Since Florence Nightingale introduced Nursing profession, it is continuously evolving in order fit in modernized world. The outgrowth profession propels it into scientific enquiry, and diverted towards evidence base practice. All these artistic ideas draw bases for using theatrical framework. Although first theoretical framework was introduced by Florence Nightingale entitled as “environmental theory” to promote health of individual after the experience solders care during Crimean war (Florence Nightingale, 1860). Utilization of theories becomes more common, since nursing professional practice as it expand towards higher educational degrees, and get enrolled in administration and research fields. Up to date many theories are introduced. This paper presents the LCM perspective including the assumption, characteristic of concepts, sub concepts, and their statement of relationship. This paper then gives a brief review of NSM. Following this the paper will present compares and contrast for LCM theory and NSM perspectives including main concepts, nursing intervention and outcomes with practical application of interventions of each model. I select Levine Conservation Model as its nursing goal focus to achieve health for person using careful assessment and nursing intervention and matched to Neuman system model. Moreover this model was used in variety of setting including hospital and community. Few applications of LCM includes: Promotion for preterm Infants (Mefford, 2004), Ostomy wound management (Leach, 2009).
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Levine’s Conservational Model (LCM) perspective
Myra Levine was the nurse to whom Loyola University president awarded the title of “renaissance woman” as an appreciation for using vast knowledge in nursing care (Alligood, 2010 & Tomey). She developed conservation theoretical framework, as an attempt to teach medical surgical nursing concepts to undergraduate nursing students and to provide a new approach to associate degree students for daily nursing activities in 1973 (George, 2002; Alligood, 2010) by influencing scientific knowledge that she gained from Canon; fight and flight response, Selye’s, stress work, and Gibson’s, perception of environment. The goal of this theory was to promote adaptation and maintain wholeness using the principles of conservation (George, 2010).
LCM framework constructed on three major concepts and few sub concepts the major concepts are explained explicitly but the sub concepts are remain implicit. Following section of paper will explain the major concepts and sub concept embedding within major concepts. The major concepts that form the basis of conservation Model are; conservation of energy, adaptation and wholeness, among these the conservation of energy considered most important. Levine (1971), describe conservation with four principles these includes; conservation of energy, conservation of the structural integrity, conservation of the personal integrity, and the conservation of the social integrity, of the individuals. Levine (1971) further says understanding of all these principles will help nurse as to keep living system together which promote wholeness.
The first principle of energy conservation, depend on environmental stimuli that often become source for loss of energy consequently disequilibrium of whole. LCM talks internal and external environment. In internal environment includes physiological (temperature, blood pressure) and altered physiological process. Then she split external environment into three levels, off these three first is perceptual, take account of the individuals sense of world, second level in cooperate physical aspect such as microorganisms, and third level is conceptual and which is comprise of cultural pattern symbolized by way of life. While caring patient Levine emphasize nurse to assess individual’s response and capability for adjusting with both environmental situations and help accordingly (Alligood & Tomey, 2010). The second principle of conservation relates to structural integrity and focus on defense ability of the body, which nurse can recognize from functional abilities challenged by internal and external environment. Then the third principle conservation of personal integrity deals with personal protection by promotion of self actualization. The last principle; conservation of social integrity refers person’s family, friends, community, and society which could be achieved using the nurses role by assisting in religious activities and using of interpersonal relationship (George, 2002; Alligood, 2010).
The second concept in conservation theory is adaptation. Levine (1966) view adaptation as physiological and behavioral responses of individuals that changes as a result of internal and external environmental interaction to achieve balance in life. In Levine (1966) view a successful adaptation helps to achieve personal integrity consequently will helps person to move towards wholism. However in case of unsuccessful adaptation nurse can help individuals to achieve balance by promoting the environmental cleanliness, safety, and com-fort, both physical and mental. Furthermore George (2002) proposes three characteristics adaption process that appear implicit as sub concepts. These are “historicity” that focus the way of dealing life situation in past and the second “specificity” includes pattern of personal and genetic forces used to conserve energy The third sub concept that helps to assess adaptation is redundancy, means fail-safe body’s process available for survival.
In LCM the third concept is wholeness, refers the health which is the pattern of wellbeing, and integrity. Well being is the goal of adaptive change (Alligood, 2010) All together the conservation of energy concept is viewed as an outcome, adaptation as process to achieve wholeness (see Appendix A for concept and sub concept).
Neuman System Model (NSM) Review
The NSM introduced by Betty in 1971, Known as identification stressors and management stress model. The aim of model was to promote the stability (health) in individual. This model is considered unique in nature as it uses the knowledge from various disciplines. The important one includes, general system theory which reflects the nature of living organism as an open system, but also incorporates knowledge from Selyes stress theory, Gestalt theory: of homeostasis, deChardin Philosophy wholeness of life and Caplan’s Conceptual Model of Primary, Secondary and Tertiary Levels of Prevention.
NSM perspective is based on assumptions that are enclosed in four nursing paradigm these are person, environment, health and nursing. NSM perspective focused to assess stressors with its degree of reaction and promote health by using three level of prevention as nursing intervention. The central view starts from wholeness of person (consist of individual, family or community group) represent within boundaries of defense circles. Of these boundaries outer one is flexible line of defense (FLD), next to this is normal line of defense (NLD) following this there is line of resistance. Each of these boundaries viewed as a composite of physiological, psychological, sociocultural, developmental and spiritual variables. The function of these boundaries is to protect person from environmental stressor as person is constantly interact environmental stressors consist of intra, inter and extra-personal. Then environment viewed as internal, external and created. Health is denoted as stability, considered as dynamic in nature which can be achieved by successfully adjusting to environmental stressors. On other hand system is challenged by environmental situation despite of using energy in other means the three types of defense lines that exist around client, considered as protective barriers fails to protect system from stressors. The state then recognized as illness, which can be reconstituted by using of three level of prevention as nursing intervention that are used to strengthen the three lines of defense (George, 2002; Alligood & Tomey 2010). For further understanding of concepts (see NSM in Appendix B).
