Myra Erstin Levine - TFN Notes PDF

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Myra Estrin Levine

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Prepared and reported by: April Ann N. Demonteverde, RN

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Background and Credentials  

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1920- Myra Estrine Levine was born in Chicago The eldest among the three children ( has 1sister & 1 brother ) Levine developed an interest in nursing because her father (who had gastrointestinal problems) was frequently ill and required nursing care on many occasions. 1969/1973/1989- Publication on "An Introduction to Clinical Nursing" made a significant contribution to the "why's" of nursing actions. 1992- awarded as Honorary Doctorate for Loyola University 1996 - She died at the age of 75.

Educational Achievement   

1944- Diploma in nursing:-Cook county SON, Chicago 1949 - Bachelor of Science in Nursing-University of Chicago 1962 - Masters of Science in Nursing -Wayne state University, Detroit

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Theoretical Sources for Theory Development The following is a list of the influences in the development of her philosophy of nursing and the conservation model. 1.

Achievements       

Civilian nurse at the Gardiner General Hospital Director of Nursing at Drexel Home in Chicago Clinical instructor at Bryan Memorial Hospital in Lincoln, Nebraska Administrative supervisor at university of Chicago Chairperson of clinical nursing at Cook Country SON Visiting professor at Tel Aviv University in Israel Authored 77 published articles

Distinctions/Awards   

A charter fellow of the American Academy of Nursing(1973) An honorary membership in the American Mental Health Aid to Israel (1976) Honorary Recognition from the Illinois Nurses' Association

Member of Sigma Theta Tau (Alpha Beta Chapter, Loyola University) Enlisted in Who's Who in American Women (1977-1988) Enlisted in Who's Who in American Nursing (1987) Elected fellow in the Institute of Medicine of Chicago (1987-1991) First recipient of the Elizabeth Russel Belford Award for excellence in teaching from Sigma Theta Tau (1977) Both the first and second editions of her book, Introduction to Clinical Nursing, received American Journal of Nursing (AJN) Book of the Year awards and her 1971 book, Renewal for Nursing was translated to Hebrew Awarded Honorary Doctorate of Humane Letters from Loyola University of Chicago (1992)

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Myra Levine credited Florence Nightingale (1859) with the importance of observation to the process of nursing. Observation is a guardian activity (Levine, 1992). Levine indicated that Nightingale provided great attention to energy conservation and recognized the need for structural integrity. Levine relates Nightingale’s discussion of social integrity to Nightingale’s concern for sanitation, which she says implies an interaction between the person and the environment. Irene Beland was Myra’s teacher and thesis advisor. Beland influenced her thinking about nursing as a compassionate art and rigid intellectual pursuit (Levine, 1988b). Levine also credited Beland (1971) for the theory of specific causation and multiple factors. Feynman (1965) provided support for Myra’s position that conservation was a natural law, arguing that the development of theory cannot deny the importance of natural law (Levine, 1973). Bernard (1957) is recognized for his contribution in the identification of the interdependence of bodily functions (Levine, 1973). Levine (1973) emphasized the dynamic nature of the internal milieu, using Waddington’s (1968) term “homeophoresis.”

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Use of Bates’s (1967) formulation of the external environment as having three levels of factors—perceptual, operational, and conceptual—challenging the integrity of the individual, helped to emphasize the complexity of the environment. 7. The description of illness is based on Wolf’s (1961) description of disease as adaptation to noxious environmental forces. 8. Selye’s (1956) definition of “stress” is included in Levine’s (1989c, p. 30) description of her organismic stress response as “being recorded over time and influenced by the accumulated experience of the individual.” 9. The perceptual organismic response incorporates Gibson’s (1966) work on perception as a mediator of behavior. His identification of the five perceptual systems, including hearing, sight, touch, taste, and smell, contributed to the development of the perceptual response. 10. The notion that individuals seek to defend their personhood is grounded in Goldstein’s (1963) explanation of the soldiers who, despite brain injury, sought to cling to some semblance of selfawareness. 11. Dubos’s (1965) discussion of the adaptability of the organism helped support Levine’s explanation that adaptation occurs within a range of responses. 12. Levine’s personal experiences influenced her thinking in several ways. When hospitalized, “the experience of wholeness is universally acknowledged."

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Adaptation Adaptation is the process of change and integration of the organism in which the individual retains integrity or wholeness. Three Concepts of Adaptation

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Major Concepts and Definitions Wholeness  Individuals continuously defend their wholeness in constant interaction with their environments and choose the most economical, frugal, energy-sparing options available to safeguard their integrity.  A person is a holistic being, who is sentient, thinking, futureoriented and past-aware. It  A holistic being who has open and fluid boundaries that co-exist with the environment.  He is "whole"  A unified social being

"Whole" not only in the physical aspect but also with regards to psychosocio-cultural and spiritual aspects A person is a sense of identity and worth. A unique individual in unity and integrity, feeling, believing, thinking and whole system of system.

