FOUR CONSERVATION PRINCIPLES OF NURSING Theorist: MYRA ESTRIN LEVINE

Born: Chicago, Illinois in 1920 Died: Hospice of the North Shore at Evanston Hospital in 1996.

Nursing Education History

Diploma in nursing: Cook County School of Nursing in 1944 Bachelor of Science in Nursing: University of Chicago in 1949 Master of Science in Nursing:Wayne State University in 1962

Career Milestones in Nursing Profession and Science

Enjoyed a varied career. Her nursing experience: staff nursing, administrative and teaching supervision, clinical instruction, and direction of nursing services.

Published Article
"Trophicognosis: An Alternative to Nursing Diagnosis,"

LEVINES CONSERVATION THEORY and ITS CONCEPTS

Levines Conservation Theory was developed because she believed that nursing revolves around controlling and preserving the energy resources of the patient. A big factor in the development of this theory was her strong physical science background. With this background she influenced the practice of nursing through the attainment of the nursing goal, promoting wholeness.

MAJOR CONCEPTS
PERSON
A holistic beingnot only in the physical needs, but also the psychosocial, cultural and spiritual aspectswho constantly strives to preserve wholeness and integrity One who is sentient, thinking, future-oriented, and pastaware A unique individual in unity and integrity, feeling, believing, thinking and whole system of system. A holistic being who has open and fluid boundaries that coexist with the environment. He is a whole being who is conserved and integral. An example is a patients anxiety is still present despite the alleviation of pain.

Environment
ENVIRONMENT Plays an important role in completing the individuals wholeness. Where the individual lives her life. The individual has both an internal and external environment: a. internal environment combines the physiological and pathophysiological aspects of the individual and is constantly challenged by the external environment. b. external environment is divided into the perceptual, operational, and conceptual environments:

Environment
perceptual environment - individuals respond to with their sense organs and includes light, sound, touch, temperature, chemical change that is smelled or tasted, and position sense and balance. operational environment - interacts with living tissue even though the individual does not possess sensory organs that can record the presence of these factors and includes all forms of radiation, microorganisms, and pollutants. In other words, these elements may physically affect individuals but are not perceived by the latter. conceptual environment - consists of language, ideas, symbols, and concepts and inventions and encompasses the exchange of language, the ability to think and experience emotion, value systems, religious beliefs, ethnic and cultural traditions, and individual psychological patterns that come from life experiences.

Environment
Individuals respond to the environmental challenges by means of four integrated processes: Fight-or-flight mechanism - most primitive response. Hospitalization, illness and new experiences triggers a response . An individual may turn away "flight" or face his condition "fight" to assure his safety and well-being. Inflammatory-immune response - a way of healing, a defense mechanism to protect self from insult in a hostile environment. Uses available energy to remove or keep out unwanted irritants or pathogens. Environmental control is important. Stress response- according to Selye, stress response syndrome is a predictable non-specifically induced organismic changes. Characterized by irreversibility and influences the way patients respond to nursing care. Perceptual awarenessinformation seeking response used by the individual to seek and maintain safety for himself. Includes the basic orienting, synaptic, auditory, visual, and taste-smell systems.

NURSING
Involves engaging in human interactions - rooted on the organic dependency of an individual as well as communications with other human beings. The goal of nursing is to promote wholeness. The nurse enters into a partnership of human experience where sharing moments in timesome trivial, some dramaticleaves its mark forever on each patient (Levine, 1977, p. 845). Wholeness can be achieved through the use of supportive and therapeutic aspect of caring.

 A profession as well as an academic discipline that always should be studied and practiced along with other health sciences. Human interaction is the focus of nursing.A nurse should have the following goals: 1. Realize that every individual requires a unique and separate cluster of activities 2. Assist the person (his sole concern) to defend and to seek its realization 3. Make decision through prioritizing course of action 4. Be aware and able to contemplate objects, condition and situation 5. Involve the whole individual Nurses should also use the nursing process in giving care to their patients.

