Promotion in Nursing Practice (1982) - She Developed The Idea That Promoting Optimal Health Supersedes
Promotion in Nursing Practice (1982) - She Developed The Idea That Promoting Optimal Health Supersedes
Promotion in Nursing Practice (1982) - She Developed The Idea That Promoting Optimal Health Supersedes
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 health-
promoting 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 high-
level state, is assumed to be a goal toward which an individual strives.
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 self-
esteem. 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.
Ourselves, our body, our health….. enhancing self usage towards prevention of illnesses & promoting well-
being.
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)
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 hard…hard as if you don’t know how to solve the problems of the world…But 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 Pender’s
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 government’s health agency, which is
the Department of Health (DOH), there’s 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 model’s 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.
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 client’s 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:
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.