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Nursing 3225 - Theoretical Critique

Nola J. Pender - The Health Promotion Model

Reggie Antasuda

on 17 March 2011

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Transcript of Nursing 3225 - Theoretical Critique

Nola J. Pender

The Health Promotion Model PHD, RN, FAAN

Professor Emerita
Division of Health Promotion and Risk Reduction (Division II)
University of Michigan School of Nursing

Loyola University of Chicago
- 1959-1962 RN West Suburban Hospital School of Nursing, Oak Park, Illinois
- 1962-1964 B.S. Michigan State University Nursing, East Lansing, Michigan
- 1963-1965 M.A. – Human Growth and Development-Michigan State University, East Lansing, Michigan
- 1967-1969 Ph.D – Psychology and Education-Northwestern University, Evanston, Illinois
- 1980-1983 – 20 Graduate Nursing hours-Rush University Community Health, Chicago, Illinois-
- 1992-Hon. Doctor of Science, Wideener University, Chester, Pennsylvania Publications:

Health Promotion in Nursing Practice

- Updated nursing text offering comprehensive coverage of the nurses' role in promoting healthy lifestyles and preventing disease.
- Include relevant examples and expanded coverage of vulnerable populations.
- For practicing nurses and students.
Her History, Our Overview • Pender, N.J., Murdaugh, C., & Parsons, M.A. Health promotion in nursing practice, 6th edition. Upper Saddle River, NJ: Pearson/Prentice-Hall, 2010.
• Hendricks, C., Murdaugh, C., & Pender, N. The adolescent lifestyle profile: Development and psychometric characteristics. Journal of National Black Nurses Association, 2006;17(2): 1-5.
• Robbins, L.B., Gretebeck, K.A., Kazanis, A.S., Pender, N.J. (2006). Girls on the Move program to increase physical activity participation. Nurs Res 2006;55(3):206-216.
• Pender, N.J., Bar-Or, O., Wilk, B. & Mitchell, S. Self-efficacy and perceived exertion of girls during exercise. Nurs Res, 2002; 5: 86-91.
• Pender, N.J., Bar-Or, O., Wilk, B. & Mitchell, S. Self-efficacy and perceived exertion of girls during exercise. Nurs Res 2002; 51(2): 86-91.
• Whitlock, E.P., Orleans, C.T., Pender, N. J., Allan, J. Evaluating primary care behavioral counseling interventions: An evidence-based approach. Amer J Prev Med 2002;22(4): 267-284.
• Eden, K.B., Orleans, C.T., Mulrow, C.D., Pender, N.J., Teutsch, S.M. Does counseling by clinicians improve physical activity? A summary of the evidence for the U.S. Preventive Services Task Force. Annals of Intern Med 2002;137 (3):208-215.
• Shin, Y.H., Jang, H.J., & Pender, N.J. Psychometric evaluation of the exercise self-efficacy scale among Korean adults with chronic diseases. Res Nurs Health. 2001;24: 68-76.
• Robbins, L.B., Pender, N.J., Conn, V.S., Frenn, M.D., Neuberger, G.B., Nies, M.A., Topp, R.V., & Wilbur, J.E. Physical activity research in nursing. J Nurs Schol 22001; 25: 25-36.
• Garcia, A.W., Pender, N.J., Antonakos, C.L., & Ronis, D.L. Changes in physical activity beliefs and behaviors of boys and girls across the transition to junior high school. J Adol Health. 1998;22(5): 394-402.
• Pender, N.J. Motivation for physical activity among children and adolescents. In J.Fitzpatrick & J. S. Stevenson (Eds). Annual Review of Nursing Research, New York: Springer.1998; 16: 139-172.
• Pender, N.J. Health promotion: An emerging science for self care and professional care. Qual Nurs 1997; 3(5): 449-454.
• Pender, N.J., Sallis, J., Long, B.J., et al. Health care provider counseling to promote physical activity. In R. K. Dishman (Ed.) Advances in Exercise Adherence Champaign, IL: Human Kinetics, 1994; 213-235.
• Pender, N.J., Walker, S.N., Stromborg, M.F., & Sechrist, K.R. Predicting health-promoting lifestyles in the workplace. Nurs Res 1990; 39 (6): 326-332.
The Outline: 1) Her History
2) The Theory
3) Key Definitions
4) How clear is this theory?
5) How simple is this theory?
6) How general is this theory?
7) How acessible is this theory?
8) How important is this theory?
9) Case Study
10) Questions,Thoughts and Opinions
11) References The Theory The Health Promotion Model Key Definitions PERSONAL FACTORS

- Personal factors categorized as biological, psychological and socio-cultural. These factors are predictive of a given behavior and shaped by the nature of the target behaviour being considered.

