The current essay provides an understanding of one of the most popular nursing middle range theories known as Health Promotion Model. It was formed by Nola Pender on the background of her strong nursing and psychological knowledge and numerous observations. This work identifies various problems and health issues which are addressed by this middle range theory. Much attention is paid to the description of the ways of reasoning used by the researcher. The major concepts and relationships among them are explained and visualized. The evaluation of the Health Promotion Model is performed by the identification of used assumptions, discussion of the clarity and connection to the four concepts of the nursing metaparadigm. Nola Pender developed a middle range theory that can guide nursing actions for the improvement of the patients’ health. It is notable that this model can be applied to various areas of nursing.
The Background of the Theory
This essay contains a description of the middle range theory called Health Promotion Model. This theory was proposed by Nola Pender in 1982 (Pender, 2011). The researcher proposed the methodology for the improvement of the health of the individuals and groups of people by adopting healthy behaviors.
Nola Pender graduated from Michigan State University in 1962 (Hendricks, 2015). There she obtained a bachelor’s degree in nursing (Hendricks, 2015). In 1969, Nola got a doctorate degree in psychology and philosophy. She obtained a wide experience in health care during her work connected with the military industry and space technologies. Her experience of rendering health care services to numerous representatives of various professions considerably increased Nola’s knowledge of health issues and the ways of their treatment. She studied the causes and consequences of different health diseases. This experience served as the background for the understanding that health depends greatly on personal characteristics, experience, and cognition. Close interaction with different people helped Nola support her ideas concerning preventive health behaviors. In 1975, her first work was published (Pender, 2011). Nola Pender introduced a model for preventive health behavior. Seven years later, she introduced the first edition of the Health Promotion Model (Pender, 2011). This model was directed towards the improvement of the health of individuals and the whole community.
This middle range theory was described and evaluated by various researches. Kathleen Masters (2011) in her work Nursing theories: A framework for professional practice wrote that “the obtained model can be generalized to broader adult populations”. This statement is based on the understanding that Nola Pender performed her observations on people of different ages, professions, and social groups. Kathryn Hendricks (2015) supported this idea by stating that Nola Pender “utilizes nursing assessment, diagnosis, and interventions to operationalize the Health Promotion Model through practical application and research”. Nola Pender (2011) in her work Health promotion model manual described the major concepts of her Health Promotion Model: “individual characteristics and experiences, behavior-specific cognitions and effect, and behavioral outcomes”. Masters (2011) put emphasis on the fact that the Health Promotion Model is clear, logical and understandable: “the relationships among the various factors are linked, and relationships are identified and consistently defined”.
This middle range theory addresses health care issues of individuals and communities through the facilitation of a healthy lifestyle. Health care providers, especially nurses, stipulate the development of health-promoting behaviors through interpersonal relationships with patients. The current theory is based on providing information concerning various preventive measures to the representatives of different ages, genders, professions and social classes. It is notable that the Health Promotion Model can be applied to the management of specific health behaviors. This middle range theory can be used at health care providing centers, working places and at homes (Peterson & Bredow, 2012). The current theory can address smoking, weight-related issues, and stress management.
Description of the Theory
This middle range theory is based on the application of inductive reasoning: “Pender’s model was formulated using inductive reasoning and existing research, which is the common approach when building middle range theories” (Masters, 2011). Nola Pender based her ideas on real-life observations of numerous patients. Representatives of different ages, genders, social groups and professions took part in these investigations. That is why “the obtained model can be generalized to broader adult populations” (Masters, 2011). The researcher supplied strong support to previously stated theories concerned with human behavior. These theories are Fishbein’s Expectancy-Value Theory and Bandura’s Social Cognitive Theory. The general description of these theories will be provided below. Relevant evidence of these two theories was obtained during Pender’s working practice. This information formed the background for the statements presented in her Health Promotion Model.
Health Promotion Model is based on three major concepts: “individual characteristics and experiences, behavior-specific cognitions and effect, and behavioral outcomes” (Pender, 2011). The first concept is based on the understanding that each person is unique because an individual has some life experience that differs greatly those of other people. Hence, this experience can have a considerable influence on health formational behaviors. That is why health care providers should apply unique approaches for each person.
