical settings including critical care, child care
and long term care.
7. Theories must be consistent with other validated theries, 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 an
sciences.
UTILITY OF THE THEORY IN NURSING
In nursing practice
 Nursing actions and interventions should aim to conserve 4 areas of integrity:
 ENERGY:- The nurse will foster balance between energy output and input to avoid
excessive fatigue
 Support adjustment to changes in living situations (ie SNF)
 Improve nutritional status or control pain and anxiety
 Reduce patient activity when appropriate.
 Promote exercise.
 Rehabilitation within the patient’s abilities, limitations and comfort.
 CONCLUSION

by comparing the perspective of NSM and LCM it has been learnt that both
theorist focus on achievement of health through using uniqueness methodologies.
Despite using different concept and framework, these theories guide for nursing
assessment and intervention moreover this comparison explains that the NSM is
broad and provide rich content for comprehensive assessment and nursing care. On
other hand LCM appear with energy conversation focus. From all this it is gained
that nurse needs to understand explicit and implicit concept of theoretical
framework to assess and plan efficient nursing interventions.
 BIBLIOGRAPHY

 NAVNDEEP KAUR BRAR/ HC RAWAT, Text Book of advance Nursing practice, Second
edition, published by JAYPEE , Unit-VI philosophy and theories of nursing, topic levine’s
theory Page no. – 605– 614.
 [Link]
 [Link]
 [Link]

