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What is nursing theory? Nursing theory is concept that accumulated from some aspect of nursing, which help to converse the purpose of describing, explaining, predicting or prescribing nursing care (Meleis, 2012). Hence, it can guide for nurses to apply their nursing knowledge in a more complete and organized system for the clients who need care for their health and wellness, whereby clients can be any individual, family members or support group that are the recipient of care (Tomey & Alligood, 2002; Parker, 2001).
Why is nursing theory important for nurses? As stated by Tomey and Alligood (2002), the theories enable nurses to think, make decision and provide care for clients' best interest. Therefore, the nursing theories will maintain constant progression in nurses' advancement in their professional work and status.
Despite the important of nursing theory, but there is still present of nursing theory and practice gap. According to Rafferty, Allcock and Lathlean (1996), the tension between theory and practice is unavoidable and it will not be sealed, as there are a few factors that complicate the closing the gap, like clients or hospital rule and protocol. In recent articles, Hatlevik (2012) found that students with better understanding of coherence between theory and practice during their nursing education will have better reflective skill and theoretical knowledge during their clinical practice.
Hence, this paper will be focus on Levine's perspective of the four metaparadigms and discussion on Levine's conservation theory application to the nursing practice today. As the author feel that Levine's theory is more holistic and applicable to current hospital acute care setting. With this assignment, it will improve the author understanding of coherence between nursing theory and practice.
2. Levine's Conservation theory
Levine (as cited in McEwen & Wills, 2007) believes that nursing is a form of interaction. Levine theory was developed after referencing ideas from other theorist (McEwen & Wills, 2007).With that, Levine conceptualizes an individual as an adaptive being that will have constant interaction with environment, whose behaviors are integrated in responses to internal and external environment stimuli (Meleis, 2012). Hence, the model will reflect on how an individual will interact with the ever-changing environment.
All in all, Levine's theory emphasizes the promoting of adaption and maintaining the wholeness of clients using the principles of conservation (Schaefer, 2001). The process of adaptation is not only change, but also a process to maintain an individual's integrity whiles the interaction with environment (Pieper, 1989). The nurses' responsible is to encourage healing and promote the adaptation process with the four conservation principles, which include the conservation of energy, structure integrity, personal integrity and social integrity (Meleis, 2012).
However, Levine (as cited in Fawcett, 1989) stated nurses should assess and deliver the conservation intervention according to each individual's specific patterns of adaptation.
3. Nursing metaparadigms
Nursing's metaparadigm guides the activity of the nursing profession, including knowledge, philosophy, theory, educational experience and practice (Perry, 2001). Most of the nursing theories focus on the four agreed metaparadigms - namely person, environment, health and nursing, to refer table 1 for definition (Chia & Tan, 1997). To further understand the four metaparadigms relationship defines by Levine, each metaparadigms will be explored further below.
Levine's model viewed a person as an ever-changing individual that has to constantly interact with the changing environment while trying to maintain oneself integrity and wholeness (Meleis, 2012). The person consists of physiological, sociological, and psychological components of a whole (Glass, 1989, p, 340).
Her definition of person is not limited to only ill, hospitalized individual, but being defined as a whole human being who is the focus of nursing acts (Pieper, 1989).
According to Levine, all individual has both internal and external environment. Both environment are ever changing and they help to complete the wholeness and integrity of the individual (Fawcett, 1995).
The internal environment is represented by the study of physiology and pathophysiology, which consist of homeostasis and homeorrhesis (Glass, 1989). The author will elaborate on homeostasis, as Levine (as cited in Fawcett, 1995) favored homeostasis as the best descriptor of internal environment. It is basically the autoregulation of physiological system. When a patient temperature is 38 degree Celsius, the body will reduce the temperature by vasodilating blood vessel so more heat will be conducted out from the skin surface and nurses can help by giving patient paracetamol to decrease the temperature.
The external environment is related to factors that impose on and change the individual and consists of the perceptual, operational and conceptual (Pieper, 1989). Perceptual environment is a surroundings an individual can use all their sensory organs to seek and test information from, in order to find the own definition of life, to constantly protect their safety and identity, and adapt to the ever-changing environment. Operational environment is a surrounding that an individual cannot use their sensory organs, but it important because it will affect the individual as well. Lastly, Conceptual environment are factors like language, value systems, religion, the ability to think and experience, and etc. that will affect an individual (Fawcett, 1995).
When the person is able to adapt to their realistic environment, with the help of nursing intervention, the person will be able to maintain their wholeness and integrity.
According to WHO (as cited in Grad, 2002, p. 984), health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity. Levine defined health and disease as patterns of adaptive change and described that health can be obtain when individual's experience wholeness and adaptation, by using the least resources (as cited in Fawcett, 1995, p.143). As compare, Levine definition of health is more like a process on achieving WHO definition of health.
With Levine model, the nurses can introduce the newly diagnose diabetic patient to join a diabetic society support group, so that the patient can adapt faster after knowing others' experiences (social integrity).
Levine viewed nursing as a discipline based on interactions of an individual on their relationship with other individual (as cited in Fawcett, 1995). Levine is more focus on the nursing intervention rather than nursing, therefore according to the theorist nurses are expected to create an individualized atmosphere to promote healing and adaptation for all people (Glass, 1989; Melsis, 2012). Nurses will only step in when an individual is not able to adapt to the environment.
Levine (1989) stated that it important to observe and assess patient before planning an individualized and scientific nursing intervention, hence the theorist developed a nine models of guide assessment (refer appendix A) to enhanced nurses' assessment.
In this discussion, the author will apply Levine's theory onto clinical area, like intensive care units (ICU). As the nursing care provided in this areas are to promote healing with the conservation principles as mention in Levine's theory, furthermore it also focus an individual as a unique self upon delivery of care.
In the author's workplace medical ICU, most of the patients are critically ill and will usually require long term ventilator support due to their lung conditions. According to Higgins' (1998) study, patients who are on long term ventilation, commonly experienced fatigue which will lead to others feeling like hopelessness and depressed. Levine (1973) explained that fatigue occurs when the energy supply is unable to meet the demand.
In critically ill ventilated patients, there will be high demand of the energy being used for healing process, causing discrepancy between energy supply and demand. To worsen the condition, most of the ventilated patients will have lower energy supply due to undernourished and deprive of quality rest (Higgins, 1998). Furthermore, intubated patient will be given sedatives that will reduce their awareness about the enviroment
Since the patient is not able to adapt to both