Personal biological factors

• Include variable such as age gender body mass index pubertal status, aerobic capacity, strength, agility, or balance.

Personal psychological factors

• Include variables such as self esteem self motivation personal competence perceived health status and definition of health.

Personal socio-cultural factors

• Include variables such as race ethnicity, accuculturation, education and socioeconomic status.
• Behavioural Specific Cognition and Affect PERCEIVED BENEFITS OF ACTION

• Anticipated positive outcome that will occur from health behaviour.


• Anticipated, imagined or real blocks and personal costs of understanding a given behaviour


• Judgment of personal capability to organise and execute a health-promoting behaviour.


• Subjective positive or negative feeling that occur before, during and following behaviour based on the stimulus properties of the behaviour itself. INTERPERSONAL INFLUENCES

• Cognition concerning behaviours, beliefs, or attitudes of the others. Interpersonal influences include: norms, social support and modelling. Primary sources of interpersonal influences are families, peers, and healthcare providers.


• Personal perceptions and cognitions of any given situation or context that can facilitate or impede behaviour.
Behavioural Outcome


• The concept of intention and identification of a planned strategy leads to implementation of health behaviour.

• Competing demands are those alternative behaviour over which individuals have low control because there are environmental contingencies such as work or family care responsibilities.

• Endpoint or action outcome directed toward attaining positive health outcome such as optimal well-being, personal fulfillment, and productive living.
How Clear is this Theory? Semantic Clarity/ Consistency

- The theory clearly defined the meaning of the concepts
- Clearly define each dimension which affects the individual
- When nurses come to read it is clear and similar empiric images come mind when the concept is used.
- Diagrams are clear and self- explanatory
- The concepts are used consistently with their definition.
- The theory’s purpose, the definition of concepts and the relationship are consistent with the stated and unstated assumptions of the theory. Structural Clarity/ Consistency

- Overall Concepts are interconnected and recognised and organized into a coherent whole
- The structure concept is linear How Simple is This Theory? There are 3 Major Concepts and 11 Sub-Concepts in the Health Promotion Model:

A. Individual Characteristics and Experiences – 2 subcategories

1. Prior Related Behavior
2. Personal Factors

B. Behavior Specific Cognitions and Affects – 6 subcategories

1. Perceived Benefits of Actions
2. Perceived Barriers to Action
3. Perceived Self-Efficacy
4. Activity-Related Affect
5. Interpersonal Influences
6. Situational Influences

C. Behavioral Outcome – 3 subcategories

1. Commitment to a Plan of Action
2. Immediate Competing Demands and Preferences
3. Health Promoting Behavior
The respective sub-concepts can be seen as related to each other independently under the 3 major concepts.

From this viewpoint there are 2 relationships between the 3 major concepts

1. Individual Characteristics and Experiences -> Behavior Specific Cognitions and Affects

2. Behavior Specific Cognitions -> Behavioral Outcome
How General is This Theory? To whom or what does this theory apply, and when does it apply? From a health care perspective, it applies to every patient in the system. The theory has a very large scope

The theory can be linked to other concepts such as:
- Cultural Awareness
- Preserving Personhood
- Promoting Autonomy Does the purpose pertain to all health care professionals? Does the purpose apply to specific specialities of nursing and only at given times? Yes, it allows for a better understanding of compliance or non-compliance of behavioural outcomes. It can be applied every time any nurse interacts with a patient. How Accessible is This Theory? 1. Are the concepts abstract or concrete?

Although there are a total of 14 concepts, the concepts are relatively concrete. The key definitions of the major concepts and sub-concepts are clearly defined.

