Application to our Profession

Nursing research

• Principles of conservation have been used for data collection in various researches
• Conservational model was used by Hanson et al.in their study of incidence and prevalence of pressure ulcers in hospice patient
• Newport (n.d.) used principle of conservation of energy and social integrity for comparing the body temperature of infant’s who had been placed on mother’s chest immediately after birth with those who were placed in warmer

Nursing education

• Conservational model was used as guidelines for curriculum development
• It was used to develop nursing undergraduate program at Allentown college of St. Francis de Sales, Pennsylvania
• Used in nursing education program sponsored by Kapat Holim in Israel
• Nursing administration
• Taylor (n.d.) described an assessment guide for data collection of neurological patients which forms basis for development of comprehensive nursing care plan and thus evaluate nursing care
• McCall (n.d.) developed an assessment tool for data collection on the basis of four conservational principles to identify nursing care needs of epileptic patients
• Family assessment tool was designed by Lynn-Mchale and Smith (n.d.) for families of patient in critical care setting

Nursing practice

• Conservational model has been used for nursing practice in different settings
• Bayley (n.d.) discussed the care of a severely burned teenagers on the basis of four conservational principles and discussed patient’s perceptual, operational and conceptual environment
• Pond (n.d.) used conservation model for guiding the nursing care of homeless at a clinic, shelters or streets

I. IN THE HOSPITAL

As A Ward Nurse
By: Alvir B. Nombrefia RN
St. Jude Family Hospital

         "Sir pansamantala po, hindi muna kayo makagagamit ng banyo, bibigyan ko muna kayo ng ihian para hindi na kayo lalakad pa,
para maiwasan po yung muling pagsakit ng dibdib at pagkahapo ninyo". Kung kailangan nyo po ng tulong ko sabihin nyo lang po o pindutin yung buzzer kung may nararamdaman, salamat po.
         Talking to a 70 yrs old patient with a chief complaint of difficulty of breathing and chest pain diagnosed with congestive heart failure. As part of his care plan, As his nurse I need to make sure that he can recover not only with the aid of pharmacological treatment such as diuretics and anti anginal drugs and dependent nursing actions coming from doctors but also to initiate action in such a way to alleviate his condition. Conserving his energy to promote better respiration, lessen cardiac workload is a big help for the patient having congestion. On the other hand, assisting patient what to do in a nice way or with respect will maintain their personal integrity. by these simple nursing intervention, faster recovery of patient is at hand, Levine's conservation principles were indeed valuable in hospital settings.

As A Ward Nurse
By: Anthony Cobangbang, RN
Mafraq Hospital
Abu Dhabi, United Arab Emirates 

      

         As a nurse in a Trauma ward, I’m making use of Levine’s Four Conservation Principles in my practice. When we receive a trauma patient from Accident/Emergency, we have to consider the patient as a whole being. Our nursing goal should be to promote the “wholeness” of the patient through adaptation in his present condition. It means that our nursing care plan includes the 4 Conservation Principles.
        (1) Conservation of Energy: Irrespective of the severity of the trauma, the patient needs rest. Complete bedrest for the first 24 hours is usually implemented unless the physician orders otherwise based on his assessment. The presence of family members and significant others is also very important for psychological and emotional support since a trauma patient is also in high level of psychological/emotional stress.
        (2) Conservation of Structural Integrity: For a trauma patient, expect some skin damage which maybe minor or major depending on the severity of the trauma. Bone fracture is also common. Since the structural integrity is already compromised for a trauma patient, it is our responsibility as a nurse to implement measures to promote healing and to prevent further deterioration. If a patient is on bedrest, skin protocol is a must i.e. hourly change of position. Other nursing interventions include dressing of wounds under aseptic technique to prevent infection, maintaining alignment of bones through skin/skeletal traction as ordered by the doctor and preparing the patient for emergency surgery to prevent loss of function of a body part or in some cases, to prevent possible loss of a body part.
        (3) Conservation of Personal Integrity: Show respect to the patient and maintain his privacy. Call him by his preferred name and do not forget to introduce yourself to him. Include him in his plan of care; it will help retain his self-worth.
        (4) Conservation of Social Integrity: The presence of family and friends at bedside gives a positive effect on the patient’s well-being. Promote interaction as tolerated by his condition. This makes a patient feel that he still “belongs” despite his condition.

As a Dialysis / CRRT Nurse
Anjela Dominguez Bulaong, RN
Kanoo Kidney Center 

       I deal with a number of different kinds of patients, from the very quiet and preserved young boy to a very demanding old lady. Whoever is assigned to my care, I always make sure that I use Levine's Conservational Principles. All these patients, in one way or another, need care related to removing all the toxins their kidneys can no longer do for them. But the only way to do that is for them to have an access, an invasive procedure which requires them to be aseptically cannulated every time they need dialysis, or their central venous catheters need to be exposed and frequently dressed before and after the dialysis session.

