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CHAPTER 12 Myra Estrin Levine 213

was shopping for shoes at the mall, which now is prayer, Bible reading, and humor to help her feel
difficult for her. better, (3) discuss medication therapy and what
Social integrity acknowledges that the patient is a might help her achieve restful sleep, (4) refer her
social being. Yolanda is a married mother of three for blood work to assess hormone levels, and
grown children. She keeps a lot of her feelings from (5) assist her with determining the meaning of
her children but does share them with her husband. the symptoms (e.g., menopause or fibromyalgia).
He is a major source of support for her. He takes her Yolanda indicated that when she was able to get
food shopping and makes sure that she gets to her 6 hours of uninterrupted sleep, her pain was less
appointments on time. She shared at the time of intense and she felt better. Finding both medication-
her visit that she wants to have a picnic for her induced and nonpharmaceutical approaches to
birthday, but the only way she can do it is to ask her improve sleep is a high priority.
grandchildren to help her husband clean the yard. The nurse practitioner will assess the outcome
Yolanda is a middle-aged woman with a history of Yolanda’s care based on the organismic re-
of severe pain, sleeplessness, and fatigue. Diagnostic sponses. The following predicted responses suggest
studies have been unrevealing, with the exception adaptation:
of multiple tender points. The history of pain and n Reports comfort as a result of prayer, Bible
positive tender points supported the diagnosis of reading, and humor
fibromyalgia. She has stopped taking all medications n Distinguishes symptoms of menopause from
and reports that she may be going through meno- symptoms of fibromyalgia
pause. She reports severe pain and fatigue that make n Reports feeling rested after 6 hours of unin-
it difficult for her to sleep and to do normal house- terrupted sleep
work. Her husband and grandchildren are available n Reports a perceived reduction in pain and
to help with chores at home, and she seeks the sup- fatigue
port of prayer and reading her Bible to ease her n Collaborates with health care providers to
discomfort. She also finds that humor helps her to manage symptoms of menopause
feel better. *This case study is based on raw data from a completed study (Schaefer,
The initial plan of care includes (1) validate the 2005). Yolanda is a fictitious name used to protect the privacy and anonymity
illness experience, (2) encourage continued use of of the participant.

CRITICAL THINKING ACTIVITIES
1. Keep a reflective journal about a personal health appropriate interventions using Levine’s conserva-
or illness experience or that of someone very close. tion principles.
Reflect on its consistency with the Conservation 4. Watch one of the following movies: City of Joy,
Model—how to modify, expand, or delimit the Soul Food, The Secret Garden, Courageous, or
model to provide a context for explanation. The Descendents. Use examples from the movie
2. Levine stated, “Health is culturally determined; it to support or refute Levine’s propositional
is not an entity on its own, but rather a definition statements.
imparted by the ethos and beliefs of groups to 5. Apply the Conservation Model to a pathography
which the individual belongs” (M. Levine, such as Love and Other Infectious Diseases by
personal communication, February, 21, 1995). Molly Haskell, and explain life with illness.
3. Visit a museum, and evaluate how artistic expres- 6. Identify what may be missing in simulation expe-
sion captures the beliefs of different ethnic groups. riences of nursing practice from the perspective
Then explore how these beliefs shape definitions of this nursing model. Suggest how you might
of health and illness. On the basis of an ethnically develop your style of nursing practice to encom-
derived definition of health, propose ethnically pass the total patient experience.