Pender's Health

Promotion Model
By: Lampacan, Juleen Grecel L. and Laruan, Trisha Mae S.
 TABLE OF CONTENTS
I. The Theorist VI. Use of Empirical Evidence
II. Theoretical Sources for VII. Acceptance by the
Theory Development Nursing Community
III. Major Concepts & Definition VIII. Analysis
IV. Major Assumptions of the IX. Application of the Theory
Theory/Metaparadigm in Nursing X. Conclusion
V. Theoretical Assertion XI. References
I. The Theorist: Nola J. Pender
Early Life
Born on August 16, 1941, in Lansing, Michigan.
Her first encounter with the nursing profession
when she was 7 years old.
Education
1962- received her Nursing Diploma
1965- Master's Degree
1969- Ph.D. in Psychology and Education
I. The Theorist
Career
1962- Works on a medical surgical unit
1985 to 1987- president of the Midwest Nursing
Research Society...
1991 to 1993-president of the American Academy
of Nursing and was also a member of the
Research America's Board of Directors
1990 to 2001- Associate Dean for Research at the
University of Michigan School of Nursing
1998 to 2002- member of the U.S. Preventative
Services Task Force
 II. Theoretical Sources for
Theory Development
Holistic nursing perspective, social psychology and learning theory
as a foundation for Health Promotion Model (HPM).
Social Cognitive Theory by Albert Bandura (1977) - Central of
HPM
The expectancy model of human motivation by Feather (1982) -
Model development.
 Background of the Theory
The health Promotion Model (HPM) proposed by Nola J. Pender
(1982; revised, 1996) was designed to a "complementary counterpart
to models of health promotion".
It defines health as "a positive dynamic state not merely the absence
of disease".
The health promotion model describes the multi-dimensional nature
of persons as they interact within their environment to pursue health.
 III. Major Concepts &
Definition
Pender recognized that there are particular behaviors that
promote individual ownership of prevention of illness
and continued awareness of personal health.
Focuses on prior behavior and personal factors that
contributed to the outcome.
Conceptual Model
 Individual Factors and
Experiences
Prior related behavior - Frequency of the same or similar health
behavior in the past.
Personal factors - Personal biological factors, person psychological
factors, and personal socio-cultural factors.
1. Individual Characteristics and experiences
2. Behavior-specific cognitions and affect
3. Behavioral outcomes
 Behavior-Specific Cognitions
and Affect
1. Perceived Benefits of Action -Anticipated positive outcomes that
will occur from health behavior.
2. Perceived Barriers to Action - Anticipated, imagined or real blocks
and personal costs of understanding a given behavior.
3. Perceived Self-Efficacy - Judgment of personal capability to
organize and execute a health-promoting behavior.
 Behavior-Specific Cognitions
and Affect
4. Activity-Related Affect - Subjective positive or negative feeling
that occurs before, during and following behavior based on the
stimulus properties of the behavior itself.
5. Interpersonal Influences - Cognition concerning behaviors, beliefs,
or attitudes of the others.
6. Situational Influences - Personal perceptions and cognitions of any
given situation or context that can facilitate or impede behavior.
 Behavior-Specific Cognitions
and Affect
7. Commitment to Plan of Action - The concept of intention and
identification of a planned strategy leads to the implementation of
health behavior
8. Immediate Competing Demands and Preferences - Competing
demands are those alternative behaviors over which individuals
have low control.
- Competing preferences are alternative behaviors over which
individuals exert relatively high control.
 Behavioral Outcome - Health
Promoting Behavior
1. Health-Promoting Behavior - An endpoint or action outcome that
is directed toward attaining positive health outcomes such as
optimal wellbeing, personal fulfillment, and productive living.
 IV. Major Assumptions of the
Theory/Metaparadigm in Nursing
Individuals seek to actively regulate their own behavior.
Individuals in all their biopsychosocial complexity interact with the
environment, progressively transforming the environment and being
transformed over time.
Health professionals constitute a part of the interpersonal
environment, which exerts influence on persons throughout their life
span.
Self-initiated reconfiguration of person-environment interactive
patterns is essential to human change.
 Metaparadigm
Person - A biopsychosocial organism that is partially shaped by the
environment but also seeks to create an environment in which
inherent and acquired human potential can be fully expressed the
relationship between person and environment is reciprocal.
Environment - Described as the social, cultural, and physical
context in which life unfolds. It can be manipulated by the individual
to create a positive context of cues and facilitators for health-
enhancing behaviors.
 Metaparadigm

Nursing - collaboration among patients, families, and communities

to create the best conditions for the expression of optimal health and
high-level well-being.
Health - The actualization of human potential through goal-directed
behavior, self-care, and relationships with others with necessary
adjustments made to maintain relevant environments.
 V.Theoretical Assertion
Prior behavior (inherited and acquired), influences beliefs, affect and
enactment of HPM behavior.
Persons commit to HPM behaviors through personal valued beliefs.
Perceived barriers can constrain the commitment to action, the
mediators of behavior, and the actual behavior.
Self-efficacy to execute a given behavior increases the likelihood of
commitment to action and actual performance of given behavior.
Persons are more likely to commit and engage in HPM behavior
when significant others model the behavior support and enable the
good behavior.
 V.Theoretical Assertion

Families peers in healthcare providers are important sources of

interpersonal influences that can increase or decrease HPM behavior.
Commitment to a plan of action is less likely to result in the desired
behavior when competing demands over which persons have little
control requiring immediate attention.
Persons can modify condition affect and the interpersonal and
physical environment to create incentives for health actions.
 VI. Use of Empirical Evidence

