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Myra Estrin Levine: The Conservation Model of Nursing

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By Angelo Gonzalo, BSN, RN

Myra Estrin Levine (1921–1996) is a nursing theorist known for her esoteric nursing model—the Conservation Model. In this model, nursing aims to promote adaptation and maintain wholeness using the four principles of conservation. Aside from being a major influence in the nursing profession, Levine was also a family woman, friend, educator, administrator, student of humanities, scholar, enabler, and confidante. She was creative and knowledgeable, opinionated, and global in her concept of nursing.

Table of Contents

Biography of Myra Estrin Levine

Early Life

Myra Estrin Levine was born in Chicago in 1920, the first child of three siblings. Her involvement throughout her father’s persistent gastrointestinal illness contributed to her interest in and devotedness to nursing.


In 1944, Myra Estrin Levine received her diploma in nursing from the Cook County School of Nursing, then continued to finish her Bachelor of Science in Nursing from the University of Chicago in 1949. Her Master’s of Science in Nursing was granted to her from Wayne State University in Detroit in 1962.

Career and Appointments

Myra Estrin Levine
Myra Estrin Levine

Myra Estrin Levine had experienced several careers. She was a private duty nurse in 1944, a civilian nurse in the U.S. Army in 1945, a preclinical instructor in the physical sciences at Cook County from 1947 to 1950, director of nursing at Drexel Home in Chicago from 1950 to 1951, and surgical supervisor at both the University of Chicago Clinics from 1951 to 1952, and the Henry Ford Hospital in Detroit from 1956 to 1962.

In 1951, Levine also became a clinical instructor at Bryan Memorial Hospital in Lincoln, Nebraska, and administrative supervisor at the University of Chicago. Levine also worked as a chairperson of clinical nursing at her alma mater, the Cook County School of Nursing, from 1963 to 1967. She managed to work her way up the academic ranks at Loyola University from 1967 to 1977 and the University of Illinois from 1962 to 1963 and from 1977 to 1987. She coordinated the graduate nursing program in oncology at Rush University from 1974 to 1977.

Levine was a director of the Department of Continuing Education at Evanston Hospital from March to June 1974 and a consultant to the department from July 1974 to 1976. She was also a professor of Humanistic Studies at the University of Illinois from 1981 to 1987. In 1987, she became a Professor Emerita, Medical-Surgical Nursing, at the University of Illinois at Chicago. She was also a visiting associate professor at Tel Aviv University in Israel in 1974. She was also a visiting professor at Recanati School of Nursing, Ben Gurion University of the Negev, at Beer Sheva, Israel, from March to April 1982.


As a charismatic speaker, Myra Estrin Levine was a regular presenter of programs, classes, courses, and councils and a prolific writer concerning nursing and education. She also worked as a consultant to different hospitals and schools of nursing. Even though she never planned to develop a nursing theory, she presented an organizational structure for teaching medical-surgical nursing and a stimulus for theory development.

“The Four Conservation Principles of Nursing” was the first statement of the conservation principles. Other preliminary works included are:

  • Adaptation and Assessment: A Rationale for Nursing Intervention
  • For Lack of Love Alone
  • The Pursuit of Wholeness

Levine is known for her publication, Introduction to Clinical Nursing, which was first published in 1969, with additional editions printed in 1973 and 1989 when she elaborated on how redundancy characterizes the availability of adaptive responses when stability is threatened.

Awards and Honors

Myra Estrin Levine was granted numerous honors, including charter fellow of the American Academy of Nursing in 1973, an honorary membership in the American Mental Health Aid to Israel in 1976, an honorary recognition from the Illinois Nurses’ Association, a Member of Sigma Theta Tau at Alpha Beta Chapter, Loyola University, enlisted in Who’s Who in American Women from 1977 to 1988, enlisted in Who’s Who in American Nursing in 1987, and elected fellow in the Institute of Medicine of Chicago from 1987 to 1991.

She was also the first recipient of the Elizabeth Russel Belford Award for excellence in teaching Sigma Theta Tau in 1977.

Her book, Introduction to Clinical Nursing, received an American Journal of Nursing (AJN) Book of the Year awards, and her 1971 book, Renewal for Nursing, was translated to Hebrew. Levine was awarded the Honorary Doctorate of Humane Letters from the Loyola University of Chicago in 1992.


Myra Estrine Levine died on March 20, 1996, at the age of 75. She drops a legacy as an administrator, educator, friend, mother, nurse, scholar, student of humanities, and wife.

Nursing Theory: The Conservation Model

Levine’s conservation model believes nursing intervention is a conservation activity, with energy conservation as a fundamental concern, four conservation principles of nursing. It guides nurses to concentrate on the importance and responses at the level of the person. Nurses fulfill the theory’s purpose by conserving energy, structure, and personal and social integrity.

Every patient has a different array of adaptive responses, which vary based on personal factors, including age, gender, and illness. The fundamental concept of Myra Estrin Levine’s theory is conservation. When an individual is in a phase of conservation, it means that the person can adapt to the health challenges with the slightest amount of effort. The core of Levine’s Conservation Model is to improve a person’s physical and emotional well-being by considering the four domains of conservation she set out. By proposing to address the conservation of energy, structure, and personal and social integrity, this nursing theory helps guide nurses in providing care that will help maintain and promote the health of the patient.