Nola Pender stated that individual characteristics and experiences contain the following factors: “biologic, psychologic and sociocultural” (Pender, 2011). Biologic factors are represented by age, strength, aerobic capacity, etc. The major psychological factors are personal motivation and self-esteem. Race, education, and position in society are the main sociocultural factors.
Additionally, every individual has unique behaviors that are reflected in personal actions, perceptions, and self-esteem. Previous life experiences and personal behaviors form the background of particular life decisions. During the application of the Health Promotion Model, much attention should be paid to the negative prior behaviors, because they can become a barrier to necessary changes in patient’s behavior (Pender, 2011). Health care providers should determine the background of the negative prior behaviors to “help individuals grasp perceived benefits to change behavior” (Hendricks, 2015). These changes lead to the establishment of health-promoting courses and the improvement of health condition.
All the above-mentioned concepts are operational because they are defined in terms of the process of promotion of healthy behaviors. Nola Pender “utilizes nursing assessment, diagnosis and interventions to operationalize the Health Promotion Model through practical application and research” (Hendricks, 2015). Additional attention should be paid to the fact that the researcher is consistent in the use of the concepts in her Health Promotion Model. All the concepts are properly ordered, linked and congruent. Concepts present in this middle range theory are very popular among health care providers, because “the relationships among the various factors are linked, and relationships are identified and consistently defined” (Masters, 2011). The representation of relationships is clear. Their position in the model depends on their influence on personal actions and behaviors. This positioning will be discussed below. The design of the model is easily understandable and applicable to various representatives of different ages as well as social and ethnic groups. Moreover, this middle range theory enables health care providers to predict personal behavior and actions.
Nola Pender provided explicit definitions for the concepts in the middle range theory: “the metaparadigm concepts and propositions of the Health Promotion Model are explicit, and the philosophical claims are clear” (Hendricks, 2015). All of them are stated logically and precisely. The researcher based her statements on numerous real-life observations during her work in the military industry and space technologies.
Personal characteristics and experiences have an influence on the behavior-specific cognitions. It is notable that behavioral outcomes are influenced by both behavioral cognitions and individual characteristics. Moreover, much attention should be paid to the fact that the first concept may have a direct and indirect influence on the latter. As it is visualized in the figure below, personal factors can be connected with the health promotional behavior directly or through interpersonal and situational influences. Hence, all these concepts cannot be considered separately in this middle range theory, because all of them form the background of personal health-promoting actions. Relationships among the parts of these concepts are shown in figure 1 (Hendricks, 2015).
Relationships between concepts of the Health Promotion Model
This figure shows that past behaviors and established understandings and traditions, such as culture and family, can influence an individual’s ability to take part in health-promoting actions. For example, a person can choose to not eat meat, because his/her parents were vegetarians and did not cook meat, but not because of his personal perception of vegetarianism.
Evaluation of the Health Promotion Model
Nola Pender built her theory on two assumptions. The first assumption was presented in Fishbein’s Expectancy-Value Theory (Hendricks, 2015). According to this assumption, patients will consciously and unconsciously apply their efforts in anticipation of positive outcomes. Hence, personal behaviors and attitudes towards health promotion should be changed for reaching some positive results. The second assumption is based on Bandura’s Social Cognitive Theory (Hendricks, 2015). It states that behavioral changes could be facilitated by self-efficacy. Both assumptions are explicit. Nola Pender supported and proved them by her real-life observations and knowledge. She defined “health as a positive state of wellness” (Hendricks, 2015). During her work, she determined that health care providers can help patients attain a healthy lifestyle. Nola Pender in her studies proved that the quality of life could be improved by health promotional behavior.
