Myra Levine Grand Nursing Theory Based on Interactive Process Biography — Early & Family Life Myra Levine was born in 1920 in Chicago, IL (“Myra Estrin Levine,” 2016) First of three children Her father’s “persistent gastrointestinal illness” sparked her interest in pursuing a career in nursing Myra Levine died on March 20, 1996, at age 75 (Gonzalo, 2019) Biography — Education Graduated from Cook County School of Nursing Obtained BSN from the University of Chicago in 1944 Obtained MSN from Wayne State University in Detroit in 1962 Earned honorary doctorate from Loyola University in 1992 (“Myra Estrin Levine,” 2016) Biography — Nursing Career Oncology nurse at Gardiner General Hospital in Chicago Became Director of Nursing Drexel Home in Chicago Clinical instructor at Bryan Memorial Hospital in Lincoln, NE (“Myra Estrin Levine,” 2016) Surgical supervisor at the University of Chicago and Henry Ford Hospital in Detroit (Gonzalo, 2019) Chairperson of clinical nursing at Cook County School of Nursing (“Myra Estrin Levine,” 2016) Chronological order Biography — Publications, Awards, & Honors Works: “The Pursuit of Wholeness,” “For Lack of Love Alone,” “Adaptation and Assessment: A Rationale for Nursing Intervention,” “The Four Conservation Principles of Nursing,” & “Introduction to Clinical Nursing” Charter fellow of the American Academy of Nursing in 1973 Honorary recognition from the Illinois Nurses’ Association Member of Sigma Theta Tau at Alpha Beta Chapter Elected fellow in the Institute of Medicine of Chicago First recipient of the Elizabeth Russel Belford Award for excellence in teaching from Sigma Theta Tau in 1977 (Gonzalo, 2019) Best known for “The Four Conservation Principles of Nursing,” the others were preliminary works She never planned on developing a nursing theory, she worked as a consultant for different hospitals and nursing schools and came up with an organizational structure for teaching med-surg nursing which was the basis for theory development Philosophical Underpinnings Understanding the era in which Myra Levine matured helps give background to her theory Healthcare was based on authoritarianism and physician decisions were not questioned Nurses were taskers, operating without a scientific origin (Toon, 2014) -In noting pioneers in nursing, it is suitable to recall the era in which theorists such as Myra Levine matured. In Levine’s case it is helpful to recall the era in sociological terms, cultural terms and recall the available technology and the discipline of medicine and how nurses ‘fit’ at the time. The environment of her maturation and development became the underpinning of her career and her Theory of Conservation for Nursing. -nurses were primarily seen as the ‘handmaidens’ of doctors; neither patients nor nurses were anticipated to que ...

1. Myra Levine
Grand Nursing Theory Based on Interactive Process
Biography — Early & Family Life
Myra Levine was born in 1920 in Chicago, IL (“Myra Estrin
Levine,” 2016)
First of three children
Her father’s “persistent gastrointestinal illness” sparked
her interest in pursuing a career in nursing
Myra Levine died on March 20, 1996, at age 75
(Gonzalo, 2019)
Biography — Education
Graduated from Cook County School of Nursing
Obtained BSN from the University of Chicago in 1944

2. Obtained MSN from Wayne State University in Detroit in
1962
Earned honorary doctorate from Loyola University in 1992
(“Myra Estrin Levine,” 2016)
Biography — Nursing Career
Oncology nurse at Gardiner General Hospital in Chicago
Became Director of Nursing Drexel Home in Chicago
Clinical instructor at Bryan Memorial Hospital in Lincoln, NE
(“Myra Estrin Levine,” 2016)
Surgical supervisor at the University of Chicago and Henry
Ford Hospital in Detroit (Gonzalo, 2019)
Chairperson of clinical nursing at Cook County School of
Nursing (“Myra Estrin Levine,” 2016)
Chronological order
Biography — Publications, Awards, & Honors
Works: “The Pursuit of Wholeness,” “For Lack of Love Alone,”
“Adaptation and Assessment: A Rationale for Nursing

