Myra Estrin Levine (1921-1996) was a nursing theorist known for her Conservation Model, which emphasizes the importance of wholeness, adaptation, and the environment in nursing care. Levine's model presents concepts such as the organismic response to environmental challenges, conservation principles, and the metaparadigm of nursing that focus on promoting adaptation and integrity for individuals. Her work underscores the interconnectedness of health, personhood, and the sociocultural context within which nursing occurs.

1. Myra Estrin
Levine
(1921-1996)
THE CONSERVATION MODEL

2. - Myra Estrin Levine was born in Chicago, Illinois in 1920.
- A nusing theorist known for her esoteric nursing
model-- The Conservation Model.
- She was first child of three siblings. Her involvement
throughout her father’s persistent gastrointestinal illness
contributed to her interest in and devotedness to
nursing.
- In 1944, Myra Estrin Levine received her diploma in
nursing from the Cook County School of Nursing, then
continued to finish her Bachelor of Science in Nursing
from the University of Chicago in 1949. Her Master’s of
Science in Nursing was granted to her from Wayne State
University in Detroit in 1962.
- Aside from being a major influence in the nursing
profession, Levine was also a family of woman, friend,
educator, administrator, student of humanities, scholar,
enabler, and confidante. She was creative and
knowledgeable, opinionated, and global in her concept in
PERSONAL BACKGROUND

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Both the 1st Book (Introduction
to Clinical Nursing) and her 2nd
Book Edition ( Renewal for
Nursing) received an award “
American Journal of Nursing
Book of the Year Award”.

4. Major Concepts and
Definitions

5. • Wholeness (Holism)
-Levine based her use of wholeness on Erikson’s (1964,
1968) description of wholeness as an open system. Levine
(as cited in 1969a) quotes Erikson, who states, “Wholeness
emphasizes a sound, organic, progressive mutuality
between diversified functions and parts within an entirety,
the boundaries of which are open and fluent”. Levine
(1996) believed that Erikson’s definition set up the option
of exploring the parts of the whole to understand the
whole. Integrity means the oneness of the individuals,
emphasizing that they respond in an integrated, singular
fashion to environmental challenges.

6. • Adaptation
-“Adaptation is a process of change whereby the individual retains his
integrity within the realities of his internal and external environment”
. Conservation is the outcome. Some adaptations are successful and
some are not. Adaptation is a matter of degree, not an all-or-nothing
process. There is no such thing as maladaptation.
Levine (1991) speaks of the following three characteristics of
adaptation:
1. Historicity
2. Specificity
3. Redundancy

7. She states, “…every species has fixed patterns of
responses uniquely designed to ensure success in
essential life activities, demonstrating that adaptation
is both historical and specific” . In addition, adaptive
patterns may be hidden in the individual’s genetic
code. Redundancy represents the fail-safe options
available to individuals to ensure adaptation. Loss of
redundant choices through trauma, age, disease, or
environmental conditions makes it difficult for the
individual to maintain life. Levine (1991) suggests that
“the possibility exists that aging itself is a
consequence of failed redundancy of physiological

8. • ENVIRONMENT
-Levine (1973) also views each individual as having his or
her own environment, both internally and externally.
Nurses can relate to the internal environment as the
physiological and pathophysiological aspects of the
patient. Levine uses Bates’ (1967) definition of the external
environment and suggests the following three levels:
1. Perceptual
2. Operational
3. Conceptual

9. These levels give dimension to the interactions between
individuals and their environments. The perceptual level
includes 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,
things 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, and history (Levine, 1973).

10. • ORGANISMIC RESPONSE
- The capacity of the individual to adapt to his or her environmental
condition is called the organismic response. It can be divided into the
following four levels of integration:
1. Fight or flight
2. Inflammatory response
3. Response to stress
4. Perceptual awareness
Treatment focuses on the management of these responses to illness
and disease (Levine, 1969a).

11. • Fight or Flight
-The most primitive response is the fight or flight syndrome. The individual
perceives that he or she is threatened, whether or not a threat actually exists. Hospitalization,
illness, and new experiences elicit a response. The individual responds by being on the alert
to find more information and to ensure his or her safety and well-being (Levine, 1973).
* Inflammatory Response
-This defense mechanism protects the self from insult in a hostile environment. It
is a way of healing. The response uses available energy to remove or keep out unwanted
irritants and pathogens. It is limited in time because it drains the individual’s energy reserves.
Environmental control is important (Levine, 1973).
* Response to Stress
-Selye (1956) described the stress response syndrome to predictable, non–
specifically induced organismic changes. The wear and tear of life is recorded on the tissues
and reflects long-term hormonal responses to life experiences that cause structural change. It
is characterized by irreversibility and influences the way patients respond to nursing care.
* Perceptual Awareness
- This response is based on the individual’s perceptual awareness. It occurs only as
the individual experiences the world around him or her. The individual uses this response to
seek and maintain safety. It is information seeking (Levine, 1967a, 1969b).

