Critique of a Nursing Theory

3 March 2017

This is a critique of Myra Estrin Levine’s conservation principles model. I will be discussing the meaning of the theory of the four principles; conservation of energy, conservation of structural integrity, conservation of personal integrity, and conservation of social integrity. I will be using the criterion-based model (C-BaC) as a focus of the positive aspects of the theory, as outlined by Johnson & Webber (Johnson & Webber, 2010, p. 92-214). I will discuss the intent and theory, the concepts and propositions, and the usefulness in nursing practice. How a nurse is defined could be very influential for those who aspire to become a nurse, and even for those who are already nurses. My definition of a nurse is one whose main focus is to care for others, medically, emotionally, and spiritually. Myra Levine has a unique outlook on the world of nursing that many may find hard to interpret.

She had her own theories and principles of nursing that implemented health and well-being to patients through her conservation principles model. Her model was originally developed, not to be a nursing theory, but to attempt to teach nursing students a new approach to daily nursing activities. Intent and Boundaries The meaning of the theory of Myra Levine consists of four principles: conservation of energy, conservation of structural integrity, conservation of personal integrity, and conservation of social integrity.

Each are fundamental to the expected outcomes when the model is used, but Levine also discussed “two other concepts critical to the use of her model; adaptation and wholeness” (“Myra Levine’s Conservation Theory“, 2009) (which will be discussed throughout the critique). Her goal was to “promote adaptation and maintain wholeness by using the principles of conservation” (Nursing Theories: A Companion to Nursing Theories and Models, 2010). Conservation of energy: balancing energy output and input to avoid fatigue.

Conservation of structural integrity: maintaining the integrity of a patient by restoring the structure of the body by preventing physical breakdown and facilitating healing. Conservation of personal integrity: to recognize a sense of self-worth, identity and acknowledging uniqueness. Conservation of social integrity: an individual who is recognized as someone who is part of a family, a community, and a population. Levine’s conservation model was designed to “provide a curriculum that would recognize medical-surgical coursework for a graduate curriculum” (Johnson & Webber, 2010, p. 140).

She believed that the conservation model was for the use of all fields of professional nursing practice, but she also believed that a professional nursing practice “could only be achieved at a graduate level” (Johnson & Webber, 2010, p. 140). Other theorist’s such as Selye’s, Bertalanffy, and Erickson had an impact on Levine’s idea for her theory. My definition of nursing and Levine’s theory do differ in many ways, but our ultimate goals are the same. Levine, in my opinion, focuses on the integrity, uniqueness, and the structure of the patient, and then she focuses on whatever necessary to make the patient well.

Within my nursing practice, and with the evolution of nursing since Levine’s time, my focus is comfort of the patient, educating the patient, the patient’s family, the community, and teaching how to adapt and maintain a healthy lifestyle physically, emotionally, and spiritually. Levine’s theory has been applied for research purposes, such as: “The investigation of an exercise intervention to mitigate cancer – related to fatigue (Mock et al. , 2007, p. 1). There is a table on page 5 of the journal that shows the breakdown of the study and how Levine’s conservation model is implemented for the study. Boundaries are consistent with nursing practice” according to Johnson & Webber (2010, p. 193). These boundaries, as I interpret them form Levine, when a patient is in a state of conservation, then the patient has successfully adapted to optimal energy, structural, personal, and social integrity, and this is achieved by nurse-patient rapport and interaction. Although I do not define optimal patient health as Levine would, I do believe that the boundaries of today’s health disciplines and Levine’s theory ultimately have the same patient goal; patient wholeness.

The meaning of Levine’s conservation theory is defined differently in all the secondary sources used. There are no words used that are misunderstood. I would not constitute any of the definitions read as jargon, slang or unnecessary and meaningless writing. The primary source, Levine’s definition of “Conservation of Social Integrity is to recognize the individual as one who strives for recognition, respect, self awareness, selfhood and self determination” (Nursing Theories: A Companion to Nursing Theories and Models, 2010).

