The goal of the Four Conservation Principles of Nursing, created by Myra Estrine Levine, is to promote

adaptation and maintain wholeness by using the principles of conservation. The model guides the
nurse in focusing on the influences and responses at the organismic level.

There are assumptions made by the theory.

✧ The nurse creates an environment in which healing can occur.
✧ A human being is more than the sum of his or her parts.
✧ Human beings respond in a predictable way.
✧ Human beings are unique in their responses.
✧ Human beings know and appraise objects, conditions, and situations.
✧ Human beings sense, reflect, reason, and understand.
✧ Human beings actions are self-determined, even when emotional.
✧ Human beings are capable of prolonging reflection through strategies such as asking
questions.

According to Levine’s theory, every patient has a unique range of adaptive responses, which vary based
on the individual circumstances of the patient including age, gender, and illness. The responses are the
same, but the timing and manifestation of organismic responses will be unique for each patient’s pulse
rate. An ongoing process of change in which the patient maintains his or her integrity within the
realities of the environment. Adaptation is achieved through the “frugal, economic, contained and
controlled use of environmental resources by individual in his or her best interest.”

Wholeness exists when the interaction or constant adaptations to the environment permits the
assurance of integrity, and is promoted by the use of conservation principle. Conservation is the
product of adaptation. It is the achievement of balance of energy supply and demand that is within the
biological realities of the individual patient.

The Four Conservation Principles in Levine’s model of nursing are: conservation of energy,
conservation of structural integrity, conservation of personal integrity, and conservation of social
integrity. They help the nurse accomplish the goals of the model.

Conservation of energy refers to balancing the input and output of energy in order to protect from
over-fatigue. It includes adequate rest, nutrition, and exercise. The conservation of structural integrity
means maintaining or restoring the physical body by preventing physical breakdown or promoting
healing. Personal integrity conservation recognizes the patient as someone who seeks recognition,
respect, self-awareness, self-hood, and self-determination. The conservation of social integrity exists
when a patient is recognized as someone who lives with a family, a community, a religious or ethnic
group, a political system, and a nation.

Levine’s model explains the environment in two parts: internal and external. The environment
completes the wholeness of the patient, who is seen as a holistic being who strives to preserve
wholeness and integrity.

The internal environment has two components, which are homeostasis and homeorrhesis.
Homeostasis is a state of energy-sparing that also provides the necessary baselines for a multitude of
synchronized physiological and psychological factors. Homeorrhesis is a stabilized flow rather than a
static state. It emphasizes the fluidity of change within a space-time continuum. It describes the pattern
of adaptation, which permits the patient’s body to sustain its well-being with the vast changes that
encroach upon it from the environment.

The external environment has three components: preconceptual, operational, and conceptual.
Preconceptual is the aspect of the world that the patient is able to intercept. The operational
environment contains elements that may physically affect patients, but are not perceived by them. This
includes things like radiation, micro-organisms, and pollution. The conceptual is part of the patient’s
environment that includes cultural patterns characterized by spiritual existence, ideas, values, beliefs,
and tradition.

According to Levine, the patient and environment have three concepts: adaptation, organismic
response, and conservation.

Adaptation has three characteristics: historicity, specificity, and redundancy. Historicity states that
adaptations are grounded in history and await the challenges to which they respond. Specificity refers
to the individual responses and their adaptive pattern, which varies on the basis of specific genetic
structure. Finally, redundancy explains the options available to the patient to ensure continued
adaptation.

Organismic response is a change in the behavior of a patient during an attempt to adapt to the
environment. These responses help the patient protect and maintain his or her integrity. There are four
types of these responses:
1. Fight or flight, which is an instantaneous response to real or imagined threat. It is the most
primitive response.
2. Inflammatory, which is a response intended to provide for structural integrity and the
promotion of healing.
3. Stress, which is a response developed over time and influenced by each stressful experience
the patient encounters.
4. Perceptual, which involves gathering information from the environment and converting it into
a meaning experience

Levine’s theory includes nine models of guided assessment:

a. Vital signs
b. body movement and positioning
c. ministration of personal hygiene needs
d. pressure gradient system in nursing interventions
e. nursing determination in provision of nutritional needs
f. pressure gradient system in nursing
g. local application of heat and cold
h. administration of medicine
i. establishing an aseptic environment

The model explains that “Nursing is a profession as well as an academic discipline, always practiced
and studied in concert with all of the disciplines that together form the health sciences.” Nursing
involves human interactions, which rely on communication, rooted in the organic dependency of the
individual human beings in relationships with other human beings. The goal of nursing is to promote
wholeness, realizing that every individual patient requires a unique and separate cluster of activities.
The individual integrity is his or her abiding concern, and it is the nurse’s responsibility to assist him
or her to defend and to seek its realization. The steps of the nursing process in Levine’s model are
assessment, trophicognosis, hypothesis, interventions, and evaluation.