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For many, the journey into nursing began when the nurse or a family member fell ill.

This experience
gave the nurse one of his or her first views into healthcare and the duties performed by the nursing
staff. The same is true for nurse theorist Nola J. Pender. At the age of 7, Penders aunt was
hospitalized. She states, The experience of watching the nurses caring for my aunt in her illness
created in me a fascination with the work of nursing, (Alligood & Tomey, 2010). And so began
Penders journey into nursing and consequent formation of her Health Promotion Model.

According to an interview given by Pender (Fitne, Inc, 2008), she wanted to develop a theory focusing
on a positive health seeking behavior approach rather than the negative approach she had seen used
in other theories. Her concepts help identify influences in the patients perceptions and cognitions that
the nurse needs to address in order for the patient to be able to adopt positive lifestyle behaviors.
Penders educational experience also helped to shape her middle-range theory. She earned her PhD.
in psychology and education, so her assumptions and concepts come from a behavioral science

Alligood and Tomey (2010) list the assumptions of the Health Promotion Model in this way: 1) Persons
seek to create conditions of living through which they can express their unique human health
potential. 2) Persons have the capacity for reflective self-awareness, including assessment of their
own competencies. 3) Persons value growth in directions viewed as positive and attempt to achieve a
personally acceptable balance between change and stability. 4) Individuals seek to actively regulate
their own behavior. 5) Individuals in all their biopsychosocial complexity interact with the environment,
progressively transforming the environment and being transformed over time. 6) Health professionals
constitute a part of the interpersonal environment, which exerts influence on persons throughout their
life spans. 7) Self-initiated reconfiguration of person-environment interactive patterns is essential to
behavior change (pp. 441). Again, Penders desire to focus on positive aspects can be seen in her
assumptions. She assumes that patients value positive change and that they are capable of self-
awareness and self-assessment. In evaluating these assumptions, one must implicitly assume that
the patient has the mental and physical capacities to actively decide on their health behaviors. Severe
mental disabilities or injury may prevent the patient, who wants to participate in healthy behaviors,
from doing so.

In addition to developing theoretical assumptions, the nurse theorist must also develop the concepts
of his or her theory. Concepts are formulated for both the large scale nursing metaparadigm and also
for the specific theory. Pender defines the metaparadigm concept of person as a biopsychosocial
entity that is shaped by the environment, but who also seeks to create its own environment where it
can express its full potential. Its relationship with the environment is reciprocal. The environment is the
context, whether that be social, cultural, or physical, in which the life course takes place. It can be
altered so that the person may be able to more readily participate in health promoting behaviors.
Health is defined as the person realizing inherent and acquired potential through their goal directed
behavior in the areas of self-care, social relationships, and body integrity. Finally, nursing is defined by
Pender as working in partnership with the patients, their families, and communities to create a positive
and supporting environment in which the patient can express their full potential and perform health
promoting behaviors (N. Pender, personal communication, September 14, 2011).

Penders theory is based on the concepts of prior related behavior, personal factors, including
biological, psychological, and sociocultural factors, perceived benefits of actions, perceived barriers to
action, perceived self-efficacy, activity-related affect, interpersonal influences, situational influences,
intention, immediate competing demands and preferences, and health-

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1. Description of the theory including assumptions, conceptual
definitions and propositional statements. Content below provides the format you follow in
analyzing and evaluating the theory:
2. Internal evaluation and analysis of the theory
1. Evaluate assumptions, both explicit and implicit. Assumptions are statements
that are understood to be true without proof or demonstration. They are beliefs about
phenomena one accepts as true.
2. How does the theorist define the four concepts of the paradigm of nursing?
These concepts are: Nursing, Environment, Person and Health. Most theorists have defined
these concepts differently.
3. How does the theorist define and inter-relate major concepts of their own
4. Evaluate propositional statements
5. Analyze consistency of the theory. Consistency (logical form) refers to
systematic development and structural clarity. Definitions of concepts should be consistent
across the theory and relationships across concepts clearly identified. Is the theory logical?
6. Comment on the adequacy, simplicity and generality of the
theory. Adequacy is a term that refers to how the theory is accepted by the nursing
community. Is it applicable to practice? Does this theory explain nursing? Simplicity refers to
having few concepts and simple relationships. Complex theory would have many concepts
and multiple relationships. Generality refers to the scope of concepts and goals. The more
limited the concepts and goals, the less general the theory. The more general the theory, the
greater the applications.
7. Type of theory refers to: Grand theory, Middle range or Micro theory,
3. External evaluation and analysis
1. Relationship of theory to practice (summarize an article)
2. Relationship of theory to education (summarize an article)
3. Relationship of theory to research (summarize an article)
4. Draw conclusions about how applicable this theory is to nursing practice,
research and education.
5. How can you apply the theory in your own current practice setting?