MYRA ESTRIN LEVINE PPT.pptx

MYRA ESTRIN LEVINE PPT

1. levine’S THEORY AND IT’S APPLICATION PRESENTED BY: MS. ANMOL RATTAN MSC NURSING 1 st YEAR R.A.K.C.O.N

2. Myra estrin levine one of the most influential theorist

3. Background of the theorist : MYRA ESTRIN LEVINE (1920-1996) was born in Chicago. She was the oldest of three children. She had one sister and one brother with whom she shared a close relationship. She was also fond of her father, who was a hardware man. He was often ill and frequently hospitalized with gastrointestinal problems. She thinks that this might have been why she had such a great interest in nursing. Levine began attending the University of Chicago but choose to attend Cook Country School of Nursing when she could no longer afford the university. She received her diploma from Cook Country in 1944. She later received her Bachelor of science degree from University of Chicago in 1949 and her master of science in nursing from Wayne State University in 1962.

4. Background of the theorist: She had clinical experience in the operating room and in oncology nursing. She was a civilian nurse at the Gardinar General Hospital, director of nursing at Drexal home in Chicago and administrative supervisor at University of Chicago clinics and Henry Ford Hospital in Michigan. She was chairperson of clinical nursing at Cook County School of Nursing and a faculty member at Loyola University, Rush University, and University of Illinois. She was a visiting professor at Tel Aviv University in Israel and Recanti School of Nursing at Ben Gurion University of the Negev in Beer Sheeva , Israel. She was professor emeritus in Medical Surgical Nursing, University of Chicago, a charter fellow of the American Association of Nurses (FAAN), and a member of Sigma Theta Tau International, from which she received the Elizabeth Russell Belford Award as distinguished educator.

5. achievements 1 1973: Charter fellow of the American Academy of Nursing. 2 1976: Honorary member of American Mental Aid. 3 1977: Honorary recognition from Illinois Nurses Association and first recipient of the Elizabeth Russell Belford Award for excellence in teaching from Sigma Theta Tau . 5

6. Contributions She authored 77 published articles which included "An Introduction to Clinical Nursing’’ with multiple publication years on 1969, 1973 and 1989.

7. INTRODUCING THE THEORY : Levine told others that she did not set out to develop a “nursing theory’’ but 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. She also wrote a book: FOUNDATIONS OF CLINICAL NURSING

8. FOUNDATIONS OF CLINICAL NURSING Levine's original reason for writing the book was to find a way to teach the foundations nursing that would focus on nursing itself and was organized in such a way of that students would learn the skill as well as the rationale for skill. She felt that the nursing research was generally ignored. Her intent was to bring practice and research together to establish nursing as an applied science. The nursing care chapters in her text focus on nursing care of the patient with: 1. Failure of the nervous system; 2. Failure of the integration resulting from hormonal imbalance; 3. Disturbance of homeostasis: fluid and electrolyte imbalance; 4. Disturbance of homeostasis: nutritional needs; 5. Disturbance of homeostasis: systemic oxygen needs; 6. Disturbance of homeostasis: cellular oxygen needs; 7. Disease arising from aberrant cellular growth; 8. Inflammatory problems; 9. Holistic response.

9. Goal of the theory: To promote adaptation and to maintain wholeness using the principle of conservation .

10.   Major concept and composition the conservation model: Levine discusses adaptation, conservation and wholeness . Adaptation is the process by which conservation is achieved and the purpose of conservation is integrity. The core of Levine’s theory are her four conservation principles.

11. ADAPTATION Adaptation is the life process by which people maintain their wholeness or integrity as they respond to environmental challenges; it is the consequences of interaction between the person and the environment. Successful engagement with the environment depends on adequate store of adaptation. Every individual has unique range of adaptive response. These responses will vary based on heredity, age, gender or challenges of an illness experiences. Levine speaks of three characteristics of adaptation: 1.Historicity 2.Specificity 3.Redundancy

12. CONSERVATION Conservation is from Latin word conservationem , which means to keep together. The product of adaptation is conservation. Through conservation, individuals are able to confront obstacles, adapt according, and maintain their uniqueness. Conservation describes how complex systems continue to function in the face of challenges; it provide not only for current survival but also for future vitality through facing challenges in the most economical way possible