3. Intervention,” “The Four Conservation Principles of Nursing,”
& “Introduction to Clinical Nursing”
Charter fellow of the American Academy of Nursing in 1973
Honorary recognition from the Illinois Nurses’ Association
Member of Sigma Theta Tau at Alpha Beta Chapter
Elected fellow in the Institute of Medicine of Chicago
First recipient of the Elizabeth Russel Belford Award for
excellence in teaching from Sigma Theta Tau in 1977
(Gonzalo, 2019)
Best known for “The Four Conservation Principles of Nursing,”
the others were preliminary works
She never planned on developing a nursing theory, she worked
as a consultant for different hospitals and nursing schools and
came up with an organizational structure for teaching med-surg
nursing which was the basis for theory development
Philosophical Underpinnings
Understanding the era in which Myra Levine matured helps give
background to her theory
Healthcare was based on authoritarianism and physician
decisions were not questioned
Nurses were taskers, operating without a scientific origin
(Toon, 2014)

4. -In noting pioneers in nursing, it is suitable to recall the era in
which theorists such as Myra Levine matured. In Levine’s case
it is helpful to recall the era in sociological terms, cultural
terms and recall the available technology and the discipline of
medicine and how nurses ‘fit’ at the time. The environment of
her maturation and development became the underpinning of her
career and her Theory of Conservation for Nursing.
-nurses were primarily seen as the ‘handmaidens’ of doctors;
neither patients nor nurses were anticipated to question a
physicians perspective or decision
Philosophical Underpinnings Continued
Social revolution evolved in the 1960’s to early 1970’s
Intellectual development was blossoming
Myra Levine had many different roles (clinical instructor,
supervisor, chairperson) (Myra Estrin Levine, 2019).
Definitions of “nursing science” were vague
Theorists began applying biological, medical, and social
sciences to nursing (Aita VA, 1995)
Levine had incorporated the conservation of energy, structure,
personal, and social integrity into a theory that guided nurses in
the provision of care that promotes health through environment,
predictably, and illuminates the fact that humans are greater
than the sum of their parts, that human response is predictable,
that humans are unique, are capable of assessing conditions,
situations and objects, and drawing an understanding of those
perceptions. Further, Levine extrapolated that humans are self-

5. determinate (even during periods of stress and emotion and that
they will formulate their own opinions via reflection (Four
Conservation Principals, 2016).
Philosophical Underpinnings Continued
Levine’s focus was on influences and responses, energy supply
and demand
Her theory allows for the enhancement of health by working
with the patient instead of ‘on’ the patient (Frauman and Rasch,
1995)
Theory was built responsively to her era
Based on patient care perspective and scientific perspective
(Myra Levine’s Remarks, 1995)
-Levine’s focus was on influences and responses, energy supply
and demand- and the patient outcome when that patient is acted
upon and exists with structural, personal, and social integrity
and is capable of conservation of energy. Her theory
incorporated and explained homeostatic and homeorhetic states
of existence and the fluidity of adaptation
-Levine’s theory is the antithesis of authoritarianism and is
principally and philosophically balanced to allow healing.
-The fact remains that Levine’s esoteric theory began to develop
in a time when a patient’s ‘need to know’ about their care or
disease process(es) was nearly nil and physicians were a rarified
group and usually authoritarian. It appears that Levine’s theory
was built responsively to her era of medical understanding and
practice. She developed the highly adaptive model of care that
was responsive to the patient’s specific context/need and less
focused on medical procedures and standard interventions.

6. -The bedrock for her logic was crafted by both the era and her
unique understanding of what needed to improve in nursing,
both from a patient care perspective and from a scientific
perspective.
Analysis — Introduction
Purpose of the conservation model is to improve the physical
and emotional wellbeing of a person by considering the four
domains of conservation
Client Energy
Personal integrity
Structural integrity
Social integrity
Nursing’s role in conservation is to help the person with the
process of “keeping together” the total person through the least
amount of effort
A conceptual model with three nursing theories
Conservation
Redundancy
Therapeutic intention
(Alligood & Tomney, 2015)
Analysis — Conservation Model
Focuses on promoting adaptation & maintaining wholeness
using the conservation principle
Goal: to improve the physical and emotional wellbeing of a
person

