THEORETICAL

FRAMEWORK


Conservation Theory

"Ethical behavior is not the display of one's moral rectitude in
times of crisis it is the day-to-day expression of one's commitment
to other persons and the ways in which human beings relate to
one another in their daily interactions." - Levine, Myra (1972)



Bibliography
Myra Estrin Levine (1920-1996) was born in Chicago, Illinois. She was the oldest of three
children. She had one sister and one brother. Levine developed an interest in nursing because her father
(who had gastrointestinal problems) was frequently ill and required nursing care on many occasions.
Levine graduated from the Cook County School of Nursing in 1944 and obtained her BS in nursing from
the University of Chicago in 1949. Following graduation, Levine worked as a private duty nurse, as a
civilian nurse for the US Army, as a surgical nursing supervisor, and in nursing administration. After
earning an MS in nursing at Wayne State University in 1962, she taught nursing at many different
institutions (George, 2002) such as the University of Illinois at Chicago and Tel Aviv University in Israel.
She authored 77 published articles which included An Introduction to Clinical Nursing with multiple
publication years on 1969, 1973 & 1989. She also received an honorary doctorate from Loyola University
in 1992. She died on 1996.
Levine told others that she did not set out to develop a nursing theory but had wanted to find a
way to teach the major concepts in medical-surgical nursing and attempt to teach associate degree
students a new approach for daily nursing activities. Levine also wished to move away from nursing
education practices that were strongly procedurally oriented and refocus on active problem solving and
individualized patient care.
Levine defined nursing as supportive & therapeutic interventions based on scientific or
therapeutic knowledge. Nursing actions based on four principles: conservation of energy, structural
integrity, personal integrity, & social integrity.
Myra Estrin Levine

COMPOSITION OF CONSERVATION MODEL

Levines Conservation Model is focused in promoting adaptation and maintaining wholeness
using the principles of conservation. The model guides the nurse to focus on the influences and responses
at the organismic level. The nurse accomplishes the goals of the model through the conservation of
energy, structure, and personal and social integrity (Levine, 1967). Although conservation is fundamental
to the outcomes expected when the model is used, Levine also discussed two other important concepts
critical to the use of her model adaptation and wholeness.
Adaptation is the process of change, and conservation is the outcome of adaptation. Adaptation is
the process whereby the patient maintains integrity within the realities of the environment (Levine, 1966,
1989a). Adaptation is achieved through the frugal, economic, contained, and controlled use of
environmental resources by the individual in his or her best interest.
Wholeness is based on Eriksons (1964, p. 63) description of wholeness as an open system:
Wholeness emphasizes a sound, organic, progressive mutuality between diversified functions and parts
within an entirety, the boundaries of which are open and fluid. Levine (1973, p. 11) stated that the
unceasing interaction of the individual organism with its environment does represent an open and fluid
system, and a condition of health, wholeness, exists when the interaction or constant adaptations to the
environment, permit easethe assurance of integrityin all the dimensions of life. This continuous
dynamic, open interaction between the internal and external environment provides the basis for holistic
thought, the view of the individual as whole.
Conservation, on the other hand, is the product of adaptation. Conservation is from the Latin
word conservation, meaning to keep together (Levine, 1973). Conservation describes the way complex
systems are able to continue to function even when severely challenged. Through conservation,
individuals are able to confront obstacles, adapt accordingly, and maintain their uniqueness. The goal of
conservation is health and the strength to confront disability as ... the rules of conservation and integrity
hold in all situation in which nursing is requires (Levine, 1973, pp. 193- 195). The primary focus of
conservation is keeping together of the wholeness of the individual. Although nursing interventions may
deal with one particular conservation principle, nurses must also recognize the influence of other
conservation principles (Levine, 1990).

KEY CONCEPTS (Conservational principle)

I. Conservation of energy Refers to balancing energy input and output to avoid
excessive fatigue. It includes adequate rest, nutrition and exercise.

II. Conservation of structural integrity Refers to maintaining or restoring the
structure of body preventing physical breakdown and promoting healing.


III. Conservation of personal integrity recognizes the individual as one who strives
for recognition, respect, self-awareness, selfhood and self-determination.

