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Dr. Nola J.

Pender PhD, RN, FAAN a nursing theorist who first presented her Health Promotion Model for nursing in her book Health Promotion in Nursing Practice (1982). She developed the idea that promoting optimal health supersedes preventing disease. Pender's theory identifies cognitive-perceptual factors in the individual, such as importance of health, perceived benefits of health-promoting behaviors, and perceived barriers to healthpromoting behaviors. These factors are modified by demographic and biologic characteristics and interpersonal influences, as well as situational and behavioral factors. They help predict participation in health-promoting behavior. The individual's definition of health for himself or herself has more importance than a general statement about health. A major assumption in Pender's theory is that health, as a positive highlevel state, is assumed to be a goal toward which an individual strives. Pender Nursing Theory

The Health Promotion Model of nursing Nola Pender, former professor of nursing at the University of Michigan, has developed a rational-choice model of healthcare. This is not really a nursing theory per se, but a psychological look at how human beings perceive themselves, their health and their ability to change their lifestyles to promote health. As a result of this focus, Pender's model is normally called the "Health Promotion Model" of nursing. Features 1. This model is based on the idea that human beings are rational, and will seek their advantage in health. But the nature of this rationality is tightly bounded by things like self-esteem, perceived advantages of healthy behaviors, psychological states and previous behavior. As for the medical profession in general, the main purpose here is not merely to cure disease, but to promote healthy lifestyles and choices that affect the health of individuals. Function 2. The central function of this theory is to show the individual as self-determining, but as also determined by personal history and general personal characteristics. Health is a dynamic process, not a static state. Health, to put it differently, is a lifestyle conditioned by a number of choices made by the individual to actually live a healthy lifestyle. The medical profession itself is only a small part of this world. The individual is posited in this model as "being" health, "living" it, rather than considering health a static state. Health is a lifestyle. Effects 3. The main effect of Pender's model is that it puts the onus of healthcare reform on the person, not on the profession. Healthcare is a series of intelligent, rational choices that promote health concerning things like diet, exercise and positive thinking. All of these are choices and ingredients in living healthy. The real struggle of the health profession, doctors and nurses included, is to eliminate the self-destructive nature of unhealthy choices and replace them with healthy ones. Unhealthy lifestyles,

in other words, are the result of distorted thinking that may derive from ignorance of lack of selfesteem. If these thoughts can be reformed (which is itself a life-long process), then rational choices can take their place, leading to a truly healthy lifestyle. Significance 4. Health is up to the person. The significance here is that the medical profession is really not the main ingredient in living a healthy lifestyle. They might be an important part, but always serve a secondary role to the basic rational choices of healthy living. The health profession, in other words, is useless unless individuals reform their own lives and perception of what is healthy. Considerations 5. As healthcare costs continue to climb, a rational alternative to dependency on the medical profession is the living of a rational, i.e., healthy, life. A healthy lifestyle is the ultimate antidote to rising healthcare costs, since a rational population is a healthy one, which would naturally drive down healthcare costs. Pender is an advocate of preventive medicine, which is another word for rational, healthy thinking and therefore, healthy and rational living.

Health Promotion Model: Heuristic Device for Health Care Professionals Ourselves, our body, our health.. enhancing self usage towards prevention of illnesses & promoting wellbeing. Nora J. Pender developed the Health Promotion Model that is proposed as a holistic predictive model of health-promoting behavior for use in research and practice. She is Professor Emeritus in the School of Nursing at the University of Michigan, and an advocate of health promotion. I committed myself to the proactive stance of health promotion and disease prevention with the conviction that it is much better to experience exuberant well-being and prevent disease than let disease happen when it is avoidable and then try and cope with it. Health Promotion Model has given health care a new direction. According to her, Health Promotion and Disease Prevention should be the primary focus in health care, and when health promotion and prevention fail to prevent problems, and then care in illness becomes the next priority. She defined 2 concepts: health promotion & health protection. Health promotion is defined as behavior motivated by the desire to increase well-being and actualize human health potential. It is an approach to wellness. On the other hand, health protection or illness prevention is described as behavior motivated desire to actively avoid illness, detect it early, or maintain functioning within the constraints of illness. (Kozier, 2004) Figure 1 Health Promotion Model This model (Figure 1) is moving towards understanding multi-faceted nature of persons correlating with their interpersonal nature and interacting with their interpersonal & physical environments as they trail towards health. Because of the model, nurses have already advanced their health approaches, addressing not only the curative side, but as well as prevention of diseases & promotion of well-being. Application of this theory is varied and substantive on its own.

