Credentials and background of the theorist*

Myra Estrin Levine enjoyed a varied career. She was a private duty nurse (1944), a civilian nurse in the U.S. Army (1945), a preclinical instructor in the physical sciences at Cook County (1947 to 1950), director of nursing at Drexel Home in Chicago (1950 to 1951), and surgical supervisor at both the University of Chicago Clinics (1951 to 1952) and the Henry Ford Hospital in Detroit (1956 to 1962). Levine worked her way up the academic ranks at Bryan Memorial Hospital in Lincoln, Nebraska (1951), Cook County School of Nursing (1963 to 1967), Loyola University (1967 to 1973), Rush University (1974 to 1977), and the University of Illinois (1962 to 1963, 1977 to 1987). She chaired the Department of Clinical Nursing at Cook County School of Nursing (1963 to 1967) and coordinated the graduate nursing program in oncology at Rush University (1974 to 1977). Levine was director of the Department of Continuing Education at Evanston Hospital (March to June 1974) and consultant to the department (July 1974 to 1976). She was adjunct associate professor of Humanistic Studies at the University of Illinois (1981 to 1987). In 1987, she became a Professor Emerita, Medical Surgical Nursing, at the University of Illinois at Chicago. In 1974, Levine went to Tel-Aviv University, Israel, as a visiting associate professor and returned as a visiting professor in 1982. She also was a visiting professor at Recanati School of Nursing, Ben Gurion University of the Negev, at Beer Sheva, Israel (March to April, 1982).

Levine received numerous honors, including charter fellow of the American Academy of Nursing (1973), honorary member of the American Mental Health Aid to Israel (1976), and honorary recognition from the Illinois Nurses Association (1977). She was the first recipient of the Elizabeth Russell Belford Award for excellence in teaching from Sigma Theta Tau (1977). Both the first and second editions of her book, Introduction to Clinical Nursing (Levine, 1969a; 1973) received American Journal of Nursing Book of the Year awards, and her book, Renewal for Nursing, was translated into Hebrew (Levine, 1971a). Levine was listed in Who’s Who in American Women (1977 to 1988) and in Who’s Who in American Nursing (1987). She was elected fellow of the Institute of Medicine of Chicago (1987 to 1991). The Alpha Lambda Chapter of Sigma Theta Tau recognized Levine for her outstanding contributions to nursing in 1990. In January 1992, she was awarded an honorary doctorate of humane letters from Loyola University, Chicago (Mid-Year Convocation, Loyola University, 1992). Levine was an active leader in the American Nurses Association and the Illinois Nurses Association. After her retirement in 1987, she remained active in theory development and encouraged questions and research about her theory (Levine, 1996).

A dynamic speaker, Levine was a frequent presenter of programs, workshops, seminars, and panels, and a prolific writer regarding nursing and education. She also served as a consultant to hospitals and schools of nursing. Although she never intended to develop theory, she provided an organizational structure for teaching medical-surgical nursing and a stimulus for theory development (Stafford, 1996). “The Four Conservation Principles of Nursing” was the first statement of the conservation principles (Levine, 1967a). Other preliminary work included “Adaptation and Assessment: A Rationale for Nursing Intervention,” “For Lack of Love Alone,” and “The Pursuit of Wholeness” (Levine, 1966b, 1967b, 1969b). The first edition of her book using the conservation principles, Introduction to Clinical Nursing, was published in 1969 (Levine, 1969a). Levine addressed the consequences of the four conservation principles in Holistic Nursing (Levine, 1971b). The second edition of Introduction to Clinical Nursing was published in 1973 (Levine, 1973). After that, Levine (1984) presented the conservation principles at nurse theory conferences, some of which have been audiotaped, and at the Allentown College of St. Francis de Sales (now DeSales University) Conference.

Levine (1989) published a substantial change and clarification about her theory in “The Four Conservation Principles: Twenty Years Later.” She elaborated on how redundancy characterizes availability of adaptive responses when stability is threatened. Adaptation processes establish a body economy to safeguard individual stability. The outcome of adaptation is conservation.

She explicitly linked health to the process of conservation to clarify that the Conservation Model views health as one of its essential components (Levine, 1991). Conservation, through treatment, focuses on integrity and the reclamation of oneness of the whole person.

Levine died on March 20, 1996, at 75 years of age. She leaves a legacy as an administrator, educator, friend, mother, nurse, scholar, student of humanities, and wife (Pond, 1996). Dr. Baumhart, President of Loyola University, said the following of Levine (Mid-Year Convocation, Loyola University, 1992):

From Beland’s (1971) presentation of the theory of specific causation and multiple factors, Levine learned historical viewpoints of diseases and learned that the way people think about disease changes over time. Beland directed Levine’s attention to numerous authors who became influential in her thinking, including Goldstein (1963), Hall (1966), Sherrington (1906), and Dubos (1961, 1965). Levine uses Gibson’s (1966) definition of perceptual systems, Erikson’s (1964) differentiation between total and whole, Selye’s (1956) stress theory, and Bates’ (1967) models of external environment. Levine was proud that Rogers (1970) was her first editor. She acknowledged Nightingale’s contribution to her thinking about the “guardian activity” of observation used by nurses to “save lives and increase health and comfort” (Levine, 1992, p. 42).

Levine (1973) 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.

Introduction to Clinical Nursing is a text for beginning nursing students that uses the conservation principles as an organizing framework (Levine, 1969a, 1973). Although she did not state them specifically as assumptions, Levine (1973) valued “a holistic approach to care of all people, well or sick” (p. 151). Her respect for the individuality of each person is noted in the following statements:

Schaefer (1996) identified the following statements as assumptions about the model:

Although many theoretical assertions can be generated from Levine’s work, the four major assertions follow:

Levine (1991) provided some thoughts about two theories in their early stages of development. The theory of therapeutic intention is intended to provide the basis of nursing interventions that focus on biological realities of the patient. Although not planned as such, the theory naturally flows from the conservation principles. The theory of redundancy expands the redundancy domain of adaptation and offers explanations for redundant options such as those found in aging and the physiological adaptation of a failing heart.

Levine and others have worked on using the conservation principles as the basis for a nursing diagnosis taxonomy (Stafford, 1996; Taylor, 1989). Additional work has been done on the use of Levine’s model in administration and with the frail elderly. The model was used to develop and test the Theory of Health Promotion in Preterm Infants based on Levine’s Conservation Model (Mefford, 2000; Mefford & Alligood, 2011a, 2011b) and has great potential for studies of sleep disorders and in the development of collaborative and primary care practices (Fawcett, 2000). The philosophical, ethical, and spiritual implications of the model are research challenges yet to be realized (Stafford, 1996).