IV. 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.









Myra Levines Model also discusses other assertions and assumptions

The nurse creates an environment in which healing could occur.
A human being is more than the sum of the part.
Human beings respond in a predictable way.
Human beings are unique in their responses.
Human being knows and appraises objects, condition and situation.
Human being senses reflects reason and understand.
Human being actions are self-determined even when emotional.
Human beings are capable of prolonging reflection through such strategists raising questions.
Human beings make decision through prioritizing course of action.
Human being must be aware and able to contemplate objects, condition and situation.
Human beings are agents who act deliberately to attain goal.
Adaptive changes involve the whole individual.
A human being has unity in his response to the environment.












Self-care Deficit Theory of Nursing

Individuals, families, groups and communities
Need to be taught self-care Dorothea Orem




Bibliography

Dorothea Orem is one of Americas foremost nursing theorists. She was born in Baltimore,
Maryland in 1914. Orem started her nursing career at Providence Hospital School of Nursing in
Washington D.C., where she received a diploma of nursing in the early 1930s. Dorothea Orem later
completed her Bachelor of Science in Nursing in the Catholic University of America in 1939 and in 1946;
she received her Master of Science degree in Nursing Education from the same university.
Dorothea Orems early nursing experiences included operating room nursing, private duty
nursing, hospital staff nursing on pediatric and adult medical-surgical units, evening supervisor in the
emergency room, and biological science teaching. Orem held directorship of both the nursing school and
the department of nursing at Providence Hospital, Detroit, from 1940 to 1949. After leaving Detroit, she
lived in Indiana and worked in the Division of Hospital and Institutional Services of the Indiana State
Board of Health.
In 1957, Orem moved to Washington, D.C. to take a position at the Office of Education, US
Department of Health, Education and Welfare as curriculum consultant. She worked on a project to
upgrade practical nurse training that stimulated a need to address the question: What is the subject matter
of nursing? This led to the development of Guides for Developing Curricula for the Education of
Practical Nurses on 1959. Later that year, Orem became an assistant professor of nursing education at
CUA. She subsequently served as acting dean of the School of Nursing and an associate professor of
nursing education. She continued to develop her concepts of nursing and self-care at CUA. Dorothea
Orem died on June 22, 2007 at her home on Skidaway Island.
Dorothea Elizabeth Orem

Self-Care Deficit Theory
Self-care
Self-care is an activity that promotes a persons well-being. It is performed by people
who are aware of the time frames on behalf of maintaining life, continuing personal development and a
healthy functional living.
Self-care Requisites
Self-care requisites are insights of actions or requirements that the person must be able to
meet and perform in order to achieve well-being.
Two elements:
1. The factor to be controlled or manage to keep aspects of human functioning and
development within the norms compatible with life, health and personal well-being and;
2. The nature of the required action.
Universal self-care requisites
These are universally set goals that must be undertaken in order for an individual to
function in scope of a healthy living. The Eight Self-care requisites common in men, women and children
are as follows:
1. The maintenance of a sufficient intake of air
2. The maintenance of a sufficient intake of water
3. The maintenance of a sufficient intake of food
4. The provision of care associated with elimination
5. The maintenance of a balance between activity and rest
6. The maintenance of a balance between solitude and social interaction
7. The prevention of hazards to human life, human functioning, and human well-being
8. The promotion of human functioning and development.

Nursing is as art through which the practitioner of nursing gives specialized assistance to persons with
disabilities which makes more than ordinary assistance necessary to meet needs for self-care. The nurse
also intelligently participates in the medical care the individual receives from the physician.

Humans are defined as men, women, and children cared for either singly or as social units, and are the
material object of nurses and others who provide direct care.

Environment has physical, chemical and biological features. It includes the family, culture and
community.

Health is being structurally and functionally whole or sound. Also, health is a state that encompasses
both the health of individuals and of groups, and human health is the ability to reflect on ones self, to
symbolize experience, and to communicate with others.

Self-care is the performance or practice of activities that individuals initiate and perform on their own
behalf to maintain life, health and well-being.

Self-care agency is the humans ability or power to engage in self-care and is affected by basic
conditioning factors.

Basic conditioning factors are age, gender, developmental state, health state, sociocultural orientation,
health care system factors, family system factors, patterns of living, environmental factors, and resource
adequacy and availability.

