Introduction and overview to the grand nursing theory
According to Masters (2012), the nursing profession is one of the fields of healthcare that has had tremendous evolution ever since Florence Nightingale begun writing notes. Theories have evolved, and models flourished; one of the theories is Myra Levine’s conservational theory (Masters, 2012). Initially, the theory was aimed at teaching students the major concepts in nursing degree education regarding new approaches to daily nursing activities. She aimed at diverting the nursing education from procedural oriented education practices and lay focus on vigorous problem-solving and personalized patient care.
The conservation theory aims at promoting adaptation and enhancing wholeness under the principle of conservation (Fawcett, 2012). The theory teaches the nurses to lay their focus on influences and responses and the individual level. Myra established four main areas of conservation, which focus on promoting emotional and physical well-being of the patient. Fawcett (2012) explains that the areas include conservation, adaptation, and wholeness. Wholeness regards to the fact that the nurse must try to address the patient’s external and internal environments; hence, allow the patient to be considered as a whole person rather than as ill.
Adaptation regards to the process of change, which results to conservation. The client should maintain their integrity within the realities of the external environment (Fawcett, 2012).
Conservation result from adaptation and it implies that the complex systems within the client maintain their integrity and continue functioning even when they are severely challenged. Levine explains that individuals have the capability to face their challenges and adapt accordingly while maintaining their uniqueness. In this theory, Myra Levine explains that every patient has a range of adaptive responses that vary basing on their circumstances. Although the adaptations are the same, the timing and manifestations of the results remain unique to each of the clients (Meleis, 2011).
Considering a case study in which a 52-year-old woman is diagnosed with type 2 diabetes mellitus 6 years back that begins to have complaints of right foot weakness and an itching rash in her groin area, the Myra Levine theory of conservation can be applied in the nursing care of the patient. The patient is worried that her case is worsening due to the deteriorating symptoms of the condition despite the failed to adhere to recommendations for care. She is developing anxiety over the emergence of problems in her right foot and an itching rash in her groin area. The patient is also worried about the eyesight, which has become tiresome while watching television. Additionally, the patient has developed urinary frequency characterized by her having to get up at night to urinate.
The patient’s worries are exacerbated by the fact that her family history is positive for type 2 diabetes mellitus, which her sister and mother have and are on pills. Since she failed to adhere to recommendations for care, her fears for the worsening condition are evident. A patient’s support system had not been too helpful since she could not comply to recommendations despite having a family history with a mother and sister with the same condition. She is obese and has gained more weight, which is another reason for fear, and her diet is not quite remarkable for control of diabetes mellitus and obesity.
Although type 2 diabetes mellitus is a highly controllable condition, the patient’s grief comes in the sense that she delayed to take the necessary nursing care recommendations; hence, leading to complications such as the effects on the eye-sight. Her grieving also manifests in her history of presentation when she states that her sleeping patterns have changed since she has to get up for urination, and there is increased thirst. The pain in the right foot is also a major cause of grief.
Basing on the assessment of the patient in the case, the approach is multifold. According to Levine’s theory of conservation, the concepts of the patient and the environment include adaptation, response, and conservation. The patient in the case has several worries that are part of the external environment and the internal environment. Nursing care in this case has to conform to the fact that the patient must be cared for to promote adaptation and maintenance of wholeness through conservation; hence, the care will focus on influencing the patient to adapt. Therefore, the nursing care will aim at providing an environment that is suitable for healing to occur.
Nursing intervention
In intervention, the patient will be nursed, as an inpatient to facilitate close monitoring, which is a necessity. The patient will be assessed where the nursing care will involve observation and speaking to the client in conjunction with their medical records and the diagnostic results thereby assessing the possible challenges within their external and internal environments that may hinder their ability to gain complete health and wellness. In the Levine theory, the areas to focus on include conservation of energy regarding expenditure and supply of energy, structural integrity, which deals with the body defense system; and personal integrity, where the client is assessed for self-worth, validation, and independence. Additionally, the client is assessed for social integrity and in this she is observed and evaluated about how well she can be part of a social system such as a family. This will be important for the patient in the case since she is worried about her worsening situation bearing in mind that two of her family members have the same condition.
