untitled

a unified theory of health and disease, the mean-
ing of the conservation principles, the hospital as
environment, and patient-centered intervention.
The nursing care chapters in her text focus on nurs-
ing care of the patient with:

1. failure of the nervous system;


2. failure of the integration resulting from hor-
   monal imbalance;


3. disturbance of homeostasis: fluid and electrolyte
   imbalance;


4. disturbance of homeostasis: nutritional needs;


5. disturbance of homeostasis: systemic oxygen
   needs;


6. disturbance of homeostasis: cellular oxygen
   needs;
   7. disease arising from aberrant cellular growth;
   8. inflammatory problems; and
   9. holistic response.
   Her way of organizing the material was a shift
   from teaching nursing based on the disease model.
   Her final chapter on the holistic response repre-
   sented a major shift away from disease to the sys-
   tems way of thinking. Informed by other disciplines,
   she discussed the integrated system, the interaction
   of systems creating the sense of well-being, energy
   exchange at the organismic level and at the cellular
   level, perception of self, the affect of space on self-
   perception, and the circadian rhythm.
   As Levine wrote her book, major changes took
   place in the curriculum at Cook County Hospital

96 SECTION II Evolution of Nursing Theory: Essential Influences

Box 9–1 Influences on the Conservation Model

Levine used the inductive method to develop her model. She “borrowed” information from other disciplines

while retaining the basic structure of nursing in the model (Levine, 1988a).As she continued to write about her

model, she integrated information from other sciences and increasingly cited personal experiences as evidence

of her work’s validity. The following is a list of the influences in the development of her philosophy of nursing

and the Conservation Model.

1. Levine indicated that Florence Nightingale, through her focus on observation (Nightingale, 1859) provided
   great attention to energy conservation and recognized the need for structural integrity. Levine relates
   Nightingale’s discussion of social integrity to Nightingale’s concern for sanitation, which she says implies an
   interaction between the person and the environment.


2. Irene Beland influenced Levine’s thinking about nursing as a compassionate art and rigid intellectual pursuit
   (Levine, 1988b). Levine also credited Beland (1971) for the theory of specific causation and multiple factors.


3. Feynman (1965) provided support for Levine’s position that conservation was a natural law, arguing that the
   development of theory cannot deny the importance of natural law (Levine, 1973).


4. Bernard (1957) is recognized for his contribution in the identification of the interdependence of bodily func-
   tions (Levine, 1973).


5. Levine (1973) emphasized the dynamic nature of the internal milieu, using Waddington’s (1968) term “home-
   ophoresis.”


6. Use of Bates’s (1967) formulation of the external environment as having three levels of factors (perceptual,
   operational, and conceptual), challenging the integrity of the individual, helped to emphasize the complexity
   of the environment.


7. The description of illness is based on Wolf’s (1961) description of disease as adaptation to noxious envi-
   ronmental forces.


8. Selye’s (1956) definition of “stress” is included in Levine’s (1989c) description of her organismic stress
   response as “being recorded over time and...influenced by the accumulated experience of the individual”
   (p. 30).


9. The perceptual organismic response incorporates Gibson’s (1966) work on perception as a mediator of be-
   havior. His identification of the five perceptual systems, including hearing, sight, touch, taste, and smell, con-
   tributed to the development of the perceptual response.


10. The notion that individuals seek to defend their personhood is grounded in Goldstein’s (1963) explanation
    of soldiers who, despite brain injury, sought to cling to some semblance of self-awareness.


11. Dubos’s (1965) discussion of the adaptability of the organism helped support Levine’s explanation that adap-
    tation occurs within a range of responses.


12. Levine’s personal experiences influenced her thinking in several ways.When hospitalized, she said, “the ex-
    perience of wholeness is universally acknowledged” (Levine, 1996, p. 39).