7. By proposing to address the conservation of energy, structure,
and personal and social integrity, this theory helps guide nurses
in the provision of care that will help maintain and promote the
health of the patient
(Erickson, Tomlin, & Swain, 2014)
Analysis — Conservation Model Continued
Nursing’s role in conservation is to help the person with the
process of “keeping together” the total person through the least
amount of effort
Nurse is seen as part of the environment and uses skill,
knowledge, and compassion to assist each client to confront
environmental challenges in resolving problems
Effectiveness of interventions is determined by maintenance of
client integrity
(Erickson, Tomlin, & Swain, 2014)
Analysis — Principles
Conservation of energy refers to balancing energy input and
output to avoid excessive fatigue

8. Includes adequate rest, nutrition and exercise
Conservation of personal integrity recognizes the individual as
one who strives for recognition, respect, self-awareness,
selfhood, and self-determination
Involves acknowledging and preserving patient’s space needs
(Roy, 2014)
Analysis — Principles Continued
Conservation of structural integrity refers to maintaining or
restoring the structure of body preventing physical breakdown
and promoting healing
Includes assisting patients in ROM exercise and the
preservation of patient’s personal hygiene
Conservation of social integrity exists when a patient is
recognized as someone who resides within a family, a
community, a religious group, an ethnic group, a political
system, and a nation
Nursing care should help the individual to preserve his or her
place in a family, community, and society
(Roy, 2014)

9. Analysis — Concepts
Wholeness is the singular, yet integrated response of the
individual to forces in the environment
Adaptation is 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
Conservation includes joining together and is the product of
adaptation including nursing intervention and patient
participation to maintain a safe balance
(Sitzman & Eichelberger, 2011)
Analysis — Levine’s Theory in Nursing
Nursing is the human interaction relying on communication,
rooted in the organic dependency of the individual human being
in his relationships with other human beings (Meleis, 2013)
Analysis — Levine’s Theory in Health
Health is the pattern of adaptive change of the whole being
It should be noted that it is not only the insult or the injury,

10. which is repaired, but also the individual him/herself
Health is not only the healing of an afflicted part, but a return
to normalcy (Roy, 2014)
Analysis — Levine’s Theory in Patient
Person/patient is the unique individual in unity and integrity,
feeling, believing, thinking, and whole (Sitzman &
Eichelberger, 2011)
Analysis — Levine’s Theory in Environment
Focus is given to the three aspects of external environment
drawn upon Bates’ (1967) classification which are:
The operational environment consists of the undetected natural
forces which impinge on the individual
The perceptual environment consists of information that is
recorded by the sensory organs
The conceptual environment is influenced by language, culture,
ideas, and cognition

11. (Alligood & Tomney, 2015)
Analysis — Relationship Between Concepts
The relationships between the concepts serves as the basis for
nursing interventions
All nursing interventions are based on careful and continued
observation over time
(Erickson, Tomlin & Swain, 2014)
Analysis — Usefulness of Theory
Levine’s (1973) model has been useful in nursing education
Used to develop a nursing undergraduate program at Allentown
College of Saint Francis de Sales in Center Valley, PA
Deemed to be compatible with the mission and philosophy of
the college
Also used in the graduate program at the same school as the
framework for development of the content of the graduate
nursing courses
(Meleis, 2013)

12. Analysis — Usefulness of Theory
The ED at the Hospital of the University of Pennsylvania used
the four conservation principles of Levine’s model as an
organizing framework for nursing practice
Believed that use of the model strengthened communication and
improved nursing care in the hospital through an atmosphere of
collaboration among disciplines
The conservation principles were also found to be useful in
directing nursing practice in the care of children
The concept of adaptation and the four conservation principles
were particularly relevant and especially important to the
healing of the ill child
(Meleis, 2013)
Analysis — Usefulness of Theory
A concept analysis was published using Levine’s conservation
model to refine the concept of creativity for nursing practice
Mefford (2004) based her theory of health promotion for
preterm infants on Levine’s conservation model

