untitled

tered by the patient. If the experience is pro-
longed, the stress can lead to damage to the
systems.
4.Perceptual response.This is the fourth level of re-
sponse. It involves gathering information for the
environment and converting it to a meaningful
experience.

The organismic responses are redundant in the
sense that they coexist. The four responses help indi-
viduals protect and maintain their integrity. They are
integrated by their cognitive abilities, the wealth of
previous experiences, the ability to define relation-
ships, and the strength of their adaptive abilities.

Nurses use the scientific process and creative

abilities to provide nursing care to the patient

(Schaefer, 1998). The nursing process incorporates

these abilities, thereby improving the care of the

patient (see Table 9–1).

PHILOSOPHICAL NOTES

ASSUMPTIONS AND VALUES OF THE

CONSERVATION MODEL

The person is viewed as a holistic being:

“The experience of wholeness is the foundation

of all human enterprises” (Levine, 1991, p. 3).

100 SECTION II Evolution of Nursing Theory: Essential Influences

Table 9–1 Use of the Nursing Process According to Levine

Process Application of the Process

Assessment Collection of provocative facts through observation and interview of challenges to the internal

and external environments.

The nurse observes the patient for organismic responses to illness, reads medical reports,

evaluates results of diagnostic studies, and talks with patients and their families (support per-

sons) about their needs for assistance. The nurse assesses for physiological and pathophysiologi-

cal challenges to the internal environment and the factors in the perceptual, operational, and

conceptual levels of the external environment that challenge the individual.

Trophicognosis* Nursing diagnosis that gives the provocative facts meaning.

The nurse arranges the provocative facts in a way that provides meaning to the patient’s

predicament. A judgment is the trophicognosis.**

Hypotheses Direct the nursing interventions with the goal of maintaining wholeness and promoting adaptation.

Nurses seek validation of the patients’ problems with the patients or support persons. The nurses

then propose hypotheses about the problems and the solutions, such as: Eight glasses of water

a day will improve bowel evacuation. These become the plan of care.

Interventions Test the hypotheses.

Nurses use hypotheses to direct care. The nurse tests proposed hypotheses. Interventions are

designed based on the conservation principles: conservation of energy, structural integrity, per-

son integrity, and social integrity. Interventions are not imposed but are determined to be mutu-

ally acceptable. The expectation is that this approach will maintain wholeness and promote

adaptation.

Evaluation Observation of organismic response to interventions.

The outcome of hypothesis testing is evaluated by assessing for organismic response that means

the hypotheses are supported or not supported. Consequences of care are either therapeutic

or supportive: therapeutic measures improve the sense of well-being; supportive measures pro-

vide comfort when the downward course of illness cannot be influenced. If the hypotheses are

not supported, the plan is revised and new hypotheses are proposed.

*The novice nurse may use the conservation principles at this point to assist with the organization of the provocative facts. The

expert nurse integrates this into the environmental assessments.

**Trophicognosis is a nursing care judgment arrived at through the use of the scientific process (Levine, 1965). The scientific

process is used to make observations and select relevant data to form hypothetical statements about the patients’ predica-

ments (Schaefer, 1991a).

Source:“Levine’s Nursing Process Using Critical Thinking.” In M. R. Alligood & A. Marriner-Tomey (Eds.). (1997).Nursing theory:

Utilization and application.St. Louis: Mosby. Revised and used with permission of Mosby.

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