THEORETICAL FOUNDATIONS IN NURSING

NOLA PENDER’S HEALTH PROMOTION MODEL OF NURSING

(Week No. 11)

INTRODUCTION

The concept of health promotion is necessary in disease prevention and in nursing practice. Health care
providers share a common goal of improving the health and well being of the clients. Pender’s Health
Promotion Model serves as a guide for nurses to plan for behavior modification interventions for the
improvement of the client’s health condition.

The purpose of this model is to assist the nurse in understanding the determinant of health behavior based
as basis for behavioral counseling to promote health lifestyles (Pender, 2011).

LEARNING OUTCOME

After finishing this module the student will be able to:

1. Discuss the concept of Nola Pender on Health Promotional Model of Nursing.
2. Understand the significance of the Health Promotional Model of Nola Pender.
3. Discuss the function of the Health Promotion Model (HPM) in Nursing

OUTLINE
1. Credentials and Background of the Theorist
2. Features of HPM of Nursing
3. Major Assumptions
4. Theoretical Assertions
a. Nursing
b. Health

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c. Environment
d. Person
5. References

CONTENT

Credentials and Background of the Theorist

Nola Pender attended Michigan State University to earn her Bachelor and Master’s degrees in
1964 and 1965, respectively. Sher earned her PhD. from Northwestern University in 1969.

She received a Lifetime Achievement Award from the Midwest Nursing Research Society in
2005. She was awarded an honorary Doctorate of Science degree in 1992 from Widener
University. She was given a Distinguished Alumni Award from the Michigan State University
School of Nursing in 1972. She has many publications in a variety of texts and journals, including six editions
of Health Promotion in Nursing Practice (6th edition).

Nola Pender has served as a member of organizations. She is also a co-founder of the Midwest Nursing
Research Society, and currently serves as a trustee. She is currently a Professor Emerita in the Division of
Health Promotion and Risk Reduction at the University of Michigan School of Nursing, and serves as a
Distinguished Professor at Loyola University Chicago’s School of Nursing. Currently, she is already retired
and spends her time consulting on health promotion research nationally and internationally.

Purpose of Health Promotion Model of Nursing (HPM)

• The purpose of this model is not merely to cure a disease but to promote healthy lifestyle and
choices that affect the health of individuals.

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• This model would convey the self-determining quality of an individual. Health is a dynamic process,
whereas, the individual is posited in this model as “being” healthy, “living” it, rather than health as a
static state.
• Offer framework on promoting health to rationalize research studies.

Definition of Health Promotion Model of Nursing (HPM)

The Health Promotion Model defines health as positive dynamic state rather than simply the absence of
disease. Health promotion is directed at increasing a client’s level of well-being. The HPM describes the
multidimensional nature of persons as they interact with their environment to pursue health.

The Health Promotion Model

Nola Pender 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. Thus, Pender’s model is normally called the “ Health Promotion Model” of
nursing.

The Major Concepts and Definitions Health Promotion Model

• Individual characteristics and experiences includes personal factors such as a)prior related
behavior, b) personal factors ie. biologic, psychological, and socio-cultural factors.
• Behavior-specific cognitions and affect include perceived barriers to action, perceived self-
efficacy, activity related affect, interpersonal influences, and situational influences.
• Behavioral outcome are commitment to action plan, and immediate competing deman and
preferences.

Definition
1. Personal Factors Personal factors are categorized as biological,
psychological, and socio-cultural. These factors are

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predictive of a given behavior and shaped by the

nature of the target behavior.
2. Personal Include variables such as age, gender, body mass
biological factors index, pubertal status, aerobic capacity, strength,
agility, or balance.
3. Personal Include variables such as self-esteem, self-
psychological motivation, personal competence, perceived health
factors status, and definition of health.
4. Personal socio- Include variables such as race, ethnicity, socio-
cultural factors culturation, education, and socio-economic status.
Behavior specific cognition and affect.
5. Perceived Anticipated, positive outcomes that will occur from
Benefits of Action health behavior.
6. Perceived Barriers Anticipated, imagined or real blocks and personal
to Action costs of understanding a given behavior.
7. Perceived Self Judgment of personal capacity to organize and
Efficacy execute a health-promoting behavior. Perceived self
efficacy influences perceived barriers to action so
higher efficacy result in lowered perception of barriers
to the performance of the behavior.
8. Activity Related Subjective positive or negative feeling that occurs
Affect before, during, and following behavior based on the
stimulus properties of the behavior 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
effect.
9. Interpersonal Cognition concerning behaviors, beliefs, or attitudes
Influences of the others. Interpersonal influences include norms
(expectations of significant other), social support

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(instrumental and emotional encouragement), and

modeling (various learning through observing others
engaged in a particular behavior). Primary sources of
interpersonal influence are families, peers, and
healthcare providers.
10. Situational Personal perceptions and cognition of any given
Influences situation or context that can facilitate or impede
behavior. Include perception 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 behavior.
11. Behavioral The concept of intention and identification of a
Outcomes planned strategy leads to implementation of health
Commitment to behavior.
Plan of Action
12. Immediate Competing demands are those alternative behaviors
Competing over which individuals have low control because there
Demand and are environmental contingencies such as work or
Preferences family care responsibilities. Competing preferences
are alternative behavior over which individuals exert
relatively high control over things.

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Assumptions of the Health Promotion Model

1. Individual 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 change.

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Revised HPM (From Pender, NJ (2002). Health Promotion in Nursing Practice,

4th Ed. Murdaugh, C.L. & Pasons, MA.

Pender’s model focuses on three areas: individual characteristics and

experiences, behavior-specific cognitions and affect, and behavioral
outcomes. The theory notes that each person has unique personal
characteristics and experiences that affect subsequent actions. The set
of variables for behavior specific knowledge and affect have important
motivational significance. The variables can be modified through nursing
actions. Health promoting behavior is the desired behavioral outcome,
which makes it the end point in the Health Promotion Model. These
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

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demand and preferences, which can derail intended actions for

promoting health.

THEORETICAL PROPOSITION 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 proposition:

1. Prior behavior and inherited and acquired characteristics influence

beliefs, effect, 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 of 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
specific health behavior.
6. Positive affect toward a behavior results in greater perceived self-
efficacy, which can in turn, result in increased positive effect.
7. When positive emotions 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
behavior.
9. Families, peers, and health care providers are important sources of
interpersonal influence that can increase/decrease commitment to and
engagement in health promoting behavior.
10. Situational influences in the external environment can
increase/decrease commitment/participation in health promoting
behavior.
11. The greater the commitments to a specific plan of action, the more
likely health promoting behaviors are 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 pf action is less like to result in the desired
behavior when competing behavior/actions are more attractive and thus
preferred over the target behavior.
14. Persons can modify cognitions, affect, and the interpersonal and
physical environment to create incentives for health actions.

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REFERENCES

Alligood, M. R., & Marriner-Tomey, A. (2010). Nursing theorists and their

work (7th ed.). Maryland Heights, Mo.: Mosby/Elsevier.

Quimbao-Udan, J. (2020). Theoretical Foundation in Nursing 2nd Ed. APD

Publishing House

Prepared by:
JUDITH J. SUGAY, PhD, RN
Faculty, FEU-IN

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