Therapeutic Self-care Demand is the totality of self-care actions to be performed for some duration in
order to meet known self-care requisites by using valid methods and related sets of actions and
operations.

Self-care Deficit delineates when nursing is needed. Nursing is required when an adult (or in the case of a
dependent, the parent or guardian) is incapable of or limited in the provision of continuous effective self-
care.

Nursing Agency is a complex property or attribute of people educated and trained as nurses that enables
them to act, to know, and to help others meet their therapeutic self-care demands by exercising or
developing their own self-care agency.

Nursing System is the product of a series of relations between the persons: legitimate nurse and legitimate
client. This system is activated when the clients therapeutic self-care demand exceeds available self-care
agency, leading to the need for nursing.











Lydia Eloise Hall
Biography

Lydia Eloise Hall, nursing theorist of the Care, Cure, and Core model of nursing was
born in New York City on September 21, 1906 and grew up in Pennsylvania. Lydia Hall
graduated at York Hospital School of Nursing on1927, Bachelors in Public Health Nursing on
1932, and earns a Master of Arts degree in 1942 at Teachers College, Columbia University. She
was an innovator, motivator, and mentor to nurses in all phases of their careers, and advocate for
the chronically ill patient. She promoted involvement of the community in health-care issues.
She derived from her knowledge of psychiatry and nursing experiences in the Loeb Center the
framework she used in formulating her theory of nursing. These experiences might have given
her insight in on the distinct roles of nurses in providing care for the patients and how the nurses
can be of utmost importance in caring for these patients.







LYDIA ELOISE HALL: Care, Cure, Core Nursing Theory



Lydia Hall Care Core Cure enumerated three aspects of the person as patient: the person (core),
the body (care), and the disease (cure). These aspects were envisioned as overlapping circles that
influence each other.
Hall clearly stated that the focus of nursing is the provision of intimate bodily care. She
reflected that the public has long recognized this as belonging exclusively to nursing. Being expert in the
area of body involved more than simply knowing how to provide intimate bodily care. To be expert, the
nurse must know how to modify care depending on the pathology and treatment while considering the
unique needs and personality of the patient.
Based on her view of the person as patient, Hall conceptualized nursing as having three aspects,
and delineated the area that is the specific domain of nursing, as well as those areas that are shared
with other professions. Hall believed that this model reflected the nature as a professional
interpersonal process. She visualized each of the three overlapping circles as an aspect of the nursing
process related to the patient, to the supporting sciences, and to the underlying philosophical dynamics.
The circles overlap and change in size as the patient progresses through a medical crisis to the
rehabilitative phase of the illness. In the acute care phase, the cure is the largest. During the evaluation
and follow-up phase, the care circle is predominant.

Care
This is the part of the model reserved for nurses, and focused on performing that noble task of
nurturing the patients, meaning the component of this model is the motherly care provided by nurses,
which may include, but is not limited to provision of comfort measures, provision of patient teaching
activities and helping the patient meet their needs where help is needed. This aspect provided the
opportunity for closeness and required seeing the process as an interpersonal relationship. Hands on
care for patients produce an environment of comfort and trust and promotes open communication
between nurses and patients.


Cure
The second aspect of the nursing process is shared with medicine and is labeled as the cure.
Hall comments on the two ways that this medical aspect of nursing may be viewed; it may be viewed as
the nurse assisting the doctor by assuming medical tasks or functions. The other view of this aspect of
nursing is to see the nurse helping the patient through his or her medical, surgical, and rehabilitative
care in the role of comforter and nurturer.
Core
The third are that nursing shares with all of the helping professions is that of using relationships
for therapeutic effect the core. This area emphasizes the social, emotional, spiritual, and intellectual
needs of the patient in relation to family, institution, community and the world. Knowledge
foundational to the core was based on the social sciences and therapeutic use of self. Through the
closeness offered by the provision of intimate bodily care, the patient will feel comfortable enough to
explore with the nurse who he is, where he is, where he wants to go and will take or refuse help in
getting there the patient will make amazingly rapid progress toward recovery and rehabilitation. Hall
believed that through this process, the patient would emerge as a whole person.