Myra Levine: The Four Conservation Principles of

Nursing
Summary
Myra Levine grew up with a high interest in nursing. She attended years of schooling and
through hard work, she eventually earned her masters degree. Once she achieved her
educational goal, she was able to work in a variety of areas in the profession, which expanded
her views and beliefs. Levines beliefs lead her to forming the Conservation Principles. Myra
Levine's theory was based on conservation. Her main focus was to provide care to the patients
while maintaining, or conserving their independence, "wholeness", and their integrity.
Adaptation, conservation, and integrity
were the concepts that Levine used to
describe her theory. Levine proposed
four principles including the
conservation of energy, the conservation
of structural integrity, the conservation
of personal integrity, and the
conservation of the social integrity of the
individual that are the foundation of her
theory. The four components of the
metaparadigm specifically associated
with nursing can easily be applied to
Levine's theory of conservation. She
believed human beings cannot be
separated from their circumstances and
these happenings or life experiences are
displayed by a person's outward
appearance and inward state. The
component of health is mostly associated
with adaptive change and includes the
idea of structural, personal, and social
integrity to aide a person's healing process. The environment component can be summed up as
the idea that environmental influences such as language, cognition, culture, and community can
promote or impair conservation and adaptation. Lastly, the nursing component defines the way in
which nurses should serve those who need care. As Levine's theory has become popular and
widespread, it has begun to influence many areas of nursing including practice, education, and
research. The conservation principles guide daily nursing care especially in high-risk acute
settings. However, this model has also begun to influence other areas of nursing including
community nursing. With current research investigating other areas this theory could affect, the
range of influence is growing. Levine's theory has also impacted education. Of course, this
theory is taught by most nursing schools. However, certain institutions have made this theory a
point of focus for their nursing programs.

Education and Nursing Specialty
Education
Myra Estrin Levine was born in 1920 as the oldest of three children. She grew up with
her father being frequently ill, which sparked her interest in the nursing profession. Levine
attended Cook County School of Nursing in Chicago, Illinois and graduated in 1944. Several
years later, she earned her bachelors degree from the University of Chicago in 1949 and in
Detroit, Michigan, 1962, she complete her masters in nursing from Wayne State University
(George, 2011).
Specialties
Throughout her years as a nurse, Levine has worked in various places and practiced in a
number of areas of nursing. For example, Levine has worked as a private duty nurse, with the
United States Army as a civilian nurse, as a surgical supervisor, and as a director of nursing. Not
only has she practiced clinically, but she has also served in higher positions at a number of places
including schools and hospitals, such as Bryan Memorial Hospital in Lincoln, Nebraska, Cook
County School of Nursing, where she attended nursing school, Loyola University, Rush
University, and the University of Illinois, Chicago. Levine was also known for teaching. She
became Professor Emerita from the University of Illinois, Chicago (George, 2011).
Developing the Theory
Levines beliefs about the nursing profession were shaped through her career, specifically
about independence, which led her to develop The Conservation Principles. Levine believed that
once put in the hands of the healthcare system, independence decreases which leads to
dependence. She suggested that dependence is related to the term patient due to the terms
meaning, which is sufferer. It was essential to Levine to preserve the patients integrity while
providing the care needed. She supported being a trustworthy nurse and allowing patient
participation in order to help them achieve independence (George, 2011).
Levines Theory and Concepts
Myra Levines Theory on Conservation, began with her ideas on patient care. Levines
focus was on providing care that is individualized to each patient and she emphasized the
importance of a patients sense of personal independence and wholeness. Her theory is based on
three concepts: adaptation, conservation, and integrity.
Adaptation is the process of adjusting to changes that occur in the environment. Past
experiences can affect the way a person adapts to a certain change. Levine describes adaptation
as being explanatory rather than predictive because a patients responses can differ from what is
expected. Adaptation is also specific, especially when referring to the body of a patient, because
every system is very unique therefore adjustments may differ. Each body system also deals with
different tasks; therefore everything is specific to the system. When one system does not adapt,
another body system will perform that task, which is part of redundancy. Redundant systems are
not only important in adapting, but also protecting the body. Conservation describes how a
person can adapt to changes or challenges in their environment, yet maintain their individuality,
uniqueness, and integrity. Homeostasis is an example of conservation (George, 2011).