HEALTH
A state of wholeness and not just an absence of disease and successful adaptation and not merely healing of an affected part. Ability to function normally and able to return to daily activities, self-hood, and ability to pursue one's interest without constraints.

KEY CONCEPTS
The Four Conservation Principles The nurse has to promote conservation of energy, structural integrity, personal integrity and social integrity of the client.

I. Conservation of Energy
It refers to balance between energy expenditure and conservation. Patient activity is dependent on energy balance. Illness increases energy demand, and that increased energy demand can be measured by the level of fatigue. Energy is measured in everyday nursing practice via body temperature, blood gases, pulse, and blood pressure; fluctuations determine either energy expenditure or conservation. The balance is brought by proper rest, adequate hydration, inhaling of clean air, proper nutrition and exercising.

II. Conservation of Structural Integrity

Focused on preserving the anatomical structure of the body and preserving healing Refers to maintaining or restoring the structure of body preventing physical breakdown and promoting healing Changes in structure ultimately affect function, that structural integrity may be compromised by pathophysiological processes, and that healing restores.structural integrity. Therefore, to regain structure and function, the body needs to restore structural integrity through repair and healing Nursing Intervention aims in helping the individual to prevent skin breakdown and limiting the amount of tissue involvement in infectious disease. Examples include: a. Maintenance of clean, dry, wrinkle free linen. b. Regular turning of patient side to side every 2 hours to patients who are bedridden. c. Perform ROM exercise d. Maintenance of patients personal hygiene

III. Conservation of Personal Integrity

A client is a person with dignity, sense of identity and self-worth. Individual strives for recognition, respect, self awareness, selfhood and self-determination. Individuals require privacy and are responsible for their own decisions. Illness and hospitalization compromise personal integrity, selfidentity, and self-respect Persons integrity is compromised when the individual becomes dependent. Nursing interventions include protecting and respecting patient privacy, possessions, and defense mechanisms and supporting personal choice.

Examples include: a. Expression of patients feelings b. Involvement of patient in plan of care, c. Focus on self aspect by not comparing to others d. Reinforce positive traits e. Promote socialization in such a way he can developed positive self-esteem. f. Recognize and protect patients space needs

IV. Conservation of Social Integrity

An individual is recognized as someone who resides and interacts with in a family, a community, academe, a religious group, an ethnic group, a political system and a nation Individuals recognize social responsibilities, traditional customs and spiritual group. Individual behavior is influenced by the ability to relate to various social groups, families often are affected by an individuals illness, and hospitalization results in social isolation. Nursing Intervention: Helping the individual to preserve his or her place in the family, community and society.

Examples include: a. In the case of a pregnant women scheduled for caesarean operation,her support system is very important both before and after the operation. b. Position patient in bed to foster social interaction with other patients c. Avoid sensory deprivation d. Promote patients use of news paper, magazines, radio. TV e. Provide support and assistance to family The Goal of the individual is conservation or preserving an integrated and balance whole(Levine, 1973)

(Application in Nursing Practice, Education & Research)

Nursing Practice Used in variety of settings, from critical care, acute care, long-term care, community care, homeless, patients with burns, cervical cancer, chronic pain, congestive heart failure, and epilepsy; emergency room, intensive care nursery, pediatrics, perioperative nursing, smoking cessation (as cited by George, 2008) and geriatric nursing where majority of the elderly patients will have some problems in at least two of the conservation models (Bautista, 2008).

Scenario: A 75 year old man currently staying in a long term care facility. He has a history of congestive heart failure and generalized weakness. Currently he states that he has been feeling depressed due to his inability to do his own personal care. He also states that he misses his old friends in the community. The nurse could use the four principles of conservation to address his needs as follows: 1. Conservation of Energy: Ensure the patient has enough rest periods to provide the energy needed for activities of daily living. 2. Conservation of structural integrity: The patient is at high risk for immobility due to CHF and weakness, so the nurse will need to put interventions in place for prevention of pressure ulcers. 3. Conservation of personal integrity: The nurse recognizes that the patient wants to maintain a sense of independence, so she will take steps to have the patient achieve as high a level of independence as possible with personal care (i.e. working together with a physiotherapist / occupational therapist). 4. Conservation of social integrity: The nurse can facilitate the maintenance of old friendships by contacting the family and asking if they would be able to take him out on social leave. Also, the nurse can discuss with the interdisciplinary team (i.e. activity / recreation aides) ways of having the patient form new connections with other patient within the long term care facility.

