Pender’s Health Promotion Model

1. Pender’s Health Promotion Model Presented by Jessica Konopka, Nicky Reed, Nacole Shafer, Cheryl Shapiro, & Sara Walters

2. Introduction • Purposes and Issues, questions or problems to solve • Introduction - The purpose of this assignment is to chose a nursing model and evaluate the model by critically thinking using the elements of reasoning. The nursing model that we have chosen is the Health Promotion Model by Nola J. Pender. This model was chosen because of the fact that the decisions and changes individuals make in their lives are affected by certain modifying and cognitive-perceptual factors (Sakraida, 2010). One of the problems that professionals can have is deciding which variables affect each individual the most. Each person will have different variables and figuring out which ones can affect that particular individual is one of the most important concepts in understanding how this model functions. • Evaluation - The focus of this model is to look at factors that influence a persons’ health promotion behavior. When Pender first started constructing the model, she studied how individuals made decisions about their own health care (Sakraida, 2010). Certain factors influenced the decisions and actions of individuals that were made to prevent disease and promote a healthy lifestyle. Health is perceived differently by each person, but if each person understood the importance and benefits of a healthy life-style, then that individual is more likely to participate in health-promoting behaviors.

3. Pender’s Health Promotion Model Revised Health Promotion Model. (From Current Nursing (2010) Health Promotion Model. Retrieved from http://currentnurisng.com/nursing_theory/health_promotion_model.html )

4. Assumptions and Point of view • Pender’s motivation for developing the Health Promotion Model. • Personal experience - As a young girl observed professional nurses caring for her aunt and developed a belief that “the goal of nursing was to help people care for themselves” (Sakraida, 2010, p. 434). • Educational influences – A master’s degree in human growth and development facilitated and interest in health over the human life span. A PhD in psychology and education lead to thoughts about “how people think and how a person’s thoughts motivate behavior” (Sakraida, 2010, p. 434).

5. Pender’s philosophic values about nursing and knowledge development. Pender has a strong belief in the benefits of nursing and knowledge development shown through her involvement as a professional nurse. • Contributions of research, teaching, presentations, and writings. • The Health Promoting Lifestyle Profile, a study done at Northern Illinois University helped to support the Health Promotion Model (HPM). • Additional involvement in many other research studies and the facilitation of research in nursing. • Health Promotion in Nursing Practice textbook published to facilitate learning of the model in the clinical setting. • Publication of many articles related to the health promotion model and it’s use in the clinical setting. • Promotion of scholarly activity through her involvement with Sigma Theta Tau international, Midwest Nursing Research Society, and the Cabinet on Nursing Research of the American Nurses Association.

6. Influences of Pender’s philosophy • Personal experiences • Parents were advocates for women pursuing education. • Family support of her going to school to become a Registered Nurse. • Educational experiences • Master’s degree in human growth and development helped her to develop a holistic approach to health over the human lifespan. • PhD in psychology and education led to ideas about how individual’s thoughts influence behavior.

7. Information and Concepts • Eleven major concepts of Nora Pender’s Health Promotion Model (2006). Pender recognized that there are particular behaviors that promote individual ownership of prevention of illness and continued awareness of personal health. The Health Promotion Model focuses on prior behavior and personal factors that contributed to the outcome. • Prior related behavior A similar behavior in the past that can be direct or indirect effects of health promoting behaviors. • Personal factors Biological, psychological, and socio-cultural are personal factors considered that are predictive of target behavior being addressed. • Personal biological factors Age, gender, body mass index, pubertal status, menopausal status, aerobic capacity, strength, agility and balance are considered variables. • Personal psychological factors Personal self-esteem, self-motivation, competence, perceived health status, and definition of health are analyzed variables. • Personal sociocultural factors Race, ethnicity, acculturation, education and socioeconomic status are included variables. Also considered are behavioral-specific cognitions and affects that are indicative of nursing actions.

