Pender's Model

“I committed myself to the proactive stance of health promotion and disease prevention with the conviction that it is much better to experience exuberant well-being and prevent disease than let the disease happen when it is avoidable and then try to cope with it."- Nola Pender

Pender's first version of the HPM model appeared in 1982.

Based on theoretical perspectives and empirical findings, a revised version of the model was released in 1996.

• Persons seek to create conditions of living through which they can express their health potential.
• Persons have the capacity to reflect self-awareness.
• Persons value growth in directions that are viewed positive and attempt to achieve balance between change and stability.
• Individuals seek to actively regulate their own behavior.
• Individuals interact with their environment.
• Health professionals constitute a part of the interpersonal environment.
• Self-initiated reconfiguration of person-environment interactive patterns is essential to behavior change.

The structure of the original model (1987) concludes that modifying factors directly influences cognitive-perceptual factors; cognitive-perceptual factors directly influence health-related behavior; but modifying factors do not directly influence health-related behavior.

The revised HPM (1996), includes the same factors, but places them in a different structure. They are divided into two categories:

a) Individual Characteristics and Experiences

b) Behavior-Specific Factors

Group #12 Members:

Olivia Akins

Lauren Hall

Charles King

Lynsey Nowell

Success

Development of the Model

• Pender's doctoral studies in psychology and cognitive processes furthered her interest in individuals' ability to take responsibility, make decisions, and participate in self-care activities.

• Pender's Health Promotion Model incorporates research findings from nursing, public health, and psychology.

Our case study has developed a plan which includes:

• Smoking cessation
• Changes in diet
• Adherence to medication regimen
• Exercise routine

(Fitneinc, 2011)

References

(Pender, 2011, p. 1)

Nola J. Pender, PhD, RN, FAAN

There are several assertions in Pender's HPM that lead us to believe that our case study has a high commitment to his plan of action and a high chance of success.

• Positive emotions increase probability of commitment
• Health care providers and family support can increase engagement in behavior
• The greater the commitment, the more likely to be maintained over time
• People can modify their cognition to create incentives for action.

• Nola Pender began development of the Health Promotion model (HPM) after observing health professionals intervene only after patients experienced health problems. She believed that by preventing these problems before they occurred, patients could achieve a higher quality of life and healthcare costs could be reduced.

• Pender recognized that most HPMs are centered on negative motivation. Her model focuses on positive motivation.

Education

(Pender, 2011)

(Pender, 2009)

These are just a few of the potential keys to increase his chances of success. Along with his spiritual beliefs and support from others, he has a positive chance to improve his life for many years despite his advanced age.

• 1964- Bachelor of Science of Nursing from Michigan State University
• 1965- Master's in Human Growth and Development from Michigan State University
• 1969- PhD in Psychology and Education from Northwestern University in 1969

Bryer, J., Cherkis, F., & Raman, J. (2013). Health-Promotion Behavior of Undergraduate Nursing Students: A Survey Analysis. Nursing Education Perspectives, 34(6), 410-415.

Chinn, P.L., & Kramer, M.K. (2015). Description and Critical Reflection of Empiric Theory, Knowledge Development in Nursing (pp. 186- 209). St. Louis, Missouri: Elsiver

Fitne. (2011, October 10). The nurse theorists v2 - Nola Pender promo [video file]. Retrieved from

https://www.youtube.com/watchv=WYiE8-UoPCg

Mohamadian, H., Eftekhar, H., Rahimi, A., Mohamad, H. T., Shojaiezade, D., & Montazeri, A. (June 2011). Predicting health-related quality of life by using a health promotion model among Iranian adolescent girls: A structural equation modeling approach. Diagram. Nursing & Health Sciences, 13(2), 142. http://dx.doi.org.libproxy.troy.edu/10.1111/j.1442-2018.2011.00591.x

Padden, D., Conners, R., Posey, S., Ricciardi, R., & Agazio, J. (2013). Factors Influencing a Health Promoting Lifestyle in Spouses of Active Duty Military. Health Care for Women, 34, 674-693.