Conservation Principles and Propositions
To expand on her theory of conservation, Levine proposed four principles. The first of
these principles is the conservation of energy of the individual. This is an important principle
because the body needs energy to restore a patients health, therefore conserving energy is an
important aspect in providing care. Vitals signs are examples of the type of energy that could be
conserved, such as temperature, respirations, and the other vitals. The second, third, and fourth
principles all deal with the integrity of the individual. There is the conservation of the structural
integrity of the individual which focuses on the actual healing process. This process is not only
physiological, but it also requires a specific mind-set that leads towards healing. There is also the
conservation of the personal integrity of the individual which respects the patients privacy and
individuality. It allows the patient to focus on themselves and have a sense of self. The last
principle is the conservation of the social integrity of the individual. Patients are defined by the
people they are surrounded by which can include their family, friends, workplace, religion, and
many other relationships that the patients are connected to. Levine states that with the healthcare
system, conserving social integrity is virtually impossible. These four principles that, Levine
proposed cannot work individually, but must be implemented together. They are not fixed, but
the principles change with the environment and with each individual and unique patient.
(George, 2011).
Application of Meta-paradigms in the Nursing Theory
The meta-paradigm applied specifically to nursing theories consists of the four following
components: human beings, health, environment, and nursing. Human beings are the person or
people of interest and how they should be viewed and/or taken care of. The health component of
a theory gives the definition of health according to the theorist and describes how it can be
promoted in an individual. Factors that can effect a patients care and the setting in which they
take place are summed up with the concept of environment. Finally, the nursing component
describes nursing care as defined by the theory, which typically relates to how the theorist views
health.
Human Beings
Levine strongly believed that once patients were admitted to a health care facility, they
lost a large portion of their independence. Because she associated being admitted with
dependence, she believed that one could not separate a person from the context of the time,
place, and influence of the circumstances under which that person is functioning. In other words,
to fully understand or study a human being, one must consider the whole person including where
he or she is residing, his or her stage of life, and the happenings affecting him or her. In
particular, Levine believed these happenings, a sum of a persons life experiences, are
displayed by a persons outward appearance and inward state. An outward appearance might
include damage to a persons body tissues due to an injury or disease, while an inward state
would describe ones mental and spiritual status. When human beings must adapt to these
changes to their body or spirit, conservation is a result. Conservation, meaning the way a
persons body systems can maintain proper functioning even when seriously challenged, is how
individuals deal with a continuously changing environment. Levines idea of a suffering
individual justifies that person being required to give up a portion of independence in order to
accept the services of a nurse (George, 2011).
Health
To Levine, adaptations are the way in which a person maintains vitality, and health and
disease are patterns of adaptive change (George, 2011, p. 218). While some adaptations to the
environment are more beneficial than others, each adaptation is ultimately initiated and designed
to produce the best outcome. Levine identifies adaptations that do overcome the demands of a
changing environment, yet promote conservation as the most successful. The goal, in other
words, is for the person to achieve an optimal level of health without the body being extensively
strained. Not only does Levine believe health should be viewed holistically, she also thinks
health and integrity go hand-in-hand. A nurse should strive to promote a persons structural,
personal, and social integrity to aid a persons healing process. While health does include
healing, it is further a return to daily activities, selfhood and the ability of the individual to
pursue once more his or her own interest without constraints (Levines, 2013). Even though
many theorists have made an attempt to define health, it is Levines belief that each person has
his or her own personal definition of health (George, 2011).