8. Information and Concepts • Perceived benefits of action Anticipated positive outcomes from actions resulting in healthy behavior are perceived benefits. • Perceived barriers to action Anticipated, imagined or real blocks from actions are perceived barriers. Also considered is personal cost of the given behavior. • Perceived self-efficacy Personal capability to organize and execute a health promoting behavior is perceived self-efficacy. An ability to analyze personal barriers and creating action for these barriers demonstrates this capability. • Activity-related affect Subjective positive and negative feelings that occur before, during and following behavior based on the stimulus properties of the behavior itself. • Interpersonal influences Influential cognitions are concerning behaviors, beliefs, or attitudes of others that directs ones thoughts. Some influences include norms, social support, and modeling. • Situational influences These are personal perceptions and cognitions of any given situation or context that can facilitate or impede behavior. The perceptions can be available options, demand characteristics, and aesthetic features of the environment that health-promoting behaviors are proposed to take place. Situational influences can be direct or indirect.

9. Information and Concepts • Commitment to a plan of action A description of commitment of intention and identification of a planned strategy the leads to implementation of healthy behavior. • Immediate competing demands and preferences Competing demands are alternative behaviors over which individuals have low control. Competing preferences are alternative behaviors over which individuals exert relatively high control. • Health-promoting behavior The end point or action outcome that is directed toward attaining positive health outcomes such as optimal well-being, personal fulfillment, and productive living. • Global concepts The four global concepts are addressed in the Health Promotion Model as follows: • Human-being- Pender ascertains in her theory that individuals are responsible to create healthy choices for their own human health potential. These persons must be able to reflect on their behaviors. • Environment- The individual creates an environment to pursue and maintain for optimal health. • Health- Pender encourages healthy prevenative behaviors throughout the lifespan. • Nursing- Nursing provides interpersonal influence to aid in commitment to healthy behaviors

10. Interpretation & Inference and Implications & Consequences Helping people change their lifestyle and move toward a state of optimal health. This sums up the health promotion model (HPM). It is a simple model to comprehend although it involves complex variables of behavior, biological and sociocultural factors. The potential beneficial effects are not disputable. The difficulty lies in finding methods of drawing people away from their risky behaviors and instilling healthy ones. • Origins and Influences • HPM is clearly influenced by the health belief and health-protecting behaviors models. It was conceived by Nola Pender and undoubtedly reflects her education. She holds a masters degree in human growth and development and a PhD in psychology and education. It is holistic within the person and across the lifespan. It could be summed up by the old saying; an ounce of prevention is worth a pound of cure. In this light it is not unique to nursing, but when the necessary details are added, it takes a caring nurse’s nature and preparation to apply to clients.

11. Interpretation & Inference and Implications & Consequences • Four Global Concepts • An individual to an entire nationality is its targeted population. • Environment acknowledged as a variable. • HPM works best in a community health care setting. Here they can focus on activities that can improve the well-being of people. • Nurses help identify factors which work against participation in healthy lifestyles and analyze factors in their life that contribute to their participation. • Narrow or Wide View • HPM has a broad application base. This includes those with no current health problems and those who have chronic diseases.

12. Interpretation & Inference and Implications & Consequences • Examples • Geriatrics - “Older adults may underestimate their capabilities, inadvertently leading them to engage in risky health habits such as stress, poor nutrition, and physical inactivity (Byam & Salyer, 2010, p. 115)”. Meals on wheels is an excellent example of promoting better nutrition for this group. • Low income families - Instruction about a balanced diet, exercise and the importance of early detection of illnesses might even be added to food pantries in the community. • Obstetrics – Increase in prenatal care. • Pediatrics – Well child checkups.