Nursing Education Provides a student friendly nursing theory. This reflects simple yet complete and concise nursing theory. Used as a curriculum model and is a part of both undergraduate and graduate curricula (Marriner-Tomey & Alligood, 2006). Provided an organizational structure for teaching Medical-Surgical Nursing and stimulus for theory development. (Basavanthappa, 2007). She aimed to move away from a procedurally oriented educational process and instead sought to teach the major concepts of medical surgical nursing as generalized content. Used to develop nursing undergraduate program at Allentown college of St. Francis de Sales, Pennsylvania and KapatHolim in Israel.

Nursing Research Enhances the foundation of nursing practice and nursing education. Hypotheses have been developed from Levines theory, and research has been conducted to test these hypotheses (George, 2008).

MARTHA ROGERS
The Science of Unitary Human Beings

Brief History
Martha Elizabeth Rogers was born in Dallas, Texas May 12, 1914; sharing her birthday with Florence Nightingale. She grew up in a family, where learning was fostered and reading was a favorite pastime. Received Nursing diploma from Knoxville General Hospital in 1936. She completed her BSN in Public Health Nursing in 1937 from George Peabody College Nashville in 1937 and worked as a public health nurse. Earned her master's degree in public health nursing from Teacher's College Columbia University.

Essence of Theory:
The energy field of the human being interacts with the energy field environment. (The human being and the environment cannot be understood in isolation of each other). Nursing Client: Human beings-environment energy fields relationship. Nursing therapeutics: Repatterning of man and environment for more effective fulfillment of lifes capabilities

CONCEPTS
Energy field The energy field is the fundamental unit of both the living and nonliving. This energy field "provides a way to perceive people and environment as irreducible wholes". The energy fields continuously varies in intensity, density, and extent. Openness The human field and the environmental field are constantly exchanging their energy back and forth. There are no boundaries or barriers that inhibit energy flow between the fields. Pattern Pattern is defined as the distinguishing characteristic of an energy field. "Pattern is an abstraction and it gives identity to the field". Pan-dimensionality Pan-dimensionality is defined as "non linear domain without spatial or temporal attributes". The parameters that humans use in language to describe events is arbitrary. The present is relative; there is no temporal ordering of lives.

CONCEPTS
Unitary Human Being (person) A unitary human being is an "irreducible, indivisible, pan-dimensional (four-dimensional) energy field identified by pattern and manifesting characteristics that are specific to the whole and which cannot be predicted from knowledge of the parts" and "a unified whole having its own distinctive characteristics which cannot be perceived by looking at, describing, or summarizing the parts". The person has the capacity to participate knowingly and probabilistically in the process of change. Environment The environment is an "irreducible, pan-dimensional energy field identified by pattern and integral with the human field". The two fields coexist and are integral. Manifestations emerge from this field and are perceived by the person. Health Rogers defined health as an expression of the life process; they are the "characteristics and behavior emerging out of the mutual, simultaneous interaction of the human and environmental fields". Health and illness are the part of the same continuum. The multiple events taking place along life's axis denote the extent to which man is achieving his maximum health potential and vary in their expressions from greatest health to those conditions which are incompatible with maintaining life processes.

Nursing Nursing as a science - The theory asserts the independent science of nursing because an organized body of knowledge which is specific to nursing is arrived at by scientific research and logical analysis. Nursing as an art - Rogers claimed that the creative use of science for the betterment of humans and the creative use of its knowledge is the art of its nursing.

Assumptions about people and nursing:

Nursing exists to serve people. It is the direct and overriding responsibility to the society. The safe practice of nursing depends on the nature and amount of scientific nursing knowledge the individual brings to practice. People need knowledgeable nursing.