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The Health Promotion Model: Nola J. Pender

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The Health Promotion Model: Nola J. Pender. Theory/Author Name and Background. The paper herein addresses the Health Promotion Model by Nola J. Pender, which is a mid-range theory. However, before this article delves deep into this topic, it would be appropriate first to provide background details of the theorist as well as the theory. Born on 16th August 1941, Nola J. Pender is an honored nursing theorist, academic, and author. She attended the Michigan State University where she earned her bachelor’s and master’s degrees in 1964 and 1965 respectively. Later on, she managed to receive a Ph. D. from Northwestern University in 1969. Around the time Pender was studying for a doctorate, she became very interested in the promotion of health. Pender stated that she had been influenced by James Hall, one of her doctoral advisors who studied how individual’s thoughts shaped their behaviors and motivation (Alligood & Tomey, 2013); this happened in the mid-1970’s. Accordingly, Pender began examining health-promotion nature and published the Health Promotion Model in the year 1982. Dr. Pender was a nurse professor for over forty years. During her teaching career, she mentored bachelor’s, master’s and Ph.D. students from all walks of life. She was honored in 1998 for her significant works as a teacher by being awarded the Teacher of the Year by the University of Michigan. Currently, she is a professor at the Loyola University, situated I Chicago, under the School of Nursing.
Pender stated that the Health Promotion Theory was developed from Albert Bandura’s (1977) social learning theory (which postulates that cognitive processes affect behavior change) and is influenced by Fishbein’s (1967) theory of reasoned action (which asserts that personal attitudes and social norms affect behavior) using a perspective from nursing.

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The model was modified thrice times since it was originally published, in the 1980’s, in 1996 and most recently in 2014. During her active examination, Pender conducted tests on the model on adolescents and adults. Moreover, Pender along with her research team cultivated a program dubbed “Girl on the Move,” where they conducted intervention research on the model’s usefulness in assisting adolescents embrace physically active lifestyles into their day to day life, establishing several instruments that were utilized to measure the model’s composition.
Moving on to the Health Promotion Model (HPM), it was developed to be a completing counterpart to other models that deal with the protection and promotion of health. The model defines health as a state of being positive and dynamic and not the mere absence of diseases. Its primary goal is increasing a patient’s well-being level. The HPM construes am individual’s multidimensional nature as they interact with their environment in the pursuit of health. It focuses on three areas namely: individual experiences and characteristics; behavior-specific cognitive behavior and its effects; behavioral outcomes (Sakradia, 2014). Under individual experiences and characteristics, it deals with personal factors such a psychological, biological and sociocultural as well as prior related behavior. On the other hand, under behavior-specific cognitive behavior and its effects, it deals with perceived benefits and barriers to actions, interpersonal influences such as peers, family and providers, perceived self-efficiency of an individual, and situational influences such as aesthetics, demand characteristics, and options. Finally, behavioral outcomes deal with the commitment to a particular plan of action, immediate competing preferences and demands, and health promotion behavior.
Theory Description.
The HPM notes that every individual has unique experiences and personal characteristics that affect their subsequent actions. The variables that affect behavioral specific knowledge and also have a significant effect on motivational significance. Pender’s model utilizes inductive reasoning to complement existing studies. This approach is common in the formulation of middle-range theories (Masters, 2013).
As earlier discussed, the model focuses on three areas namely: individual experiences and characteristics; behavior-specific cognitive behavior and its effects; behavioral outcomes. The stated variables can be adjusted through nursing actions. The end point in HPM is the health promotion behavior and is the behavioral outcome that is desired. Health promotion behaviors ought to result in enhanced health, functional ability and improved quality of life at all the development stages. Additionally, the final behavioral demand is affected by preferences and immediate competing demand, which can end up derailing the desired health promotion actions. On the other hand, all individuals aim to regulate their own behavior (Sakradia, 2014).. These individuals possessing their biopsychosocial complexities interact with their environment, and, in turn, transform their environment and also being transformed by their environment. Professionals in the health department make up a part of this interpersonal environment that influences an individual throughout their life. Therefore, self-initiated person-environment interaction pattern reconfiguration is vital to behavioral change.