13. Conclusion At a young age Pender believed that “the goal of nursing was to help people care for themselves” (sakraida 2010, p. 434). Her parents were very supportive of her wanting to become a registered nurse. Her education has assisted her with how individual’s thoughts influenced behaviors. The Health Promotion Model has 11 major concepts. The idea behind the model is helping people change their lifestyles, and move toward a state of optimal health. The model effects everyone, healthy or not. The problem is finding a way to attract people to change a bad habit for a good one. The following are scholarly journals and web-links that provide additional information and evidence of how Pender’s model is utilized in practice for further understanding of this nursing theory.

14. Resources and Web-links • Scholary articles related to Pender’s Health Promotion Model • Agazio, J., & Buckley, K. (2010). Finding a balance: health promotion challenges of military women. Health Care for Women International, 31(9), 848-868. Retrieved from CINAHL database. This journal discusses health promotion in military women. The military women used different tools to evaluate factors effecting their performance in health promoting activities. Self-efficacy and interpersonal influences most influence on health promotion. This article focused on working military women meeting health promotion activities. It also concentrates on how to best support their ability to participate in healthy behaviors. • Byam-Williams, J.B. (2010), Salyer, J. Factors influencing the health-related lifestyle of community-dwelling older adults. Home Healthcare Nurse, 28(2), p 115–121, doi: 10.1097/NHH.0b013e3181cb5750 People are living longer, but are not necessarily healthier. This study examined factors influencing health related life styles with a goal of increasing knowledge to encourage healthy lifestyles. Pender's revised Health Promotion Model (HPM) guided the study. A self-administered questionnaire was used to collect data. It points out that nurses in the community setting could function in supportive and educational roles. This could be done in churches and senior apartments by developing strategies to encourage older adults to use existing skills to practice more behaviors that contribute to a healthy lifestyle.

15. Resources and Web-links • Lannon, S. (1997). Using a health promotion model to enhance medication compliance. Journal of Neuroscience Nursing,(29)3, 170-178. Retrieved from Health and Wellness Resource Center. This article looks specifically at three individual case studies and how their compliance to seizure medication for control of their epilepsy has an effect on their level of wellbeing. The author uses Pender’s Health Promotion Model to look at how each factor relates to their compliance with antiepileptic drugs. This article shows how Pender’s model is used in the clinical setting. • Kelley, J. A., Sherrod, R. A., & Smyth, P. (2009). Coronary artery disease and smoking cessation intervention by primary care providers in a rural clinic.  Online Journal of Rural Nursing & Health Care, 9(2), 78-90.Retrieved from Academic OneFile  database. This article discusses how Kelley, Sherrod, and Smyth (2009) did a study that was published in the Online Journal of Rural Nursing and Health Care about smoking cessation intervention by primary care providers for patients who smoke and have been diagnosed with coronary artery disease (CAD) within the past year. Nola J. Pender’s revised Health Promotion Model was the basis and structure for this study. The study used different factors that were then divided into three categories: biological, psychological, and sociocultural (Kelley et al., 2009 p. 86). The biological factors were age and gender. The psychological factors included self-esteem, self-motivation, and perceived health status. Sociocultural factors included race, education, and socioeconomic status. The primary people that influence an individual’s health-promoting behavior are family, peers, and health care providers. The study’s plan was to pressure the patients into making a commitment to quit smoking which would hopefully show that the care providers could have an influence on the patients’ health-promoting behaviors (Kelley et al., 2009 p. 86).

16. Resources and Web-links • Srof, B.J., & Velsor- Friedrich, B. (2006). Health promotion in adolescents: a review of Pender’s health promotion model. E-Journal of Nursing Science Quarterly, 19 (4), 366-373. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/16982726 This journal discusses teen-adolescents role from transition of parent managed care to self-care responsibilities. Pender’s health promotion model is explored related to change in adolescent behavior. Social cognitive theories are reviewed supporting Pender’s theoretical underpinnings. It notes that further research is also recommended.