What is the Conservation Model?

The core of the conservation model is to improve a person’s physical and emotional well-being by considering the four domains of conservation she set out. Nursing’s role in conservation is to help the person with the process of “keeping together” the total person through the least amount of effort. Levine (1989) proposed the following four principles of conservation:

  1. The conservation of energy of the individual.
  2. The conservation of the structural integrity of the individual.
  3. The conservation of the personal integrity of the individual.
  4. The conservation of the social integrity of the individual.

“The conservation principles do not, of course, operate singly and in isolation from each other. They are joined within the individual as a cascade of life events, churning and changing as the environmental challenge is confronted and resolved in each individual’s unique way. The nurse as a caregiver becomes part of that environment, bringing to every nursing opportunity his or her own cascading repertoire of skill, knowledge, and compassion. It is a shared enterprise, and each participant is rewarded.” (Levine, 1989)

Conservation of Energy

Conservation of energy refers to balancing energy input and output to avoid excessive fatigue. It includes adequate rest, nutrition, and exercise.

Examples: Availability of adequate rest; Sustenance of adequate nutrition

Conservation of Structural Integrity

Conservation of structural integrity refers to maintaining or restoring the body’s structure, preventing physical breakdown, and promoting healing.

Examples: Assist patient in ROM exercise; Preservation of patient’s personal hygiene

Conservation of Personal Integrity

Conservation of personal integrity recognizes the individual as one who strives for recognition, respect, self-awareness, selfhood, and self-determination.

Example: Acknowledge and preserve patient’s space needs

Conservation of Social Integrity

Conservation of social integrity exists when a patient is recognized as someone who resides within a family, a community, a religious group, an ethnic group, a political system, and a nation.

Example: Help the individual to preserve his or her place in a family, community, and society.

Major Concepts of Levine’s Conservation Model

In this section, we will define the nursing metaparadigm and the major concepts of the theory:


The environment includes both the internal and external environment.  Three Aspects of Environment Drawn upon Bates’ (1967) Classification:

  • The operational environment consists of the undetected natural forces and that impinge on the individual.
  • The perceptual environment consists of information that is recorded by the sensory organs.
  • The conceptual environment is influenced by language, culture, ideas, and cognition.


The person is a unique individual in unity, integrity, feeling, belief, thinking, and whole.


Health is the pattern of adaptive change of the whole being.


Nursing is the human interaction relying on communication, rooted in the individual human being’s organic dependency in his relationships with other human beings.


Adaptation is the process of change and integration of the organism in which the individual retains integrity or wholeness. It is possible to have degrees of adaptation.


Conservation includes joining together and is the product of adaptation, including nursing intervention and patient participation to maintain a safe balance.

Personal Integrity

Personal integrity is a person’s sense of identity and self-definition. Nursing intervention is based on the conservation of the individual’s personal integrity.

Social Integrity

Social integrity is life’s meaning gained through interactions with others. Nurses intervene to maintain relationships.

Structural Integrity

Structural integrity: Healing is the process of restoring structural integrity through nursing interventions that promote healing and maintain structural integrity.


Three Concepts of Adaptation


Adaptation is a historical process. Responses are based on past experiences, both personal and genetic.


Adaptation is also specific. Each system has particular responses. The physiologic responses that “defend oxygen supply to the brain are distinct from those that maintain the appropriate blood glucose levels.” (Levine, 1989)


Although the changes that occur are sequential, they should not be viewed as linear. Rather, Levine describes them as occurring in “cascades” in which there is an interacting and evolving effect in which one sequence is not yet completed when the next begins.

Energy Conservation

Nursing interventions are based on the conservation of the patient’s energy.


The singular yet integrated response of the individual to forces in the environment.


Stable state normal alterations in physiologic parameters respond to environmental changes; an energy sparing state, a state of conservation.

Modes of Communication

The many ways information, needs, and feelings are transmitted among the patient, family, nurses, and other health care workers.

Therapeutic Interventions

Interventions that influence adaptation favorably, enhancing the adaptive responses available to the person.


The following are the major assumptions of The Conservation Model.

Assumptions About Individuals

Each individual “is an active participant in interactions with the environment… constantly seeking information from it.” (Levine, 1969)

The individual “is a sentient being, and the ability to interact with the environment seems ineluctably tied to his sensory organs.”

“Change is the essence of life, and it is unceasing as long as life goes on. Change is characteristic of life.” (Levine, 1973)

Assumptions About Nursing

“Ultimately, the decisions for nursing intervention must be based on the unique behavior of the individual patient.”

