Levine’s mentor during her graduate studies at Wayne State directed her attention to many of the authors who greatly influenced Levine’s thinking (1988a). 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 the individual’s 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 the age of 75. She leaves a legacy as an administrator, educator, friend, mother, nurse, scholar, student of humanities, and wife (Pond, 1996). Dr. Baumhart (Mid-Year Convocation, Loyola University, 1992), President of Loyola University, said the following of Levine: Mrs. Levine is a renaissance woman…who uses knowledge from several disciplines to expand the vision of health needs of persons that can be met by modern nursing. In the Talmudic tradition of her ancestors, [she] has been a forthright spokesperson for social justice and the inherent dignity of [the] human person as a child of God (p. 6). 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). 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 didn’t 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: Levine (1973) stated the following about nursing: Professional nursing should be reserved for those few who can complete a graduate program as demanding as that expected of professionals in any other discipline…There will be very few professional nurses (Levine, 1965, p. 214). Nursing practice is based on nursing’s unique knowledge and the scientific knowledge of other disciplines adjunctive to nursing knowledge (Levine, 1988b), as follows: The nurse participates actively in every patient’s environment and much of what she does supports his adjustments as he struggles in the predicament of illness (Levine, 1966b, p. 2452). The essence of Levine’s theory is as follows: The goal of nursing is to promote adaptation and maintain wholeness (1971b, p. 258). Person is described as a holistic being; wholeness is integrity (Levine, 1991). Integrity means that the person has freedom of choice and movement. The person has a sense of identity and self-worth. Levine also described person as a “system of systems, and in its wholeness expresses the organization of all the contributing parts” (pp. 8–9). Persons experience life as change through adaptation with the goal of conservation. According to Levine (1989), “The life process is the process of change” (p. 326). Health is socially determined by the ability to function in a reasonably normal manner (Levine, 1969b). Social groups predetermine health. Health is not just an absence of pathological conditions. Health is the return to self; individuals are free and able to pursue their own interests within the context of their own resources. Levine stressed the following: Even for a single individual, the definition of health will change over time. Environment is conceptualized as the context in which individuals live their lives. It is not a passive backdrop. “The individual actively participates in his environment” (Levine, 1973, p. 443). Levine discussed the importance of the internal and external environment to the determinant of nursing interventions to promote adaptation. “All adaptations represent the accommodation that is possible between the internal and external environment” (p. 12). 1. “Nursing intervention is based on the conservation of the individual patient’s energy” (Levine, 1967a, p. 49). 2. “Nursing intervention is based on the conservation of the individual patient’s structural integrity” (Levine, 1967a, p. 56). 3. “Nursing intervention is based on the conservation of the individual patient’s personal integrity” (Levine, 1967a, p. 56). 4. “Nursing intervention is based on the conservation of the individual patient’s social integrity” (Levine, 1967b, p. 57). 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 helps define what nursing is by identifying the activities it encompasses and giving the scientific principles behind them. Conservation principles as a framework are not limited to nursing care in the hospital but can be generalized and used in every environment, hospital, or community (Levine, 1990, 1991). Conservation principles, levels of integration, and other concepts can be used in numerous contexts (Fawcett, 2000). Hirschfeld (1976) has used the principles of conservation in the care of the older adult. Savage and Culbert (1989) used the Conservation Model to establish a plan of care for infants. Dever (1991) based her care of children on the Conservation Model. Roberts, Fleming, and Yeates-Giese (1991) designed interventions for women in labor based on the Conservation Model. Mefford (2000) 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 the 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 caregivers. Cooper (1990) developed a framework for wound care focusing on structural integrity while integrating all the integrities. Leach (2007) published a white paper on use of the Conservation Model to guide wound care practices. Webb (1993) used the Conservation Model to provide care for patients undergoing cancer treatment. Roberts, Brittin, and de Clifford (1995) and Roberts, Brittin, Cook, and deClifford (1994) used the Conservation Model to study the boomerang pillow technique effect on respiratory capacity. Taylor (1974) used it to measure the outcomes of nursing care and again in her textbook, Neurological Dysfunction and Nursing Interventions (Taylor & Ballenger, 1980). Jost (2000) used the model to develop an assessment of the needs of staff during the experience of change. Conservation principles have been used as a framework for numerous practice settings in cardiology, obstetrics, gerontology, acute care (neurology), pediatrics, long-term care, emergency care, primary care, neonatology, critical care, and in the homeless community (Savage & Culbert, 1989; Schaefer & Pond, 1991). Levine (1973) wrote Introduction to Clinical Nursing as a textbook for beginning students. It introduced new material into the curricula. She presented an early discussion of death and dying and believed that women should be awakened after a breast biopsy and consulted about the next step. Introduction to Clinical Nursing provides an organizational structure for teaching medical-surgical nursing to beginning students (Levine, 1969a, 1973). In both the 1969 and 1973 editions, Levine presents a model at the end of each of the first nine chapters. Each model contains objectives, essential science concepts, and nursing process to give nurses a foundation for nursing activities. These models are not part of the Conservation Model. The Conservation Model is addressed in the Introduction and in Chapter 10 of the introductory text. The teachers’ manual that accompanies the text remains a timely source of educational principles that may be helpful to both beginning teachers and seasoned teachers (Levine, 1971c). Critics argue that although the text is labeled introductory, a beginning student would need a fairly extensive background in physical and social sciences to use it (Canadian Nurse, 1970). A critic of the second edition suggests that the emphasis of scientific principles is a definite strength, but the text’s weakness is that it does not present adequate examples of pathological profiles when disturbances are discussed (Canadian Nurse, 1974). For this reason, this one reviewer recommends that the text be used as a supplementary or complementary text, not as a primary text. Hall (1979) indicates that Levine’s model is used as a curriculum model. The model has been integrated successfully into undergraduate and graduate curricula (Grindley & Paradowski, 1991; Schaefer, 1991a).
The Conservation Model
CREDENTIALS AND BACKGROUND OF THE THEORIST*
THEORETICAL SOURCES
MAJOR ASSUMPTIONS
The person can be understood only in the context of his or her environment (Levine, 1973).
“Every self-sustaining system monitors its own behavior by conserving the use of the resources required to define its unique identity” (Levine, 1991, p. 4).
Human beings respond in a singular, yet integrated, fashion (Levine, 1971a).
Nursing
Person
Health
Environment
THEORETICAL ASSERTIONS
APPLICATIONS TO THE NURSING COMMUNITY
Practice
Education
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