Myra Estrin Levine: The Conservation Model of Nursing

Strip the theory away and Levine's question is one you ask at every bedside: how do I help this patient hold together with the least possible drain on what they have left. Myra Estrin Levine (1921–1996) built the Conservation Model around that idea. Nursing promotes adaptation and maintains wholeness through four conservation principles: energy, structural integrity, personal integrity, and social integrity. Levine never set out to write a theory. She was teaching medical-surgical nursing and needed a way to organize it.

Biography of Myra Estrin Levine

Early Life

Levine was born in Chicago in 1920, the first of three children. Her father had a chronic gastrointestinal illness, and her involvement in his care pulled her toward nursing.

Education

She earned her nursing diploma from the Cook County School of Nursing in 1944, a Bachelor of Science in Nursing from the University of Chicago in 1949, and a Master of Science in Nursing from Wayne State University in Detroit in 1962.

Career and Appointments

Levine moved through clinical, administrative, and academic roles. She was a private duty nurse in 1944, a civilian nurse in the U.S. Army in 1945, a preclinical instructor in the physical sciences at Cook County from 1947 to 1950, director of nursing at Drexel Home in Chicago from 1950 to 1951, and surgical supervisor at the University of Chicago Clinics from 1951 to 1952 and Henry Ford Hospital in Detroit from 1956 to 1962.

In 1951 she became a clinical instructor at Bryan Memorial Hospital in Lincoln, Nebraska, and administrative supervisor at the University of Chicago. She chaired clinical nursing at her alma mater, Cook County, from 1963 to 1967, rose through the academic ranks at Loyola University from 1967 to 1977 and the University of Illinois from 1962 to 1963 and again from 1977 to 1987, and coordinated the graduate oncology nursing program at Rush University from 1974 to 1977.

She directed the Department of Continuing Education at Evanston Hospital from March to June 1974 and consulted to it from July 1974 to 1976. She was professor of Humanistic Studies at the University of Illinois from 1981 to 1987 and became Professor Emerita of Medical-Surgical Nursing at the University of Illinois at Chicago in 1987. Abroad, she was a visiting associate professor at Tel Aviv University in Israel in 1974 and a visiting professor at the Recanati School of Nursing, Ben Gurion University of the Negev, in Beer Sheva, Israel, from March to April 1982.

Works

Levine spoke and wrote constantly on nursing and education and consulted to hospitals and nursing schools. "The Four Conservation Principles of Nursing" was her first statement of the conservation principles. Earlier work included Adaptation and Assessment: A Rationale for Nursing Intervention, For Lack of Love Alone, and The Pursuit of Wholeness.

She is best known for Introduction to Clinical Nursing, first published in 1969 with later editions in 1973 and 1989, where she developed how redundancy characterizes the availability of adaptive responses when stability is threatened.

Awards and Honors

Levine was a charter fellow of the American Academy of Nursing in 1973, held an honorary membership in the American Mental Health Aid to Israel in 1976, received honorary recognition from the Illinois Nurses' Association, was a member of Sigma Theta Tau at the Alpha Beta Chapter, Loyola University, was listed in Who's Who in American Women from 1977 to 1988 and Who's Who in American Nursing in 1987, and was elected fellow of the Institute of Medicine of Chicago from 1987 to 1991. She was the first recipient of the Elizabeth Russel Belford Award for excellence in teaching from Sigma Theta Tau in 1977.

Introduction to Clinical Nursing won an American Journal of Nursing (AJN) Book of the Year award, and her 1971 book Renewal for Nursing was translated into Hebrew. Loyola University of Chicago awarded her an Honorary Doctorate of Humane Letters in 1992.

Death

Myra Estrin Levine died on March 20, 1996, at the age of 75.

Nursing Theory: The Conservation Model

Levine treats nursing intervention as a conservation activity, with energy conservation as the core concern. The work happens at the level of the person: conserve energy, structure, and personal and social integrity, and you help the patient adapt to a health challenge with the least effort.

Every patient brings a different set of adaptive responses, shaped by age, gender, and illness. When a person is conserving, they can meet a health challenge with minimal effort. The model's aim is to improve physical and emotional well-being by addressing four domains of conservation.

What is the Conservation Model?

Nursing's role in conservation is to help the person hold the whole self together with the least amount of effort. Levine (1989) set out four principles of conservation:

1. The conservation of energy of the individual.
2. The conservation of the structural integrity of the individual.
3. The conservation of the personal integrity of the individual.
4. The conservation of the social integrity of the individual.

