Introduction
Nola Pender introduced her Health Promotion Model in 1982 as a theoretical understanding to support other existing theories of health protection (Nursing Planet, 2012, p. 1). The model touches on the core purpose of nursing which is to assist patients to take care of themselves and make informed choices about their health. Nola Pender’s Health Promotion Model focuses on the behavioral traits of patients by proposing the view that health is not defined by the absence of a disease but by the presence of a positive dynamism in a person’s wellbeing (Nursing Planet, 2012, p. 1). This view advocates for the understanding of human health as a multifaceted concept touching on the way people interact with their environment by observing positive behavioral health. Therefore, the health model is mainly centered on improving patients’ wellbeing and not merely the prevention of diseases. This paper seeks to analyze Nola Pender’s Health Promotion Model by focusing on the major concepts of the theory, structural aspects of the theory, uses of the theory and the application of the model in the nursing practice.
Components of the Theory
Major concepts of the theory
The major concepts of Nola Pender’s Health Promotion Model are centered on influencing behavioral outcomes among patients. This influence is mainly achieved by appealing to patients’ individual characteristics and experiences (to change their behavioral characteristics for positive health outcomes) because Pender designed the model to be behavior specific (especially on cognition and affect). From this understanding, Nola Pender’s Health Promotion Model builds its concepts of five pillars – people, environment, nursing, health and illness (Nursing Theory, 2011).
Focusing on the concept of “people”, Nola Pender’s health model notes that people are mainly a product of their interaction with the environment. The relationship between people and their environment is hereby cyclical and reciprocal because people also strive to maintain an environment where they can realize their full potential. Consulting this perspective, Nursing Theory (2011) maintains that, “The environment is described as the social, cultural, and physical context in which life unfolds” (p. 3). The environment is therefore influenced by people to create a positive context where people can improve their behaviors to realize positive health outcomes. Conversely, people’s behaviors are mainly attributed to their unique behavioral characteristics, which have a profound impact on the way they conduct themselves. The relationship between people and the environment highlights the first and second concepts of the model. The third concept of the model is nursing. Nursing plays a critical role in Pender’s health promotion model because it seeks to integrate the input of the community, family members and patients to create an environment for positive health (Nursing Theory, 2011). Therefore, people’s health can be influenced by specific nursing actions. The influence of nursing actions on human behaviors and their health is undoubted because the behavioral characteristics of every person have a strong motivational impact on their lives. This is the fourth principle of Pender’s Health Promotion Model (health). The fifth principle is “illness” but it is perceived to be a deterrent to the achievement of positive health outcomes as opposed to a facilitator for positive health outcomes like the concepts of environment, people and nursing.
Therefore, the promotion of individual health is the main basis for positive behavioral outcomes that Nola Pender’s Health Promotion Model seeks to achieve (because the model mainly seeks to promote individual health). Several outcomes are expected to be realized in the context of health promotion. Improved human functionality is one such outcome but the overall improvement of individual health is at the core of expected behavioral outcomes. Ultimately, the improvement of the quality of life is also a general outcome expected at all stages of Nola Pender’s Health Promotion stages (Nursing Theory, 2011).
Philosophical Basis
Nola Pender’s Health Promotion Model traces its philosophical roots to a global understanding of human interaction. This view perceives human interaction to be comprised of a holistic conception of how people interact with their environment to fulfill their goals. However, the worldview can be divided into different parts, which can be studied separately (Pender, 2011).
Conceptual Model
Before the introduction of Nola Pender’s Health Promotion Model, the health belief model existed to explain health behaviors. This theory explained that negative health consequences were the main determinant of positive health behaviors. In fact, observers see the health benefit model as having birthed Nola Pender’s model because Pender was focused on avoiding negative state fears as a motivator for positive health behaviors while the health benefit model advocated for the use of fear or threat as a motivator for positive health behaviors (Pender, 2011).
Structural Aspects of the Theory
Assumptions
The assumptions underlying Pender’s Health Promotion Model are mainly centered on people’s perceptions, ideas and reflections (which influence their behaviors). One assumption (in the development of Pender’s Health Promotion Model) is the belief that people always strive to create conditions (in their primary and secondary environments) where they can achieve their full human potential (Ripollone, 2010). Another assumption underlying Pender’s Health Promotion Model is the belief that people have a strong and reflective self-awareness capability, which allows them to evaluate their competencies and weaknesses. It is also a strong assumption (underlying Pender’s Health Promotion Model) that people value growth and therefore, many people would want to realize a strong balance between growth and stability (Ripollone, 2010).
The assumptions described above are also complemented by the belief that people will always strive to regulate their behaviors through their interaction with the environment. Consequently, human behavior is likely to change over time. However, Pender’s Health Promotion Model assumes that nurses and healthcare professionals make up an integral part of interpersonal development, which creates a positive push among individuals to change their behaviors for the better (Ripollone, 2010).
