Welcome to the Nursing Theories blog! This part of the blog introduces you to the theory of the Four Conservation Principles of Nursing. The full version of this theory was formulated by Myra Estrin Levine in 1973, and continues to influence nursing practice, education, and research until today.

This part of the blog will briefly introduce the theorist and her background in order to understand her thought processes in developing the theory. Next, the theory, its characteristics, and its concepts will be presented, along with its strengths and limitations. The paradigm will then be presented in a series of diagrams, followed by a discussion of the theory’s application in nursing practice, education, and research. Finally, a registered nurse will share his experience in using Levine’s theory in his nursing practice.

We hope that you will find this helpful, and we eagerly wait for your comments!

July 12, 2011

What's in the name (Autobiograpy & Characteristics of Theory )



Born: Chicago, Illinois in 1920
Died: Hospice of the North Shore at Evanston Hospital in 1996.

Nursing Education History:

Myra Levine developed an interest in nursing due to her father’s GI problems. She obtained a diploma in nursing at Cook County School of Nursing in 1944.She obtained her Bachelor of Science in Nursing at University of Chicago in 1949, and got her Master of Science in Nursing at Wayne State University in 1962.

Career Milestones in Nursing Profession and Science:

Levine had enjoyed a varied career. Her nursing experience included staff nursing, administrative and teaching supervision, clinical instruction, and direction of nursing services.

Published Article

Her paper entitled "Trophicognosis: An Alternative to Nursing Diagnosis," can be found in the American Nurses' Association publication Exploring Progress in Medical-Surgical Nursing Practice, New York, 1966, vol. 2.

  •  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 Americal 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)

Extracurricular Activities

Levine  was an active leader in the American Nurses Association and the Illinois Nurses' Association. A dynamic speaker, she was a frequent presenter on programs, workshops, seminars and panels, and a prolific writer regarding nursing and education.
Although she never intended to develop theory, she provided an organizational structure for teaching medical-surgical nursing and a stimulus for theory development. "The Four Conservation Principles of Nursing" was the first statement of the conservation principles.
Other preliminary work included "Adaptation and Assessment: A Rationale for Nursing Intervention," "For Lack of Love Alone," and "The Pursuit of Wholeness." The first edition of the book was published in 1973. Afterwards, Levine presented the conservation principles at nurse theory conferences, some of which have been audiotaped, and at the Allentown College of St. Francis de Sales Conferences in April 1984.

Influential Beings

Levine’s theory drew from many other people’s ideas and viewpoints. She learned historical viewpoints of diseases and the way people think about disease changes over time from Beland's presentation of the theory of specific causation and multiple factors. Levine used James E. Gibson's definition of perceptual systems, Erik Erikson's differentiation between total and whole, Hans Selye's stress theory, and M. Bates' models of external environment.Kurt Goldstein, Sir Arthur Sherrington, and Rene Dubos were also influential in her work.Martha Rogers was her first editor.

Characteristics of the Theory
  1.  Levine’s work is categorized as a conceptual model of nursing and is an example of the works of those often referred to as the grand theories in nursing which are comprehensive and tend to include major concepts with which nursing is concerned.
  2. Levine’s model possesses clarity. The model has numerous terms; however, Levine was able to adequately define them.
  3. Levine also used deductive logic in developing her model which can be used to generate research questions. She integrated theories and concepts from the humanities and the sciences and used this information to analyze nursing practice situations and described nursing skills and activities with the underlying belief that people are dependent on their relationships with other people.
  4. It interrelates concepts in such a way as to create a different way of looking at a particular phenomenon. Ideas about nursing, the concepts of illness, adaptation, nursing interventions, and evaluation of nursing interventions are joined together and synthesized in such a way that the viewpoint of nursing care changes, grows and evolves.
  5. It has logical nature. Levine’s ideas about nursing are organized in such a way as to be sequential and logical. They can be used to explain the consequences of nursing actions. There are no apparent contradictions in her ideas.
  6. A simple yet generalizable theory. Levine’s theory is easy to use. Its major elements are easily comprehensible, and the relationships have the potential for being complex but are easily manageable. 
  7. Levine’s ideas can be tested. Hypotheses can be derived from them. The principles of conservation are specific enough to be testable. For example, it is possible to test if physiological structure is being supported or improved, thus testing the principle of conservation of structural integrity.
  8. Levine’s ideas can be used by practitioners to guide and improve their practice. Paula E. Crawford-Gamble successfully applied Levine’s theory to a female patient undergoing surgery for the traumatic amputation of fingers.
  9. Levine’s ideas seem to be consistent with other theories, laws and principles, particularly those from the humanities and sciences, and many questions are left unanswered which would be worthy of investigation.
  10.  Levine's theory for nursing focuses on one person - the patient. In utilizing this theory the nurse is concerned with the patient’s family and/or significant others only to the point that they influence or have an offer on the patient's progress. Nursing is human interaction.

Levine's point (Major & Key Concepts)


Levine’s Conservation Theory was developed because she believed that nursing revolves around controlling and preserving the energy resources of the patient. A big factor in the development of this theory was her strong physical science background. With this background she influenced the practice of nursing through the attainment of the nursing goal, promoting “wholeness”.


  •  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.


  •  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:
a.    internal environment combines the physiological and pathophysiological aspects of the individual and is constantly challenged by the external environment.
b.    external environment is divided into the perceptual, operational, and conceptual environments: 

  •   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.