Historicity Adaptation is a historical process, responses are based on past experiences, both personal and genetic. Specificity Adaptation is also specific. Each system has very specific 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 Although the changes that occur are sequential, they should not be viewed as linear. Rather, Levine describes them as occurring in “cascades” in which there is an interacting and evolving effect in which one sequence is not yet completed when the next begins.

Environment    1.

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

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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.

Organismic Response The capacity of the individual to adapt to his or her environmental condition is called the organismic response. It can be divided into four levels of integration: (1) fight or flight, (2) inflammatory response, (3) response to stress, and (4) perceptual awareness. Treatment focuses on the management of these responses to illness and disease. (Levine, M.E. 1973. Introduction to clinical Nursing) 1.

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Fight or flight - An instantaneous response to real or imagined threat, most primitive response. Hospitalization, illness, and new experiences elicit a response. The individual responds by being on the alert to find more information and to ensure his or her safety and wellbeing. Inflammatory Response – this defense mechanism protects the self from insult in a hostile environment. It is a way of healing. The response uses available energy to remove or keep out unwanted irritants or pathogens. It is limited in time because it drains the individual’s energy reserves. Environmental control is important. Response to stress - according to Selye, stress response syndrome is a predictable non-specifically induced organismic changes.

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Characterized by irreversibility and influences the way patients respond to nursing care. Perceptual Awareness – This response is based on the individual’s perceptual awareness. It occurs only as the individuals experiences the world around him or her. It is an information seeking response used by the individual to seek and maintain safety for himself. Includes the basic orienting, synaptic, auditory, visual, and tastesmell systems.

Trophicognosis – is defined as “a nursing care judgment arrived at by the scientific method” (Levine, 1966a, p.57). Levine recommended trophicognosis as an alternative to nursing diagnosis. It denotes the knowledge of the art of nursing and is analogous to diagnosis and prognosis for the art of medicine. Conservation   

The core, or central concept, of Levine’s theory is conservation. Conservation comes from the Latin word Conservatio, meaning to keep together. When a person is in a state of conservation, it means that individual adaptive responses conform change productively, and with the least expenditure of effort, while preserving optimal function and identity. Conservation is achieved through successful activation of adaptive pathways and behaviors that are appropriate for the wide range of responses required by functioning human beings.

Conservation Principles 1.

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Conservation of energy: Refers to balancing energy input and output to avoid excessive fatigue. This is the balance between energy input and output to avoid fatigue. Conservation of structural integrity: Refers to maintaining or restoring the structure of body preventing physical breakdown and promoting healing. In this model, it is the nurse's duty to promote healing as well as protect the patient from external factors that may contribute to physical breakdown. Conservation of personal integrity: Recognizes the individual as one who strives for recognition, respect, self-awareness, selfhood

and self-determination. This is achieved through appreciating the patient's effort towards recovery, helping the patient regain his selfesteem and bod-image. 4.

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Conservation of social integrity: An individual is recognized as someone who resides with in a family, a community, a religious group, an ethnic group, a political system and a nation. A man is not an island. This quote we hear every day as a child and it is indeed true.

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 USE OF EMPIRICAL EVIDENCE Levine believed that specific nursing activities could be deducted from scientific principles. The scientific theoretical sources have been well researched. She based much of her work on accepted science principles.

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MAJOR ASSUMPTIONS

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Schaefer identified the following statements as assumptions about the model: 1. 2.

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selection of relevant data from the basis for her assessment of his nursing requirements.” “The nurse participates actively in every patient’s environment and much of what she does supports his judgments as he struggles in the predicament of illness.” “When nursing intervention influences adaptation favorably, or toward renewed social well-being, then the nurse is acting in a therapeutic sense; when the response is unfavorable, the nurse provides supportive care.” “The goal of nursing is to promote adaptation and maintain wholeness.

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The person can only be understood in the context of his or her environment. “Every self-sustaining system monitors its own behavior by conserving the use of the resources required to define its unique identity.” Human beings respond in a singular, yet integrated, fashion.

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Nursing

A holistic being—not only in the physical needs, but also the psychosocial, cultural and spiritual aspects—who constantly strives to preserve wholeness and integrity One who is sentient, thinking, future-oriented, and past-aware 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 patient’s anxiety is still present despite the alleviation of pain.

Persons experience life as change through adaptation with the goal of conservation. “The life process is the process of changes.”

