The Health Promotion Model (HPM), designed by Nola J. Pender, describes the multidimensional nature of persons as they interact within their environment to pursue health while increasing their level of well-being. Pender offers a theory that places importance on behaviors that improve health through a lifetime. The HPM offers insight into how influencing factors experienced by an individual and their interactions with the environment affect the pursuit of health. HPM remains applicable as health promotion and illness prevention continue to be as important as the treatment of disease.
Health is an active state in which constant efforts are made by the individual, in their environment, to achieve and maintain health. The patient has a distinct set of factors influencing their actions to attain health. The success of the HPM is based on the assumption that an individual is willing and able to play an active role through health promoting behavior (Alligood & Tomey, 2010). Internal evaluation and analysis of the theory Identify assumptions, both explicit and implicit. Assumptions are statements that are understood to be true without proof or demonstration.
They are beliefs about phenomena one accepts as true. Pender’s assumptions of the Health Promotion Model are explicit and testable. Explicit assumptions are statements that are clearly defined and eliminate (remove any) ambiguity. Due to the explicit nature, this model has been used as the basis of many research studies, both nursing and non-nursing. The explicit assumptions of Pender’s theory include:
1) Persons seek to create conditions of living through which they can express their unique human health potential. 2) Persons have the capacity for reflective self-awareness, including assessment of their own competencies. ) Persons value growth in directions viewed as positive and attempt to achieve a personally acceptable balance between change and stability. 4) Individuals seek to actively regulate their own behavior. 5) Individuals in all their biopsychosocial complexity interact with the environment, progressively transforming the environment and being transformed over time. 6) Health professionals constitute a part of the interpersonal environment, which exerts influence on persons throughout their life spans. 7) Self-initiated reconfiguration of person-environment interactive patterns is essential to behavior change (Alligood & Tomey, 2010).
How does the theorist define the four concepts of the paradigm of nursing? These concepts are: Nursing, Environment, Person and Health. Most theorists have defined these concepts differently. While the HPM focuses on health promotion and offers many holistic approaches to understanding health, the four major concepts of the nursing paradigm are not defined by Pender. The model helps nurses plan and implement health-promoting changes. It takes into consideration the multidimensional nature of persons as they interact within their environment to pursue health while increasing their level of well-being.
How does the theorist define and inter-relate major concepts of their own theory? While health promoting behaviors are the desired outcome of the model, Pender identifies relationships between concepts. The model links the major concepts under three headings: individual characteristics and experiences, behavior-specific cognitions and affect, and behavioral outcome. Individual characteristics, which include prior related behaviors and personal factors, are the best predictors of future behavior. Individual characteristics affect behavior specific cognitions and affect.
The behavior specific cognitions and affect are listed by Pender as the following: Perceived benefits barriers, self-efficacy, activity related affect, interpersonal influences, situational influences, commitment to plan of action, and immediate competing demands and preferences. Behavior specific cognitions and affect are most amenable to be changed by intervention, which makes them the core for nursing intervention in the HBM. Both individual characteristics, experiences, behavior specific cognitions, and affect have direct effects on the behavioral outcome (George, 2010). Identify propositional statements
Pender developed fourteen theoretical assertions or propositional statements for The Health Promotion Model. These statements demonstrate how the biopsychosocial processes motivate individuals to engage in behaviors directed towards the enhancement of health (Alligood & Tomey, 2010). The theoretical assertions or statements are the following:
1) Prior behavior, as well as inherited and acquired characteristics, influence beliefs, affect, and enactment of health-promoting behavior. 2) Persons commit to engaging in behaviors from which they anticipate deriving personally valued benefits. ) Perceived barriers can constrain the commitment to action, the mediator of behavior, and the actual behavior. 4) Perceived competence or self-efficacy to execute a given behavior increases the likelihood of commitment to action and actual performance of behavior. 5) Greater perceived self-efficacy results in fewer perceived barriers to specific health behavior. 6) Positive affect toward a behavior results in greater perceived self-efficacy, which, in turn, can result in increased positive affect. 7) When positive emotions or affect are associated with a behavior, the probability of commitment and action is increased. ) Persons are more likely to commit to and engage in health-promoting behaviors when significant others model the behavior, expect the behavior to occur, and provide assistance and support to enable the behavior. 9) Families, peers, and healthcare providers are important sources of interpersonal influences that can increase or decrease commitment to and engagement in health-promoting behavior. 10) Situational influences in the external environment can increase or decrease commitment to or participation in health-promoting behavior.
1) The greater the commitment to a specific plan of action, the more likely health-promoting behaviors will be maintained over time. 12) Commitment to a plan of action is less likely to result in the desired behavior when competing demands over which persons have little control require immediate attention. 13) Commitment to a plan of action is less likely to result in the desired behavior when other actions are more attractive and thus preferred over the target behavior. 14) Persons can modify cognitions, affect, and the interpersonal and physical environments to create incentives for health actions (Alligood & Tomey, 2010).
Analyze consistency of the theory Consistency (logical form) refers to systematic development and structural clarity. Definitions of concepts should be consistent across the theory and relationships across concepts clearly identified. Is the theory logical? The model’s conceptual diagram and its variables are easy to understand. The theory is logical because there are many relationships between each concept, many of them both directly and indirectly affecting the ultimate endpoint of health promoting behavior. Comment on the adequacy, simplicity and generality of the theory.
