Yolanda is a 55-year-old married African American mother of two adult children who has a history of breast cancer. She was diagnosed with fibromyalgia 2 years ago, after years of unexplained muscle aches and what she thought was arthritis. The diagnosis was a relief for her; she was able to read about it and learn how to care for herself. Over the past 2 months, Yolanda stopped taking all of her medicine, because she was seeing a new primary care provider and wanted to start her care at “ground zero.” In addition to her family responsibilities, she is completing her degree as an English major. At the time of her clinic appointment, she told the nurse practitioner that she was having the worst pain possible. Using Levine’s conservation model, the nurse practitioner completes a comprehensive assessment in preparation for developing a plan of care. A thorough assessment of characteristics of the internal and external environments is performed, with assessment of the adequacy of the adaptive fit that Yolanda has achieved in response to the changing environmental conditions produced by this health challenge. Nursing care is planned using the conservation principles. Yolanda’s diagnosis of fibromyalgia was based on the cluster of presenting symptoms (pain, fatigue, and sleeplessness) and the exclusion of other illnesses. The assessment of the internal environment (physiological and pathophysiological processes) was performed by a thorough physical examination and various laboratory and diagnostic tests. Yolanda’s tests results were within normal limits. The external environment includes perceptual, operational, and conceptual factors. Perceptual factors are perceived through sensory input. Yolanda reported a history of unexplained fatigue and sensations of pain for years. She recently stopped her medications “to clean my body out.” However, she reported that the pain became unbearable and was making it difficult for her to sleep. She noted that when she sleeps at least 6 hours a night, her pain is less intense. With the current insomnia, her pain is very intense. Operational factors are threats within the environment that the patient cannot perceive through the senses. Yolanda reported severe pain in response to both the cold weather and changes in barometric pressure. The conceptual environment includes cultural and personal values about health care, the meaning of health and illness, knowledge about health care, education, language use, and spiritual beliefs. In response to breast cancer, Yolanda developed her spirituality through prayer and reading the Bible. She believes this is how she is getting through the painful moments of her current illness. Conservation of energy focuses on the balance of energy input and output to prevent excessive fatigue. Yolanda complains of a fatigue that just “comes over me.” She has difficulty doing housework. A day of work usually means 1 day in bed because of extreme fatigue. Her hemoglobin level and hema.

1. Yolanda is a 55-year-old married African American mother of
two adult children who has a history of breast cancer. She was
diagnosed with fibromyalgia 2 years ago, after years of
unexplained muscle aches and what she thought was arthritis.
The diagnosis was a relief for her; she was able to read about it
and learn how to care for herself. Over the past 2 months,
Yolanda stopped taking all of her medicine, because she was
seeing a new primary care provider and wanted to start her care
at “ground zero.” In addition to her family responsibilities, she
is completing her degree as an English major. At the time of her
clinic appointment, she told the nurse practitioner that she was
having the worst pain possible.
Using Levine’s conservation model, the nurse practitioner
completes a comprehensive assessment in preparation for
developing a plan of care. A thorough assessment of
characteristics of the internal and external environments is
performed, with assessment of the adequacy of the adaptive fit
that Yolanda has achieved in response to the changing
environmental conditions produced by this health challenge.
Nursing care is planned using the conservation principles.
Yolanda’s diagnosis of fibromyalgia was based on the cluster of
presenting symptoms (pain, fatigue, and sleeplessness) and the
exclusion of other illnesses.
The assessment of the internal environment (physiological and
pathophysiological processes) was performed by a thorough
physical examination and various laboratory and diagnostic
tests. Yolanda’s tests results were within normal limits.
The external environment includes perceptual, operational, and
conceptual factors. Perceptual factors are perceived through
sensory input. Yolanda reported a history of unexplained fatigue

2. and sensations of pain for years. She recently stopped her
medications “to clean my body out.” However, she reported that
the pain became unbearable and was making it difficult for her
to sleep. She noted that when she sleeps at least 6 hours a night,
her pain is less intense. With the current insomnia, her pain is
very intense.
Operational factors are threats within the environment that the
patient cannot perceive through the senses. Yolanda reported
severe pain in response to both the cold weather and changes in
barometric pressure.
The conceptual environment includes cultural and personal
values about health care, the meaning of health and illness,
knowledge about health care, education, language use, and
spiritual beliefs. In response to breast cancer, Yolanda
developed her spirituality through prayer and reading the Bible.
She believes this is how she is getting through the painful
moments of her current illness.
Conservation of energy focuses on the balance of energy input
and output to prevent excessive fatigue. Yolanda complains of a
fatigue that just “comes over me.” She has difficulty doing
housework. A day of work usually means 1 day in bed because
of extreme fatigue. Her hemoglobin level and hematocrit are
normal; her oxygen saturation is also within normal limits.
These normal physiological assessments are typical in patients
with fibromyalgia.
Conservation of structural integrity involves maintaining the
structure of the body to promote normal functioning.
Fibromyalgia treatment focuses on reducing symptoms.
Yolanda’s symptoms could not be traced to any physical or
structural alteration, yet she reports severe pain and fatigue. It
is important to acknowledge the reality of the symptoms and
work with the patient to determine whether activities of daily