Pender, N. (2011). The health promotion model: manual, 1-18. Retrieved from http://deepblue.lib.umich.edu/bitstream/handle/2027.42/85350/?sequence=1

Pender, N. (2009). Most frequently asked questions about the health promotion model and my professional work and career. Retrieved from http://sitemaker.umich.edu/pender.health.promotion.model/files/faqs.pdf

Ronis, D. L., Hong, O., & Lusk, S. L. (2006). Comparison of the original and revised structures of the health promotion model in predicting construction workers' use of hearing protection. Research in Nursing & Allied Health, 29, 3-17. doi:10.1002/nur.20111

Sinasac, L. (2012). The community health promotion plan: A CKD prevention and management strategy. Canadian Association of Nephrology Nurses and Technologists, 22(3), 25-28.

University of Michigan School of Nursing. (2014). Nola J. Pender. Retrieved from http://www.nursing.umich.edu/faculty-staff/nola-j-pender

Affiliations and Service

• Co-founded and served as president of the Midwest Nursing Research Society
• Served as President of the American Academy of Nursing
• Served on the Board of Directors of Research America
• Member of U.S. Preventive Services Task Force and American Nurses’ Association

Teaching and Publication

• Professor emerita at the University of Michigan School of Nursing
• Distinguished professor at Loyola University Chicago School of Nursing
• Many publications in various journals and texts, including six editions of Health Promotion in Nursing Practice

(University of Michigan School of Nursing, 2014)

Nursing Metaparadigms

Case Study

Person

A biopsychosocial organism that attempts to create an environment in which intrinsic and obtained human potential can be thoroughly expressed. Individual attributes and life events and experiences influence health behaviors.

There are many factors that may influence health promoting behaviors in the elderly population. The desire for improved overall well being is one of the first steps toward health promotion.

Environment

The social, cultural, and physical factors that are part of one's life. Individuals can manipulate the environment to produce positive health behaviors.

Accessability

Structure

Nursing

Change of Heart

A collaboration of the individual with their family and community to generate optimal conditions for health and well-being.

Health

The achievement of intrinsic and obtained human potential through purposeful behavior, quality self-care and fulfilling relationships, while necessary accommodations are made to sustain structural stability and harmony with relevant environments. Health is an evolving life experience.

In our study, the patients desire and outlook on life changed with his survival of colon cancer. His personal, situational, and environmental factors altered his prior lifestyle and compelled him to a commitment to a plan of action toward more health promoting behaviors.

Chinn and Kramer (2015) define accessibility

in terms of “empirically identifiable phenomena” (pp.207).

A theory must have research to support it.

To be tested by research, the concepts must be measurable.

Behavior

Individual

Exp

Char/

Factors

(Pender, 2011)

Behavior

Outcomes

(Ronis, Hong, & Lusk, 2006, p. 4)

Pender's Health Promotion Model

For 27 years the Health Promotion Model has been studied, used, and tested.

Many different scenarios can be applied using the HPM. Pender (2011) gives two different examples: one example is physical activity and the other is nutrition.

HPM Diagram

Importance

An important theory is one that is usable in nursing practice, but also is aimed at bettering the future.

Purpose

(Mohamadian, et al., 2011)

The purpose of the health promotion model is

to assist nurses in understanding the major

determinants of health behaviors as a basis for

behavioral counseling to promote healthy

lifestyles.

• The entire premise of Pender’s Health Promotion Model IS health promotion!
• The model seeks to identify background elements that effect health. Once negative behaviors are identified change can occur.
• Change = a better future.

Definitions

Relationships

(Pender, 2011)

The HPM defines a significant relationship between a person and their environment.

A nursing theory to aid nurse comprehension of the primary determinants of health behaviors as a foundation for healthy lifestyle counseling

Individual Characteristics and Experiences:

• Prior Related Behavior
• Personal Factors

Behavior-Specific Cognitions and Affect:

• Perceived Benefits/Barriers of Action
• Perceived Self-Efficacy
• Activity-Related Affect
• Interpersonal Influences
• Situational Influences
• Commitment to a Plan of Action
• Immediate Competing Demands and Preferences

Behavioral Outcome:

• Health Promoting Behavior

Individual characteristics and

experiences throughout a lifespan

shape a person's well-being and

health behavior.

(Pender, 2011)

Assumptions

Generality

HPM Propositions

Simplicity

(Pender, 2011)

Different theories call for varying degrees

of simplicity or complexity.

Even if a theory is broad, one should still be able to describe or explain it in simple terms.