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Compare and Contrast for NSM and LCM
Completing the review of LCM and NSM, now this section will compare and contrast these models from the perspective of background, nursing goal, major concepts including nursing intervention. Starting from the background, both the models are developed by American nurses who had different background. Levine was from medical surgical and Betty Neuman belonged to psychiatric nursing. Both model published in 1973. And both used the knowledge from various disciplines, in which Selyes stress work is common. Including all above, both model set to achieve goal of health for individuals, families, communities, and populations at large using some similar and some different concepts, pattern of assessment and nursing interventions. Coming towards major concepts it is observed from literature (George, 2002; Alligood, 2010; Alligood & Tomey, 2010) that LCM consist few simple concepts (see Appendix A) but NSM comprise of many complex concepts (see Appendix B). Upcoming few paragraphs will present compare and contrast for few major concepts that are common and take central place in each theoretical model.
Both, NSM & LCM uses the concept of wholeness very explicitly attaching with component of person, environment, health, and nursing. Within NSM wholeness in connection to person viewed in link of five variables physiological, consist of structure of body and its function psychological, comprise of mental processes and internal and external environmental effects, socio-cultural, and include cultural aspects developmental, seen with stages of ages and spiritual beliefs and influences. In contrast LCM considers person as complete whole in the view of physiological variable only. But also includes patho-physiological condition as an assessment indicator. Following this Neuman and Levine both also see wholeness as a product of internal and external environmental interactions. This means all individuals are constantly interacting with internal and external environment and adjustment with its challenges, keeps person integrated whole, and failure takes person towards illness. As Alligood & Tomey (2010) state wholeness is viewed as oneness and described as integrity of person Furthermore Alligood (2010) ‘Wholeness is health” (p. 214). Next wholeness with nursing component is emphasized as an approach of assessment and consider for promotion. Assessing wholestic approach suggests including client variable in assessment. NSM include five variable, therefore it is believed that this model allow for comprehensive assessment. Opposite to this LCM focus on physiological including path- physiological condition, seems simple but set limitation and may leaves gaps in assessment. Coming to promotion of wholeness NSM include nursing intervention with three level of prevention. Reverse to this LCM model use conservation principle As Mefford,(2004) show example by health promotion for preterm infants.
NSM take energy conservation concept viewed as a process of helping in promoting wholeness but presented in an implicit way using the term negentrophy and does not stand as central idea. In NSM energy and conservation of energy refers person’s genetic makeup, strength and weakness and maintained in view of line of defense. Neuman 2002, 1995, 1989, 1982) cites negentrophy [is] â€¦ a process of energy conservation (Alligood, & Tomey 2010, p.312). The characteristic of variable can boost the energy sources. But it could deplete if line of resistance fail to protect the basic energy resources, which may cause illness consequently death. Comparing to this in Levine model conservation concept appear as central phenomenon and it forms bases for its framework. Todaro-Franceschi (2001) state Levine defines conservation as “keeping together”. She use these words as she see person as patient who requires help to store energy. Furthermore Levine (1967) cites that all of fundamentally life’s processes dependent upon the production and expenditure of energy (Todaro-Franceschi, 2001). Furthermore Levine believes safeguard of energy sources is necessary to maintain the integrity of individuals and consequently health. To make its implication simple Levine gave four principle of conservation; these include conservation of energy, structural integrity, personal integrity, and the social integrity (George, 2002). Although both the model sees conservation of energy in deferent way, do invites nurse to study the characteristic of energy provide guide to plan appropriate activities for its conservation.
Again NSM talk about adaptation process implicitly embedded with wellness and illness concepts. Which in NSM depend upon the level of penetration of environmental stressors (Alligood & Tomey, 2010) As George (2002) says when client interact with environment produce response to stressor help to adapt or control stressor. Adaptation is process which occurs with the help of line of defense. There are three level defense network laid around the person to protect the penetration of stressors. Among these first outer line is called flexible line of defense (FLD), which provide protection to normal line that is second outer line in case of stressors attack. Lacks of nutrition, fatigue or daily stress are the circumstances that make FLD to come in action. The second line is normal line of defense (NLD) that lies under the protection of FLD symbolize the normal wellness level of the client system. This line is consisting of coping patterns, lifestyle factors, developmental, spiritual, and cultural matter influences. If the NLD is been attacked by environmental stressors, the LOR are activate to protect the basic structure. (Alligood, 2010). On other hand in Levine model the adaptation is second most central phenomenon of LCM and Levine (1966) states any processes that ascertain stability for life are regard as adaptations and George (2002) highlights that the conservation depend of process of adaption. Successful adaptation promotes health whereas failure of adaption introduces illness. For this situation LCM considers nursing to play role to promote adaptation (Alligood, 2010).
By comparing the perspective of NSM and LCM it has been learnt that both theorist focus on achievement of health through using uniqueness methodologies. Despite using different concepts and framework, these theories guide for nursing assessment and intervention. Moreover this comparison explains that the NSM is broad and provide rich content for comprehensive assessment and nursing care. On other hand LCM appear with energy conservation focus. From all this it is gained that nurse needs to understand explicit and implicit concepts of theoretical framework to assess and plan efficient nursing interventions.
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