Adequacy is a term that refers to how the theory is accepted by the nursing community. Is it applicable to practice? Does this theory explain nursing? The Health Promotion Model is applicable to nursing and accepted by the nursing community due to the use of the nursing process. The nursing process is a goal-oriented method of caring that provides a framework to nursing care. It involves five major interconnected cyclic steps: assessment, diagnosis, evaluation, planning, and implementation. The most important steps of the nursing process as it relates to this model involve the implementation and evaluation phases.
Although assessment, diagnosis and planning phases are important to the development of the HPM, they are not directly reflected in the model. Implementation can be found throughout the entire model through the use of the characteristics, experiences, cognitions, and affect information to identify how to support the commitment to a plan of action and how to encourage the client to seek to avoid competing demands and not become entangled by competing preferences. Evaluation is based upon the performance of the target health-promoting behavior (George, 2010). Simplicity refers to having few concepts and simple relationships.
Complex theory would have many concepts and multiple relationships. Pender’s concepts are simple and easily understood. The concepts can be logically applied to any situation in which a client aspires to change health related behaviors and those environmental influences to support this change. Flexibility of the model allows for identification of the most important variables in relation to a selected health behavior. Generality refers to the scope of concepts and goals. The more limited the concepts and goals, the less general the theory. The more general the theory, the greater the applications.
Generalizability of a model centers on assessing its applicability to other situations or phenomena. This model focuses on evaluating the individual but is not easily generalizable to groups or community populations. It can be applied to different settings and is not limited to specific cultures as it allows for the diversity of the individual. Type of theory refers to: Grand theory, Middle range or Micro theory, Philosophy. The Health Promotion Model is considered a middle range theory. It has been formulated through induction by the use of existing research to form a pattern of knowledge about health behavior.
Middle range theories commonly are generated through this approach. These theories are more precise, with a focus on answering specific nursing practice questions. External evaluation and analysis Relationship of theory to practice The intent of the model is to provide guidance to nurses when identifying how to be most supportive to a patient when planning and implementing health related change. It takes into consideration that individuals are unique, and their life experiences and personal characteristics influence health behavior changes.
With the ability to consider all of these variables, this model acts as an appropriate tool for promoting positive health related behaviors. It has strength of use in practice because looking at all variables provides a more complete picture of the client. This completeness in turn should enhance the possibility of positive outcomes (George, 2010). One study read for this assignment proposed the need for health promotion and disease prevention for family caregivers of post-stroke patients in Taiwan.
Formal health care and social service resources for post-stroke care in Taiwan are limited. Patients are cared for at home with family members as the primary sources of care. The Health Promotion Model provides a framework for a modified model in this study, which in turn facilitates examining the relationship between and among caregiver’s personal factors, the care recipient’s functional status, the caregiver’s perceived self-efficacy, social support, reactions to caregiving, and health promotion behaviors in family caregivers of community dwelling stroke patients in Taiwan.
Nurses often neglect incorporating social support into teaching of family members. Social support is an important aspect for caregivers because the caregivers need as much support as possible from others. Nurses can refer these caregivers to, and even establish, community training programs and support groups for family caregivers. The findings of this study indicated the need to follow up with caregivers and referring them to the appropriate health care services where necessary (Tang and Chen, 2002). ? Relationship of theory to education
This model and its variables provide a tool for successfully incorporating health education into practice. The variables can be modified through nursing actions, which facilitates ease of adopting health-related behavioral change and is more realistic because it takes into account a client’s behaviors and preferences. This allows the nurse to develop a unique care plan that takes these behaviors into account. Nurses are in a position to influence healthy behaviors and incorporate them into patient teaching.
A recent study using Pender’s Health Promotion Theory as the framework focused on the relationship between nurses’ beliefs regarding the benefits of exercise, their exercise behavior and their recommendation of exercise for health promotion or as part of a treatment plan. Beliefs of the benefits of exercise were measured using the Exercise Benefits/Barriers Scale (EBBS). The beliefs of benefits were determined using the EBBS benefits subscale score, with a higher score reflecting the individual’s feelings of stronger positive benefits of exercise.
Results showed positive correlations between exercise benefits, physical activity and recommendation of exercise to patients. Nurses who believe in health promotion and embrace healthy behaviors are more likely to be positive role models and teach healthy behaviors to their patients (Esposito and Fitzpatrick, 2011). We believe that nurses have a professional responsibility to provide the best care for their patients, and are in the position to be role models.
Nurses spend the most time with patients and, as a result, impact patient health by teaching healthy behaviors and health promotion. Relationship of theory to research Pender revised and based the Health Promotion Model on her previous research studies identifying factors involving studies of how individuals make decisions about their own health care in a nursing context. This model has served as a framework for research intending to demonstrate desirability for clients to seek behavior change and possibly changing the environment to support healthy behavior (George, 2010).
Both quantitative and qualitative methods have been used, with descriptive studies being most common. One example of using the theory in research is as follows. Nola Pender’s Health Promotion Model was the framework for a non-experimental, quality assurance study using descriptive retrospective chart review in rural family practice clinic in the southern United States. The purpose of this study was to evaluate smoking cessation intervention by primary care providers for patients who smoke with a known history of CAD.
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