17. Web-links • http:// currentnursing.com/nursing_theory/health_promotion_model.html Current Nursing. (2010). Health promotion model. This website provides further information on the Health Promotion Model. It includes the concepts and how the model works and relates to a patient’s level of wellbeing. • http://nursingtheories.blogspot.com/2008/07/health-promotion-model-heuristic-device.html Philippines Open University (2008), Health Promotion Model: Heuristic Device for Health Care Professionals. Nursing theories blog spot. This is a blog about nursing theories. It contains a full summery and is interactive for blog comments and questions. • http://www.ehow.com/about_6367507_pender-nursing-theory.html Ehow. (2010). Walter J. Johnson. This web-link is a summary of the health promotion model. This summary is in basic terms so anyone could read it and understand the article. At the end of the article it talks about Pender helping decreasing healthcare costs because of this model. • http://www.nurses.info/nursing_theory_midrange_theories_nola_pender.htm Nurses.info. (2010). Nola J. Pender. This website provides intellectual information that is proposed by Nola Pender regarding the Health Promotion Model. Included are links to relevant books, articles, and Propositions. • http://www.nursingtheory.net/mr_healthpromotion.html Nursingtheory.net. (2005). Health promotion model. This web-link provides information on places to search to find scholarly articles that are related to the Health Promotion Model. It also discusses that multiples variables are the important concept in deciding which variables would affect each individual.

18. Case Study Sally , a 25 year old, Caucasian student wants to lose weight. She would like to have more energy during the day. She is tired of seeing the scale in the 180s. High blood pressure runs in her family. Her father has had three stents put into his heart by the age of 50 and had a mild heart attack. Upon assessment her blood pressure is 118/44 mmHg, height is 5’3”, weight 182 lbs. Sally States that her stress level is high. She is unable to get a job, and has two children to take care of. He husband works full-time making minimum wage. She is a non smoker. She levels the office to have more blood work completed. Questions • What evidence would show Sally is ready for weight loss management? • What are some perceived barriers and perceived benefits of action? • What are some personal factors that affect her weight loss and health? • What are some behavior options to go over with Sally?

19. Case Study Answer Key 1. What evidence would show Sally is ready for weight loss management? • She came to the office on her own • She is tired of the scale being in the 180s • Family history 2. What are some perceived barriers and perceived benefits of action? • Perceived barriers • Not having enough time or energy to exercise • Not having money to buy healthy foods • High stress level • Perceived benefits of action • More energy to play with children • Healthier • Decreased chances of heart disease

20. Case Study Answer Key 3. What are some personal factors that affect her weight loss and health? • Young adult • BMI is obese • Sees self as overweight • Lower socioeconomic status • Caucasian • College education 4. What are some behavior options to go over with Sally? • Help establish an exercise routine that fits into her schedule • Set short and long term goals • Schedule weekly weight checks • Go over a healthy diet • Talk about stress management • Address any dietary concerns

21. References • Byam-Williams, J.B. (2010), Salyer, J. Factors influencing the health-related lifestyle of community- dwelling older adults. Home Healthcare Nurse. 28(2), p 115–121, doi:10.1097/NHH.0b013e3181cb5750 • Current Nursing. (2010). Health Promotion Model. Retrieved from http://currentnursing.com/nursing_theory/health_promotion_model.html • Kelley, J. A., Sherrod, R. A., & Smyth, P. (2009). Coronary artery disease and smoking cessation intervention by primary care providers in a rural clinic.  Online Journal of Rural Nursing & Health Care, 9(2), 78-90. Retrieved from Academic OneFile database. • Nursing Theory. (2010). Health Promotion Model. Retrieved from http://www.nursingtheory.net /mr_healthpromotion.html • Pender, N. J., Murdaugh, C. L., & Parsons, M. (2006). Health Promotion in Nursing Practice. Upper Saddle River, New Jersey: Pearson Prentice Hall. • Sakraida, T.J. (2010). Nola J. Pender: Health Promotion Model. In M. R. Alligood, & A. M. Tomey (Eds.), Nursing Theorists and Their Work (pp.434-454) (7th ed). Maryland Heights, MO: Mosby Elsevier.