The first category encompasses every individual’s personal experiences and characteristics, which affect a person’s individual actions. The significant components in this category are personal factors and prior related behavior. Prior related behavior is vital in influencing people’s future behavior. The second section entails behavior-specific effect and cognitions, which act as behavior-specific variables in the HPM (Capic, 1998). These variables are assumed to have motivational significance. It deals with perceived benefits and barriers to actions, interpersonal influences such as peers, family and providers, perceived self-efficiency of an individual, and situational influences such as aesthetics, demand characteristics, and options. The final category is a behavioral outcome and is the commitment to an action plan that marks the commencement of a behavioral event. The interventions in HPM are focused on improving consciousness on promoting self-reliance, health-promotion behaviors, benefits of change enhancement, and managing the barriers that one might experience during change (Capic, 1998).
The propositions of the Health Promotion Model are an important tool that form the basis for health behaviors investigative work. Some of these propositions include prior behavior, as well as acquired and inherited characteristics, have an influence on the person’s affect, beliefs, and health-promotion behavior enactment. Individuals perceived barriers can halt commitment to a particular action, a behavior mediator, and actual behavior (Thomas & Burman, 2014). Finally, self-efficacy and perceived competence to do a given behavior enhance the likelihood of actual behavior performance and commitment to action.
On contemplating the theory, the all the three concepts of the theory were defined both theoretically as well as implicitly. Moreover, the author was consistent in the use of all the three concepts and other terms in the theory. The concepts were also defined explicitly in that the author delved deep into the topic enabling the reader to comprehend all the concepts and the theory as a whole. Nola J. Pender’s theory can be described as complete in all aspects related to nursing. Accordingly, nursing practitioners all over the world should be taught this model and should apply it in their practice.
The major concepts of nursing according to Pender.
The person involved in the health promotion model is the individual who falls as the primary focus of the model. Each person is considered to have unique characteristics as well as experiences that affect their health behaviors. Their personal surroundings, as well as their families, are said to have an effect on the behaviors they display (Thomas & Burman, 2014).
The environment
This sector of the model comprises of the external environment as well as the social circumstance within which the individual is found. The absence of toxic substances, as well as the availability of restorative experiences from time to time, is required in the health behaviors of the individual. Economic and human resources are critical to this phase (Sakradia, 2014).. The social conditions including crime and poverty are believed to have adverse effects on the person in the model.
This is the high-level state of the individual in consideration whereby their individual definitions of health are considered critical. This sector is also viewed in the context of health promotion as well as in the instances of disease prevention in the patient (Masters, 2013). The desire to increase the well-being of a patient is critical in optimizing its occurrence as the patient is required to uptake illness prevention methods. The health promotion factor in the model is considered as a multidimensional concept that happens to include all the dimensions of the individual; family, community, and personal culture (Masters, 2013).
Nursing is another critical stage factored in the model whereby the role of the nurse is to raise consciousness that relates to the promotion of health behaviors (Capic, 1998). Further, on the nurse has to promote self-efficiency in the affected person as well as to enhance benefits that relate to change. Moreover, the nurse is required to support behavior change in the patient by controlling their environments in bringing forth health behaviors. The management of barriers to health actions during behavior change is a critical role of the nurse to the affected individual in the whole process. The model consists of an APN role that is the focus on health promotion. Its role is to serve as an important pragmatic process in encouraging the promotion of healthy behaviors by the patients to benefit the changing process.
The analysis of the health promotion model consists of the examination of several assumptions as wells propositions of the model. Further, on the clarity and simplicity of the Pender’s health promotion model are assessed.
Assumptions of the health promotion model.
The assumptions mainly factor on the nursing and scientific behaviors on the perspectives found in the model. They also circulate on the patient’s role in shaping and controlling their health behaviors.Moreover, it focuses on the modification of environmental factors affecting health behaviors.
The first assumption is that persons seek to create their conditions of living with which they express their individual body potential.
Secondly, it is assumed that persons have their capacities in reflecting self-awareness that includes the assessments of their competencies.
Thirdly the person’s value growth according to directions are viewed as positive and do attempt to achieve an acceptable personal balance between their change and their stability.
Fourthly, the persons look for ways to actively regulate their individual behaviors.
Fifth of the assumptions states that as for the persons whose biopsychological complexities interact with environments, undergo a progressive transformation in their environments and are therefore transformed over a period.
The sixth assumption is that the health professionals hold a part of their interpersonal environments that have huge influences on them all through their lifetime.