“Patient-centered nursing care means individualized nursing care. It is predicated on the reality of common experience: every man is a unique individual, and as such he requires a unique constellation of skills, techniques, and ideas designed specifically for him.” (Levine, 1973)


  • Conservation of energy is based on nursing interventions to conserve through a deliberate decision to balance activity and the person’s available energy.
  • Conservation of structural integrity is the basis for nursing interventions to limit the amount of tissue involvement.
  • Conservation of personal integrity is based on nursing interventions that permit the individual to make decisions for himself or participate in the decisions.
  • Conservation of social integrity is based on nursing interventions to preserve the client’s interactions with the family and the social system they belong to.
  • All nursing interventions are based on careful and continued observation over time.

Analysis of the Conservation Model

Although there are many concepts similar to that of other nursing theories, Levine’s energy conservation concept makes it unique in guiding nursing actions.

Borrowed concepts from Bates regarding Levine’s view of the environment were not translated into how it affects the individual. The necessity of connecting incorporated concepts is crucial when developing a model for nursing to be applied to human care.

The concept of conservation, adaptation, and integrity can be applied to any age group since every individual needs to expand and reserve bodily energy.

Levine’s operational definition of homeostasis is in question since to achieve homeostasis; the body is continuously using energy; thus, her statement that homeostasis is energy sparing state is quite vague in nature. Rewording might be helpful in this part of her model.

Strengths and Weaknesses

The four principles of conservation were briefly stated.


Levine has interrelated the concepts of adaptation, conservation, and integrity in a way that provides a nursing view different from that of the adjunctive disciplines with which nursing shares these concepts.

Levine’s work is logical. One thought or idea flows from the previous one and into the next.


There are many concepts with comparatively unspecified relationships and unstated assumptions.

Recommended books and resources to learn more about nursing theory:

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  • Nursing Theorists and Their Work (10th Edition) by Alligood
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  • Knowledge Development in Nursing: Theory and Process (11th Edition)
    Use the five patterns of knowing to help you develop sound clinical judgment. This edition reflects the latest thinking in nursing knowledge development and adds emphasis to real-world application. The content in this edition aligns with the new 2021 AACN Essentials for Nursing Education.
  • Nursing Knowledge and Theory Innovation, Second Edition: Advancing the Science of Practice (2nd Edition)
    This text for graduate-level nursing students focuses on the science and philosophy of nursing knowledge development. It is distinguished by its focus on practical applications of theory for scholarly, evidence-based approaches. The second edition features important updates and a reorganization of information to better highlight the roles of theory and major philosophical perspectives.
  • Nursing Theories and Nursing Practice (5th Edition)
    The only nursing research and theory book with primary works by the original theorists. Explore the historical and contemporary theories that are the foundation of nursing practice today. The 5th Edition, continues to meet the needs of today’s students with an expanded focus on the middle range theories and practice models.
  • Strategies for Theory Construction in Nursing (6th Edition)
    The clearest, most useful introduction to theory development methods. Reflecting vast changes in nursing practice, it covers advances both in theory development and in strategies for concept, statement, and theory development. It also builds further connections between nursing theory and evidence-based practice.
  • Middle Range Theory for Nursing (4th Edition)
    This nursing book’s ability to break down complex ideas is part of what made this book a three-time recipient of the AJN Book of the Year award. This edition includes five completely new chapters of content essential for nursing books. New exemplars linking middle range theory to advanced nursing practice make it even more useful and expand the content to make it better.
  • Nursing Research: Methods and Critical Appraisal for Evidence-Based Practice
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  • Nursing Research (11th Edition)
    AJN award-winning authors Denise Polit and Cheryl Beck detail the latest methodologic innovations in nursing, medicine, and the social sciences. The updated 11th Edition adds two new chapters designed to help students ensure the accuracy and effectiveness of research methods. Extensively revised content throughout strengthens students’ ability to locate and rank clinical evidence.

See Also

Recommended site resources related to nursing theory:

Other resources related to nursing theory:


References and resources for this study guide about Myra Estrin Levine’s nursing theory:

  • Alligood, M. R. (2013). Nursing Theory-E-Book: Utilization & Application. Elsevier Health Sciences.
  • Levine, M. E. (1969). Introduction to clinical nursingIn McEwen, M. and Wills, E. (Ed.). Theoretical basis for nursing. USA: Lippincott Williams & Wilkins.
  • Levine, M. E. (1973). Introduction to clinical nursing(2nd ed.). In McEwen, M. and Wills, E. (Ed.). Theoretical basis for nursing. USA: Lippincott Williams & Wilkins.
  • Levine, M.E. (1989).  The conservation principles of nursing: Twenty years later. In George, J. (Ed.). Nursing theories: the base for professional nursing practice. Norwalk, Connecticut: Appleton & Lange.

Biography was written by Wayne, G. 

Angelo Gonzalo earned his Nursing degree in the year 2010 and continued his studies at St. Paul University Manila taking up Masters of Arts in Nursing Major in Clinical Management. He worked as an intensive care nurse for more than six years. He advocates for proper training and development of new nurses, quality assurance and compassionate care. He has also been involved in community development for 10 years steering programs on good governance, health, sports, and education. Angelo aims to build a good foundation for aspiring nurses. He would like to impart the importance of understanding nursing theories that he hopes to be translated successfully to practice.

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