Individuals respond to the environmental challenges by means of four integrated processes:
  1. Fight-or-flight mechanism - most primitive response. Hospitalization, illness and new experiences triggers a response . An individual may turn away "flight" or face his condition "fight" to assure his safety and well-being.
  2. Inflammatory-immune response - a way of healing, a defense mechanism to protect self from insult in a hostile environment. Uses available energy to remove or keep out unwanted irritants or pathogens. Environmental control is important.
  3. Stress response- according to Selye, stress response syndrome is a predictable non-specifically induced organismic changes. Characterized by irreversibility and influences the way patients respond to nursing care.
  4. Perceptual awareness—information seeking response used by the individual to seek and maintain safety for himself. Includes the basic orienting, synaptic, auditory, visual, and taste-smell systems.
  •  Involves engaging in “human interactions” - rooted on the organic dependency of an individual as well as communications with other human beings.
  • The goal of nursing is to promote wholeness. The nurse enters into a partnership of human experience where sharing moments in timesome trivial, some dramaticleaves its mark forever on each patient (Levine, 1977, p. 845).
  •   “Wholeness” can be achieved through the use of supportive and therapeutic aspect of caring.
  • A profession as well as an academic discipline that always should be studied and practiced along with other health sciences. Human interaction is the focus of nursing.A nurse should have the following goals: 
  • 1. Realize that every individual requires a unique and separate cluster of activities
  • 2. Assist the person (his sole concern) to defend and to seek its realization
  • 3. Make decision through prioritizing course of action
  • 4. Be aware and able to contemplate objects, condition and situation
  • 5. Involve the whole individual
  •   Nurses should also use the nursing process in giving care to their patients.

  •  A state of wholeness and not just an absence of disease and successful adaptation and not merely healing of an affected part.
  •  Ability to function normally and able to return to daily activities, self-hood, and ability to pursue one's interest without constraints.


The Four Conservation Principles

The nurse has to promote conservation of energy, structural integrity, personal integrity and social integrity of the client.

       I. Conservation of Energy

  • It refers to balance between energy expenditure and conservation.  Patient activity is dependent on energy balance.
  •  Illness increases energy demand, and that increased energy demand can be measured by the level of fatigue.
  • Energy is measured in everyday nursing practice via body temperature, blood gases, pulse, and blood pressure; fluctuations determine either energy expenditure or conservation.
  • The balance is brought by proper rest, adequate hydration, inhaling of clean air, proper nutrition and exercising.

      II. Conservation of Structural Integrity

  •  Focused on preserving the anatomical structure of the body and preserving healing
  • Refers to maintaining or restoring the structure of body preventing physical breakdown and promoting healing
  •   Changes in structure ultimately affect function, that structural integrity may be compromised by pathophysiological processes, and that healing restores.structural integrity.  Therefore, to regain structure and function, the body needs to restore structural integrity through repair and healing
  •  Nursing Intervention aims in helping the individual to prevent skin breakdown and limiting the amount of tissue involvement in infectious disease. Examples include:
a.    Maintenance of clean, dry, wrinkle free linen.
b.    Regular turning of patient side to side every 2 hours to patients who are bedridden.
c.    Perform ROM  exercise
d.    Maintenance of patient’s personal hygiene

III. Conservation of Personal Integrity 

  • A client is a person with dignity, sense of identity and self-worth.
  •  Individual strives for recognition, respect, self awareness, self-hood and self-determination.
  •  Individuals require privacy and are responsible for their own decisions.
  • Illness and hospitalization compromise personal integrity, self-identity, and self-respect
  • Person’s integrity is compromised when the individual becomes dependent.
  • Nursing interventions include protecting and respecting patient privacy, possessions, and defense mechanisms and supporting personal choice. 
  • Examples include:

a.    Expression of patient’s feelings
b.    Involvement of patient in plan of care,
c.    Focus on self aspect by not comparing to others
d.    Reinforce positive traits
e.  Promote socialization in such a way he can developed positive self-esteem.
f.     Recognize and protect patient’s space needs

IV. Conservation of Social Integrity

  •   An individual is recognized as someone who resides and interacts with in a family, a community, academe, a religious group, an ethnic group, a political system and a nation
  •   Individuals recognize social responsibilities, traditional customs and spiritual group.
  •   Individual behavior is influenced by the ability to relate to various social groups, families often are affected by an individual’s illness, and hospitalization results in social isolation.
  •   Nursing Intervention: Helping the individual to preserve his or her place in the family, community and society. Examples include:
a.  In the case of a pregnant women scheduled for caesarean operation,her support system is very important both before and after the operation.
b.    Position patient in bed to foster social interaction with other patients
c.    Avoid sensory deprivation
d.    Promote patient’s use of news paper, magazines, radio. TV
e.    Provide support and assistance to family

The Goal of the individual is conservation or preserving an integrated and balance whole(Levine, 1973)

Strengths and Limitations

  • Values the holistic approach to all individual, well or sick
  • Values patient’s participation in nursing care 
  • Comprehensive content, in-depth 
  • Scientific principles are emphasized.
  • Provides direction of nursing research , education, administration and practice
  •  Logically congruent
  • Shows high regard to adjunctive disciplines to develop theoretical basis for nursing

  •  Limited attention can be focused on health promotion and illness prevention. Nurse has the responsibility for determining the patient ability to participate in the care ,and if the perception of nurse and patient about the patient ability to participate in care don’t match, this mismatch will be an area of conflict.
  • The major limitation is the focus on individual in an illness state and on the dependency of patient.