The Health Promotion Model provides a description of four concepts of the nursing metaparadigm. These concepts are person, environment, health, and nursing (Alligood, 2014). All of these concepts are incorporated into the theory as parts of individual characteristics and behavior-specific cognitions. The chosen middle range theory shows that each of these concepts has sufficient influence on the quality of health care provision. The idea of a person is related to personal factors and prior behavior. It contains sociocultural, physical, biological and economic components. This concept explains the influence of the family and the community on health-promoting behavior.
According to the second concept, other external and internal factors have a significant influence on the health condition and decisions, which have either a positive or negative effect on personal health. These factors are represented in the form of an outer environment and other extremal factors, such as nutrition or vegetarianism. It is also visualized in the Health Promotion Model.
The concept of health is related to the level of personal physical and psychological illness or wellness. Physical condition and personal behaviors have a considerable influence on one other. Hence, one of the major tasks of health care providers in the formation of behavior directed towards a healthy lifestyle. This influence is shown by links and relations between different parts of the scheme.
The last concept of nursing metaparadigm is represented by a nurse because he/she can have a considerable influence on the formation of healthy behaviors. Their actions should be directed towards supporting the patient’s endeavors of improving personal health. What is more, they should provide relevant knowledge and assistance to patients in order to stipulate their health-oriented actions.
Health Promotion Model is characterized by clarity and lucidness. It is simple and understandable. Nola Pender used a logical scheme for showing connections and interrelations among various concepts in her middle range theory. Even people, who are not involved in the health care provision, can determine direct and indirect relationships among individual characteristics and experiences, behavior-specific cognitions and effect, and behavioral outcomes. All the integral parts and concepts are presented in a terse manner and connected with each other. At the same time, they cover various aspects of the concepts. Generalized ideas of Fishbein’s Expectancy-Value Theory and Bandura’s Social Cognitive Theory were supported by the real-life studies for the creation of the understandable and logical Health Promotion Model.
Application of the Theory
The theory proposed by Nola Pender is considered to be a “guide for exploration of the complex biopsychological processes that motivate individuals to engage in behaviors directed toward the enhancement of health” (Pender, 2010). Her Health Promotion Model can be applied to any person with any behaviors. Firstly, nurses should determine internal and external factors which form the harmful behavior. Then, health care providers should direct efforts towards the minimization of these factors and replace them with health-promoting behaviors. This can be achieved by educating and empowering the patient for personal efficiency. The application of the above-mentioned theory will make nursing actions more patient-oriented because the needs and behaviors of each individual will be assessed and met. Thus, health care providers will be focused on the prevention of diseases instead of their treatment.
Health Promotion Model can be used during the practice of health care provision in schools, nursing centers, and communities. Nurses should share their knowledge concerning the ways of prevention of mass diseases during face-to-face communication with patients and community meetings. The emphasis can be put on stress management, eating habits, and physical activities. Special plans of actions can be developed for eliminating various health-related issues, such as diabetes, obesity and cardiovascular diseases caused by stress. Additionally, these plans can be based on the improvement of personal confidence through the presentation of different methods of attaining a healthy lifestyle.
The current essay provides a description and evaluation of one of the most popular middle range of nursing theories. Health Promotion Model was introduced by Nola Pender after her nursing and philosophical studies. This model has been formed on the basis of two theories, which describe personal health behaviors. They are the Fishbein’s Expectancy-Value Theory and Bandura’s Social Cognitive Theory. Her ideas were supported by real-life experiences during her health care practice connected with military industry and space technologies. The introduced Health Promotion Model is based on three major concepts: individual characteristics and experiences, behavior-specific cognitions and effect, and behavioral outcomes. This model can be visualized as a clear and understandable scheme. All the concepts have links and connections to each other. Various researchers in their works stated that Pender’s middle range model is logical and consistent. It is notable that the Health Promotion Model describes four concepts of the nursing metaparadigm: person, environment, health, and nursing. All of them are presented as the components which have considerable influence on the formation of personal health promotion. This middle range theory will help nurses to determine and eliminate barriers for the healthy lifestyle, provide patients with information concerning preventive measures, and support the attainment of a healthy lifestyle. All in all, the Health Promotion Model can be applied to various areas of nursing for the improved health condition of separate individuals and the whole communities.
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