Nola J. Pender, PhD, RN, FAAN

by amy higgins and diane morris

Health Promotion Model

Background information Born August 16, 1941 in Lansing, Michigan Education

BS, Michigan State University, East Lansing, MI, 1964 MA, Michigan State University, East Lansing, MI, 1965 PhD, Northwestern University, Evanston, IL, 1969

TeachingDr. Pender has been a nurse educator for over forty years. She has taught baccalaureate, masters, and PhD students; she also mentored a number of postdoctoral fellows. Currently, she serves as a Distinguished Professor at Loyola University Chicago, School of Nursing

Scholarly expertise & interests

InterestsPhysical activity Adolescent health behaviors Health promotion Health behavior counseling

Began studying Health Promoting Behavior in mid 1970’sFirst published Health Promotion Model 1982Later revised in late 1980’s and again 1996Considered a middle range theorist

…in the beginning 1974: World Health Organization defines HEALTH

as… “a state of complete physical, mental and social well-being and not merely the absence of disease and infirmity”

1979: The U.S. surgeon general published Healthy People which was a landmark document stating that major health advances would result from: Improved nutrition Increased physical fitness Personal Life styles Immunizations Environmental Modifications

What is the Health promotion model?

Pender proposed the Health Promotion Model (HPM) as a framework for integrating…

NursingBehavioral

Science Perspectives

Health Promotion

Model

Health Promotion model……focuses on factors that influence Health

Behaviors and is a guide to exploring biopsychosocial processes that motivate people to engage in behavior to enhance health

Major Concepts:1. Individual Characteristics and

Experiences2. Behavior-Specific Cognitions and Affect3. Behavior Outcomes

MOTIVATIONAL BASE FOR HEALTH BEHAVIOR

The Actualizing Tendency: “need to experience all facets of self and the world about them” (Pender, 1986).

› Driving force toward ↑ levels of well-being› Individuals/Families are motivated to engage in health

promoting behaviors when they know their own capacity for growth and potential

The Stabilizing Tendency: is responsible for protective maneuvers, primarily maintaining internal & external environments within a range compatible with continuing existence…AKA “steady state”

Assumptions of HPM The HPM is based on the following assumptions, which

reflect both nursing and behavioral science perspectives:

1. Individuals seek to actively regulate their own behavior. 2. Individuals in all their biopsychosocial complexity interact

with the environment, progressively transforming the environment and being transformed over time.

3. Health professionals constitute a part of the interpersonal environment, which exerts influence on persons throughout their lifespan.

4. Self-initiated reconfiguration of person-environment interactive patterns is essential to behavior change

   

Framework of

Health Promotion Concepts

Society

Communities

Health Promotion

Health Protection

Families

Individuals

Society•Policy Making•Program

planning•Environmental

restructuring

Communities•Community

assessment•Population-

based programs

Health Promotion•Wellness•Growth•Self-

actualization

Health Protection•Primary•Secondary•Tertiary

Families•Family

assessment•Health

promotion planning

•Change in family behavior patterns

Individuals•Health

assessment•Health

promotion planning

•Change in lifestyle

SETTINGS FOR HPM

Communities at large

Nursing centers Schools

Workplace Hospitals

LIMITING FACTORSProgress toward Health Promotion is “slowed by vested interests in the economic gains inherent in ‘illness-oriented’ care and by political concerns about national debt and the high cost of health services” (Pender, 1986).

RN-CLIENT RELATIONSHIP“Ultimate goal is empowerment of client for self-

determination and self management in order to enable attainment of high level health and well-being” (Pender, 1986).

Based on:1) Individual and family ultimately responsible for own

health2) Clients have inherent capacity for change in both

constructive and destructive directions3) Clients have a right to health information in order to

make informed decisions concerning behavior and lifestyle choices

Summary The health promotion model (HPM) was

designed to be a “complementary counterpart to models of health protection.”

It defines health as a positive dynamic state not merely the absence of disease.

Health promotion is directed at increasing a client’s level of wellbeing.

The health promotion model describes the multi dimensional nature of persons as they interact within their environment to pursue health.

Fawcette’s Criteria Significance

› Are metaparadigm concepts and propositions addressed by the theory explicit?

› Are the philosophical claims on which the theory is based explicit?

› Is the conceptual model on which the theory was derived explicit?

› Are the authors of antecedent knowledge acknowledged and citations given?

Fawcette’s continued…

Internal Consistency› Are the context (philosophy and

conceptual model) and the content (concepts and propositions) of the theory congruent?

› Do the concepts reflect semantic clarity and consistency?

Fawcette’s cont… Parsimony

› Is the theory content stated clearly and concisely?

Testability› Is the research methodology identified and

congruent with philosophical claims?› Will data obtained from research

sufficiently capture the essence of the theory?

Fawcette’s cont… Empirical Adequacy

› Are the findings from studies of descriptions of personal experiences congruent with the concepts and theory propositions?

› Are theoretical assertions congruent with emperical evidence?

Fawcette’s cont… Pragmatic Adequacy

› Are education and special training required before application of the theory in nursing practice?

› Has the theory been applied in the real world of nursing practice?

› Is it generally feasible to implement practice derived from the theory?

› Does the practitioner have the legal ability to implement and measure the effectiveness of theory-based nursing actions?

› Is the application of theory-based nursing action designed so that comparisons can be made between outcomes of use of the theory and outcomes in the same situation when the theory was not used?

REFERENCES Pender, N. J. (1987). Health promotion in

nursing practice (2 ed.). Norwalk, Connecticut.

http://currentnursing.com/nursing_theory/health_promotion_model.html

http://www.nursingtheory.com http://www.umich.edu/faculty-staff/nola-j-p

ender McEwen, M., & Willis, E. M. (2007).

Theoretical basis for nursing (3 ed.). Philadelphia, PA: Lippincott Williams & Wilkins.