Transcription
Hello, my name is Angela Kar, and today I would like to share with you a presentation on the health promotion model developed by Nola Pender. Throughout this presentation, I will provide a brief overview of Nola Pender, her educational background and contributions to nursing, my rationale for choosing this particular middle-range theorist, an overview of the health promotion model, as well as a critique. How the model impacted nursing and how it links theory to clinical nursing practice.
Nola Pender was born on August 16th, 1941, in Laning, Michigan. She is currently a professor emerita of nursing at the University of Michigan. Throughout her career, Pender has contributed several scholarly published works to the nursing profession, as well as serving as a member of several organizations. One organization in particular is the Midwest Nursing Research Society, in which she is a co-founder. Pender's experience within the healthcare field through nursing education and psychology have contributed to the theoretical sources in the development of the middle-range theory known as the health promotion model.
As a nurse in a private practice setting, a great deal of my time is spent educating and advising patients on how to improve and maintain a healthy lifestyle. Pender touches on the aspect of advanced practice nurses becoming key components for developing health education, health promotion, and disease prevention. As I continue to advance my career and knowledge base in the nursing field, Pender's health promotion model will offer a great deal of guidance as I impact my patients and their health behavior.
Pender focused on prevention of chronic health problems after observing that healthcare professionals did not intervene in a patient's care until it had reached the point of an acute or chronic health problem. Pender believed that if patients were educated on how to lead a healthy lifestyle, that it would prevent a patient from developing an illness. It is important to focus on improving the quality of life, as it has been shown that more than 50% of deaths in America are directly related to a person's negative health behavior and careless lifestyle. Another statistic that coincides with the previous was that physical inactivity has been identified as the fourth leading risk for global mortality, causing an estimated 3.2 million deaths per year. Pender's goal of the health promotion model was to provide positive motivation and reinforcement in hopes that the patient would be more willing to participate and carry out the aspects of a healthy lifestyle in the future. One important factor to include regarding the health promotion model is that it focuses on positive motivation, allowing the model to be applied constructively throughout the lifespan.
Pender wanted to impact nursing by providing a resource in which nursing protocols and interventions can be clinically developed. She believed that the health promotion would contribute long-term benefits to the healthcare field in terms of one's quality of life, reducing exponential healthcare costs, and increasing the lifespan of the patient. The health promotion model was proposed after Pender suggested that health prevention and health-promoting behaviors were components of a healthy lifestyle. The health promotion model was initially developed in the 1980s by Nola Pender to provide a way for nurses to combine nursing and behavioral science together based on factors that had an effect on health behavior. It has been described through literature reviews as providing a foundation in which a nurse can examine how a patient is motivated to participate in behaviors that promote their health and guides the nurse through effective interventions.
The health promotion model is to be utilized as a resource to assist nurses in discovering the motivations of health behavior in order to gain a framework for how best to educate and counsel patients. This model is based on social cognitive theory, which includes cognition, affect, actions, and environmental events that are the driving forces behind a person's behavior. The focus of this model is that of a multi-dimensional approach to assessing the individual's current health state and perception of health. The goal of the health promotion model is promoting a healthy behavior. The health promotion model is a way to assess the patient and their willingness and readiness to make life changes in order to achieve optimal health.
The three focal areas of this model include individual experiences, behavioral specific knowledge and affect, and behavioral outcome. The individual experiences include relating to past behavior as well as personal factors such as age, race, and ethnicity. The behavioral specific knowledge and affect components include perceived benefits of action, which address how improving health behavior will have a positive impact on the patient; perceived barriers to action, which is defined as the cost of improving a lifestyle, for example, the increased cost of fruits and vegetables or the cost of a fitness center membership; perceived self-efficacy, meaning the patient's self-confidence to make the changes and to put the time and effort into improving their health; activity-related affect, which is the course of changes that a patient feels in their mental state as they progress to healthy behaviors; interpersonal influences, including positive and negative impacts of family, the cohort, or colleagues of the patient, and social media; situational influences, meaning how a patient's environment encourages or hinders his or her health behavior; how the patient will commit to following through with changing their health behavior in order to obtain their goal of a healthy promoting behavior; and lastly, immediate competing demands and preferences, which is the potential of the patient to second-guess their decision to lead a healthy lifestyle.
Five key components that impact the outcome of the model include a person, as their health behavior is shaped by the environment and life experiences; the environment, because the patient can be driven by a positive motivation to improve their health behaviors; nursing, as they work with both the patient and the family to achieve the greatest outcome for the patient's well-being; health, as it focuses on the individual's capability to continually evolve to environmental changes; and lastly, illness, as it relates to the events during a patient's lifespan that have an effect on their health.