13. LEVINE’S LAW OF CONSERVATION :

14. Healing is the process of restoring structuring and functional defense in wholeness. Nurses can limit the amount of tissue involved in disease by early recognition of functional changes. Refers to maintaining or restoring the structure of body preventing physical breakdown and promoting healing. Changes in structure ultimately affect function that structural integrity may be compromised by pathophysiological processes, and that healing restores structural integrity. Therefore, to regain structure and function, the body needs to restore structural integrity through repair and healing. Nursing intervention aims in helping the individual to prevent skin breakdown and limiting the amount of the tissue involved in infectious disease. Examples: Maintenance of clean, dry wrinkle-free linen. Regular turning of patient side-to-side every 2 hours to patients who are bedridden. Maintenance of patient's personal hygiene . C onservation of Structural Integrity:

15. WHOLENESS Wholeness is based on Erikson's (1964) 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) stated that "the unceasing interaction of the individual organism with its environment does represents an ‘open and fluid’ system, and a condition of health, wholeness, exists when the interaction or constant adaptions to the environment, permit ease- the assurance of integrity in all dimensions of life.’’

16. Environment contd. Levine also views each individual as having his or her own environment, both internally and externally. Nurses can relate the internal environment as the physiological and pathophysiological aspects of the patient. Levine uses Bates' definition of the external environment' and suggests three levels: (1) perceptual, (2) operational, (3) conceptual. These levels give dimension to the interactions between individuals and their environments. The perceptual level includes the aspects of the world that individuals are able to intercept and interpret with their sense organs. The operational level contains things that affect individuals physically although they cannot directly perceive them such as microorganisms. At the conceptual level, the environment is constructed from cultural patterns, characterized by a spiritual existence and mediated by the symbols of language, thought, history.

17. Individuals Respond to the Environmental Challenges by Means of Four Integrated Processes :

18. THEORETICAL ASSERTIONS Levine's work was intended to provide an organizational structure for teaching medical-surgical nursing rather than to develop theory; Therefore she did not explicitly identify theoretical assertions. Although many theoretical assertions can be generated from her work, the four major assertions follow: 1. " Nursing intervention is based on the conservation of the individual patient's energy"   2. "Nursing intervention is based on the conservation of the individual patient's structural integrity "   3. " Nursing intervention is based on the conservation of the individual patient's personal integrity."   4. "Nursing intervention is based on the conservation of the individual patient's social integrity."

19. USE OF NURSING PROCESS ACCORDING TO LEVINE: PROCESS APPLICATION OF THE PROCESS ASSESSMENT     Collection of provocative facts through interview and observation of challenges to environments, with consideration of conser - vation principles   1. Energy conservation 2. Structural integrity 3. Personal integrity 4. Social integrity   Collection of provocative facts through observation and interview of challenges to the internal and external environments. The nurse observes the patient for organismic responses to illness, reads medical reports evaluates results of diagnostic studies, and talks with patients and their families (support persons) about their needs for assistance. The nurse assesses for physiological and pathophysiological challenges to the internal environment and the factors in the perceptual operational and conceptual levels of the external environment that challenge the individual . TROPHICONOSIS   Nursing diagnosis gives the provocative facts meaning Nursing diagnosis gives provocative facts meaning. The nurse arranges the provocative facts in a way that provides meaning to the patient's predicament.

20. HYPOTHESIS     Direct the nursing interventions with the goal of maintaining wholeness and promoting adaptation Direct the nursing interventions with the goal of maintaining wholeness and promoting adaptation: nurse seeks validation of the patient's problems with the patient or support persons. The nurse then proposes hypotheses about the problems and the solutions, such as eight glasses of water a day will improve bowel evacuation. These become the plan of care INTERVENTION Test the hypotheses. Nurses use hypotheses to direct care. The nurse tests proposed hypotheses. Interventions are designed based on the conservation principles: conservation of energy, structural integrity, personal integrity, and social integrity. Interventions are not imposed but are determined to be mutually acceptable. The expectation is that this approach will maintain wholeness and promote adaptation .

21. EVALUATION   Observation of organismic response to interventions                 Observation of organismic response to interventions. The outcome of hypothesis testing is evaluated by assessing for organismic response that means the hypotheses are supported or not supported. Consequences of care are either therapeutic or supportive therapeutic measures improve the sense of well-being supportive measures provide comfort when the downward course of illness cannot be influenced. If the hypotheses are not supported, the plan is revised and new hypotheses are proposed.

22. EXAMPLE OF NURSING PROCESS ACCORDING TO LEVINE’S MODEL: Mona, wife of an abusive husband, underwent a radical hysterectomy Postoperatively had pain, weight loss, nausea, inability to empty bladder. Patient had history of smoking and stayed in house which had no hygiene. Assessment Challenges to the internal environment of weight loss, nausea, loss of reproductive ability Challenges to the external environment of abusive husband, unhygienic conditions at home. Energy conservation : Weight loss, nausea, pain. Structural integrity: Threatened by surgical procedure, inability to pass urine. Personal integrity : Not able to give birth to more children Social integrity: Strained relationship with husband.

