Myra Levine Nurses and Patients Are Engaged

Myra Levine

Nurses and patients are engaged in a "partnership of human experience," (Levine, 1977, p. 845). The ethical obligations and core values of nursing are rooted in this fundamental assumption about the relationship between nurse and patient. Nursing entails ethical obligations. "To be a nurse requires the willing assumption of ethical responsibility in every dimension of practice," (Levine, 1977, p. 845). The ethical obligations of a nurse are best explained by the belief that patients are holistic beings who constantly "thrive to preserve wholeness and integrity," ("Levine's Four Conservation Principles," 2012). Each patient is unique, too, and each seeks wholeness in a unique way. Nursing is defined as "a human interaction designed to promote 'wholeness' through adaptation." Myra Levine's theory is patient-centered, rather than disease-centered; the patient is treated and not just the disease. Because it offers specific guidelines within a rubric of ethical and philosophical tenets, Levine's conceptual framework is a middle range theory. The theory was developed over the course of several decades of Levine's work as a nurse in the mid-20th century.

The theory is rooted in the concept of adaptation, in the sense that the nurse helps the patient to adapt to his or her internal and external environments. Adaptation requires conservation of resources. There are four conservation principles that apply to the profession of nursing. Those four conservation principles include the conservation of energy, the conservation of structural integrity, the conservation of personal integrity; and the conservation of social integrity. Energy conservation is generally accomplished with rest, and the nurse can aid patient rest by ensuring the external environment is comfortable. The external environment is itself comprised of three main elements: the preconceptual, the conceptual, and the operational. Social and cultural variables are taken into account as part of the patient's external environment. Internal factors that inhibit rest, such as pain and anxiety, also need to be attended to by the nurse.

Structural integrity refers to the maintenance of personal hygiene and the restoration of the body's formal structures, such as by healing after a surgery. This aspect of conservation is best illustrated by the two qualities of internal environment: homeostasis and homeorrhesis. Homeostasis is defined as "a state of energy sparing that also provides the necessary baselines for a multitude of synchronized physiological and psychological factors," ("Myra Levine's Conservation Theory," 2009). Homeorrhesis is defined as "A stabilized flow rather than a static state," ("Myra Levine's Conservation Theory," 2009).