INTRODUCTION:

Myra Levine (1920-1996) believed the entry into the health care system is associated p some measure of personal independence. To designate the person who has entered the health care system a client reinforces the state of dependency for a client is a follower She supported the term ‘patient’ because patient means sufferer and dependency is associated with suffering. Levine discussed adaptation, conservation and integrity. Adaptation is the process by which conservation is achieved, and the purpose of conservation is integrity, the core of Levine ‘s theory is her four principles of conservation.

1. Adaptation:

It is the process by which over time people maintain their wholeness and integrity as they respond to environmental challenges, It is the consequence of interaction between the person and the environment. Successful engagement with the environment depends on an adequate store of adaptation. The better patients can adapt to the changes in health, the better they are able to respond to treatment and care. Every individual has unique range of adaptive responses which vary based on heredity, age, gender or challenges of an illness experience. Although the responses are same, the timing and manifestation of the organismic response will be unique for each individual. For e.g. response to weakened cardiac muscle is increased heart rate, dilation of the ventricle and thickening of the myocardial muscle. Adaptive responses are based on three factors:

Historicity:

It refers to the notion that adaptive responses are rooted in personal and genetic past history. Adaptive responses are combination of these personal and genetic factors. E.g. persons having HbS gene instead of HbA gene are resistant to malaria.

Specificity:

It refers to the notion that each system that makes up a human being has unique response pathways to each stimulus. Responses are stimulated by specific stressors and are task oriented. E.g. human body has number of specific antibodies that bind to specific antigens and generate response.

Redundancy:

It refers to the fail-safe options available to an individual to maintain adaptation. If one pathway/system is unable to ensure adaptation then other pathway may take over the job. E.g. If primary defence i.e. skin, mucus, cilia fail to kill a microorganism, then secondary defence i.e. phagocytes come in action and destroy the microorganisms.

Conservation:

The product of adaptation is conservation. It is a universal concept a natural law that deals with defense of wholeness and system integrity. Conservation defends the wholeness of living systems by ensuring their ability to confront change appropriately and retain their unique identity. Conservation describes how complex systems continue to function in the face of severe challenges It provides not only for current survival but also for future vitality through facing challenges in the most economical way possible. Conservation is clearly the consequence of the multiple, interacting and synchronized negative feed back systems that provide for the stability of the living organism. Levine’s conservation model explained the way in which the person and environment become congruent overtime. The specific adaptive responses make conservation possible at all levels. Nursing’s role in conservation is to help the person with the process of keeping together the total person through the least expense of effort, Levine proposed the following four principles of conservation:

Conservational of Energy

Conservational of structural integrity

Conservational of personal integrity

Conservation of social integrity.

a) Energy Conservation:

It is dependent on free exchange of energy within the internal and external environment to maintain the balance of energy supply and demand. Imbalance in energy conservation is evident in form of clinical manifestations.

E.g Availability of adequate rest, Maintenance of adequate nutrition

b) Structural integrity:

It is dependent on the presence of an intact defence system that supports healing and repair to preserve structure and function of whole being.

E.g Assist patient in ROM exercise, Maintenance of patient’s personal hygiene.

c) Personal integrity:

It involves maintaining or restoring patient’s sense of self-worth, self-esteem, human-ness, self-hood and self-determination.

E.g Recognize and protect patient’s space needs.

d) Social integrity:

It recognises that an individual is a social being who continuously interacts with his/her society, family, community.

E.g Position patient in bed to foster social interaction with other patients, Avoid sensory deprivation, Promote patient’s use of news paper, magazines, radio, TV. Provide support and assistance to family.

The outcome of nursing involves assessment of the organismic response. The four responses help individuals protect and maintain their integrity. The levels of organismic response include:

i. Response to fear (fight/flight response):

It is the most primitive response which includes physiological and behavioural readiness to respond to sudden and unexpected environmental change. It is instantaneous response to a real or imagined threat.

ii. Inflammatory response:

It is second level of response and maintains the structural integrity and promotes healing.

iii. Response to stress:

It is third level of response that develops over time and is influenced by the each stressful experience encountered by the patient. If the stressful experience is prolonged, the stress can lead to damage to the systems.

iv.Perceptual response:

The fourth level of response which includes gathering information from the environment and converting it to meaningful experience.

METAPARADIGM:

1. PERSON:

The person is a holistic being who is aware of the past and oriented to the future. The person responds to change in an integrated, sequential yet singular fashion while in constant interaction with the environment. Person can be an individual, family or community.

2. HEALTH:

Health and disease are patterns of adaptive change. From a social perspective, health is the ability to function in social roles. Health is culturally determined. Health is an individual response that may change over time in response to new situations; new life challenges; ageing or social, political, economic or spiritual factors. Health implies unity and integrity. The goal of nursing is to promote health.

3. ENVIRONMENT:

The environment completes the wholeness of an individual. The individual has both an internal and external environment. The internal environment combines the physiological and pathophysiological aspects of the individual and is constantly challenged by the external environment. The external environment includes factors that impinge on and challenge the individual. The external environment consists of three levels:

Perceptual environment:

It includes aspects of the world that individuals are able to interpret through senses and respond to with their sense organs. It includes light, sound, touch, temperature, etc.

Operational environment:

It includes factors that may physically affect individuals but are not directly perceived by them such as radiation, microorganisms and pollution.

Conceptual environment:

It includes cultural patterns characterized by spiritual existence and mediated by language, thought and history. Factors that affect behaviour such as norms, values, beliefs are also part of conceptual environment.

4. NURSING:

Nursing is human interaction. The goal of nursing is to promote adaptation and maintain wholes. The goal is accomplished through the use of conservation principles: energy, structural, personal and social integrity. Nursing care is both therapeutic and supportive.