23. EXAMPLE OF NURSING PROCESS ACCORDING TO LEVINE’S MODEL: 2. Trophicognosis : Inadequate nutritional status. Pain Potential for wound and bladder infection . Need to learn self- catheterization. Decreased self-worth Potential for abuse.

24. EXAMPLE OF NURSING PROCESS ACCORDING TO LEVINE’S MODEL: 3 .Hypothesis Nutritional consultation Teaching and return demonstration of urinary catherization. Care of surgical wound. Exploring concern regarding hysterectomy .  

25. EXAMPLE OF NURSING PROCESS ACCORDING TO LEVINE’S MODEL: 4. INTERVENTIONS Energy Conservation Providing medication for pain and nausea Allowing rest period.

26. EXAMPLE OF NURSING PROCESS ACCORDING TO LEVINE’S MODEL Structural Integrity Administering antibiotic for wound. Teaching self-catheterization. Personal Integrity Exploring her feeling about uterus removal while respecting her privacy. Social Integrity Assess potential abuse from husband. Support to family.

27. LEVINE'S WORK AND CHARACTERISTICS OF THEORY Theories can interrelate concepts in such a way as to create a different way of looking at a particular phenomenon. - Levine has incorporated concepts of adaptation, conservation, integrity in a way that provide a different nursing view. Theories must be logical in nature. -Levine's work is logical. One thought or idea flows from the previous one and into the next .

28. LEVINE'S WORK AND CHARACTERISTICS OF THEORY Theories should be relatively simple yet generalizable. - There are only three concepts in Levine's theory. This is the essence of simplicity. -The theory is generalizable as it can be used in any setting with any human assistance from a nurse. Theories can be the bases for hypotheses that can be tested . -Levine's idea can be tested. Hypothesis can be derived from them -Research have been conducted to test this hypothesis . Theories contribute to and assist in increasing the general body of knowledge within the discipline trough research implemented to validate them. -Research has been conducted using Levine’s theory that has contributed to the general body of knowledge.

29. The assumptions and values related to model : 1.The person is viewed as a holistic being: "The experience of wholeness is the foundation of all human enterprises" 2.Human beings respond in a singular yet Integrated fashion. 3. Each individual responds wholly and completely to every alteration in his or her life pattern. 4.Individuals cannot be understood out of the context of their environment. 5."Ultimately, decisions for nursing care are based on the unique behavior of the individual patient.... A theory of nursing must recognize the importance of unique detail of care for a single patient within an empiric framework which successfully describes the requirements of all patients".

30. The assumptions and values related to model 6 "Patient-centered care means individualized nursing care. It is predicated on the reality of common experience: every man is a unique individual, and as such requires a unique constellation of skills, techniques, and ideas designed specially for him". 7 "Every self-sustaining system monitors its own behavior by conserving the use of resources required to define its unique identity". 8 The nurse is responsible for recognizing the state of altered health and the patient's organismic response to altered health. 9 Nursing is a unique contributor to patient care. 10. The patient is in an altered state of health. A patient is one who seeks health care because of a desire to remain healthy or one who identifies a known or possible risk behavior.

31. values 1.All nursing actions are moral actions. 2.Two moral imperatives are the sanctity of life and the relief of suffering. 3.Ethical behavior 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. 4. A fully informed individual should make decisions regarding life and death in advance of the situations. These decisions are not the role of the health-care providers or families. 5 Judgments by nurses or doctors about quality of life are inappropriate and should not be used as a basis for the allocation of care. 6 "Persons who require the intensive interventions of critical care units enter with a contract of trust. To respect trust... is a moral responsibility"

32. APPLICATIONS : 1. Practice Levine helps define what nursing is by identifying the activities it encompasses and giving the scientific principles behind them. Conservation principles as a framework are not limited to nursing care in the hospital, but can be generalized and used in every environment, hospital, or community.

33. APPLICATION Conservation principles, levels of integration, and other concepts can be used in numerous contexts. Hirschfeld has used the principles of conservation in the care of the older adult. Savage used the Conservation Model to establish a plan of care for infants. Dever based her care of children on the Conservation Model. Roberts, Fleming, and Yeates -Giese designed interventions for women in labor on the basis of the Conservation Model. Pond used conservation model for guiding the nursing care of homeless at a clinic, shelters or streets:- 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, with them recognizing that the interventions should be related to the adaptive pathways, while remembering that each pathway is influenced by historicity, specificity, and redundancy. Applied in rendering comprehensive nursing care incorporated in the nursing process.