12. • Trophicognosis
- Levine (1966) recommended
trophicognosis as an alternative to nursing
diagnosis. It is a scientific method of
reaching a nursing care judgment.

13. • CONSERVATION
- Conservation is from the Latin word conservatio, which means
“to keep together” (Levine, 1973). “Conservation describes the
way complex systems are able to continue to function even
when severely challenged” (Levine, 1990, p. 192). Through
conservation, individuals are able to confront obstacles, adapt
accordingly, and maintain their uniqueness. “The goal of
conservation is health and the strength to confront disability” as
“…the rules of conservation and integrity hold” in all situations
in which nursing is required (Levine, 1973). The primary focus of
conservation is keeping together the wholeness of the
individual. Although nursing interventions may deal with one
particular conservation principle, nurses also must recognize
the influence of the other conservation principles (Levine, 1990).

14. Levine’s (1973) model stresses nursing interactions and
interventions that are intended to promote adaptation and
maintain wholeness. These interactions are based on the
scientific background of the conservation principles.
Conservation focuses on achieving a balance of energy supply
and demand within the biological realities unique to the
individual. Nursing care is based on scientific knowledge and
nursing skills. There are four conservation principles.

16. • CONSERVATION PRINCIPLES
- The goals of the Conservation Model are achieved through
interventions that attend to the conservation principles.
1. Conservation of Energy
The individual requires a balance of energy and a constant
renewal of energy to maintain life activities. Processes such as
healing and aging challenge that energy. This second law of
thermodynamics applies to everything in the universe,
including people. Conservation of energy has long been used in
nursing practice even with the most basic procedures. Nursing
interventions “scaled to the individual’s ability are dependent
upon providing care that makes the least additional demand
possible” (Levine, 1990).

17. 2. Conservation of Structural Integrity
Healing is a process of restoring structural
and functional integrity through
conservation in defense of wholeness
(Levine, 1991). The disabled are guided to a
new level of adaptation (Levine, 1996).
Nurses can limit the amount of tissue
involved in disease by early recognition of
functional changes and by nursing

18. 3. Conservation of Personal Integrity
Self-worth and a sense of identity are important. The most
vulnerable become patients. This begins with the erosion of
privacy and the creation of anxiety. Nurses can show
patients respect by calling them by name, respecting their
wishes, valuing personal possessions, providing privacy
during procedures, supporting their defenses, and teaching
them. “The nurse’s goal is always to impart knowledge and
strength so that the individual can resume a private life—no
longer a patient, no longer dependent” (Levine, 1990). The
sanctity of life is manifested in all people. “The conservation
of personal integrity includes recognition of the holiness of
each person” (Levine, 1996).

19. 4. Conservation of Social Integrity
Life gains meaning through social
communities, and health is socially
determined. Nurses fulfill professional
roles, provide for family members, assist
with religious needs, and use interpersonal
relationships to conserve social integrity
(Levine, 1967b, 1969a).

20. NURSING METAPARADIGM

21. - The goal of nursing is to promote adaptation and maintain wholeness.
- It is the nurse’s task to bring a body of scientific principles, on which decisions depend, into the
precise situation that she shares with the patient. Sensitive observation and the selection of relevant
data form the basis for her assessment of his nursing requirements.
-The nurse participates actively in every patient’s environment and much of what she does supports his
adjustments as he struggles in the predicament of illness.
NURSING

22. PERSON
Person is described as a holistic being; wholeness is integrity (Levine, 1991). Integrity means that the
person has freedom of choice and movement. The person has a sense of identity and self-worth.
Levine also described person as a “system of systems, and in its wholeness expresses the
organization of all the contributing parts”. Persons experience life as change through adaptation
with the goal of conservation. According to Levine (1989), “The life process is the process of
change”

23. HEALTH
Health is socially determined by the ability to function in a reasonably normal manner (Levine, 1969b). Social groups
predetermine health. Health is not just an absence of pathological conditions. Health is the return to self;
individuals are free and able to pursue their own interests within the context of their own resources. Levine
stressed the following:
It is important to keep in mind that health is also culturally determined—it is not an entity on its own, but rather a
definition imparted by the ethos and beliefs of the groups to which individuals belong (M. Levine, personal
communication, February 21, 1995).
Even for a single individual, the definition of health will change over time.

24. ENVIRONMENT
Environment is conceptualized as the context in which individuals live their lives. It is
not a passive backdrop. “The individual actively participates in his environment”
(Levine, 1973). Levine discussed the importance of the internal and external
environment to the determinant of nursing interventions to promote adaptation.
“All adaptations represent the accommodation that is possible between the internal
and external environment” .

25. ASSUMPTIONS
● “Ultimately, the decisions for nursing intervention must be based on the
unique behavior of the individual patient.”
● “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)
● Each individual “is an active participant in interactions with the
environment… constantly seeking information from it.” (Levine, 1969)
● The individual “is a sentient being, and the ability to interact with the
environment seems ineluctably tied to his sensory organs.”