NURSING THEORY

Levines Conservation Model

Levines Conservation Model

Myra Estrin Levine (1920-1996) was born in Chicago, Illinois. Levine graduated from the Cook County School of Nursing in 1944 and obtained her BS in nursing from the University of Chicago in 1949. Following graduation, Levine worked as a private duty nurse, as a 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 taught nursing at many different institutions (George, 2002) such as the University of Illinois at Chicago and Tel Aviv University in Israel. 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.

CONSERVATION

Berasal dari bahasa latin conservatio yang berarti to Keep Together Suatu sistem yang kompleks dan mampu meneruskan fungsi walaupun dalam kondisi dengan tantangan yang berat Individu berusaha melawan gangguan, beradaptasi,dan mempertahankan keunikannya.(Tomey, 2006. ed.8)

FOKUS CONSERVATION MODEL

Goal: To promote adaptation and maintain wholeness using the principles of conservation Model guides the nurse to focus on the influences and responses at the organismic level Nurse accomplishes the goal of model through the conservation of energy, structure and personal and social integrity

COMPOSITION OF CONSERVATION MODEL

Adaptation

Levine,1989 defines adaptation is the process of change, and conservation is the outcome of adaptation. Adaptation is the process whereby the patient maintains integrity within the realities of the environment (Master Student,2009)
Every individual has a unique range of adaptive responses The responses will vary by heredity, age, gender or challenges of illness experiences Example: The response 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 environmental resources by individual in his or her best interest"

COMPOSITION OF CONSERVATION MODEL Cont....

Wholeness is based on Eriksons (1964)description of wholeness as an open system: Wholeness emphasizes a sound, organic, progressive mutuality between diversified functions and parts within an entirety, the boundaries of which are open and fluid. Levine (1973) 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 adaptations to the environment, permit easethe assurance of integrityin all the dimensions of life. This continuous dynamic, open interaction between the internal and external environment provides the basis for holistic thought, the view of the individual as whole.

Cont...
Conservation (Levine, 1973) is the product of adaptation. The goal of conservation is health and the strength to confront disability as ... the rules of conservation and integrity hold in all situation in which nursing is requires (Tomey,2006) Achieving a balance of energy supply and demand that is with in the unique biological realities of the individual (Current Nursing,2010)

MAJOR CONCEPTS CONSERVATION MODEL

four central or major concepts: (Nursings Paradigm) 1. person, 2. environment, 3. nursing 4. health. (Master Student,2009 & Current Nursing 2010)

1. PERSON

A holistic being who constantly strives to preserve wholeness and integrity A unique individual in unity and integrity, feeling, believing, thinking and whole system of system thinking, future-oriented, and past-aware. The wholeness (integrity) of the individual demands that the individual life has meaning only in the context of social life (Current Nursing,2009)

2. ENVIRONMENT
Lingkungan internal Kombinasi aspek fisiologi dan patofisiologi individu dan dipengaruhi oleh lingkungan eksternal, dan merupakan interaksi fungsi tubuh antara homeorrhesis dan omeostasis yang bertujuan membentuk energi Lingkungan Eksternal

Perceptual : respon individu terhadap sensori (cahaya, suara, sentuhan, suhu, bahan kimia dan keseimbangan Operational; elemen yang mempengaruhi fisik individu (interaksi dengan jaringan) seperti radiasi,mikroorganisme dan pollutants. conceptual environments; terdiri dari bahasa, ide, simbolsimbol, kemampuan berfikir dan pengalaman emosi, sistem nilai, kepercayaan agama, suku, tradisi budaya, keadaan psikologi individu yang dibentuk dari pengalaman hidup.

3. KESEHATAN (HEALTH)

unity and integrity wholeness and successful adaptation. The goal of nursing is to promote health

Levine (1991,)health as: the avenue of return to the daily activities compromised by ill health. It is not only the insult or the injury that is repaired but the person himself or herself It is not merely the healing of an afflicted 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 ensue.

4. NURSING (LEVIN,1973)

human interactions The nurse enters into a partnership of human experience where sharing moments in timesome trivial, some dramaticleaves its mark forever on each patient The goal of nursing is to promote adaptation and maintain wholeness (health). realizing that every individual requires a unique and separate cluster of activities. The individuals integrity is his/her abiding concern and it is the nurses responsibility to assist the patient to defend and to seek its realization. The goal of nursing is accomplished through the use of the conservation principles: energy, structure, personal, and social integrity.

Conservational Principle
Conservation Conservation Conservation Conservation of of of of energy structural integrity personal integrity social integrity

Conservation of Energy

Refers to balancing energy input and output to avoid excessive fatigue includes adequate rest, nutrition and exercise Example: Availability of adequate rest Maintenance of adequate nutrition

Conservation of structural integrity

Refers to maintaining or restoring the structure of body preventing physical breakdown And promoting healing Example: Assist patient in ROM exercise Maintenance of patients personal hygiene

Conservation of Personal integrity

Recognizes the individual as one who strives for recognition, respect, self awareness, selfhood and self determination. Example: Recognize and protect patients space needs

Conservation of Social integrity

An individual is recognized as some one who resides: with in a family, a community, a religious group, an ethnic group, a political system and a nation. Example: Position patient in bed to foster social interaction with other patients Avoid sensory deprivation Promote patients use of news paper, magazines, radio. TV Provide support and assistance to family Help the individual to preserve his or her place in a family, community, and society. (Current Nursing,2010)

Primary Focus = Conservation of the Individual

Adaptation to changes in health and disease so as to preserve individual integrity Individuals require nursing care when they are unable to adapt and retain wholeness themselves. Leach (2006) Conservation aims to maintain an equilibrium conducive to health; accordingly, many nursing interventions use conservation principles to maintain patient wholeness (McFarland,2010).