The health promotion model has contributed greatly to nursing, as it has improved the lives of patients. The health promotion model guides nurses in their care by focusing on a patient's specific behaviors that will be most beneficial to address in order for the patient to adopt and maintain a healthy lifestyle. Health promotion has been a growing interest within society due to the exponentially rising healthcare costs. Promoting health in the community has evolved through health education, disease prevention programs, screenings, and immunizations. Examples of these community health promotions include posters encouraging healthy eating habits and exercise routines, screenings such as blood pressure and cholesterol, as well as immunizations such as the flu vaccine. Patients may be more apt to follow healthy lifestyle guidelines if they are provided with examples of how they will benefit from the changes.
The health promotion model is linked between theory and practice through three well-known theories, including the health belief model, the expectancy value theory, and the social cognitive theory. The health belief model is comprised of two main principles, which include a health goal and how likely the actions are going to be productive in achieving that goal. One way in which the health promotion model differs from the health belief model is that the health promotion model focuses on promoting a healthy lifestyle through a holistic approach centered around wellness rather than the absence of disease, whereas the health belief model is a model centered around disease avoidance. In other words, the health promotion model is guided by positive motivation, and the health belief model is guided by negative motivation. The expectancy value theory is defined as how an individual expects to achieve their goals, leading to a favorable outcome. And the social cognitive theory is based on the belief that in order for an individual to succeed, they first have to change external factors within their environment and how they think before they can change how they act and their perceptions of health behavior.
Another connection between the health promotion model and clinical practice was evaluated by Esposito and Fitzpatrick in the International Journal of Nursing Practice. This study focused on using the health promotion model to evaluate how a nurse's beliefs of exercise could promote the health promotion aspect of the plan of care for the patient. As quoted in this article, it was shown that there were positive correlations between exercise benefits, physical activity, and recommendations of exercise to patients. The method of how this study was conducted was through three key points: the first being how a nurse believes exercise to be beneficial; the second, as what type of exercise behaviors a nurse practices; and the final, being how a nurse recommends exercise to their patient as part of their plan of care to reach a healthy lifestyle. It was concluded that there is a possibility of a direct correlation between beliefs of exercise benefits and exercise recommendations.
One area of focus that I often see in my position as a private clinic nurse is the predominance of diabetes within our patient population. One article that focuses on Pender's health promotion model was published by Holmberg, Berggren, and Dorg in 2010. This article, "Diabetes Empowerment Related to Pender's Health Promotion Model," is a metasynthesis approach in describing how the health promotion model is applied to a chronic medical condition. This article focuses on researching a healthcare professional's role in needing to understand and address how specific behaviors can be modified to promoting the well-being of the patient. The study suggests that an effective empowerment strategy would be the use of activity-related affect, as well as interpersonal and situational influences, as a means of facilitating and enhancing clients' health-promoting behaviors. Holmberg, Berggren, and Dorg came to the conclusion that the health promotion model is a constructive evaluation tool that centers care around a patient's health behaviors. The health promotion model allows nurses and others working in the healthcare field to help patients overcome barriers that are preventing them from leading a healthy lifestyle.
As a critique of this theory, I believe that there is a lack of research within the adolescent population. Through the research that I conducted of Nola Pender and the health promotion model, there were few results pertaining to that of adolescents, suggesting that the health promotion model is used more in the adult setting. It is important to begin educating our patients early with the hope that they will develop a strong foundation of a healthy lifestyle. One article that evaluates the health promotion model within the adolescent population is Schoff and Vohr's article on "Health Promotion in Adolescence: A Review of Pender's Health Promotion Model." Within this article, self-efficacy was shown to be the most important component of promoting healthy behavior in the adolescent age group due to the important relationship between self-efficacy and the health promotion model. Greater research and clarification is needed when it comes to adolescents and understanding between the situational and interpersonal influences of self-efficacy. One of the shortcomings of this theoretical model, as quoted by Schoff and Vohr, is the failure to account for a relationship between health-promoting behavior and health outcomes. Although the health promotion model guides the nurse by focusing on areas of counseling for the patient, it does not portray a clear role of a nurse. One area in which the health promotion model would benefit is that of adolescents in our society and the health concerns they are faced with.
In conclusion, because the health promotion model is a middle-range theory, it provides guidance to nurses in particular situations of individual patients to help them rationalize how best to provide care for their patient with the end goal of a healthy lifestyle. The patient has to be willing to learn in order for health behavior education to be effective in improving one's quality of life. Personal commitment is an essential component needed for a patient to reach their health-promoting behavior. Above all, the goal of a nurse is promoting health in their patient population.