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Transcript of MYRA LEvine
s • The 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 when emotional
• Human being are capable of prolonging reflection through such strategists raising questions Theoretical Sources •From Beland’s presentation of the theory of specific causation and multiple factors, Levine learned historical viewpoints of diseases and learned that the way people think about disease changes over time.
•Levine uses 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.
•Levine acknowledged Nightingale's contribution to her thinking about the "guardian activity" of observation used by nurses to "save lives and increase health and comfort" Environment •Context in which we live our lives PERSON •Holistic being; wholeness is integrity meaning that the person has freedom of choice and movement
•Has a sense of identity and self-worth
•Described person as system of systems and its wholeness expresses the organization of all the contributing parts
•Life process is the process of changes Conservation of... Perceptual - the aspect of the world that individuals are able to intercept and interpret with the senses
Operational - microorganism that can affect individual physically but are not directly perceived
Conceptual - constructed from cultural patterns such as spiritual experiences and mediated by the symbols of languages, thought and history Introduction •Diploma in nursing:-Cook County SON, Chicago, 1944
•BSN:-University of Chicago,1949
•MSN:-Wayne State University, Detroit, 1962
•Publication:- An Introduction to Clinical Nursing, 1969, 1973 & 1989
•Received honorary doctorate from Loyola University in 1992
•Clinical experience in OT technique and oncology nursing
•Civilian Nurse at the Gardiner General Hospital The Conservation Theory
Myra Estrine Levine
1920-1996 Metaparadigm INTERNAL and EXTERNAL ENVIRONMENT
Internal environment – physiological and pathophysiological aspects of the individual and is constantly challenged by the external environment.
Homeorrhesis – stabilized flow, fluidity of change within a space-continuum
Homeostasis – is a state of energy sparing, a static change External Environment HEALTH •Health is a wholeness and successful adaptation
•It is not merely healing of an afflicted part ,it is return to daily activities, selfhood and the ability of the individual to pursue once more his or her own interest without constraints
•Disease: It is unregulated and undisciplined change and must be stopped or death will ensue NURSING •"Nursing is a profession as well as an academic discipline, always practiced and studied in concert with all of the disciplines that together from the health sciences"
•The human interaction relying on communication ,rooted in the organic dependency of the individual human being in his relationships with other human beings
•Nursing involves engaging in "human interactions" energy structural
integrity Composition Major Concepts and Definitions
Conservation Adaptation Wholeness W Q E R T Y A S D F holeness based on Erik Erikson
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 fluent.”
Levine believed that Erikson’s definition set up the option of exploring the parts of the whole to understand the whole. daptation Adaptation is a process of change whereby the individual retains his integrity within the realities of his internal and external environment.
Is achieved through the “frugal, economic, contained and controlled use of the environmental resources by the individual in his/her best interest G Z X C V Characteristics
Redundancy describes the notion that if one system or pathway, is unable to ensure adaptation, then another pathway may be able to take over and complete the job. Historicity refers to the notion that adaptive responses are partially based on personal and genetic past history. Each individual is made up of a combination of personal and genetic history, and adaptive responses are the result of both. Specificity refers the fact that each system that makes up a human being has unique stimulus-response pathways. Responses are stimulated by specific stressors and are task oriented. Responses that are stimulated in multiple pathways tend to be synchronized and occur in a cascade of complimentary (or detrimental in some cases) reactions. onservation To keep together, it describes the way complex systems are able to continue to function even when severely challenged. The primary focus of conservation is keeping together of the wholeness of the individual. Conservation is the outcome. Some adaptation is a matter of degree, not an all or nothing process, there is no such thing as maladaptation. Flight or Fight Inflammatory Stress Perceptual it requires the balance of energy and a constant renewal of energy to maintain life activities. Process such as healing and aging challenge that energy. it requires the balance of energy and a constant renewal of energy to maintain life activities. Process such as healing and aging challenge that energy. Examples: adequate rest,
nutrition, – healing is a process of restoring structural and functional integrity in defense of wholeness. Example: assisting in ROM exercise, personal hygiene Self-worth and a sense of identity are important. The most vulnerable become patients; it begins with the erosion of privacy and creation of anxiety and stress. Example: recognize and protect patient’s space need – life gains meaning through social communities and health is socially determined. Example: help the individual to preserve his or her place in the family, community and society Human being make decision through prioritizing course of action
Human being must be aware and able to contemplate objects, condition and situation
Human being 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
Every person possesses a unique adaptive ability based on one’s life experience which creates a unique message A human being is a social animal
A human being is an constant interaction with an ever changing society
Change is inevitable in life
Nursing needs existing and emerging demands of self care and dependant care
Nursing is associated with condition of regulation of exercise or development of capabilities of providing care •There is an order and continuity to life change is not random
•A human being respond organismically in an ever changing manner