A Conceptual Model to Guide Nursing Interventions

Conservation of: Energy Structural Integrity Personal Integrity Social Integrity

Nursing Interventions focus on promotion and support of adaptation to preserve the four principles (McFarland,2010)

Conservation of Energy

Promote the bodys energy balance when faced with changes in psychological or physiological processes so as to sustain life Leach (2006) Energy conservation is based on the following ideas: Patient activity is dependent on energy balance Illness increases energy demand Increased energy demand can be measured by the level of fatigue (McFarland,2010)

Conservation of Structural Integrity

Age and illness can produce structural changes which require adaptation Through conservation of structural integrity, patients will feel intact and whole and subsequently manifest improvements in self-identity (Leach, 2006)

Conservation of Personal Integrity

The conservation of personal integrity aims to protect personal identity, an intrinsic factor to wholeness of the individual
Leach, (2006)Conserving personal integrity is based on the following ideas: Individuals require privacy and are responsible for their own decisions Illness and hospitalization compromise personal integrity, self-identity, and self-respect (McFarland,2010).

Conservation of Social Integrity

Social interaction and relationship of self to others is key to unity of the individual Leach (2006) Conserving social integrity is based on the following principles: Individual life has meaning only in the context of social life Individual behavior is influenced by the ability to relate to various social groups Families often are affected by an individuals illness Hospitalization results in social isolation (McFarland,2010).

Example of Levines Conservation Model

www.ids-healthcare.com

How does Levines Model inform our practice?

RememberLevines Conservation Model is used to guide nursing interventions with the goal of conserving integrity of the individual through adaptation to physical and psychological changes.
Nursing actions and interventions should aim to conserve 4 areas of integrity: Energy Physical Integrity Personal Integrity Social Integrity

Nine Models To Guide Assessment (Levine,1973)

Vital Sign Body Movement and Positioning Ministration of personal hygiene needs Pressure gradient system in nursing intervention (Fluids) Nursing determinants in provision for nutritional needs Pressure gradient system in nursing (gases) Local application of heat and cold Administration of medication Establishing an aseptic environment (Meleis,1985 & Current Nursing,2010)

Nursing Interventions for Conservation of Energy

The nurse will foster balance between energy output and input to avoid excessive fatigue

Support adjustment to changes in living situations (i.e. SNF) Improve nutritional status Control pain and anxiety Reduce patient activity when appropriate Promote exercise and rehabilitation within the patients abilities, limitations and comfort

Nursing Interventions for Conservation of Structural Integrity

The nurse will help maintain or restore the patients body structure by preventing physical breakdown and promoting healing

Precautions in infection and injury prevention Promote mobility

Assist in adaptation to decreased mobility Maintain musculoskeletal integrity through ROM exercises Maintain venous integrity through use of compression therapy and/or TED hose Maintain skin integrity (early detection and management of disease processes conserve structural integrity) Positioning

Early ambulation to prevent complications of bed rest

Nursing Interventions for Conservation of Personal Integrity

The nurse will help maintain or restore the patients sense of identity and self-worth, acknowledging uniqueness of the patient

Respect ones privacy and property Support personal choice Enhance self-esteem through good hygiene and dress Foster independence

Promote appropriate coping mechanisms Exercise

Loss of independence negatively affects pride and selfidentity Provide knowledge and support, but encourage patient to maintain independence

Nursing Interventions for Conservation of Social Integrity

The nurse will foster awareness that the patient is a social being who interacts with others in their social environment.

Promote meaningful social activities and outings Encourage family support & education Promote family participation in care Foster patient interaction with others Promote healing to restore the patients mobility Promote exercise to increase the patients ability to socialize

Key Points to Remember.

Levines Model focuses on conserving the patients wholeness by regaining or maintaining their: Energy Structural Integrity Personal Integrity Social Integrity

Area Aplikasi Levines Conservation Model

Burns Cancer Chronic Pain CHF Critical Care LOng-Term Care Perioperatif Preoperative adults Pressure Ulcer (Tomey,2006. Ed.3)

Cardiomyopathy Wound Healing Emergency Holistic care Nursing adults Nursing Children Nursing infant Rehabilitation

Referensi
Meleis, 1985. Theoritical Nursing : Development & Progress. J.B Lippincott Company.

Tomey,2006. Nursing Theorists and Their Work. Sixth Edition.Mosby

Tomey,2006. Nursing Theory: Utilization & Application. Third Edition. Mosby University of Philippines,2009. Nursing Theory : Myra Levine's Conservation Theory. Diakses tanggal 30 November 2010 dari http://nursingtheories.blogspot.com/2009/07/myra-levines-conservation-theory.html Current Nursing, 2010. Levin's Four Conservation Principles. diakses tanggal 30 November 2010 daricurrentnursing.com/Levin_four_conservation_principles.html McFarland et all,2010. Leiningers Theory of Culture Care Diversity & UniversalityVs Levines Conservation Model diakses tanggal 1 Desember 2010 dari www.findtoyou.com/powerpoint/download-chf-506817.html