Selfhood is one word that I am not familiar with and had to look up for confirmation of meaning. The meaning of selfhood is integrity; strive for selfhood would be to strive for individuality or for your own true identity. Concepts and Propositions Levine’s theories share four major concepts; person, environment, health, and nursing. A concept of person is one who is being holistic and striving to accomplish complete integrity, “someone who is future-oriented and past-aware” (“Myra Levine’s Conservation Theory“, 2009). Each individual has an internal and external environment that completes their wholeness.

The internal environment is divided into “perceptual, operational, and conceptual environments” (“Myra Levine’s Conservation Theory“, 2009). Perceptual being a person’s senses, operational being the function of the body’s interaction with the elements that can have long term effects on bodies but are not perceived until later. Conceptual environment consists of “language, ideas, symbols, the ability to think and experience, to have emotion, and to have individual psychological patterns that come from life experiences” (“Myra Levine’s Conservation Theory“, 2009).

Health is the general condition in all aspects, physically, mentally and emotionally. Nursing is promoting all of the concepts above and realizing that every patient is an individual with different needs to be met to complete their wholeness. Levine’s theories are consistent with the major concepts when referring to the ultimate goal of patient health, which is to complete their wholeness. Two examples of a proposition might be: 1. Encouraging your patient to continue to wear their mouth guard at night to decrease headaches and better sleeping patterns. 2.

Teaching your patients the importance of completing their antibiotics to avoid having recurring episodes of the same bacteria causing infection. The concepts in the first example using Levine’s conservation principles would be: – Wearing the mouth guard- conservation of structural integrity. The second concept would be: – Decrease of headaches- conservation of personal integrity. Ultimately this would give the patient less pain and a better quality of life. The concepts in the second example using Levine’s conservation principles would be: – Completing the antibiotics- conservation of structural integrity.

The second concept would be: – Learning the importance of completing the antibiotics- personal integrity. By the patient completing the antibiotics he is preventing the bacteria from spreading and from becoming ill from infection. The increase of knowledge gives him understanding and knowledge about antibiotics and why it is important to complete them. The variables in the examples are “the observable and measurable concepts with the ability to change” (Johnson & Webber, 2010, p. 207). Example 1: the variable: patient compliance with wearing the mouth guard. Internal variables: compliance, physical well-being.

External variables: headaches, increased sleep (better sleeping patterns). Assumption: With continued use of mouth guard the patient will have a decrease number of headaches, better sleeping patterns and an increased quality of life. Example 2: the variable: compliance in completing the antibiotics. Internal variables: compliance, physical well-being. External variables: infection, increased knowledge. Assumption: Completion of antibiotics will indicate no presence of bacteria causing infection and learning about antibiotics will increase his knowledge. Usefulness in Nursing

Phenomenon can be defined as an “observable connection or relationship between objects, events or ideas” (Johnson & Webber, 2010, p. 317). I chose the phenomenon of referred pain because I work on a Day Surgery unit I will often get patients complain of pain that is unrelated to their surgery. 1. Phenomenon: When stimulated by pressure, different areas give rise to brief episodes of referred pain perceived at a distance from the trigger spot. 2. Frequently patients who have endured a laparoscopic cholecystectomy (gallbladder removal) complain of pain unrelated to their surgery, often in the shoulders.

It has been reported that this is due to “the analgesics used by the surgeons during the surgery” (Michaloliakou, Chung, & Sharma, 1996, p. 5). 3. This phenomenon could be a negative effect on nursing practice if the nurse’s are unaware of the possible side effects of have referred pain post laparoscopic cholecystectomy. Understanding the theory behind referred pain post-operatively has influenced by nursing practice by being able to give an educated response to patient’s inquiries about the pain. It has been beneficial to both me and my patient’s to have this knowledge. Self Evaluation

I am particularly happy with my choice to learn more about Myra Levine. Although I feel not quite fully informed of what her role was as a nurse. Most of what I had learned about her theory was how other researchers implemented her conservation theories to their research. I was also not aware completely of how to structure this type of critique in the paper. I followed the text, learned what I believe is correct, but I do not feel as though the paper flows as well as a critique should.

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