Philosophical Underpinnings of the Theory
Levine (1973) based the Conservation Model on Nightingale’s idea that “the nurse created an environment in which healing could occur” (p. 239). She drew from the works of Tillich on the unity principle of life, Bernard on internal environment, Cannon on the theory of homeostasis, and Waddington on the concept of homeorrhesis. The works of other scientists were also used. Four conservation principles form the basis of the model; these were synthesized from her scientific study and practice (Levine, 1990).
Major Assumptions, Concepts, and Relationships
The following four conservation principles are the major principles around which the model is constructed:
· The principle of the conservation of energy
· The principle of the conservation of structural integrity
· The principle of the conservation of personal integrity
· The principle of the conservation of social integrity (Levine, 1990, p. 331)
According to Levine’s model, nursing interventions are based on conservation of the client’s integrity in each of the conservation domains. The nurse is seen as a part of the environment and shares the repertoire of skill, knowledge, and compassion, assisting each client to confront environmental challenges in resolving the problems encountered in the client’s own unique way. The effectiveness of the interventions is measured by the maintenance of client integrity (Levine, 1973, 1990).
Assumptions About Individuals
· Each individual “is an active participant in interactions with the environment constantly seeking information from it” (Levine, 1969, p. 6).
· The individual “is a sentient being and the ability to interact with the environment seems ineluctably tied to his sensory organs” (Levine, 1973, p. 450).
· “Change is the essence of life and it is unceasing as long as life goes on. Change is characteristic of life” (Levine, 1973, p. 10).
Assumptions About Nursing
· “Ultimately the decisions for nursing intervention must be based on the unique behavior of the individual patient” (Levine, 1973, p. 6).
· “Patient-centered nursing care means individualized nursing care. It is predicated on the reality of common experience: every man is a unique individual, and as such he requires a unique constellation of skills, techniques and ideas designed specifically for him” (Levine, 1973, p. 23).
Many concepts are discussed in the model. Major concepts are listed in Table 8-1.
Table 8-1: Major Concepts of the Conservation Model
|Environment||Includes both the internal and external environment.|
|Person||The unique individual in unity and integrity, feeling, believing, thinking, and whole.|
|Health||Patterns of adaptive change of the whole being.|
|Nursing||The human interaction relying on communication, rooted in the organic dependency of the individual human being in his [sic] relationships with other human beings.|
|Adaptation||The process of change and integration of the organism in which the individual retains integrity or wholeness. It is possible to have degrees of adaptation.|
|Conceptual environment||The part of the person’s environment that includes ideas, symbolic exchange, belief, tradition, and judgment.|
|Conservation||Includes joining together and is the product of adaptation including nursing intervention and patient participation to maintain a safe balance.|
|Energy conservation||Nursing interventions based on the conservation of the patient’s energy.|
|Holism||The singular, yet integrated response of the individual to forces in the environment.|
|Homeostasis||Stable state normal alterations in physiologic parameters in response to environmental changes; an energy-sparing state, a state of conservation.|
|Modes of communication||The many ways in which information, needs, and feelings are transmitted among the patient, family, nurses, and other health care workers.|
|Personal integrity||A person’s sense of identity and self-definition. Nursing intervention is based on the conservation of the individual’s personal integrity.|
|Social integrity||Life’s meaning gained through interactions with others. Nurses intervene to maintain relationships.|
|Structural integrity||Healing is a process of restoring structural integrity through nursing interventions that promote healing and maintain structural integrity.|
|Therapeutic interventions||Interventions that influence adaptation in a favorable way, enhancing the adaptive responses available to the person.|
|Source: Adapted from Levine (1973).|
Relationships are not specifically stated but can be extracted from the descriptions given by Levine (1973). The relationships serve as the basis for nursing interventions and include:
· 1. Conservation of energy is based on nursing interventions to conserve energy through a deliberate decision as to the balance between activity and the person’s available energy.
Evelyn M. Wills
Kristin Kowalski is a hospice nurse who wishes to expand the scope of her therapeutic practice. She desires to delve more deeply into holistic health care, having recently completed courses of study in herbal medicine, touch therapy, and holistic nursing. Kristin is aware that to practice independently, she needs professional credentials that will be widely accepted; therefore, she applied to the graduate program of a nationally ranked nursing school at a large state university.
Because Kristin believes strongly in holistic nursing practice, for her master’s degree she decided to focus her study of nursing theories on those that look at the whole person and have a broad, nontraditional view of health. She is particularly interested in Rosemarie Parse’s Humanbecoming Paradigm because this viewpoint stresses the individual’s way of being and becoming healthy and the nurse as an intersubjective presence.
Kristin is attracted to Parse’s idea of true presence and wishes to further explore this concept as well as the rest of the perspective. She hopes to eventually apply it to her practice and use it as the research framework for her thesis. For her thesis, Kristin wants to examine the experiences of nurses who practice therapeutic touch. She desires to learn their perceptions of how therapeutic touch interventions help their clients. She also wants to learn more about Parse’s research method and hopes to use it for her study.
The term simultaneity paradigm was first coined by nursing theorist Rosemarie Parse (1987) to describe a group of theories that adhered to a unitary process perception of human beings. This group of theorists believed that humans are unitary beings: energy systems embedded in the universal energy system. Within this group of theories, human beings are seen as unitary, “whole, open and free to choose ways of becoming” (Parse, 1998, p. 6), and health is described as continuous human environmental interchanges (Newman, 1994).
The unitary process nursing model and two corollary theories are described in this chapter: Science of Unitary Human Beings (Rogers, 1994), Health as Expanding Consciousness (Newman, 1999), and Humanbecoming School of Thought (Parse, 1998, 2010). The three are grouped together because they are significantly different in their concepts, assumptions, and propositions when compared to the theories described in Chapters 7 and 8. They are universal in scope and relatively abstract.