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

Levine & Nursing (Application in Nursing Practice, Education & Research)


A.   Nursing Practice 

Used in variety of settings, from critical care, acute care, long-term care, community care, homeless, patients with burns, cervical cancer, chronic pain, congestive heart failure, and epilepsy; emergency room, intensive care nursery, pediatrics, peri-operative nursing, smoking cessation (as cited by George, 2008) and geriatric nursing where majority of the elderly patients will have some problems in at least two of the conservation models (Bautista, 2008).

1.    Bayley (n.d.) discussed the care of severely burned teenagers on the basis of four conservation principles and discussed patient’s perceptual, operational and conceptual environment.

          2.    Pond (n.d.) used conservation model for guiding the nursing care of homeless                  at a clinic, shelters or streets.

v      Used with patients across the lifespan, from the neonate to the elderly patient.
v     Used as a framework for many purposes, such as wound care, development of nursing diagnoses, care of intravenous sites, and care of patients undergoing cancer treatment.
v   Influences the interventions undertaken by nurses, with them recognizing that the interventions should be related to the adaptive pathways, while remembering that each pathway is influenced by historicity, specificity, and redundancy. 
     Applied in rendering comprehensive nursing care incorporated in the nursing process.

Scenario: A 75 year old man currently staying in a long term care facility. He has a history of congestive heart failure and generalized weakness. Currently he states that he has been feeling “depressed” due to his inability to do his own personal care. He also states that he misses his old friends in the community.
The nurse could use the four principles of conservation to address his needs as follows:

1.   Conservation of Energy: Ensure the patient has enough rest periods to provide the energy needed for activities of daily living.

2.   Conservation of structural integrity: The patient is at high risk for immobility due to CHF and weakness, so the nurse will need to put interventions in place for prevention of pressure ulcers.

3.  Conservation of personal integrity: The nurse recognizes that the patient wants to maintain a sense of independence, so she will take steps to have the patient achieve as high a level of independence as possible with personal care (i.e. working together with a physiotherapist / occupational therapist).

4.  Conservation of social integrity: The nurse can facilitate the maintenance of old friendships by contacting the family and asking if they would be able to take him out on social leave. Also, the nurse can discuss with the interdisciplinary team (i.e. activity / recreation aides) ways of having the patient form new connections with other patient within the long term care facility.     

B.  Nursing Education
  • Provides a student friendly nursing theory. This reflects simple yet complete and concise nursing theory. 
  • Used as a curriculum model and is a part of both undergraduate and graduate curricula (Marriner-Tomey & Alligood, 2006).
  • Provided an organizational structure for teaching Medical-Surgical Nursing and stimulus for theory development. (Basavanthappa, 2007). She aimed to move away from a procedurally oriented educational process and instead sought to teach the major concepts of medical surgical nursing as generalized content.
  • Used to develop nursing undergraduate program at Allentown college of St. Francis de Sales, Pennsylvania and  KapatHolim in Israel.

C. Nursing Research
      Enhances the foundation of nursing practice and nursing education. Hypotheses have been developed from Levine’s theory, and research has been conducted to test these hypotheses (George, 2008).

1.      Studies conducted by Wong (1989) and Winslow, Lane, and Gaffney (1985) support the importance of energy conservation for patients with myocardial infarctions.
2.        Pappas (1990) investigated the relationship between nursing care and anxiety in patients with sexually transmitted diseases and found significant relationships between constructs of nursing and components of anxiety.
3. Foreman (1987) found that variables that represented the four conservation principles were more important in combination than separately when used to diagnose confusion in hospitalized erderly patients.
4.   MacLean (1987) used the principles of conservation of energy and conservation of structural integrity in identifying cues that nurses use to diagnose activity intolerance.

v               Used by many researchers as a conceptual framework.

1.    Mefford (2004) used Levine’s conservation model to describe a middle range theory of health promotion for preterm infants, in order to assure that the holistic nursing care needs of infant and family were met.
2. Schaefer and Shober used Levine’s Conservation Model to provide quantitative and qualitative data on fatigue associated with congestive heart failure (Schaefer and Shober, 1993).
3.  Leach used Levine’s model to guide the practice of wound management (Leach, 2006).
4.   Gagner-Tjellesen, Yurkovich, and Gragert (2001) found that music therapy and other independent therapeutic nursing interventions could increase patient comfort and facilitate conservation of energy (aiding in healing as described in the Conservation Model).
5.    Conservation model was used by Hanson et al.in their study of incidence and prevalence of pressure ulcers in hospice patients.
6. 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.

Principles of conservation have been used for data collection in various research studies:

1.Taylor described an assessment guide for data collection of neurological patients which forms the basis for the development of comprehensive nursing care plans and thus effective nursing care. 
2. McCall developed an assessment tool for data collection on the basis of our conservation principles to identify nursing care needs of epileptic patients. 
3. Family assessment tool was designed by Lynn-Mchale and Smith for families of patient in critical care setting.

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