ADVANCE NURSING PRACTICE

ASSIGNMENT SUBMITTED TO:

MAM Mrs. GAGANDEEP KAUR LECTURER, M.Sc (OBG) ACON, PATIALA

LEVINES THEORY
SUBMITTED BY:
MANPREET KAUR SANDHU M.Sc (MSN) 1st YEAR

LEVINES THEORY
Levine discussed adaptation, conservation and integrity. Adaptation is the process by which conservation is achieved and the purpose for conservation is integrity. The core of Levines theory is her four principles of conservation.

INTRODUCTION OF THEORIST

Theorist- Myra Estrine Levine Diploma in Nursing: Cook County SON, Chicago, 1994. BSN: University of Chicago, 1949 MSN: Wayne State University, Detroit, 1962 Publication: An Introduction to Clinical Nursing, 1969,1973 and 1989 Received honorary doctorate from Loyola University in 1992 Clinical experience in OT technique and oncology nursing Civilian nurse at Gardiner General Hospital Director of nursing in Drexel Home in Chicago Clinical Instructor at Bryan Memorial Hospital in Lincoln, Nebraska Administrative supervisor at University of Chicago Chairperson of clinical nursing at Cook Country, SON Visiting professor at Tel Aviv University in Israel Died in 1996

ADAPTATION
Adaptation is the life process by which, over time, people maintain their wholeness or integrity as they respond to environmental challenges. It is the consequence of interaction between the person and the environments. Adaptation includes the concepts:

HISTORICITY SPECIFICITY REDUNDANCY

CONSERVATION
DEFINITION:- Conservation is the product of adaptation. It is a universal concept, a natural law, which deals with defense of wholeness and system integrity. Conservation defends the wholeness of giving systems by ensuring their ability to confront change appropriately and retain their unique identity.
Conservation

describes how complex systems continue to function in the face of several challenges. Conservation is clearly the consequence of the multiple, interacting and synchronized negative feedback systems that provide for the stability of the living organism. Levine states that physiological and behavioral responses are essential components of the same activity.

ASSUMPTIONS

Nurse creates an environment in which healing could occur A human being is more than the sum of the part Human being respond in a predictable way Human being are unique in their responses Human being know and appraise objects, condition and situation Human being sense, reflects, reason and understand Human being action are self-determined even if when emotional Human beings are capable of prolonging reflection through such strategies raising question

LEVELS OF BEHAVIOURS
Levine (1989) describes four levels of behavior, which are as follows: Fight or flight response: Physiological and behavioral readiness in the face of sudden and unexplained challenges in the environment. Inflammatory response: Restoration of physical wholeness and healing. Stress response: An integrated defense influenced by accumulated experience of the individual. Perceptual response: Access to environmental energy sources into meaningful experiences

INTEGRITY CONSERVATION
I.

PRINCIPLES

OF

CONSERVATION OF ENERGY: Levine states that--

Energy is not hidden Vital signs is a daily measurement of energy parameters The conservation of energy is clearly evident in the very sick, whose lethargies, withdrawal and self-concern are manifested while in its wisdom the body is spending its energy resources on the process of healing It is concerned with the integrity of the whole person; the essence of wholeness is integrity.

II.
o

CONSERVATION OF STRUCTURAL INTEGRITY

This focuses on the healing process o Human develops a mindset that expects perfect restoration of structural integrity throughout life o Healing is the defense of wholeness

III.

CONSERVATION OF PERSONAL INTEGRITY

This focuses on a sense of self Describes identification of self-actualization Human have both a public and a private self The self is defined, defended and described only by the soul that own it; that private self is unique and whole. A person can share mere fragments of it with others The most generous psychosocial approach would be to limit the recording of confidences to only those generalizations that actually make a difference in the choice of treatment plans She likens the awareness of self to independence.

IV.

CONSERVATION OF SOCIAL INTEGRITY

Ones identity is connected to family, community, culture, ethnicity, religion, vocation, education and socio economic status.

To function successfully requires a broad behavioral repertoire.

The ultimate direction for social integrity is derived from the ethical values of the social system. She discussed the need both to discuss and to fund studies and programs to deal with overwhelming health problem such as smoking, alcohol, drug abuse, AIDS and cancer.

The conservation principles are joined with an individual as a cascade of life events
The challenges resolved in each individuals unique way. The nurse brings her own cascading repertoire of skill, knowledge and compassion.