Generality basically means applicability

• To what or whom does this theory apply to?
• Can it be applied to nursing?
• Can it only be applied to a particular situation or population?

The more generalizable a theory is, the more situations it can be used in.

1. Prior behavior and inherited/acquired characteristics influence health promoting behavior.

2. Persons commit to behaviors from which they anticipate valued benefits.

3. Perceived barriers constrain commitment to action.

4. Perceived competence increases the likelihood of commitment and actual performance of the behavior.

5. Greater perceived self-efficacy results in fewer barriers to a specific health behavior.

6. Positive affect toward a behavior results in greater perceived self-efficacy.

7. Positive emotions associated with behavior increase the probability of commitment.

8. Persons are more likely to commit to health-promoting behavior when significant others support the behavior.

9. Families, peers, and health care providers are an important influence in the commitment and engagement of health-promoting behavior.

10. Situational influences in the external environment affect participation.

11. The greater the commitment to a plan of action, the more likely the behavior will be maintained over time.

12. Commitment to the plan is less likely to result in the desired behavior when competing demands that the person has little control over require immediate attention.

13. Commitment to the plan is less likely to occur when other actions seem more attractive .

14. Persons can modify cognition, affect, interpersonal and situational influences to create incentive for health-promoting behavior.

Major Concepts

(Similar to the Metaparadigms)

Pender (2011) states in a brief description of the model

that there are 8 beliefs at the center of this model.

By focusing on those 8 beliefs, a nurse can identify

barriers to health promotion and ultimately lead to positive change.

• Person
• Environment
• Nursing
• Health
• Illnesses

Pender (2011) states that the health promotion model can be used to understand a person’s reasons for certain health behaviors so that counseling can aid in promoting healthy lifestyles.

Pender (2011) defines “person” as a “…biophychosocial organism…” (p.3).

Critical Assessment

(Pender, 2011

Critical assessment of a theory determines

how well the theory relates to practice, research,

and/or education (Chinn & Kramer, 2015).

(Pender, 2011)

Chinn and Kramer (2015) give 5 elements to reflect

upon when critically assessing a theory:

• Clarity – How well something can be understood
• Simplicity – Having a minimal number of concepts and interrelationships
• Generality – Ability to be applied in many different situations
• Accessibility – The extent to which a theory can be used in practice
• Importance – Practicality and clinical significance

Examples

Clarity

Example 1

Example 2

• Our first example is from a study in which researchers, using Pender’s Health Promotion Model, examined variables that affected health behaviors of undergraduate nursing students!
• Although nursing students are taught about health promotion activities in school, it does not mean they use them personally.

• Sinasac (2012) used the Health Promotion Model in the community setting to promote CKD awareness and health promotion.
• Sinasac (2012) suggested offering classes in a variety of different environments to maximize participants and knowledge base.

Obviously, if one cannot understand a theory,

one cannot use it. The theorist(s) must clearly define the concepts being used. The theorist(s) must have established and consistent relationships between concepts.

Variables

New Responsibilities

Multiple life roles

• Student
• Spouse
• Parent

Increased age

• Classes regarding risk factors related to CKD
• Prevention and control strategies
• Gyms and schools offering exercise education/programs
• Involving local transportation systems to promote adherence to appointments and/or dialysis treatments

Example 3

Example 4

Pender identifies and defines 5 key concepts!

• Person, Environment, Nursing, Health, and Illness

Pender also identifies and defines 11 components related to the model.

• Prior related behavior, personal factors,perceived benefits of action, perceived barriers to action, perceived self-efficacy, activity-related affect, interpersonal influences, situational influences, commitment to a plan of action, immediate competing demands and preferences, and health promoting behavior.

• Researchers used Pender’s Health Promotion Model as the framework for a study involving military spouses.
• The study found that perceived health status, perceived stress, self-efficacy, social support, and health promoting behaviors all played an important role in overall health promotion

• In this article researchers were comparing the revised version of Pender’s Health Promotion Model to a previous studying involving Pender’s Health Promotion Model.

• Spiritual growth and social support were ranked highest
• Physical activity, stress management, and health responsibility were lowest

• The study found that the revised model had a better fit with the study and that it was useful in predicting whether or not construction workers would wear hearing protection because the new model put more emphasis on perceived, behavior-specific health factors.