During intervention, the nurse has to make judgment; before the judgment, he has to record provocative facts about the patient’s condition and sensibly organize them with the aim of adding meaning to the circumstances; hence, determining the nursing needs of the patient. Levine refers to this judgment as trophicognosis in patient care. The nursing care profession will then discuss the established judgment about the client and relate it with the hypothesis about the condition, which will help in formation of a care plan for the client.
The interventions will have the objective of promoting wholeness in the patient who is grieving due to the worsening condition of diabetes mellitus type 2; hence, the nurse will test the hypotheses formed earlier through direct care. The aim of the hypothesis will be addressing the areas of wellness stipulated in the conservation theory: structural integrity, energy conservation, social integrity, and personal integrity. This will involve guidance, and drug provision whereby the patient will undergo physiotherapy and psychotherapy. It is also important for the patient to be encouraged to express her fears about the condition since this will help to reveal the internal environment.
After the interventions and direct care, the nursing care will then undertake the evaluation of the patient about the hypotheses and hence initiate interventions measures. Categorically, the patient will be provided with a comfort, and the therapeutic outcomes will be evaluated through their sense of wellness.
Evaluation
In evaluating the intervention for the care of the patient in the case, conclusions might be drawn despite the worrying condition of the patient about the worsening condition of diabetes mellitus type 2. After adhering to the recommendations, the patient can move through the stages of a conservative model of nursing care satisfactorily. The professional nursing staff should provide care and individualized support that ensures wholeness of the client rather than an ill person. The patient has to appreciate the fact that despite being ill, she is “whole” and at peace with the internal and external environment. With the continuous monitoring and help from the nursing staff, the patient can adapt to coping mechanisms and return to normal daily life without failure to take the pills. Therefore, the evaluation can bring the conclusion that Myra Levine’s theory of conservation nursing model is useful in creating adaptation and applying interventions followed by evaluating the nursing interventions in ensuring wholeness of the patient. Although diabetes mellitus is a chronic metabolic syndrome, the patient can be nursed using the Levine model to lead a fruitful life through adaptation.
Applicability to the case
The patient in the case could conserve energy through maintaining proper and adequate nutrition, and taking adequate rest. Maintaining structural integrity could come in by taking monitored exercises and maintenance of proper personal hygiene. This will help to prevent infection and preventing structural breakdown. In terms of conservation of social integrity, the patient in the case would be helped to avoid sensory deprivation and promote assistance and support from the family. In the end, the patient will not only heal the affected parts of the body, but will also return to daily activities, she will regain selfness and her ability to pursue her dreams without discomfort or constraints.
Clinical practice and critique
In clinical practice, the theory and principles of conservation can be used in a collection of data from the patients and understanding the challenges that the patients face in dealing with their internal and external environments. The nurses can also use the theory in understanding the responses of the patients to different interventions and assess the factors that are affecting the patient and their whole recovery.
A critique of the ease of applying the theory is that the theory has several assumptions, which may not be real. For instance, the model assumes that the nursing care provider is directly responsible for determining the ability of the patient to participate in care, and if there is a mismatch in the expectations from care, then there will be a conflict (Masters, 2012). The theory does not provide a way forward that allays this assumption. Additionally, the model focuses on patients and their dependency.
Evaluation and conclusion
An evaluation would be that the Levine’s model of conservation works best in the nursing care of patients who worries and provides an avenue for patients to adapt and intrinsically motivate themselves to respond to interventions. For the case above, the patient would recover not because of the effective therapy, but because of the wholeness approach in the nursing care. Levine’s theory of conservation model focuses on promoting emotional and physical wellbeing. It addresses conservation through energy conservation, structural, social, and personal integrity (Meleis, 2011). Nurses have to provide care that supports the health of the client concerning wholeness and adaptation.
References
Fawcett, J. (2012). Contemporary nursing knowledge: analysis and evaluation of nursing models and theories (2nd ed.). Philadelphia: F.A. Davis Co..
Masters, K. (2012). Nursing theories: a framework for professional practice. Sudbury, MA: Jones & Bartlett Learning.
Meleis, A. I. (2011). Theoretical nursing: development and progress (3rd ed.). Philadelphia: Lippincott.