Applications Nursing Practice We are moving toward an era of science-based practice in nursing that incorporates the latest findings from the behavioral and biological sciences into practice to assist people of varying cultural backgrounds to adopt healthy lifestyles. Pender As what they say, prevention is better than cure. Thus, health promotion is valued much. But how? Question seems hardhard as if you dont know how to solve the problems of the worldBut how, again? If super heroes could save life using their super powers, we nurses could do more by using our caring touch, and therapeutic talks. Health teachings are always part of nurses experience in the workplace. Despite of various clinical & community health care settings, we nurses are always interacting with our patient/client. Community health care setting is the best avenue in promoting health & preventing illnesses. Using Penders Health Promotion Model, community program may be focused on activities that can improve the well-being of the people. Health promotion and disease prevention can more easily be carried out in the community, as compared to programs that aim to cure disease conditions. This is because the people in the rural area tend to veer away from modern medical methods. Most of them, due to financial reasons, choose to avail of the services offered by herbolarios and other folk healers. In our local setting, promoting health to our fellow Filipinos is very crucial. Though, there are campaigns provided by our governments health agency, which is the Department of Health (DOH), theres still a big percentage in the population who live unhealthily and many are suffering from different type of diseases. Nurses, though are scattered in different fields, have common primary concern: to promote health to every individual. The following are just examples of methods on how to promote health to our fellows. Insight from an Academe nurse teaching CHN A group of students taught the families the value of eating a balanced diet. They introduced the concept of including the different food groups in all their meals. They also stressed the benefits and advantages of the various vitamins and minerals found in those food. Another group encouraged the community to practice lifestyle modification. They discussed the disadvantages of vices such as smoking and drinking alcoholic beverages. For disease prevention and health protection, one group tried to inculcate the importance of early detection of illnesses. They taught the women the proper way and timing of self-breast examination. The mothers were also encouraged to avail of the vaccination services offered by the nearby health center. These programs proved to be very beneficial to the community. Because one can truly build a healthier tomorrow through good community health practice. Insight from an ICU nurse Although most patients admitted in the ICU are experiencing health problems, Health Promotion Model may still be applied in one way or another. This is projected towards improving health condition and prevention of further debilitating conditions. Diet modifications and performing passive & active range of motion exercises are examples of its application. Nursing Education I believe that the future will be very bright and productive for nurses who direct their careers toward understanding disease prevention and health promotion processes. Pender Nurses are expected to be adaptive. Indeed, changes are always constant. In health care settings, patients come & go. Meet & greet. Recover or expire. As this theory advocated, we should not allow our patients to experience severe conditions if we could only prevent them from encountering such. We are expected to know, if not in depth, the disease processes. Because of this know-how, we could apply health promotion and worsening prevention before the hands of the clock stop moving.