3. living result in changes in the pattern of illness. In addition,
Yolanda thinks she is going through menopause (a normal
physiological change in body structure), and she is having
trouble determining whether her symptoms are menopause or
fibromyalgia.
With continued questioning, Yolanda revealed that she was
diagnosed with irritable bowel syndrome several years earlier.
This condition presents further risks to structural integrity. She
is not worried about constipation but is concerned about sudden
diarrhea. She is afraid to go to school, fearing embarrassment
because she might have an “accident.” Interventions to conserve
structural integrity include interventions to promote normal
bowel function and optimize Yolanda’s nutritional status.
Personal integrity involves the maintenance of one’s sense of
personal worth and self-esteem. Yolanda reported that she “lost
control” when she was diagnosed with breast cancer. A dear
friend convinced her to go to church and encouraged her to use
prayer. When feeling sorry for herself, she would go into her
bedroom and read her Bible, cry by herself, and pray. She
believes that prayer and Bible reading helped her heal. She
continues to pray and read her Bible to gain the strength she
needs to live with her illness. She also believes that she needs
to be able to laugh at aspects of her situation; humor helps her
feel better. She actively seeks health information, as indicated
by her quest to learn about her diagnosis of fibromyalgia. She is
most upset about not being able to walk as she used to walk.
One of her favorite pastimes was shopping for shoes at the mall,
which now is difficult for her.
Social integrity acknowledges that the patient is a social being.
Yolanda is a married mother of two grown children. She
conceals many of her feelings from her children but does share
with her husband, who is supportive. Among the ways that he
cares for her are to take her places she needs to go (such as

4. grocery shopping) and to make sure she gets to her health care
appointments on time.
An initial plan of care for Yolanda includes interventions based
on the four conservation principles:
• Conservation of energy: (1) Discuss strategies to balance rest
and activity; (2) discuss strategies to help her achieve restful
sleep; (3) discuss both nonpharmacological and pharmacological
approaches to manage pain; and (4) assess her nutritional intake
to ensure adequate energy stores.
• Conservation of structural integrity: (1) Discuss any needed
modifications of activities to prevent injury; (2) assess diet to
identify whether any foods exacerbate gastrointestinal
symptoms; (3) discuss the normal physiological process of
menopause, including associated symptoms; and (4) consider
additional laboratory work or referrals to evaluate hormone
levels and assess whether additional treatment is indicated to
relieve menopause symptoms.
• Conservation of personal integrity: (1) Validate the illness
experience; (2) encourage continued use of prayer, Bible
reading, and humor to help her feel better; and (3) discuss
strategies to help her manage her anxiety related to the irritable
bowel syndrome, including both nonpharmacological and
pharmacological approaches.
• Conservation of social integrity: (1) Praise Yolanda for the
strong family relationships that she has built and encourage her
to continue to work together with her family to optimize her
health; (2) with Yolanda’s permission, talk with her husband to
answer his questions about her condition and discuss how they
can continue to work together to improve her health; and (3)
praise Yolanda for continuing to seek achievement of her goal
of completing her English degree and discuss strategies to

5. manage the irritable bowel syndrome and manage problems to
help her feel more confident about going to school.
In Yolanda’s follow-up care, these outcomes suggest effective
adaptation that is conserving wholeness and integrity:
• Feels rested, with 6 hours of uninterrupted sleep
• Reduction in pain and fatigue
• Distinguishes symptoms of menopause from symptoms of
fibromyalgia
• Collaborates with health care providers to manage symptoms
of menopause
• Reports comfort as a result of prayer, Bible reading, and
humor
• Minimal adverse bowel symptoms and adequate nutritional
intake
• Healthy relationships with family and friends.
• Attends school and participates in other social activities with
minimal limitations.
*This case study was developed from a fibromyalgia study
(Schaefer, 2005). A fictitious name was used to protect privacy
and anonymity.
Critical thinking activities
1. Are there any aspects of Yolanda’s care that you would add
to the plan as you consider nursing care with the conservation
principles?

6. 2. Keep a reflective journal about a personal health or illness
experience and apply the conservation model to that experience.
3. As you consider application of the conservation principles in
question 2, what aspects of care are assessed that previously
were not included in your plans of care?
4. Use the perspective of the conservation model to identify
what may be missed in simulation experiences of nursing
practice. What does it capture that other perspectives miss?
5. Suggest how you might begin to develop your style of
nursing practice using the conservation model.