Theoretical Prepositions
Pender’s Health Promotion Model is based on several theorems, which underlie its basic concepts. A notable theoretical preposition underlying the model is the belief that prior behavior or acquired characteristics significantly affect people’s behaviors, beliefs and affect (which consequently affect their health promoting behaviors) (Ripollone, 2010). Through this understanding, Pender’s Health Promotion Model suggests that people ordinarily engage in behaviors that resonate with their personal beliefs. Another theoretical preposition underlying Pender’s Health Promotion Model is the belief that perceived barriers can significantly affect people’s commitment to action because “Perceived competence or self-efficacy to execute a given behavior increases the likelihood of commitment to action and actual performance of the behavior” (Nursing Planet, 2012, p. 6).
Pender’s Health Promotion Model also proposes that increased self-efficacy among different people always amounts to lower perceived barriers to specific health behaviors (Nursing Planet, 2012, p. 6). The opposite is also true where increased positive affirmation (regarding behavioral actions) results in increased self-efficacies among different people. Therefore, the link between self-efficacy and positive emotions is strong because an association between the two variables amounts to increased motivational levels.
Pender’s Health Promotion Model also holds the view that people are often motivated to change their behavior when people who matter to them expect them to do so (Nursing Planet, 2012, p. 6). This observation is true because people of influence always act as facilitators and enablers to behavioral change. The circle of influence spans different groups of people in a person’s life including family members, friends (or peers) and even healthcare professionals. Therefore, the greater one’s commitment is to realizing positive health-promoting behaviors, the stronger their commitment will be to maintain such behaviors over long periods. However, Pender’s Health Promotion Model acknowledges that a strong commitment to behavior is not likely to result in health promoting outcomes if there are other factors (beyond the control of the subject) which require immediate attention. Similarly, Pender’s Health Promotion Model acknowledges that it is difficult for a person to realize positive health-promoting behavior if there are other issues that seem more attractive than positive behavioral change (regardless of the commitment level). However, the model proposes that creating a positive environment to improve cognition may result in improved health actions (Nursing Planet, 2012, p. 6).
Relations of Concepts and Assumptions
As explained in earlier sections of this study, Pender’s Health Promotion Model focuses on five concepts: people, environment, health, illness and nursing. These concepts have a strong association with the assumptions underlying the theory. For example, the assumption that people strive to regulate their behavior is cognizant of the “people” concept of positive behavioral change because it touches on human capabilities. In addition, the assumption that people strive to regulate their environment for positive behavioral change is linked to the concept of environment as a precursor to the realization of health promoting behavior (Nursing Planet, 2012). By extension, this assumption also draws the link between the “people” and “environment” concepts underlying Pender’s Health Promotion Model. The acknowledgement that healthcare personnel play a crucial role in influencing human behavior for the realization of positive behavioral outcomes also reinforces the concept of “nursing” in realizing positive behavioral outcomes that promote positive health. This link is evident because nursing is a facilitative profession that is aimed at influencing patient behavior for the realization of positive behavioral outcomes that promote good health. This link also complements another assumption of Pender’s Health Promotion Model, which puts healthcare professionals at the center of interpersonal development. Pender assumes that healthcare professionals always have a strong influence on the future wellbeing of a person because they facilitate the promotion of positive behavioral characteristics.
Clarity, Simplicity, and Ease of Application of Theory
Pender’s Health Promotion Model focuses on the basic concepts of nursing which is to help patients to better take care of themselves and practice positive health behaviors. This is the entire focus of the model. Based on this understanding, the link between nursing and Pender’s Health Promotion Model is evident. The simplicity of the model is similarly guaranteed in its application because Pender focuses on people’s basic behavioral patterns as a precursor to positive behavioral characteristics (Nursing Planet, 2012). From this understanding, it is easy for everyone to relate with the theory because public knowledge highlights the link between lifestyle choices and health. Therefore, ordinary people are likely to find it easy to relate to Pender’s Health Promotion Model. Therefore, considering the fact that Pender’s Health Promotion Model is not extremely detailed, it is easy to highlight its clarity and simplicity in explaining the intended goals of the model.
Consistency and Adequacy of the Theory
As evidenced from previous assertions in this paper, the Pender’s Health Promotion Model is aimed at promoting good health. However, its methodology stands out as a unique characteristic of the model because there is a strong emphasis on behavioral traits as a determinant of good health. Through this understanding, it is important to point out that Pender’s Health Promotion Model is highly consistent with previous behavioral theories and methodologies highlighted by other researchers. For example, assertions from Pender’s Health Promotion Model are highly reflective of specific ideologies narrated in the cognitive behavioral theory (Okun, 2007, p. 136). The relationship between the two theories transcends the disciplines of nursing and human psychology. The cognitive behavioral theory stipulates that human behavior is an enigma (Okun, 2007, p. 136). This theory also focuses a lot on how people think and how their actions affect their behavior. By extension, this analysis is stretched to explain how human behaviors affect their wellbeing. This is the point that Pender’s health promotion model draws its consistency with other psychological theories.
