PENDER'S HEALTH PROMOTION MODEL

Nola J. Pender (1941– present) is a nursing theorist who

developed the Health Promotion Model in 1982. She is also
an author and a Professor Emerita/Emeritus of nursing at the
University of Michigan. She started studying health-promoting
behavior in the mid-1970s and first published the Health
Promotion Model in 1982. Her Health Promotion Model
indicates preventative health measures and describes nurses’
critical function in helping patients prevent illness by self-care
and bold alternatives. Pender has been named a Living Legend
of the American Academy of Nursing.

Who is Nola J. Pender?

 On August 16, 1941, Nola Pender was born in Lansing, Michigan, to parents who
advocated education for women. Her first encounter with the nursing profession
was when she was 7 years old and witnessed the care given to her hospitalized
aunt by nurses. This situation led her to the desire to care for other people, and
her goal was to help people care for themselves.
 She studied at Michigan State University and Northwestern University in
Evanston, Illinois.
 She is presently a Professor Emerita at University of Michigan School of Nursing.
Also, Pender was an Associate Dean for Research at the University of Michigan
School of Nursing from 1990 to 2001. And as a co-founder of the Midwest
Nursing Research Society, she has served as a trustee of its foundation since
2009.
 Pender was designated a Living Legend of the American Academy of Nursing in
2012. The award has only been awarded to nurses who have made outstanding
contributions to the profession. Pender was the president of the academy from
1991 to 1993.
Nola Pender’s Health Promotion Model
Have you ever noticed advertisements in malls, grocery stores, or schools that advocate
healthy eating or regular exercise? Have you gone to your local centers or hospitals
promoting physical activities and smoking cessation programs such as “quit” activities
and “brief interventions?” These are all examples of health promotion. The Health
Promotion Model, developed by nursing theorist Nola Pender, has provided healthcare
a new path. According to Nola J. Pender, Health Promotion and Disease Prevention
should focus on health care. When health promotion and prevention fail to anticipate
predicaments and problems, care in illness becomes the subsequent priority.

What is Health Promotion Model?

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

Nola Pender’s Health Promotion Model theory was originally published in 1982 and later
improved in 1996 and 2002. It has been used for nursing research, education, and
practice. Applying this nursing theory and the body of knowledge that has been
collected through observation and research, nurses are in the top profession to enable
people to improve their well-being with self-care and positive health behaviors.

The Health Promotion Model was designed to be a “complementary counterpart to

models of health protection.” It develops to incorporate behaviors for improving health
and applies across the life span. Its purpose is to help nurses know and understand the
major determinants of health behaviors as a foundation for behavioral counseling to
promote well-being and healthy lifestyles.

Pender’s health promotion model defines health as “a positive dynamic state not merely
the absence of disease.” Health promotion is directed at increasing a client’s level of
well-being. It describes the multi-dimensional nature of persons as they interact within
the environment to pursue health.

The model focuses on the following three areas: individual characteristics and
experiences, behavior-specific cognitions and affect, and behavioral outcomes.
5 key sections: Person, environment, nursing, health, and illness.

Major Concepts of the Health Promotion Model

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
illness constraints.

 Individual characteristics and experiences (prior related behavior and personal

factors).
 Behavior-specific cognitions and affect (perceived benefits of action, perceived
barriers to action, perceived self-efficacy, activity-related affect, interpersonal
influences, and situational influences).
 Behavioral outcomes (commitment to a plan of action, immediate competing
demands and preferences, and health-promoting behavior).

Subconcepts of the Health Promotion Model

Prior-related behavior

How similar behavior has been done in the past

Personal Factors

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

factors are predictive of a given behavior and shaped by the target behavior’s nature
being considered.

 Personal biological factors. Include variables 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,

acculturation, education, and socioeconomic status.

Perceived Benefits of Action

Anticipated positive outcomes that will occur from health behavior.

Perceived Barriers to Action

Anticipated, imagined, or real blocks and personal costs of understanding a given

behavior.

Perceived Self-Efficacy

The judgment of personal capability to organize and execute a health-promoting

behavior. Perceived self-efficacy influences perceived barriers to action, so higher
efficacy results in lowered perceptions of barriers to the behavior’s performance.

Activity-Related Affect

Subjective positive or negative feeling occurs 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 its efficacy. In turn, increased feelings of efficacy can
generate a further positive affect.

Interpersonal Influences

Cognition concerning behaviors, beliefs, or attitudes of others. Interpersonal influences

include norms (expectations of significant others), social support (instrumental and
emotional encouragement), and modeling (vicarious learning through observing others
engaged in a particular behavior). Primary sources of interpersonal influences are
families, peers, and healthcare providers.

Situational Influences

Personal perceptions and cognitions of any given situation or context can facilitate or
impede behavior. 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
behavior.

Commitment to Plan of Action

The concept of intention and identification of a planned strategy leads to

the implementation of health behavior.

Immediate Competing Demands and Preferences

Competing demands are those alternative behaviors over which individuals have low
control because of environmental contingencies such as work or family care
responsibilities. Competing preferences are alternative behaviors over which
individuals exert relatively high control, such as choice of ice cream or apple for a snack.

Health-Promoting Behavior

A health-promoting behavior is an endpoint or action-outcome directed toward

attaining positive health outcomes such as optimal wellbeing, personal fulfillment, and
productive living.

The Health Promotion Model makes four assumptions:

1. Individuals seek to actively regulate their own behavior.

2. Individuals, in all their biopsychosocial complexity, interact with the environment,
progressively transforming the environment as well as being transformed over
time.
3. Health professionals, such as nurses, constitute a part of the interpersonal
environment, which exerts influence on people through their life span.
4. Self-initiated reconfiguration of the person-environment interactive patterns is
essential to changing behavior.

Strengths and Weaknesses

Strengths

 The Health Promotion Model is simple to understand, yet diving deeper shows its
complexity in its structure.

 Nola Pender’s nursing theory focused on health promotion and disease

prevention, making it stand out from other nursing theories.

 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.

Weaknesses

 The Health Promotion Model of Pender could not define the nursing
metapradigm or the concepts that a nursing theory should have, man, nursing,
environment, and health.

 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.

Conclusion

Due to its focus on health promotion and disease prevention per se, its relevance to
nursing actions given to ill individuals is obscure. But then again, this characteristic of
her model also gives the concepts its uniqueness.

Pender’s principles paved a new way of viewing nursing care, but then one should also
be reminded that nursing’s curative aspect cannot be detached from our practice.

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.

To fully adhere to a health-promoting behavior, he or she needs to shell out financial

resources. This limits the application of Pender’s model. An individual who economically
or financially unstable might have a lesser commitment to the planning of action,
decreasing the ideal outcome of a health-promoting behavior even if the individual has
the necessary will to complete it.

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.

Source: https://nurseslabs.com/nola-pender-health-promotion-model/