The seventh assumption is that the personal initiation of reconfiguration in the environmental interaction patterns is considered essential for changes in behavior.
Propositions of the health promotion model.
There exist some fourteen theoretical propositions of which provide a base for researches that are related to the health behaviors of a patient.
The first of the propositions states that prior behaviors and integrated characteristics influence the health customs and affect the enhancement of behaviors that promote health.
Secondly, the persons in the cases constantly engage in behaviors from which they anticipate deriving benefits of personal value.
Thirdly perceptions of barriers that have the ability to constrain the person’s commitment to health behaviors are in existence.
Fourthly, the perceived competence of being self-sufficient to display a particular behavior raises the chances of committing to actions of performance and concessive behavior.
Fifth of the propositions is that the greatness of self-sufficiency, in turn, results in a lower number of barriers that affect a particular health behavior.
The sixth proposition is that the positive effect on a given behavior leads to the greater perception of self-efficacy. This factor can lead to the increase in positive effect.
The seventh proposition states that where positive emotions are linked with behavior, the probabilities of commitment are also increased to a certain level.
The eighth proposition states that the person involved have a higher chance of committing health promoting behaviors when the significant factors model the behaviors, expect its occurrence and further provide assistance methods that promote the behaviors.
Ninthly, the family and friends of the person are critical sources of influences that increase or decrease commitment levels in the health behaviors.
On the tenth of the propositions states that there exist situational influences in the persons external surrounding that decrease or increase the commitment of the health promotional behaviors.
The eleventh proposition is that the higher levels of commitment to a given plan of action pave the way to health promotion behaviors that are consistent over a period.
Twelfth of the propositions is that commitment to a certain plan stands a low chance of resulting in the desired behaviors whereby the demands over which the persons have minimal control over requiring attention.
The thirteenth proposition is that the commitment to a given health behavior plan is not likely to result in the desired behaviors whereby other actions are more preferred to the person.
Last proposition is that persons can modify cognitions, affect, as well as the interpersonal and physical surroundings to bring forth incentives for the health behavior actions.
The simplicity of the model.
Pender’s health promotion model was formulated through the usage of inductive reasoning in researches of which is a common approach used in researches as well in the formulation of middle range theories used in nursing (Masters, 2013). The model is also said to use simple language that is familiar to the nurses and popular in the nursing practices. Moreover, the linkage amongst the factors discussed in the model are identified and consistently defined. The above reasons are why the model is common among nursing practices as well as in researches conducted worldwide.
Pender identified that the promotion of health behaviors in patients is the main goal of the twenty-first century. The model is a crucial tool in the promotion of health actions in affected persons and has therefore assisted in the nursing roles that aim at meeting this goal. The nurses roles in promoting health actions in patients are more critical than ever due to the fact that there exists health failures as well as challenges in the current system of health care. Increasing costs of health care are arrayed to come along with increases in chronic illness treatments. More so, the preventable conditions amongst populations, as well as the focus in management of health service costs, offer numerous incentives that explore concepts found in the health promotion model. Meanwhile, the APN’s struggle to make improvements in the health outcomes of patient populations.
Summary of the model.
All factors considered in the model emphasize the functions of nursing practices concerning health outcomes. According to Pender, the nurse role is to raise consciousness as well as promote self-efficiency by controlling environmental factors that result in the promotion of behavior change towards health. The nurse is meant to restore the health of the patient as well as assist in its maintenance.

Alligood, Martha; Tomey, Ann (2013). Nursing Theorists and Their Work. Elsevier. p. 435. ISBN 0323266975. Retrieved November 28, 2014.
Masters, K. (2013). Models and theories focused on nursing goals and functions. In J. B. Butts & K. L. Rich, Philosophies and theories for advanced nursing practice (2nd ed., pp. 377- 406). Burlington, MA: Jones & Bartlett Learning.
Sakraida, T. J. (2014). Health promotion model. In M. R. Alligood (Ed.), Nursing theorists and their work (8th ed., pp. 396-416). St. Louis, MO: Mosby.
Capik, L. (1998). The health promotion model applied to family-centered perinatal education. Journal of Perinatal Education, 7(1), 9-17.
Thomas, J. J., Hart, A. M. & Burman, M. E. (2014). Improving health promotion and disease prevention in np-delivered primary care. The Journal for Nurse Practitioners, 10(4), pp. 221-228. doi:″

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