13. Neswick (1997) suggested Levine’s model as the theoretic basis
for enterostomal therapy (ET) nursing
Integrated the four conservation principles into wound and
ostomy care.
The principles that she found useful were energy, structure,
personal integrity, and social integrity
Found Levine’s framework useful because of its holistic
approach
(Meleis, 2013)
Analysis — Testability
Levine’s Conservation Model has guided research studies
internationally
Schaefer and Potylycki (1993) used Levine’s model to study
fatigue in patients with congestive heart failure with a focus on
client adaptation
Leach (2006) studied wound management in Australia using
Levine’s four principles and found that the model contributed to
health and wholeness of the client and assisted in cost-effective
care
(Meleis, 2013)

14. Analysis — Parsimony
The model is fairly parsimonious whereby four succinctly stated
conservation principles comprise the model
15 concepts addressed by Levine’s model and 5 working
assumptions, covering both the individual and nursing care
Model requires some knowledge of the environment to which
the patient is responding
In every stage, an assessment must be made to determine how
effectively the patient is responding
(Sitzman & Eichelberger, 2011)
Analysis — Value in Extending Nursing Science
Levine’s (1973) Conservation Model has impacted the
discipline of nursing in education, practice, and research,
providing four defining principles that are sufficiently universal
to allow research and practice in a large number of situations
The concept of holism, although not unique to this model, was
proposed at an early stage in nursing’s scientific history and has
made an important difference in the care of clients
(Alligood & Tomney, 2015)

15. Analysis — Value in Extending Nursing Science Continued
This model has value in guiding education and in implementing
practice. It helps to fulfill the spirituality, goals, and values of
both the client and nurse
Nurses use it in diverse clinical settings, such as psychiatric
care, acute care, and community nursing
Several chapters and books by the author and associates, and
numerous journal articles have been generated by this model
(Alligood & Tomney, 2015)
Analysis — Assumptions
Each individual is an active participant in interactions with the
environment.
The individual is a sentient being.
Change is the essence of life.
Change is unceasing as long as life goes on. Change is
characteristic of life.
The decisions for nursing intervention must be based on the
unique behavior of the individual patient.
Every man is a unique individual, and as such he requires a
unique constellation of skills, techniques and ideas designed
specifically for him.

16. References
Aita VA. (1995). Toward improved practice: Formal
prescriptions and informal expressions of compassion in
American nursing during the 1950s. Retrieved from CINAHL
Complete database. (Accession No. 109873162)
Alligood, M. & Tomney, A. (2015). Nursing Theory: Utilization
& Application. St. Louis: Mosby.
Erickson, H., Tomlin, E. & Swain, M. (2014). Modeling and
Role Modeling: A Theory and Paradigm for Nursing. Columbia:
R.L Bryan.
Four conservation principles. (2016). Retrieved November 15,
2019, from Nursing Theory website: http://nursing-
theory.org/theories-and-models/levine-four-conservation-
principles.php
Frauman, A. C., & Rasch, R. (1995). Myra Levine, at last a
clear voice of reason. Journal of Nursing Scholarship, 27(4),
261. Retrieved from Clio Hosting database.

17. References
Gonzalo, A. (2019). Myra Estrin Levine: The conservation
model of nursing. Retrieved from https://nurseslabs.com/myra-
estrin-levine-the-conservation- model-of-nursing/
King, M. (1995). Myra Levine's remarks. The Journal of
Nursing Scholarship, 27(3), 174. Retrieved from Clio Hosting
database.
Meleis, A. (2013). Theoretical Nursing: Development and
Progress. London: Lippincott Williams & Wilkins.
Myra Estrin Levine - Nursing theorist. (2016). Retrieved from
https://nursing-theory.org/nursing-theorists/Myra-Estrine-
Levine.php
Roy, C. (2014). Generating middle Range Theory: From
Evidence to Practice. New York: Springer.
Sitzman, K. & Eichelberger, L. (2011). Understanding the Work
of Nurse Theorists: A Creative Beginning. Burlington. Jones
and Bartlett.
References
Toon, E. (2014). The machinery of authoritarian care:
Dramatising[sp] breast cancer treatment in 1970s Britain. Social
History of Medicine, 27(3), 557-576.
https://dx.doi.org/10.1093%2Fshm%2Fhku003
What's in the name (autobiography & characteristics of theory)
[Blog post]. (2011). Retrieved from Myra Estrin Levine: Four