        Dialysis patients vary in terms of reactions and complications they manifest during and after the session. Some may feel very tired after the session because they may have experienced hypotension during the therapy. So I make sure that I employ preventive measures such as choosing the right dialyzer, removing only his tolerable ultrafiltration goal, timely administration of 20% Human Albumin, and proper complication management, to conserve his energy.

       In terms of their access, the Arterio-venous fistula/graft and permanent central venous catheters' which are considered to be their lifeline needs to be cared for with the right skills and knowledge. For without these, they won't be able to have dialysis, thus making them prone to life threatening fluid and electrolyte imbalances. That's why when I cannulate their fistula or grafts, I use the correct technique, needles are securely anchored or when I dress their central venous catheters, catheter sutures are made sure to be intact to avoid dislodgement of the access and the safe initiation of therapy. I also confirm that the extracorporeal circuit is free of possible entanglement. In this way I can conserve the structural integrity of their accesses.

       We cater to patients with different socio-economic backgrounds and races. Some of them are offered free sessions and others are being asked to pay. Wherever they came from, I always we greet them, call them by name, ask how they are doing and treat them with equal respect regardless of their races. When we dress their catheters we close the curtains, or when the patient is a woman, I ask them to cover their faces, as their culture dictates, if a male doctor comes in the unit. Doing so, I have conserved their personal integrity.

       We don't allow watchers or significant others to stay at bedside when we start our therapy based on our protocol, however, when the need arises such as a very uncooperative patient who is in need of urgent dialysis due to metabolic acidosis or hyperkalemia, we call on their relatives to help us calm him/ her down, or to stay at their side, during insertion of temporary access and initiation of the dialysis session. This helps them feel at ease, communicate their concerns freely and help conserve their social integrity.

       Indeed using Myra Levine's Conservation Principles has aided my nursing practice to provide care for my dialysis patients.

     

As a Trauma Ward Nurse

By: Anthony Cobangbang

Mafraq Hospital in Abu Dhabi, U.A.E.

        As a nurse in a Trauma ward, I’m making use of Levine’s Four Conservation Principles in my practice. When we receive a trauma patient from Accident/Emergency, we have to consider the patient as a whole being. Our nursing goal should be to promote the “wholeness” of the patient through adaptation in his present condition. It means that our nursing care plan includes the 4 Conservation Principles.
Conservation of Energy: Irrespective of the severity of the trauma, the patient needs rest. Complete bedrest for the first 24 hours is usually implemented unless the physician orders otherwise based on his assessment. The presence of family members and significant is also very important for psychological and emotional support since a trauma patient is also in high level of psychological/emotional stress.
Conservation of Structural Integrity: For a trauma patient, expect some skin damage which maybe minor or major depending on the severity of the trauma. Bone fracture is also common. Since the structural integrity is already compromised for a trauma patient, it is our responsibility as a nurse to implement measures to promote healing and to prevent further deterioration. If a patient is on bedrest, skin protocol is a must i.e. hourly change of position. Other nursing interventions include dressing of wounds under aseptic technique to prevent infection, maintain alignment of bones through skin/skeletal traction as ordered by the doctor and to prepare the patient for emergency surgery to prevent loss of function of a body part or in some cases, to prevent possible loss of a body part.
Conservation of Personal Integrity: Show respect to the patient and maintain his privacy. Call him by his preferred name and do not forget to introduce yourself to him. Include him in his plan of care; it will help retain his self-worth.
Conservation of Social Integrity:  The presence of family and friends at bedside gives a positive effect on the patient’s well-being. Promote interaction as tolerated by his condition. This makes a patient feel that he still “belongs” despite his condition.

II. IN THE CLINIC

As A University Nurse
By: Angela Betsaida Beltran, RN
University Nurse
University of Baguio

         My field of work entails a lot of patience, perseverance and love for nursing. Caring for my clients from all walks of life, from kids to professionals, upholds a certain degree of difficulty for I have to render my nursing care for them with quality. The adaptation model is very helpful in my endeavor as a school nurse. It guides my practice because in the school setting we are looked as their main support system away from home. When a student feels ill, the first thing they do is have their check up in our clinic. It is our duty as school nurses and physicians to help then adapt to the certain change in their well being. We make sure they have enough rest while on treatment. Actually, we send them home and allot certain number of days before they can go back to their classes. In this way, conservation of energy and restoration of optimal health is achieved before they go back to their role as students. Moreover, we also advise their parents to offer support and care to their children in order to promote faster recuperation. It is our role as their health care providers to help them regain health and also provide support to them. Hence, this theory is indeed useful in the school setting, providing nursing care to students as well as the employees.