Percentage of nurses is geared towards continuing professional education. Attending seminars & conventions. Enrolling to masteral & doctoral classes. All are goaled towards becoming competent nurses. Nursing education is not a one-phase process. It does not end after passing the licensing exam. It is continuous. Unending. Ever changing. We must be abreast with new technologies, new approaches, and new techniques. Because of this theory, we nurses could address more the needs and problems of the client before it progresses to exacerbation. This model could be a basis for structuring nursing protocols and interventions. Nursing Research I was committed to health promotion and encouraged other scholars to move in that direction long before health promotion and risk reduction became popular. - Pender Research help Health Care provider to develop a systematic problem-solving approach to improve and develop strategies to promote good health to individuals. Through research we will be able to clarify and verify the phenomenon. Evidenced-based practice is fast emerging because of its factual and substantive results. These researches yield fruitful outcome that of great help in addressing arising problems and in setting nursing protocols. Much more research must be done to tailor interventions to individuals rather than to group stereotypes. If we could remember, common research topics in our nursing college days are health promotion techniques and disease prevention. To name a few, some geared their research on effectiveness of Expanded Program on Immunization, others on health practices of mothers and families, some on efficiency of early detection of common illnesses. These are all but few of the models application to research. Of all the theories presented in the module, Health Promotion Model is the easiest of them, yet substantive & useful. In our day-to-day experiences as nurses, we are always promoting health, preventing illnesses, and upholding well-being. We are seen by the public as health advocates. We have knowledge on health & illnesses, thus, we are expected to share this to laymen and contribute to their well-being. As what Pender said, We cannot continue to let people become ill when we have the means to keep many people well-particularly when problems are environmentally and behaviorally induced. Thus, the theory of Pender on Health Promotion is indeed a great to advocate to prolong and preserve life. This theory really manifests the noble work of a NURSE. Remember, nurses we are LOVE SERVES.

Health Promotion Model INTRODUCTION The health promotion model (HPM) proposed by Nola J Pender (1982; revised, 1996) was designed to be a complementary counterpart to models of health protection. It defines health as a positive dynamic state not merely the absence of disease. Health promotion is directed at increasing a clients level of wellbeing. The health promotion model describes the multi dimensional nature of persons as they interact within their environment to pursue health. The model focuses on following three areas:

Individual characteristics and experiences Behavior-specific cognitions and affect Behavioral outcomes

The health promotion model notes that each person has unique personal characteristics and experiences that affect subsequent actions. The set of variables for behavioral specific knowledge and affect have important

motivational significance. These variables can be modified through nursing actions. Health promoting behavior is the desired behavioral outcome and is the end point in the HPM. Health promoting behaviors should result in improved health, enhanced functional ability and better quality of life at all stages of development. The final behavioral demand is also influenced by the immediate competing demand and preferences, which can derail an intended health promoting actions.

ASSUMPTIONS OF THE HEALTH PROMOTION MODEL The HPM is based on the following assumptions, which reflect both nursing and behavioral science perspectives: 1. Individuals seek to actively regulate their own behavior. 2. Individuals in all their biopsychosocial complexity interact with the environment, progressively transforming the environment and being transformed over time. 3. Health professionals constitute a part of the interpersonal environment, which exerts influence on persons throughout their lifespan. 4. Self-initiated reconfiguration of person-environment interactive patterns is essential to behavior chang THEORETICAL PROPOSITIONS OF THE HEALTH PROMOTION MODEL Theoretical statements derived from the model provide a basis for investigative work on health behaviors. The HPM is based on the following theoretical propositions: 1. Prior behavior and inherited and acquired characteristics influence beliefs, affect, and enactment of health-promoting behavior. 2. Persons commit to engaging in behaviors from which they anticipate deriving personally valued benefits. 3. Perceived barriers can constrain commitment to action, a mediator of behavior as well as actual behavior. 4. Perceived competence or self-efficacy to execute a given behavior increases the likelihood of commitment to action and actual performance of the behavior. 5. Greater perceived self-efficacy results in fewer perceived barriers to a specific health behavior. 6. Positive affect toward a behavior results in greater perceived self-efficacy, which can in turn, result in increased positive affect. 7. When positive emotions or affect are associated with a behavior, the probability of commitment and action is increased.