18. Conservation Principles website: http://myra-levine-
4conservationprinciples.blogspot.com/
· Discuss the similarities and differences in how each nursing
theorist (my group’s theorist Myra Levine’s Conservational
Theory compared to the following groups’ theorists: 1. Sister
Callista Roy -The Roy Adaptation Model (RAM), and 2. Jean
Watson’s theory of Human Caring/carimng Science.
Also, defined metaparadigm concepts (that is, patient, health,
environment, and nursing).
Ensure you clearly identify to which group’s presentations you
are discussing.
Use a minimum of two scholarly references in APA style to
support your replies.
Examples of other Group posts presentation.
Group 4
The Roy Adaptation Model (RAM) is brilliant. It recognizes
that patient environments are constantly changing and nurses
can promote health by aiding patients in adaptation (McEwen &
Wills, 2014). This helps patients accept and understand their
diagnoses. Many practice guidelines, middle range theories, and
curriculums have been derived from this nursing theory
(McEwen & Wills, 2014). It is used all over the world. Its
impact on the nursing profession is immense.
I did not face many challenges in understanding the theory

19. because it is mostly straightforward. One difficulty I had was
trying to remember all the assumptions of the theory (McEwen
& Wills, 2014). As time goes on, the theory is developed
further. This leads to the formation of more assumptions.
Another obstacle I came across was interpreting some of the
specific aspects of concepts, such as the cognator and regulator
subsystems (McEwen & Wills, 2014).
I was able to solve these problems by reviewing the information
a few times. Reading about the theory more than once helped
me recall and comprehend the parts that were challenging. By
the end of the project, I felt as though I was an expert on the
subject.
The RAM is involved in a lot of nursing research and
developments today. One interesting study I found evaluated the
effectiveness of a RAM-inspired training program for mothers
of children receiving chemotherapy (Hatami & Hojjati, 2019).
Researchers found that mothers who underwent the training
program experienced improved burden (Hatami & Hojjati,
2019). Another fascinating study I found determined the
efficacy of an intervention based on the RAM for patients with
diabetes mellitus (Hadis, Reza & Reza, 2018). Researchers
found that the intervention enhanced patients’ quality of life,
health status, and adaptation (Hadis, Reza & Reza, 2018).
Group #2
Our group chose Jean Watson’s theory of human caring/caring
science. This theory is based on the belief of providing care that
focuses on being loving, kind, calm and authentic (Watson
Caring Science Institute, 2010). The core concepts of this
theory are defined as having “a relational caring for self and
others, creating transpersonal caring relationship, providing
heart-centered encounters with others, multiple ways of
knowing (through science, art, aesthetic, ethical, intuitive,
personal, cultural and spiritual), and a reflective/meditative
approach” (Watson Caring Science Institute, 2010, p. 1)
We enjoyed learning about Jean Watson’s theory of human

20. caring. We felt that Watson’s theory is important to understand
as a nurse providing care. To be able to care using Watson’s
care theory, one must first learn the value assumptions (Sitzman
& Watson, 2014) A summary of the value assumptions are listed
as:
· Caring and love are a universal source of energy
· Use wisdom in loving and caring ways
· For humanity to survive in this world, there must be deep
care for human, community, and civilization.
· A nurses’ mission should be to sustain caring ideals,
ethics, and philosophy
· To care, love, forgive, be compassionate and merciful for
others we must first be that for ourselves
· As a nurse, we must continue to be knowledgeable,
informed and ethical to sustain care and ensure survival
This theory is pretty straight forward and easy to understand. It
discusses the importance of self-care so that we can in turn,
provide the highest quality of care. Holly Wei and Jean Watson
(2018) write, “healthcare faces a wide-spread phenomenon,
professional burnout…to provide the best quality of care to
patients requires physically and psychologically healthy
healthcare professionals” (p. 22). Ames, Salmond, Holly, and
Kamienski (2017) write compassion fatigue negatively affects
the quality of care provided by the nurse which can cause risk
of safety and error. An issue with this theory is not the theory
itself but learning how to care for ourselves so that we can be
the best nurses for others. Watson is one of the few theorists
that integrates care for the provider in her theory (Jacqueline
van Wijlen, 2017). To provide the best care, it is imperative that
we as providers follow Watson’s theory and care for ourselves
so that we can provide the best possible care for others.