As An Occupational Health Nurse
By: Aileen Joy V. Pregonero,RN 

  

         

         I feel fortunate to have the opportunity of working not only as a staff nurse in a hospital setting, but also in an industrial set-up. As an Occupational Health Nurse, the company relies on you especially in the absence of the Company Physician when it comes to provision of medical care and attending health care needs. The employees are exposed to some health hazards and need medical support in case of illness and accidents. As a way to conserve their energy in case of illness at the workplace, the company clinic is provided by a bed with adequate lightning and ventilation conducive for rest, rest period is advised ,thus, promotes recovery. In cases of unexpected injury or accidents at the workplace, first-aid kit complete with first-aid materials is prepared, proper wound cleaning is ensured and hazards are removed to promote healing and maintain safety. Constant health advice, health teaching and frequent check-ups are provided not only to ensure recovery but also to provide emotional support and emphasizing self-worth and social and personal integrity.With this theory, I am able to provide quality nursing care in different set-up.

As Public School Nurse

By: Anabelle M. De Veyra
Sibagat National High School of Home Industries
Sibagat, Agusan del Sur

       


This is an application of Levine's theory based to one of my experiences . It was rainy day last October 2010 when Ms. Tito I - Einstein student bought a snacks in the school canteen . She was frightened to be late for the next class she hurriedly ran to slippery floor going to the building when she slipped on and felled down at the stairway of the building. She could not stand up and even walk because it is painful. She was crying watching her situation with abrasions of skin mixed with blood. As a public school nurse, I give first aid intervention and refer to the hospital. After the x-ray result the doctors finding was Right Popleteal Close Fracture with skin abrasions.

Problem : Fracture of the popleteal bone and skin abrasions

Splinting & bandaging and Dressing open wound
Immobilized affected part and Prevent bleeding & infection
Prevent further injury
( Internal environment controlled ) and ( External Environment controlled )

Resulted Fracture & wound Healing

1. Lessen physical & energy expenditure - conservation of ENERGY INTEGRITY
2. Decrease immobility - Conservation of the STRUCTURAL INTEGRITY
3. Preservation of the structural integrity - less apprehension & anxiety- Conservation of PERSONAL INTEGRITY
4. presence of Significant others, friends & classmates at the hospital - Conservation of SOCIAL INTEGRITY

         Through this conservation theory of Myra Estrene Levine , Ms Tito gain the optimum level functioning and continue to study.

As an Occupational Health Nurse in a Call Center Industry
By: Angela Asuncion V. Pantaleon

 

        I worked as an occupational health nurse at a clinic for employees of a call-center with people on telephones, fielding customer complaints. The purpose of work-site clinics such as this one is to maximize the bottom line for the company—keep workers as healthy as possible. Not surprisingly, stress-related health problems like headaches, hypertension and depression are commonly diagnosed at this employee clinic. As a nurse we have to gain knowledge on how they deal with irate customers and what could be the effects to them. Through listening with our patients gives them somehow the relief of stress in facing those bad customers, this is how I relate this to Levine’s conservation of personal integrity. And for keeping our agents’ physiologically well through assessing them whether they need to have their voice rest, monitoring their blood pressure and given the prescribed medicines and most especially being an advisor to our employees, thus conserves their energy as well. This theory is very applicable and useful in my field of work in promoting quality nursing care to our employees and will continuously help us to be more competent nurse.

III. PERSONAL ENCOUNTER

As a Thankful Daughter
By: Amita Antonio

       I have always sensed that our Old Man felt secure having me around whenever he was hospitalized. When he had fallen ill the last time, I was abroad and could not leave my job soon. He was so restless and uncooperative to the point of refusing major diagnostic procedures. My Mom begged me to come home soon as they all knew he was dying fast.
I found my father garbed in hospital gown but wouldn’t budge for the endoscopy. I hugged and kissed him and said “you are one tough Basileno, what’s the matter this time?”. He just smiled. After that, it was not so hard talking him into procedures anymore. He trusted in his daughter fully who, without his knowledge, was terrified beyond her wits and could hardly rely on her meager knowledge on medicine.
         During his last battle with CLD, my father was not exactly a favorite in the ward. I knew from experience how tough it is to care for a patient with encephalopathy. I am thankful for the quiet support and understanding we got from his nurses. Behind the restlessness and agitation, they saw a terrified old man. They knew father was comforted by our presence and they understood and respected that.
         I would like to cite Ms. Levine’s theory on conserving the personal and social integrity of the ill. Looking back at our experiences at the receiving end of care, I saw a reflection of this model in the way my father’s nurses took care of him. We knew he was terminally ill and nothing much could be done to save him. They have understood his need to feel whole and secure by having his loved ones nearby at his most vulnerable state. For this I am forever thankful for the angels-in-guise who have stood by our side throughout our ordeal.


"The nurse enters into a partnership of human experience where sharing moments in time-some trivial, some dramatic-leaves its mark forever on each patient" (Levine, 1977).

            To summarize, Levine expressed the view that within the nurse-patient relationship a patient’s state of health is dependent on the nurse-supported process of adaptation. This guides nurses to focus on the influences and responses of a client to promote wholeness through the Conservation Principles. The goal of this model is to accomplish this through the conservation of energy, structural, personal and social integrity. The goal of nursing is to recognize, assist, promote, and support adaptive processes that benefit the patient.