It is a shared enterprise and each participant is rewarded.

PARADIGM OF LEVINE THEORY

Human Being: She assumed

When a person is being studied, the focus should be on wholeness. A person cannot be understood outside the context of the place and time in which he or she is functioning They also are hardened by a lifetime experience which has been recorded on the tissues of the body as well as on the mind and spirit Human beings have need for nursing when they are suffering and can set aside independence and accept the services of others.

Health

Health is socially determined Health and diseases are patterns of adaptive change Health is the goal of conservation Health, whole and integrity derives from the same root word

Environment : Three aspects of environment are:

The operational environment - it consists of those undetected natural forces that impinge on the individual. The perceptual environment- it consists of information that is recorded by the sensory organs. The conceptual environment- it is influenced by language, culture, ideas and cognition. It is difficult to measure the environment, because adaptations and conservation are based upon the human beings The social integrity of the individual mirrors the community to which he or she belongs.

Nursing
Professional nursing should be restricted for those few who can complete a graduate program as demanding as that expected of professional in any other discipline.

Levine discusses the fact that the person who provides nursing care has special burden of the concern The nurse-patient relationship is based on the willful participation of both parties The goal of nursing is to promote wholeness.

NURSING PROCESS AND LEVINES THEORY

Levines concepts of adaptation, conservation and integrity can be used to guide patient care with in the nursing process.
1)

ASSESSMENT:

Assessment data in relation to principles of conservation of energy will include energy resources and expenditure. Assume data in relation to principles of conservation of structural integrity would relate to information about injury and disease process, which include laboratory values that reflect the inflammatory response, direct observation of wounds and any visible indication of disease

Data in relation to conservation of personal integrity warns about the threat to self of the patient Assessment data related to the conservation of social integrity includes information about others who have influenced the persons identification of self

NURSING DIAGNOSIS: Trophicognosis is a nursing care judgment that is arrived at through the use of scientific method. She stated that No diagnosis should be made that does not include the other persons whose lives are entwined with that of individual. 3) PLANNING: Planning focuses on what the nurse to do to aid the patient in again becoming independent. The goals that are set will reflect the patients behavior and planned activities will include both willing participants-the nurse and the patient.
2)

4) IMPLEMENTATION: The actions may focuses on increasing energy input through improved nutrition or in decreased output in full bed rest. Such actions will include appropriate positioning to prevent formation of bedsores, change of dressings and administration of antibodies. For personal integrity, efforts will be based on helping the person to preserve his or her identity and selfhood. For social integrity, nursing actions are based on helping the patient to preserve his or her place in a family, community and society.
5) EVALUATION: Levine has not discussed evaluation but her emphasis on the importance of assisting the person to return to independence as soon as possible supports the need for evaluation.

CHARACTERISTICS OF THEORY

The concept of illness adaptation, using interventions and the evaluation of nursing interventions are interrelated. Concepts are sequential and logical and can be used to explain the consequences of nursing action. Levines theory is easy to use and elements are easily comprehensible. Levines idea can be tested and hypothesis can be derived from them The principle of conservation are specific enough to be testable Levines idea have not been widely researched Levines theory have been applied in surgical settings Levines ideas are consistent with other theories, laws and principals particularly from the humanities and sciences

STRENGTHS

UNIVERSALITY: This concept applies to all human beings wherever they may be, use is not limited to any given setting

CLARITY: Theory provides clear connections to the works of others WHOLENESS

APPLICATION OF THEORY
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, paediatrics, peri-operative nursing, smoking cessation and geriatric nursing. Used with patients across the lifespan, from the neonate to the elderly patient 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. Influences the interventions undertaken by nurses

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 curriculum Provided an organizational structure for teaching Medical-Surgical Nursing and stimulus for theory development. Used to develop nursing undergraduate program
C.

Nursing Research Enhances the foundation of nursing practice and nursing education. Used by many researchers as a conceptual framework. Studies conducted by Wong (1989) and Winslow, Lane, and Gaffney (1985) support the importance of energy conservation for patients with myocardial infarctions. 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.

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 elderly patients. MacLean (1987) used the principles of conservation of energy and conservation of structural integrity in identifying cues that nurses use to diagnose activity intolerance.

LIMITATIONS
There is need for each nurse to create her own assessment tool to use Levines conservation principles. Providing flexibility and allowing each nurse to create a personal fit is required.

THANK

YOU