Environment
In order to define environment Levine (1990) drew upon Batess (1967) classifications
of three aspects of environment (George, 2011, p. 218). The natural forces that act on a person
without his or her awareness are combined to form the operational environment. All of the input
that the sensory organs receive and record is known as the perceptual environment. Lastly, the
conceptual environment includes cultural influences, language, and cognitive aspects such as
ideas. Levine found it necessary to truly understand how the environment influences a person
and the role it has in the persons state of being due to the fact that the environment can promote
or impair conservation and adaptation. Other environmental factors identified by Levine as
important are a persons ethnicity, cultural background, socioeconomic status, and life
opportunities that were either seized or disregarded. She also made the point that one's
community shapes his or her social integrity. More specifically, the values and/or rules by which
he or she lives are set in place by his or her associated social system. (George, 2011).
Nursing
Levine considered nursing to be serving others when they need care. Although patients
are dependent upon a nurse for care while in a health care facility, this dependent state is
temporary. A nurse-patient relationship can only be established when the nurse and patient are
willing to interact in an honest, fair, and respectful manner. When this relationship begins, the
nurse will then be held to a high standard. With the added responsibility of a persons life goals,
health, and well-being, the nurse must make competent, just, and informed decisions. Nursing
theory can be applied and tested practically through the actual interactions of the nurse and
patient. Levine would consider the theory successful if it has the ability to promote hope,
promise, and fulfillment for a person who has been provided with the necessary means to pursue
a life of independence after care (George, 2011).
Theorys Implication to Nursing Practice, Education, and Research
Nursing Practice
Levines Four Conservation Principles are used in daily nursing practice. Nurses
implement the conservation of energy principle by encouraging patients to rest. When health-
promotion activities are scheduled for patients, the principle of structural integrity is enacted.
When patients are empowered and care is individualized, nurses are following the third principle
of personal integrity. Finally, when nurses encourage socialization or support family ties, they
promote social integrity.
Levines theory is predominantly used in the operating room, critical care unit, and
emergency room (Nursing, 1990). These settings are the most common because this theory is
usually implemented for patients in severe crisis. Women in labor, confused elderly patients,
burn victims, and neurologically impaired patients are some prime examples of patients this
theory is applied to (Nursing, 1990). However, this theory is not strictly limited to acute settings.
It has also been used in the community when helping the homeless population (Nursing, 1990).
Education
Due to the widespread application of Levines theory, the conservational model is often
used as a guideline for curriculum development as well as a framework for medical-surgical
nursing. This theory has also played a major role in the development of undergraduate nursing
programs including Allentown college of St. Francis de Sales, Pennsylvania and KapatHolim in
Israel (Parker, 2001).
Research
Lastly this theory has played a major role in research. One specific area Levines model
has focused on is the care of preterm infants (Mefford, 2011). These premature babies often have
complications due to the immaturities of their organ systems. These complications make it
difficult for preterm babies to adapt to life outside their mothers womb, but Levines theory is
being used to examine the best possible way to overcome these difficulties (Mefford, 2011). One
simple solution being investigated is placing infants on their mothers chest to promote
conservation of energy as well as social integrity (Mefford, 2011).
Another area where conservation has become key is wound management (Leach, 2006).
Because Levines theory has often been applied to burn victims, current research is looking into
this theorys application to other types of skin impairment such as venous ulcers (Leach, 2006).

References
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Upper Saddle River, N.J: Prentice Hall.
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Ostomy Wound Management, 52(8), 74.
Levines four conservation principles. (2013, September 9). Retrieved from
http://currentnursing.com/nursing_theory/Levin_four_conservation_principles.html
Mefford, L. C., & Alligood, M. (2011). Testing a Theory of Health Promotion for Preterm
Infants Based on Levine's Conservation Model of Nursing. Journal Of Theory
Construction & Testing, 15(2), 41-47.
Myra Estrin Levine. (2011, July 12). Myra Estrin Levine. Retrieved July 22, 2014, from
http://myra-levine-4conservationprinciples.blogspot.com/
Nursing Theories in Practice. (1990). New York: Publications Development Company.
Parker, M. E. (2001). Nursing theories and nursing practice. F. A. Davis Company: Philadelphia,
PA.