8. Persons are more likely to commit to and engage in health-promoting behaviors when significant others model the behavior, expect the behavior to occur, and provide assistance and support to enable the behavior. 9. Families, peers, and health care providers are important sources of interpersonal influence that can increase or decrease commitment to and engagement in health-promoting behavior. 10. Situational influences in the external environment can increase or decrease commitment to or participation in health-promoting behavior. 11. The greater the commitments to a specific plan of action, the more likely health-promoting behaviors are to be maintained over time. 12. Commitment to a plan of action is less likely to result in the desired behavior when competing demands over which persons have little control require immediate attention. 13. Commitment to a plan of action is less likely to result in the desired behavior when other actions are more attractive and thus preferred over the target behavior. 13. Persons can modify cognitions, affect, and the interpersonal and physical environment to create incentives for health actions. THE MAJOR CONCEPTS AND DEFINITIONS OF THE HEALTH PROMOTION MODEL Individual Characteristics and Experience Prior related behaviour Frequency of the similar behaviour in the past. Direct and indirect effects on the likelihood of engaging in health promoting behaviors. 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 out comes that will occur from health behaviour. PERCEIVED BARRIERS TO ACTION Anticipated, imagined or real blocks and personal costs of understanding a given behaviour PERCEIVED SELF EFFICACY Judgment of personal capability to organise and execute a health-promoting behaviour. Perceived self efficacy influences perceived barriers to action so higher efficacy result in lowered perceptions of barriers to the performance of the behavior. ACTIVITY RELATED AFFECT Subjective positive or negative feeling that occur before, during and following behavior based on the stimulus properties of the behaviour itself. Activity-related affect influences perceived self-efficacy, which means the more positive the subjective feeling, the greater the feeling of efficacy. In turn, increased feelings of efficacy can generate further positive affect. INTERPERSONAL INFLUENCES Cognition concerning behaviours, beliefs, or attitudes of the others. Interpersonal influences include: norms (expectations of significant others), social support (instrumental and emotional encouragement) and modelling (vicarious learning through observing others engaged in a particular behaviour). Primary sources of interpersonal influences are families, peers, and healthcare providers. SITUATIONAL INFLUENCES Personal perceptions and cognitions of any given situation or context that can facilitate or impede behaviour. Include perceptions of options available, demand characteristics and aesthetic features of the environment in which given health promoting is proposed to take place. Situational influences may have direct or indirect influences on health behaviour. Behavioural Outcome

COMMITMENT TO PLAN OF ACTION The concept of intention and identification of a planned strategy leads to implementation of health behaviour. IMMEDIATE COMPETING DEMANDS AND PREFERENCES Competing demands are those alternative behaviour over which individuals have low control because there are environmental contingencies such as work or family care responsibilities. Competing preferences are alternative behaviour over which individuals exert relatively high control, such as choice of ice cream or apple for a snack HEALTH PROMOTING BEHAVIOUR Endpoint or action outcome directed toward attaining positive health outcome such as optimal well-being, personal fulfillment, and productive living.

MOST FREQUENTLY ASKED QUESTIONS ABOUT THE HEALTH PROMOTION MODEL AND MY PROFESSIONAL WORK AND CAREER Nola J. Pender, PhD, RN, FAAN Professor Emerita University of Michigan School of Nursing 1. How did you become interested in health promotion? Very early in my nursing career, it became apparent to me that health professionals intervened only after people developed acute or chronic disease and experienced compromised lives. Attention was devoted to treating them after the fact. This reactive approach did not reflect the philosophical beliefs of our predecessors in nursing who focused on maintaining conditions of healthy interaction between self and the environment. My doctoral preparation in psychology and cognitive processes furthered my interest in people's ability to take responsibility, make reasoned decisions and engage in competent self-care. Dr. Beverly McElmurry as my esteemed colleague at Northern Illinois University further sparked my thinking as we discussed her dissertation work on Health as the Basis of Nursing Curricula. I committed myself to the proactive stance of health promotion and disease prevention with the conviction that it is much better to experience exuberant well-being and prevent disease than let disease happen when it is avoidable and then try and cope with it. 2. What is your area of doctoral preparation? I became interested in doctoral preparation when there were very few doctoral programs in existence. I completed a dual major doctoral degree in Psychology and Education in 1969 at Northwestern University. It was very apparent to me at the time that doctoral preparation was a pre-requisite to a productive research career. I found the science of psychology fascinating in terms of its rigor and methodological exploration of cognitive processes. It seemed that this preparation was most applicable to nursing as scientific knowledge in psychology could be used to help people restructure their cognitive world and their health behaviors. This has proven to be true. 3. What do you think has been the impact of your work on nursing research? I believe that my work in health promotion has been direction setting for nursing research. I was committed to health promotion and encouraged other scholars to move in that direction long before health promotion and risk reduction became popular. My model is a heuristic device that encourages scholars to look integratively at variables that have been shown to impact health behavior. The HPM synthesizes research findings from nursing, psychology and public health into an explanatory model of health behavior that still must undergo further testing. Multiple variable models are needed to explain human health behavior. My own research, that of my colleagues and the dissertations and theses of multiple students have used the HPM to guide research. I have applied the model to overall health-promoting lifestyle but am primarily focused on applying the revised Health Promotion Model (Health Promotion in Nursing Practice, 3rd edition, Appleton & Lange) to exercise behavior among adolescents and young adults. 4. What do you think has been the impact of your work on nursing practice? The various health promotion strategies and tools that I have developed and presented in the three editions of Health Promotion in Nursing Practice as well as the undergirding HPM model can be used as a basis for structuring nursing protocols and interventions. Nurses in practice should focus on understanding and addressing variables that are most predictive of given health behaviors. We are moving toward an era of