The following are stated by Levine about nursing:  

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“Nursing is a human interaction.” “Professional nursing should be reserved for those few who can complete a graduate program as demanding as that expected of all professionals in any other discipline…There will be very few professional nurses.” “Nursing practice, including the teaching of nurses has always mirrored prevailing theories of health and disease.” “It is the nurse’s task to bring a body of scientific principles, on which decisions depend, into the precise situation which she shares with the patient. Sensitive observation and the

Health     

State of being "whole" not just the absence of illness or disease. Is determined by the ability to function in a reasonably normal manner. (Levine, M.E. 1969 in Alligood) It is culturally determined and influence by ethos and beliefs. Health is wholeness and successful adaptation. Not merely healing of an afflicted part, it is return to daily activities, selfhood and the ability to once more pursue by an individual, his or her own interest without constraints.

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Health can be socially determined (through their interaction with the significant others). Failure in doing so is a negative scenario.

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Environment 

Environment is the “context in which we live our lives.” It is not a passive backdrop. “We are active participants in it.”

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Where the person is constantly and actively involved. It is where we live our lives. Composed of all the experiences of the individuals. It pertains to the internal (physiologic) and external environment (perceptual, operational, and conceptual).

THEORETICAL ASSERTIONS 4 major assertions 1. 2. 3. 4.

Nursing intervention is based on the conservation of the individual patient’s energy.” “Nursing intervention is based on the conservation of the individual patient’s structural integrity.” “Nursing intervention is based on the conservation of the individual patient’s personal integrity.” “Nursing intervention is based on the conservation of the individual patient’s social integrity.”

LOGICAL FORM Levine used primary deductive logic primarily. In her development of her model, she integrated theories and concepts from the humanities and sciences of nursing, physiology, psychology, and sociology. ACCEPTANCE BY NURSING COMMUNITY Practice  Hirschfeld has used the principles of conservation in the care of the older adult.  Savage and Culbert used the Conservation Model to establish a plan of care of infants.  Dever based her care of children on the conservation model.

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Roberts, Fleming, and Yeates-Giese designed interventions for women in labor on the basis of the Conservation Model. Mefford tested a Theory of Health Promotion for Preterm Infants derived from Levine’s Conservation Model of Nursing and found a significant inverse relationship between the consistency of caregiver and the age at which the infant achieved health and an inverse relationship between the use of resources by preterm infants during the initial hospital stay and the consistency of caregiver. Bayley (n.d.) discussed the care of a severely burned teenagers on the basis of four conservational principles and discussed patient’s perceptual, operational and conceptual environment. Pond (n.d.) used conservation model for guiding the nursing care of homeless at a clinic, shelters or streets

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Levine wrote Introduction to Clinical Nursing, a textbook for beginning students that introduced new material into the curricula. Introduction to Clinical Nursing also provides an organizational structure for teaching medical-surgical nursing to beginning students. Hall indicated that Levine’s model is used a guideline for curriculum development and that it has been successfully integrated into undergraduate and graduate curricula more recently. Several graduate students also used Levine’s model for their thesis and dissertations.

Administration  Taylor (n.d.) described an assessment guide for data collection of neurological patients which forms basis for development of comprehensive nursing care plan and thus evaluate nursing care  McCall (n.d.) developed an assessment tool for data collection on the basis of four conservational principles to identify nursing care needs of epileptic patients  Family assessment tool was designed by Lynn-Mchale and Smith (n.d.) for families of patient in critical care setting Research

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Ftzpatrick and Whall state, “All in all, Levine’s model served as an excellent beginning. Its contribution has added a great deal to overall development of nursing Knowledge.” Many research questions can be generated from Levine’s model. Conservation principles were also used by graduate students as framework for their research and have been used for data collection in various researches. Conservational model was used by Hanson et al.in their study of incidence and prevalence of pressure ulcers in hospice patient. Newport (n.d.) used principle of conservation of energy and social integrity for comparing the body temperature of infant’s who had been placed on mother’s chest immediately after birth with those who were placed in warmer.

Empirical Precision  Levine used deductive logic to develop her model, which can be used to generate research questions. As she lived her conservation model, she verified the use of inductive reasoning to further develop and inform her model. Derivable Consequences  The four conservation principles are recognized as one of the earliest nursing models even though some authors question the level of contribution Levine’s model provides. It is continually being used in nursing practice and research and is receiving recognition until this day.

FURTHER DEVELOPMENT 

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Levine and others have worked on using the conservation principles as the basis of a taxonomy of nursing diagnosis. However, further development of this concept has been deferred since the American Nurses Association took over nursing diagnosis in 1992. Additional work has been done on use for Levine’s model in administration of elderly. It was also used to develop a Theory of Health Promotion in Preterm Infants. It has also great potential for studies of sleep disorders and in the development of colla...