The goal of the Four Conservation Principles of Nursing, created by Myra Estrine
Levine, is to promote adaptation and maintain wholeness by using the principles of
conservation. The model guides the nurse in focusing on the influences and responses
at the organismic level.
There are assumptions made by the theory.
The nurse creates an environment in which healing can occur.
A human being is more than the sum of his or her parts.
Human beings respond in a predictable way.
Human beings are unique in their responses.
Human beings know and appraise objects, conditions, and situations.
Human beings sense, reflect, reason, and understand.
Human beings actions are self-determined, even when emotional.
Human beings are capable of prolonging reflection through strategies such as asking questions.
According to Levine's theory, every patient has a unique range of adaptive responses,
which vary based on the individual circumstances of the patient including age, gender,
and illness. The responses are the same, but the timing and manifestation of organismic
responses will be unique for each patient's pulse rate. An ongoing process of change in
which the patient maintains his or her integrity within the realities of the environment.
Adaptation is achieved through the "frugal, economic, contained and controlled use of
environmental resources by individual in his or her best interest."
Wholeness exists when the interaction or constant adaptations to the environment permits
the assurance of integrity, and is promoted by the use of conservation principle.
Conservation is the product of adaptation. It is the achievement of balance of energy
supply and demand that is within the biological realities of the individual patient.
The Four Conservation Principles in Levine's model of nursing are: conservation of
energy, conservation of structural integrity, conservation of personal integrity,
and conservation of social integrity. They help the nurse accomplish the goals of
Conservation of energy refers to balancing the input and output of energy in order
to protect from over-fatigue. It includes adequate rest, nutrition, and exercise.
The conservation of structural integrity means maintaining or restoring the physical
body by preventing physical breakdown or promoting healing. Personal integrity conservation
recognizes the patient as someone who seeks recognition, respect, self-awareness,
self-hood, and self-determination. The conservation of social integrity exists when
a patient is recognized as someone who lives with a family, a community, a religious
or ethnic group, a political system, and a nation.
Levine's model explains the environment in two parts: internal and external. The
environment completes the wholeness of the patient, who is seen as a holistic being
who strives to preserve wholeness and integrity.
The internal environment has two components, which are homeostasis and homeorrhesis.
Homeostasis is a state of energy-sparing that also provides the necessary baselines
for a multitude of synchronized physiological and psychological factors. Homeorrhesis
is a stabilized flow rather than a static state. It emphasizes the fluidity of change
within a space-time continuum. It describes the pattern of adaptation, which permits
the patient's body to sustain its well-being with the vast changes that encroach upon
it from the environment.
The external environment has three components: preconceptual, operational, and conceptual.
Preconceptual is the aspect of the world that the patient is able to intercept. The
operational environment contains elements that may physically affect patients, but
are not perceived by them. This includes things like radiation, micro-organisms,
and pollution. The conceptual is part of the patient's environment that includes
cultural patterns characterized by spiritual existence, ideas, values, beliefs, and
According to Levine, the patient and environment have three concepts: adaptation,
organismic response, and conservation.
Adaptation has three characteristics: historicity, specificity, and redundancy. Historicity
states that adaptations are grounded in history and await the challenges to which they respond.
Specificity refers to the individual responses and their adaptive pattern, which
varies on the basis of specific genetic structure. Finally, redundancy explains the
options available to the patient to ensure continued adaptation.
Organismic response is a change in the behavior of a patient during an attempt to
adapt to the environment. These responses help the patient protect and maintain his
or her integrity. There are four types of these responses:
Fight or flight, which is an instantaneous response to real or imagined threat. It is the most primitive response.
Inflammatory, which is a response intended to provide for structural integrity and the promotion of healing.
Stress, which is a response developed over time and influenced by each stressful experience the patient encounters.
Perceptual, which involves gathering information from the environment and converting it into a meaning experience.
Levine's theory includes nine models of guided assessment:
body movement and positioning
ministration of personal hygiene needs
pressure gradient system in nursing interventions
nursing determination in provision of nutritional needs
pressure gradient system in nursing
local application of heat and cold
administration of medicine
establishing an aseptic environment
The model explains that "Nursing is a profession as well as an academic discipline,
always practiced and studied in concert with all of the disciplines that together
form the health sciences." Nursing involves human interactions, which rely on communication,
rooted in the organic dependency of the individual human beings in relationships with other
human beings. The goal of nursing is to promote wholeness, realizing that every individual
patient requires a unique and separate cluster of activities. The individual integrity is
his or her abiding concern, and it is the nurse's responsibility to assist him or her to
defend and to seek its realization. The steps of the nursing process in Levine's model
are assessment, trophicognosis, hypothesis, interventions, and evaluation.