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LEVINE'S CONSERVATION MODEL IN NURSING

"Ethical behaviour is not the display of one's moral rectitude in times of crisis...It is the day-to-day expression of one's commitment to other persons and the ways in which human beings relate to one another in their daily interactions” - Myra Levine

Background
Myra Levine (a major influence in the nursing profession) set out to find a new and effective method for teaching nursing degree students major concepts and patient care. Levine's goal was to provide individualized and responsive patient care, that was less focused on medical procedures, and more on the individual patient's context.

The main focus of Levine’s Conservation Model is to promote the physical and emotional well being of a patient, by addressing the four areas of conservation she set out. By aiming to address the conservation of energy, structure, and personal and social integrity, Levine's model helps guide nurses in provision of care that will help support the client's health. Though conservation of physical and emotional well being is the most vital part of attaining a successful outcome for patients, two additional concepts, adaption and wholeness, are also extremely important in a patient's health;
 * Adaptation- adaptation consists of how a patient adapts to the realities of their new health situation- the better a patient can adapt to changes in health, the better they are able to respond to treatment and care.


 * Wholeness - the concept of wholeness maintains that a nurse must strive to address the client's external and internal environments. This allows the client to be viewed as a whole person, and not just an illness.


 * Conservation -the product of adaptation; “Conservation describes the way complex systems are able to continue to function even when severely challenged”. Conservation allows individuals to effectively respond to the changes their body faces, while maintaining their uniqueness as a person.

Key Concepts of the Conservation Model
The central concept of Levine’s theory is conservation. When a person is in a state of conservation, it means that individual has been able to effectively adapt to the health challenges, with the least amount of effort.

Myra Levine described the Four Conservation Principles. These principles focus on conserving an individual's wholeness:

Examples: Making available adequate time for rest and maintenance of nutritional needs.
 * Conservation of energy: Balancing energy input and output to avoid excessive fatigue. It includes adequate rest, nutrition and exercise.

Examples: Assist patient in exercise and maintenance of personal hygiene.
 * Conservation of structural integrity: Addressing physical needs that preventing physical breakdown and promoting healing.

Example: Recognize and protect the patient’s personal space needs.
 * Conservation of personal integrity: Recognizes the individual as one who strives for recognition, respect, self awareness and self determination; this allows the client to preserve their independence during their care.

Example: Help the individual to preserve his or her place in their family, community, and/or society.
 * Conservation of social integrity: Assisting the patient in maintaining social and community ties will increase their support system during their time is hospital, and will also help the client's sense of self-worth.

Nursing Process Using Levine’s Model


1.	Assessment- The collection of facts, by way of interviews and observation with the patient (considering conservation principles)

2.	Judgement (Trophicognosis)- The application of nursing diagnoses which will provide the collected facts with meaning in the context of the patient’s  circumstance

3.	Hypotheses- The application of interventions that aim to maintain the patient’s wholeness and promote their adaptation in the current situation

4.	Interventions- The use of interventions will test the nurse’s hypotheses

5.	Evaluation- Assessment of the client’s responses to imposed interventions.

Application of the Nursing Process in Levine’s Conservation Model
Assessment- The nurse will observe and speak with the patient, in conjunction with medical reports, results and diagnostic studies to gather information- referred to as the collection of provocative facts.

Patients will be assessed for challenges to their external and internal environments that may impede their ability to achieve complete wellness and health. Areas focused on which may present such challenges are:


 * Energy Conservation- the balance between energy expenditure and the client’s energy supply


 * Structural Integrity- the defense system for the body


 * Personal Integrity- the client’s sense of self-worth, independence and validation


 * Social Integrity- how well one can be part of a social system (family, community, etc.)

Judgement- Taking the provocative facts of the client’s situation and organizing them in a way that makes sense and adds meaning to the patient’s circumstances, in order to decide patient needs and possible nursing interventions. Using these judgments to decide about a patient’s needs is referred to as trophicognosis.

Hypotheses- Using his or her formed judgment, the nurse will speak with the client regarding these judgments with the client. Hypothesizing about the problem and its solution will eventually form a care plan for the patient.

Interventions- With the aim of promoting wholeness and adaptation, the nurse tests his/her hypothesis via direct care. These interventions aim to address the four areas of wellness (energy conservation, structural integrity, personal integrity and social integrity).

Evaluation- Evaluation of the interventions aimed at supporting the nurse's hypotheses seek to assess the client's response to the interventions. The evaluation considers both supportive outcomes (providing comfort to the client) and therapeutic outcomes (improving the client’s sense of wellness).

Limitations
Despite the wide application of Levine's theory, the model is not without limitation. For example, Levine's Conservation Model focuses on illness as opposed to health. This means that nursing interventions are limited, addressing only the presenting condition or environment of an individual. Therefore, nursing actions in relation to Levine's theory have a short-term focus as opposed to long-term, and do not promote illness prevention, which is a key component in the nursing profession.