science-based practice in nursing that incorporates the latest findings from the behavioral and biological sciences into practice to assist people of varying cultural backgrounds to adopt healthy lifestyles. Much more research must be done to tailor interventions to individuals rather than to group stereotypes. New and evolving computer technologies will enable health professionals to assess individuals effectively as a basis for personalized interventions. 5. Which of your accomplishments are you most proud of? I am proud of the way in which my writings have encouraged nurses to become actively involved in creating the new sciences of health promotion and disease prevention. I believe that the future will be very bright and productive for nurses who direct their careers toward understanding disease prevention and health promotion processes. Most important, clients will benefit from health promotion interventions by developing skill and confidence in caring for themselves and dependent others enabling them to live healthier and more productive lives. 6. What are your current research activities? My colleagues and I have just completed a study of the physical activity of adolescents and I am very interested in gender differences in exercise behavior. Female adolescents, in particular become sedentary very early in life. This predisposes them to less energetic living and chronic disease as they age. I will soon be publishing the results of work on the effects of school transitions on exercise behavior. The HPM has provided the theoretical model for this work. 7. Are you involved in global health initiatives? Yes, I have become increasingly involved in global health initiatives. I have worked with scholars from Japan, China and Taiwan to develop health promoting lifestyle measures that are culturally appropriate for their country. Further, I have presented internationally to link the health promotion and risk reduction research that we are doing in the United States with the research of nurse scientists in other countries. I find that interest in health promotion is worldwide and globally unites nurses. 8. How does the Health Promotion Model influence Health Care Reform? I believe that the Health Promotion Model has long pointed to new directions in health care. Health Promotion and Disease Prevention should be the primary focus in health care and specific services reimbursed through health insurance coverage both by private insurers and public insurers. When health promotion and prevention fail to prevent problems, then care in illness becomes the next priority. We do not know what impact health promotion can have on the health of the population as a whole until it is widely applied in programs and services throughout our nation. Health care reform is a paradigm shift to health promotion. Quality of care, access to care, and tracking and documenting of health promotive care are all integral to reforming the health care system in a way that is most productive for health care consumers. We cannot continue to let people become ill when we have the means to keep many people well--particularly when problems are environmentally and behaviorally induced. Health promotion and prevention should be CENTRAL to any transformations of the health care system. 9. What is the role of advanced practice nurses in health promotion? The opportunities for advanced practice nurses in health promotion are absolutely astounding. Advance practice nurses must take the leadership in incorporating the findings of research about health promotion into clinical practice and protocols and into community partnerships and programs. I can think of nothing more exciting than to bring groups of researchers together with groups of advanced nurse practitioners to use the latest knowledge about behavior change and determinants of particular health or risky behaviors to develop anticipatory guidance and counseling protocols. Of course, "state of the science" care protocols must be developmentally and culturally appropriate. Advanced practice nurses can play a pivotal role in creating partnerships among scientists, practitioners and consumers to develop appropriate care strategies for specific populations. We must exercise caution in the application of research from one group to another group. For example, both the meanings and determinants of health behaviors are likely to differ across early, middle, late adolescence and adulthood. We must understand the dynamics of behavior through our research to build interventions with high potential effectiveness.