34. APPLICATION 2. Education Levine wrote Introduction to Clinical Nursing," a textbook for beginning students that introduced new material into the curricula. She presented an early discussion of death and dying and believed that women should be awakened after a breast biopsy and consulted about the next step." Introduction to Clinical Nursing provides an organizational structure for teaching medical-surgical nursing to beginning students. 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 curricula. Provided an organizational structure for teaching medical-surgical nursing and stimulus for theory development. She aimed to move away from a procedurally oriented educational process and instead sought to teach the major concepts of medical-surgical nursing as generalized content.

35. APPLICATION 3. RESEARCH Fitzpatrick and Whall state, "All in all, Levine's model served as an excellent beginning. Its contribution has added a great deal to the overall development of nursing knowledge." Enhances the foundation of nursing practice and nursing education. Hypotheses have been developed from Levine's theory, and research has been conducted to test these hypotheses. 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 in that nurses use to diagnose activity intolerance

36. CRITIQUING THE THEORY 1 Clarity Levine's model possesses clarity. Fitzpatrick and Whall believe that Levine's work is both internally and externally consistent. Fawcett states that "Levine's Conservation Model provides nursing with a logically congruent, holistic view of the person." The model has numerous terms; however, Levine adequately defines them for clarity . 2 Simplicity Although the four conservation principles appear simple initially, they contain sub concepts and multiple variables. Nevertheless, this model is still one of the simpler ones that have emerged. 3 Generality The four conservation principles can be used in all nursing contexts.

37. LIMITATIONS

38. REASEARCH ARTICLE : The effects of nursing care based on Levine's Conservation Model on fatigue, depression, perceived social support, and sleep quality in infertile women: A randomized controlled trial. Nurcan Kirca et al. Int J Nurs Knowl . 2022.     Purpose : The purpose of this study was to investigate the effects of nursing care based on the Levine's Conservation Model on depression caused by infertility, fatigue, perceived social support, and sleep quality levels.

39. REASEARCH ARTICLE Methods : This study includes randomized controlled trial that was conducted from July 2019 to April 2020, with 65 Turkish women with infertility (experimental group: 34, control group: 31). We collected data using the Visual Similarity Scale for Fatigue, the Pittsburgh Sleep Quality Index, the Beck's Depression Inventory, and the Multidimensional Perceived Social Support Scale. The experimental group received nursing care based on the Levine's Conservation Model. Data were analyzed using t-tests and χ2 tests analyses.

40. Research article Findings : As a result of the measurements made, it was found that the experimental group had a lower fatigue level than the control group, with a statistically significant difference between the groups (p < 0.001). It was also found that the experimental group had higher energy and perceived social support scores than the control group after the practice, with a statistically significant difference between the groups (p < 0.001). As a result of the measurements made after the practice, it was found that the experimental group had a lower depression level than the control group, with a statistically significant difference between the groups (p < 0.001).

41. Research article Conclusions: Nursing care based on the Levine's Conservation Model decreased fatigue and depression in women receiving infertility treatment and increased perceived social support and sleep.

42. CONCLUSION: Myra Levine’s nursing theory views the client as an integrated being who interacts with and adapts to environment. Levine expressed the view that within the nurse-patient relationship. The patient's state of health is dependent on the nurse-supported process of adaptation. This guides nurses to focus on the influences and responses of a client to promote wholeness through the Conservation Principles. The goal of this model is to accomplish this through the conservation of energy, structural, personal and social integrity. The goal of nursing is to recognize, assist, promote, and support adaptive processes that benefit the patient.

43. REFERENCES : 1.Book BRAR N.P, RAWAT HC TEXTBOOK OF ADVANCED NURSING PRACTICE, JAYPEE PUBLICATIONS, 1 st EDITION. Page No. 605-614. TOMEY MARRINER ANN, ALLIGOOD KAILL MARTHA'S NURSING THEORY UTILIZATION & APPLICATION, 5 th EDITION, MOSHY, page no.212-219 MARILYN E. PARKAR NURSING THEORIES AND NURSING PRACTICE, 2 nd EDITION, Page no. 94-124. POTTER A. PATRICIA , PERRY GRIFFIN ANNE, FUNDAMENTALS OF NURSING,MOSBY,5 TH EDITION,PAGE NO .94-96