"The conservation principles do not, of course, operate singly and in isolation from each other. They are joined within the individual as a cascade of life events, churning and changing as the environmental challenge is confronted and resolved in each individual's unique way. The nurse as a caregiver becomes part of that environment, bringing to every nursing opportunity his or her own cascading repertoire of skill, knowledge, and compassion. It is a shared enterprise, and each participant is rewarded." (Levine, 1989)

Conservation of Energy

Balance energy input and output to avoid excessive fatigue. It covers adequate rest, nutrition, and exercise. On the floor: protect rest, sustain nutrition.

Conservation of Structural Integrity

Maintain or restore the body's structure, prevent physical breakdown, and promote healing. On the floor: range-of-motion exercise, attention to hygiene.

Conservation of Personal Integrity

Recognize the individual as someone who strives for recognition, respect, self-awareness, selfhood, and self-determination. On the floor: acknowledge and preserve the patient's space needs.

Conservation of Social Integrity

The patient lives within a family, a community, a religious group, an ethnic group, a political system, and a nation. On the floor: help them keep their place in family, community, and society.

Major Concepts of Levine's Conservation Model

The nursing metaparadigm and the model's major concepts:

Environment

The environment is both internal and external. Drawing on Bates' (1967) classification, it has three aspects: the operational environment is the undetected natural forces acting on the individual; the perceptual environment is the information recorded by the sensory organs; the conceptual environment is shaped by language, culture, ideas, and cognition.

Person

A unique individual in unity, integrity, feeling, belief, thinking, and wholeness.

Health

The pattern of adaptive change of the whole being.

Nursing

A human interaction built on communication, rooted in the human being's organic dependency in relationships with other people.

Adaptation

The process of change and integration of the organism in which the individual retains integrity, or wholeness. Adaptation comes in degrees.

Conservation

The product of adaptation. It joins nursing intervention and patient participation to maintain a safe balance.

Personal Integrity

A person's sense of identity and self-definition. Nursing intervention conserves it.

Social Integrity

Life's meaning gained through interactions with others. Nurses intervene to maintain those relationships.

Structural Integrity

Healing restores structural integrity through nursing interventions that promote healing and hold structure together.

Subconcepts

Three concepts of adaptation:

Historicity. Adaptation is historical. Responses are built on past experience, both personal and genetic.

Specificity. Each system has particular responses. The physiologic responses that "defend oxygen supply to the brain are distinct from those that maintain the appropriate blood glucose levels." (Levine, 1989)

Redundancy. The changes are sequential but not linear. Levine describes them as "cascades" in which one sequence is not yet finished when the next begins.

Energy Conservation

Nursing interventions are based on conserving the patient's energy.

Holism

The single, integrated response of the individual to forces in the environment.

Homeostasis

A stable state in which normal physiologic parameters shift to meet environmental changes. An energy-sparing state, a state of conservation.

Modes of Communication

The many ways information, needs, and feelings move among patient, family, nurses, and other health care workers.

Therapeutic Interventions

Interventions that influence adaptation favorably, expanding the adaptive responses available to the person.

Assumptions

Assumptions About Individuals

Each individual "is an active participant in interactions with the environment… constantly seeking information from it." (Levine, 1969) The individual "is a sentient being, and the ability to interact with the environment seems ineluctably tied to his sensory organs." And: "Change is the essence of life, and it is unceasing as long as life goes on. Change is characteristic of life." (Levine, 1973)

Assumptions About Nursing

"Ultimately, the decisions for nursing intervention must be based on the unique behavior of the individual patient." Care is individualized: "Patient-centered nursing care means individualized nursing care. It is predicated on the reality of common experience: every man is a unique individual, and as such he requires a unique constellation of skills, techniques, and ideas designed specifically for him." (Levine, 1973)

Relationships

Conservation of energy drives interventions that balance activity against available energy. Conservation of structural integrity drives interventions that limit tissue involvement. Conservation of personal integrity drives interventions that let the patient decide for themselves or share in the decision. Conservation of social integrity drives interventions that preserve ties to family and the social system they belong to. All of it rests on careful, continued observation over time.

Analysis of the Conservation Model

Many concepts overlap with other nursing theories, but the energy-conservation concept is what makes Levine's work distinct in guiding nursing action.

The concepts she borrowed from Bates on environment were not carried through to how the environment affects the individual, and that link matters when you build a model meant to be applied to human care. The concepts of conservation, adaptation, and integrity apply to any age group, since everyone needs to expend and reserve bodily energy.

Her operational definition of homeostasis is open to question. The body uses energy continuously to hold homeostasis, so calling homeostasis an energy-sparing state is vague and would benefit from rewording.

Strengths and Weaknesses

Strengths

Levine ties adaptation, conservation, and integrity together into a nursing view distinct from the adjunct disciplines that share those concepts. Her work is logical: one idea flows into the next.

Weaknesses

Many concepts carry relatively unspecified relationships and unstated assumptions.