As nurses, it is important to have a basic understanding of the nursing practice by reflecting on various nursing theories and principles used across a variety of clinical settings. Nursing theories serve as the foundation or the guiding principle of the nursing profession. In this paper, I am going to discuss two theories – the Health Belief Model and the Social Cognitive Theory – and their relevance to the nursing practice.
Health Belief Model
The Health Belief Model, commonly abbreviated as HBM, is a psychological model that predicts and explains health behaviors of individuals based on their beliefs and attitudes towards a particular health-related issue. This theory explains that an individual’s beliefs and attitudes about certain health problems, self-efficacy, barriers, and benefits to perceived action help create health-promoting behavior. It was created in the 1950s by US social psychologists Kegels, Rosenstock & Hochbaum in response to the unsuccessful nationwide tuberculosis screening program (Thurmond & Popkess-Vawter, 2003). The core statements and assumptions of the Health Belief Model is that a health-related action should be adhered because it could help prevent the likelihood of negative health conditions, such as chronic illnesses and infectious conditions. Once individuals acquire positive expectations over a specific health-promoting action, they can then avoid the occurrence of negative health conditions (Potter & Perry, 2006).
Application of the Health Belief Model into practice
It is believed that the Health Belief Model is the main model used in the nursing process associated with health promotion and education, as well as illness prevention and protection. It has been utilized to describe various health protective activities within the primary, secondary, and tertiary level of health care. This framework serves as the basis for helping individuals engage in primary and secondary illness prevention. For instance, when nurses provide specific instructions to educate individuals that diseases could be prevented, this is part of the primary prevention that is associated with increasing the health-promoting activities of the population. If the nurse, on the other hand, educates an ill patient about how a certain disease should be treated, and the things to be avoided to prevent the disease from getting worse, this is part of the secondary level of prevention that is associated with preventing negative health conditions (Thurmond & Popkess-Vawter, 2003).
Accordingly, by providing primary and secondary prevention, the patients’ perceived benefits will likely increase their anticipatory actions and lessen health risks associated with their conditions (Bandura, 2009). Another good example of a Health Belief Model applied into nursing practice, is when a nurse creates a discharge planning education for a patient diagnosed with heart illness. By letting the patient know before discharge the importance of undergoing regular monitoring and follow-up, as well as teaching the patient to reduce risk-taking behaviors, it could help increase a patient’s health awareness and possibly reduce readmissions in the future. But most importantly, the nurse must help the patient become accepting of the belief that discharge health educations could increase self-efficacy and improve the overall quality of life.
It is important to note that the Health Belief Model is entirely reliant on the ability of the nurse to produce meaningful interventions to stimulate the cognitive sphere of the patients in terms of their health beliefs and culture (Potter & Perry, 2006). By understanding the patient’s personal values, culture, and family history the nurse could tentatively formulate how the patient views or accepts a disease condition. Finally, nurses must learn to create questions that could help identify or explore the patient’s perception about the illness or disease, so that they could have a more concrete idea about the beliefs and attitudes surrounding health-associated matters of the patient. With the help of the Health Belief Model, nurses could positively and effectively engage in health education with proper understanding of individual perceptions, values, and attitudes toward a specific disease being addressed.
Social Cognitive Theory
The Social Cognitive Theory is a learning theory based on the perception that individuals could learn new behaviors or skills by observing others (Sandoval, 2008). These newly learned behaviors can be central to the development of one’s personality or set of skills necessary for his or her profession. While it is believed that the environment in which a person grows up or becomes affiliated to may contribute to the development of learning and behavior, the cognition or the actual learning process is also important for the acquisition of new behaviors and attitudes. Proponents of the Social Cognitive Theory state that people could learn by observing other people, with the help of the environment, and through behaviors as the main factors for influencing human development (Miller, 2005).
Application of Social Cognitive Theory into nursing practice
In this theory, there are five core concepts including modeling/learning, outcome expectations, development of self-efficacy, self-regulation, and goal setting. Among these five factors, the most important factor for behavior acquisition is the modeling/learning process. That is very important for the nursing profession. According to the Social Cognitive Theory, effective modeling educates strategies and general rules necessary for dealing with various life situations (Bandura, 2009). This is similar to how the student nurses learn nursing skills during their college years. When student nurses started working with their clinical instructors, who are registered and practicing nurses, they are being taught new nursing methods so that they could learn how to deal with different nursing roles and practices in a wide range of health care settings and patient populations (Miller, 2005).
The Social Cognitive Theory serves as a guide for student nurses to acquire new nursing skills they could use in their profession. For example, student nurses learn the importance of hand washing and sterile gloving technique before engaging in surgeries from their nurse instructors. But they could not learn the proper technique of hand washing and gloving if their instructors would not imitate or demonstrate the step-by-step method of doing it (Bandura, 2009). This is a good example of learned behavior through direction observation of another individual, which is one of the core concepts of the Social Cognitive Theory. According to Sandoval (2008), the use of Social Cognitive Theory could effectively help student nurses develop certain skills they need throughout their nursing career.
The Health Belief Model and the Social Cognitive Theory both play an important role for the professional nursing practice. From the discussions above, we have learned that the Health Belief Model focuses on the ability of nurses to educate patients about health attitudes to help promote quality of life while the Social Cognitive Theory centers on learning or acquiring new skills. Student nurses may learn new nursing skills by observing their clinical instructors about the proper way of doing things (Potter & Perry, 2006).
Both of the theories have their respective importance and functions for the nursing profession, and they could be considered as two of the main guiding principles of the nursing practice – one focuses on health promotion and illness prevention and the other focuses on learning skills needed by nurses to address patient needs. When both of these theories are effectively utilized, nurses could have increased confidence and level of education to support patients and become competent in their practice.
Bandura, A. (2009). SOCIAL COGNITIVE THEORY: An Agentic Perspective. Annual Review of Psychology. 52(1): 3–26. Miller, K. (2005). Communication Theories: Perspectives, Processes, and Contexts. NY: McGraw-Hill. Potter, P. & Perry, G. (2006). Fundamentals of nursing. St. Louis, MI: Elsevier Mosby. Sandoval, J. (2008). “Social Cognitive Theory: A Framework for Understanding Learning in a Nursing Student-preceptor Relationship how nursing students learn by doing In the Presence of a practicing nurse. Southern Nursing Research Society. 19(21): 22-29. Thurmond, V. & Popkess-Vawter, K. (2003). Examination of a middle range theory: Applying Astin’s input-environment-outcome (I-E-O) model to web-based education. Online
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