APPLICATIONOF
APPLICATION OFLEVINE
LEVINE
THEORY
THEORY
NURSING
“nursing is a profession as well as
an academic discipline,always
practiced and studied in concert with
all of the disciplines that together
from the health sciences”
The human interaction relying on
communication ,rooted in the
organic dependency of the
individual human being in his
relationships with other human
beings
Nursing involves engaging in
“human interactions”
GOAL OF NURSING
To promote wholeness,
realizing that every individual
requires a unique and separate
cluster of activities
The individual integrity is his
abiding concern and it is the
nurse’s responsibility to assist
him to defend and to seek its
realization
NURSING PROCESS
Assessment
Trophicognosis
Hypothesis
Interventions
Evaluation
NURSING PROCESS
Assessment
Collection of provocative
facts through observation
and interview of
challenges to the internal
and external environment
using four conservation
principles
CONT.....
Nurses observes patient
for organismic responses
to illness,reads medical
reports,talks to patient
and family
Assesses factors which
challenges the individual
NURSING PROCESS
TROPHICOGNOSIS
Nursing diagnosis-gives provocative facts
meaning
A nursing care judgment arrived at through the
use of the scientific process
Judgment is made about patient’s needs for
assistance
NURSING PROCESS
Hypothesis
Planning
Nurse proposes hypothesis about the problems
and the solutions which becomes the plan of care
Goal is to maintain wholeness and promoting
adaptation
NURSING PROCESS
Interventions
Testing the hypothesis
Interventions are designed based on the
conservation principles
Mutually acceptable
Goal is to maintain wholeness and promoting
adaptation
NURSING PROCESS
Evaluation
Observation of organismic response to
interventions
It assesses whether hypothesis is supported or not
supported
If not supported,plan is revised,new hypothesis is
proposed
APPLICATION OF
CONSERVATION PRINCIPLES
TO CLINICAL PRACTICES
PATIENT
Mr. Rajiv , admitted with medical diagnosis of
hypertension and peripheral vascular disease.
CONSERVATION OF ENERGY
Mr. Rajiv reports he cannot walk more than ½
block without resting because of pain in his leg.
He must climb three steps to enter his house and
can usually do so without difficulty.
He lives in a two story house but has a bedroom
on the first floor.
CONT........
VITAL SIGNS are within normal limits- Mr. Rajiv
says that as he takes his antihypertension medicine
and limits the salt in his diet, his blood pressure is
controlled.
CHEST X-ray clear
LAB values: only abnormal level is cholestrol at 260
CONT......
Mr. Rajiv reports he takes care of himself and
hires someone to come in to clean his house and
do his laundry once a week. He states he aets two
meals a day and he cooks for himself.
He has to get up at least once a night to void.
His bowels are usually regular- sometimes he is
constipated.
CONSERVATION OF STRUCTURAL INTEGRITY
Medical diagnosis of peripheral vascular disease
is consistent with Mr. Rajiv’s description of
difficulty walking and indicates impairement of
his vascular system.
Mr. Rajiv reports that his left leg either hurts or
“feels strange” most of the time. Pedal pulse on
the left are dimnished.
CONT.....
History of smoking ½ pack per day for 40
years- stopped smoking 10 years ago and
report his breathinh is better since then.
Reports arthritis in both hands; physical
examination indicates arthritic nodules distal
joints of index finger.
Mr. Rajiv reports pain in proximal joints of
both thumbs and that this has weakened his
grip strength. He can fully close each hand.
CONSERVATION OF PERSONAL INTEGRITY
89 year old male
CONSERVATION OF SOCIAL INTEGRITY
Widower , lives alone
Believes in GOD but doesnot “get out to temple
much anymore. It’s just too much effeort.”
Has three living children- all are in their 60s and
live out of state.
Mr. Rajiv states they call and write regularly and
each visits once or twice a year.
CONT....
He has neighbours on either side of him who
“keep an eye out.” one of these neighbours likes
to cook and regularly brings food over.
NURSING DIAGNOSIS
Pain related to arthritis in hands and peripheral
vascular disease in legs.
Limited mobility associated with pain and
peripheral vascular disease.
DESIRED OUTCOME :
Able to continue to care for self and live in own
home.
PLANNING
Pain control using prescribed medication and
possible physical therapy to support continued
function.
Support for medical workup that could result in
recommendation of vascular surgery- provide
appropriate education and opportunity for
questions and discussion.
CONT.....
Explain all test in level of detail he desires.
Be sensitive to how detail he really wants.
IMPLEMENTATION
Conservation of Energy:
Increase the servings of fruits and vegetables to at
least five daily to help assure regularity of his
bowels.
Arrange his bath and other care activities to allow
rest before and after his physical therapy.
CONT.....
Conservation of Structural Integrity
work with physician and patient to establish an
effective plan of analgesia to decrease his pain-
help him accept that the pain will not totally
disappear.
CONT....
Conservation of Personal and Social Integrity
Encourage him to keep up the good work.
EVALUATION
Can he walk with more comfort?
Can he use his hands for activities of daily living
and desired recreation?
Is he ready to resume independence?
NURSING PROCESS ACCORDING TO
LEVINE’S MODEL
NURSING CARE OF MRS.SITA WITH
LEVINE’S MODEL
Mrs. Sita, a wife of an abusive husband,
underwent a radical hysterectomy.
Post operatively has pain ,weight loss,nausea and
inability to empty bladder .
Patient has history of smoking and stays in house
which is less than sanitary.
ASSESSMENT
Challenges to the internal env:-weight
loss,nausea, loss of reproductive ability
Challenges to the external env:-abusive husband,
insanitary condition in home
Energy conservation:-weight loss,nausea ,pain
CONT....
Structural integrity:-threatened by surgical
procedure,inability to pass urine
Personal integrity:-not able to give birth to more
children
Social integrity:-Strained relationship with
husband
TROPHICOGNOSIS
Inadequate nutritional status
Pain
Potential for wound and bladder infection
Need to learn self catheterization
Decreased self worth
Potential for abuse
HYPOTHESIS
Nutritional consultation
Teaching and return demonstration of urinary
self catheterization
Care of surgical wound
Exploring concern regarding hysterectomy
INTERVENTIONS
Energy conservation
Provide medication for pain and nausea
Allowing rest period
Structural integrity
Administrating antibiotic for wound,
Teaching self catheterization
Personal integrity
Exploring her feeling about uterus removal while respecting her
privacy
Social integrity
Assess potential abuse form husband
Support to the family
EVALUATION
Is she hving Is her abdominal
pain? wound healing?
Can she perform
Is she gaining
clean self
weight? catheterisation?
Is her relationship
with her husband
ORGANISMIC RESPONSE
Controlled pain
Abdominal wound healing
Improved appetite ,weight gain
Clean urinary self catheterization
Assistance from husband