Pender and colleagues have conducted a program of research funded by

the National Institute of Nursing Research to evaluate the HPM in the
following four populations: (1) working adults, (2) older community-
dwelling adults, (3) ambulatory patients with cancer, and (4) patients
undergoing cardiac rehabilitation.
> These studies tested the validity of the HPM
 VI. Use of Empirical Evidence

The Health Promoting Lifestyle Profile II (HPLP-II)

To measure health-promoting lifestyle behaviors.
Health responsibility, physical activity, nutrition, interpersonal
relations, spiritual growth, and stress management.
> This provides an assessment of a health promoting lifestyle of
individuals that is clinically useful to nurses in patient support and
education.
 VI. Use of Empirical Evidence

Exercise Benefits-Barriers Scale (EBBS)

Measures the cognitive and perceptual factors of perceived benefits and
perceived barriers to exercise.
> This provides clinically useful means for evaluating exercise
perceptions.
 VII. Acceptance by the
Nursing Community
Practice

Very relevant.
Contributes nursing solution
Education
Used widely in graduate education and increasingly in undergraduate
nursing education in US.
Incorporated in nursing curricula.
Research
Serves as operational definition for health-promoting behaviors.
 VIII. Analysis

Simplicity and Clarity

Simple to understand.
The conceptual definitions provide clarity and lead to greater
understanding of the complexity of health behavior phenomena.
Various factors in each set are linked logically.
The direct and indirect influences as set of factors are clearly set out
in a visual simple diagram that displays their association.
Factors are seen as independent but the sets have an interactive effect
that result in action
 VIII. Analysis

Generality
Highly generalized to adult population.
Research was based on male, female, young, old, well and ill samples.
The agenda of the research includes application in a variety of
settings.
a research program tested the applicability of the model to children
aged 10 to 16 years.
Cultural and diversity considerations support model testing in diverse
population.
 VIII. Analysis

Empirical Precision
The model continues to evolve through planned programs of research.
Continued empirical research, specially intervention studies, will
further refine the model.
The Health Promoting Lifestyle profile has emerged as an instrument
used to assess health-promoting behaviors.
 VIII. Analysis

Derivable Consequences
Health Promotion Model is identifies as a goal for twenty-first
century, just as a disease prevention was a task of the twentieth
century. The model may influence the interaction between the nurse
and consumer.
Pender has responded to the political, social, and personal
environment of her time to clarify nursing's role in delivering health
promotion services to person of all ages.
 IX. Application of the Theory
Perceived Stress and Health-Promoting Behaviors in Nursing Students
Using Pender's Health Promotion Model
By: Gail E. Dunham
Abstract
The purpose of this descriptive, correlational study was to add support to
the literature that there is a relationship between the perceived stresses
(Student Stress Inventory) that nursing students report and their practice of
health-promoting behaviors (Health Promoting Lifestyle Inventory). A
convenience sample of 36-first year associate degree nursing students was
obtained.
 IX. Application of the Theory
Perceived Stress and Health-Promoting Behaviors in Nursing Students
Using Pender's Health Promotion Model
By: Gail E. Dunham
The conceptual framework used was Pender's Health Promotion Model. No
relations were found between demographic variables and perceived stress.
Results indicated that subjects reported to engage in health promoting
behaviors more than sometimes and they perceive themselves overall a
slightly stressed. A negative correlation between perceived stress and
health-promoting behaviour was identified but it was not statistically
significant.
 IX. Application of the Theory
Perceived Stress and Health-Promoting Behaviors in Nursing Students
Using Pender's Health Promotion Model
By: Gail E. Dunham

Analysis of the stress subscales indicated the area of highest stress was
personal factors (for students rated this extremely stressful), followed
by classroom and clinical. College environment was perceived as the
least stressful.
 Strength and Weaknesses

Strength
Simple to understand yet leaving deeper shows it's complicity in its
structure.
Focused on health promotion and disease prevention.
It is highly applicable in the community health setting.
It promotes the nursing profession's independent practice, being the
primary source of health promoting interventions and education
 Strength and Weaknesses

Weakness
The conceptual framework contains multiple concepts, which may
invite confusion to the reader.
Its applicability to an individual currently experiencing a disease
state was not given emphasis.
 X. Conclusion
The HPM purpose is to assist nurses in understanding the major
determinants of health behaviors as a basis for behavioral
counseling to promote healthy lifestyles.
Community health care setting is the best avenue in promoting
health and preventing illnesses. Using Pender’s Health Promotion
Model, community programs may be focused on activities that
can improve people’s well-being. Health promotion and disease
prevention can more easily be carried out in the community than
programs that aim to cure disease conditions
 X. Conclusion

Although not stated in the model, for example, in the Intensive

Care Unit, the health promotion model may still be applied in one
way or another. This is projected towards improving health
conditions and prevent further debilitating conditions. Diet
modifications and performing passive and active range of motion
exercises are examples of its application.
 XI. References
Alligood, M. R. (2013). Nursing Theory-E-Book: Utilization
& Application. Elsevier Health Sciences.
Murdaugh, C. L., Parsons, M. A., & Pender, N. J. (2018).
Health promotion in nursing practice. Pearson Education
Canada.
https://nursing-theory.org/nursing-theorists/Nola-Pender.php
https://nursekey.com/health-promotion-model/