2. Are the indicators used in practice?

This concepts are used in practice. There are times in the clinical setting where a client’s culture, social environment and other factors can affect their behavior and cognition. It is important to understand these factors in order to address them, place appropriate interventions, and create the outcome of health promotion.

3. Are the concepts clinically relevant?

The concepts are clinically relevant because we can easily draw two interrelations between the three major concepts. Individual characteristics and experiences can be related to a client’s behavior specific cognitions and affect. In nursing practice, interventions must be put in place to alter the behavior specific cognitions and affect. The desired behavioral outcome is creating health promoting behavior for the client.

4. Are there any sub-concepts?

There are a total of 11 sub-concepts. Case Study Mr. Tomkins is a 63-year-old client recently diagnosed with Type II Diabetes. He is of Aboriginal descent and was a child of the residential school generation. Mr. Tomkins fully dropped out of school at an early age and has been working at different low paying positions since the age of 16. He has never been able to hold a position for longer than six months. The client moved out of his home at the age of 18 and has had minimal contact with his parents and family. When asked about his views about diabetes he states that he is not overly worried and that there are “pills and injections to help control that stuff”. As the community health nurse how would you implement the health promotion model during care for Mr. Tomkins? The End! Questions, Thoughts, and Opinions REFERENCES:
Berry, T., Ghofranipour, F., Kazemnejad, A., Niknami, S. & Taymoori, P. (2009) Application of the health promotion model to predict stages of exercise behavior in Iranian adolescents. Eastern Mediterranean Health Journal, 15(5), 215-225.

Chinn, P. & Kramer, M. (2011) Integrated theory and knowledge development in nursing.(8th ed.). St. Louis, MO : Saunders

Current Nursing (2011) Health promotion model. Retrieved fromhttp://currentnursing.com/nursing_theory/health_promotion_model.html


Whitehead, D. (2003) Evaluating health promotion: a model for nursing practice. Journal of Advanced Nursing, 41 (5), 490-498


http://pacman.langara.bc.ca/webct/urw/lc5122001.tp0/cobaltMainFrame.dowebct?appforward=urw/lc325518810001.tp325518845001/startFrameSet.dowebct%3Fforward=studentCourseView.dowebct%26lcid=325518810001 How Important is This Theory? Does The Theory Have Clinical Significance or Practical Value? What are the
Basic Assumptions? Do we like this theory?
Ummm... Yes...
Definitely Yes. The HPM is based on the following assumptions, which reflect both nursing and behavioural science perspectives:

1. Individuals seek to create conditions of living through which they can express their unique human health potential.

2. Individuals have the capacity for reflective self-awareness, including assessment of their own competencies.

3. Individuals value growth in directions views as positive and attempt to achieve a personally acceptable balance between change and stability.

4. Individuals seek to actively regulate their own behaviours.

5. Individuals in all their biopsychosocial complexity interact with the environment, progressively transforming the environment and being transformed overtime.

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

7. Self-initiated reconfiguration of person-environment interactive pattern is essential to behaviour change.
1. Identify Some of the possible personal factors (ie. psychological, sociocultural) that can affect Mr. Tomkin's behavior-specific cognitions and affect. 2. What do you think are some barriers to a health promoting behavioral outcome for Mr. Tomkins? 3. What are some nursing initiatives that can be implemented to create a personal commitment to a plan of action for the client? - Relevant
- Applicable a vast array of clinical situations
- Concept has been enforced since term 1 - Hollistic View
- Easy to understand
- Focuses on understanding of patient's long term behavioral changes instead of short term solutions CRNBC Competencies

Competency: Collaborates with Clients to Develop Health Care Plans

38. Engages clients in an assessment of the following: physical, emotional, spiritual, cultural, cognitive, developmental, environment, and social needs.

Competency: Provides Registered Nursing Care with Clients

62. Provides culturally safe care.

Langara College Practice Appraisal Form
Teaching/Learning Domain

2.3: Eliciting and understanding client’s interpretation of health and healing experiences

2.6: Facilitating client directed change and/or nursing care

3.2: Making clinical decisions in relation to client’s experience and understanding of health

3.6: Recognizing patterns of client response in similar situations
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