•A theory of nursing must recognized the importance of detail of care for a single patient with in an empiric framework that successfully describe the requirement of the all patient Applications Nursing research
Principles of conservation have been used for data collection in various researches
Conservational model was used by Hanson et al.in their study of incidence and prevalence of pressure ulcers in hospice patient
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 Nursing education • Conservational model was used as guidelines for curriculum development
• It was used to develop nursing undergraduate program at Allentown college of St. Francis de Sales, Pennsylvania
• Used in nursing education program sponsored by Kapat Holim in Israel
• Nursing administration
• Taylor (n.d.) described an assessment guide for data collection of neurological patients which forms basis for development of comprehensive nursing care plan and thus evaluate nursing care
• McCall (n.d.) developed an assessment tool for data collection on the basis of four conservational principles to identify nursing care needs of epileptic patients
• Family assessment tool was designed by Lynn-Mchale and Smith (n.d.) for families of patient in critical care setting •Conservational model has been used for nursing practice in different settings
•Bayley (n.d.) discussed the care of a severely burned teenagers on the basis of four conservational principles and discussed patient’s perceptual, operational and conceptual environment
•Pond (n.d.) used conservation model for guiding the nursing care of homeless at a clinic, shelters or streets Nursing Practice Limitations •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. Myra’s Conventional Model primary focus is on the individual and their wholeness measured by one’s personal and emotional well being during a specific period of time, it has been contested that this model is not the best suited when it comes to addressing one’s illness in the long term. Thus, the conventions that Myra imposes on nursing students are more driven towards a patient’s satisfaction in their current state without looking to future conditions. In addition, satisfying only current conditions does not allow room for nurses to attempt to prevent illness if following this specific model as they are concentrated more on the individual than the illness Nursing research: Thanks for
listening! Conceptual Model Conceptual Model CASE STUDY CASE STUDY
Nursing Management utilizing Myra Levine’s Conservation Principle
Mrs. RL is a 47-year-old female rushed to the emergency room due to onset of sudden severe chest pain radiating to the left arm and left angle of the jaw associated with diaphoresis, nausea, vomiting, and shortness of breath. Initial vital signs as follows: T=37.0 C, CR=110 bpm, RR=30 rpm, BP=140/90 mmHg. Oxygen was administered at 2-4 lpm via nasal cannula. Morphine 4mg was administered intravenously as ordered. 12-lead ECG shows ST-elevation consequently a medical diagnosis of Acute Coronary Syndrome ST-segment elevation Myocardial Infarction was made. Intravenous fluid resuscitation was initiated with PNSS 1L at KVO regulation. Metoclopramide 1 ampule was administered intravenously for nausea and vomiting. She was instructed nothing per orem temporarily.
Aside from the chief complaint, a non-healing wound was noticed on Mrs. RL’s right foot. Medical history confirms Diabetes Mellitus Type II. Capillary blood glucose reads 314 mg/dl and a rescue dose of Humulin R 10 units was administered intravenously as ordered.
Conservation of Energy
Energy must be conserved to prevent precipitation of the clinical distress brought about by the medical condition of Mrs. RL. Our client is prone to activity intolerance therefore provision of complete bed rest with commode privileges for 24 to 48 hours may address this problem. The goal is to prevent further myocardial tissue injury, maximize tissue perfusion, and reduce tissue demands. Energy is conserved to promote oxygenation and tissue perfusion. Instructions must be given to the patient regarding avoidance of over fatigue. Oxygen therapy must be ensured at appropriate regulation and tolerance. Position the client in Semi-Fowler’s to allow greater diaphragm expansion thereby lung expansion and better carbon dioxide-oxygen exchange. Assist the client in feeding and performing self-hygiene to minimize the efforts provided by the patient in such activities. Most importantly, anticipate the needs of the client.
Conservation of Structural Integrity
Daily wound care must be rendered over the non-healing wound of Mrs. RL on her right foot. Prevention of infection is the goal to minimize further damage. Healing should be promoted as soon as possible. Cleanse the wound properly and apply prescribed topical medications by the physician. Keep wound dressing intact over the affected area. Administer prescribed antibiotics ordered. Aside from focusing on the wound per se, capillary blood glucose levels must be under tight controls. Determine the signs and symptoms of hypoglycemia and hyperglycemia and respond accordingly with appropriate insulin therapy.
Conservation of Social Integrity
Encourage friends and relatives to visit the patient during visiting hours. This provides Mrs. RL of a sense of security in an unfamiliar environment and would relieve the anxiety brought about by present hospitalization.
Conservation of Personal Integrity
Hospitalization is a great stressor to the well-being of an individual. Promote relief of anxiety and well-being by providing an opportunity for Mrs. RL to explore concerns and to identify alternative methods of coping as necessary. Promote a positive attitude and active participation of Mrs. RL in her care during her stay in the hospital. Build up a constructive nurse-patient relationship. Use an emphatic approach when caring. Deal with the Mrs. RL as a person with specific needs rather than a patient requiring merely medical help. Make her feel more comfortable with the nurse by calling her by her name rather than bed number. Help her feel that she is respected and treated with dignity. Provide privacy through proper draping and screening when performing commode activities such as perineal hygiene, diaper change, changing of hospital gown, bed bath, and the like. Promote independence and autonomy in the course of her hospitalization. In short, “put yourself into the shoes of your client” to maintain effectively his/ her personal integrity.