The adequacy of Pender’s Health Promotion Model is however limited to understanding preventive measures in healthcare. In this regard, the theory sufficiently covers the most significant areas of behavioral therapy which affect overall human wellbeing. Issues such as the role of people, nursing and the environment are adequately covered in this analysis to show how they influence overall patient health. Through this understanding, it is easy to identify how Pender’s Health Promotion Model covers preventive health (Nursing Planet, 2012).
Uses of the Theory
Pender’s Health Promotion Model is highly useful in the nursing practice because of its importance in preventive health. Therefore, the importance of Pender’s Health Promotion Model is highly critical in implementing effective nursing practices, developing sound nursing education programs, and implementing existing nursing administration practices. From the above understanding, it is also important to highlight the fact that Pender’s Health Promotion Model is equally important in nursing research. Concerning the importance of Pender’s Health Promotion Model in the nursing practice, it is vital to highlight the behavioral focus that characterizes the model as an extract of how the model complements the nursing practice. As noted in earlier sections of this paper, nursing is more than merely taking care of patients, it also transcends to preventive health where nurses are required to facilitate the adoption of positive health promotion behaviors among patients. Here, the role of the nurses in promoting community health is emphasized (Srof, 2006). The emphasis on behavioral changes is just one way that Pender’s Health Promotion Model seeks to improve the general health of the community.
Pender’s Health Promotion Model is also useful in nursing education because it stands to emphasize the need for understanding behavioral influences in patients’ wellbeing. The model is therefore an important addition to the study of preventive health and community healthcare. Through the same lens of analysis, it is similarly easy to show how the model complements nursing research. For example, since the development of the model, Pender’s ideals have been relied on as a “complementary counterpart to other models of health protection” (Nursing Planet, 2012, p. 2). Therefore, research, which has been focused on understanding health protection, has greatly drawn their findings from the model.
The above dynamics (showing the contribution of Pender’s Health Promotion Model in the nursing discipline) can equally be used to show how the model complements nursing administration initiatives. Through an understanding of the model, it is easy for administrators to allocate health resources to research how behavioral characteristics can be used to understand preventive health. Therefore, administratively, Pender’s Health Promotion Model can lead to a policy shift on how preventive health is practiced.
One area of practice where Pender’s Health Promotion Model may be used in nursing is public health. Since public health mainly focuses on disease prevention and health promotion, Pender’s Health Promotion Model can be effectively integrated into public health methodologies because it also focuses on the same issues. This relationship outlines the appropriateness of the theory in public health. One key question that the model seeks to answer is what can be done to promote sustainable health promoting behaviors among the public? Its application would therefore imply a shift in policy to behavioral influencers as a precursor to disease prevention of health promotion.
Since Pender’s Health Promotion Model mainly focuses on behavioral elements of human behavior as the main influencer of positive health promotion behaviors, two steps will be carefully highlighted as important additions to the field of public health. One key stage is increasing the awareness of the impact personal lifestyle choices (human behavior) have on human health. Here, the public should be sensitized on the importance of adopting healthy lifestyle choices as a crucial determinant of positive health outcomes. Once, this idea has carefully been explained to the public, the second stage of behavior change should be introduced. Here, there should be a lot of emphasis on how people can adopt healthy lifestyle choices by changing their behaviors. For example, instead of consuming red meat, people should be encouraged to take white meat instead. This example shows an alternative lifestyle that can be adopted by the public. The main weakness of Pender’s Health Promotion Model is that it seeks to promote healthy behaviors based on a very sensitive issue in the society (human behavior), which may be dictated by factors which are beyond logical understanding. For example, the influence of people’s culture is likely to be a great deterrent to the application of the theory in real life context.
Evaluation of Theory
As mentioned in earlier sections of this paper, Pender’s Health Promotion Model is very simple and easy to understand. Similarly, as noted in earlier sections of this paper, the main weakness of the theory is its applicability because there are very dynamic lifestyle choices (practiced by people) which are beyond scientific reasoning. These dynamics highlight the main difficulties one would anticipate when applying the theory. Besides these issues, the theory is largely user-friendly because of the basic understanding of its concepts and the ease of relating to them. However, incorporating negative dynamic states to the model would go a long way in improving the flexibility of the model to resonate with the shifting dynamics of the world today. So far, the model mainly focuses on a positive dynamics state, which aims to advocate for good health based on the practice of positive behavioral traits.
References
Nursing Planet. (2012). Health Promotion Model. Web.
Nursing Theory. (2011). Nola Pender. Web.
Okun, B. (2007). Effective Helping: Interviewing and Counseling Techniques. London: Cengage Learning.
Pender, N. (2011). The Health Promotion Model Manual. Web.
Ripollone, J. (2010). Health Promotion Theory: A Critique With a Focus on Use in Adolescents. Web.
Srof, B. (2006). Health promotion in adolescents: A review of Pender‟s health promotion model. Nursing Science Quarterly, 19(4), 366-373.