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Running head: DR. NOLA J PENDER & THE HEALTH PROMOTION
Dr. Nola J. Pender and the Health Promotion Model Theory Fawn Beatty, Barlow Bird, Amanda Cooley, Doug Heizer, Cindy Olsen, Sarah Pitcher, Megan Stucki Dixie State University
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Nola J. Pender and the Health Promotion Model Theory Nursing theory has come a long way since the time of Florence Nightingale’s efforts to organize the profession. The amount of information on nursing theory can be overwhelming. Currentnursing.com (2012) lists more than 75 different nursing theories, models, and philosophies. Each theory has concepts or ideas that make it unique. A nursing theory can be presented as a model in order to provide a map or plan that details how to follow the ideas presented in the theory (George, 2002). Nola Pender presents her health promotion theory as a model. Her ideas can be summed by the quote, “An apple a day keeps the doctor away” (Sitzman & Eichelberger, 2004, p.128). The Health Promotion Model was designed by Nola J. Pender to be a "complementary counterpart to models of health protection" (nursingtheory.org, 2013). It defines a person’s health as not only being free from disease, but living a lifestyle that encourages optimal health. Health promotion focuses on encouraging behaviors that promote positive overall well-being. The Health Promotion Model describes the multidimensional nature of the individual and the factors that influence how they perceive and seek healthy behaviors as they interact in their environment. Pender’s model is based on encouraging patient behaviors that promote a desired outcome for the patient. Pender has been quoted as saying, “It became apparent to me that health professionals intervened only after people developed acute or chronic disease… I committed myself to a proactive stance of health promotion and disease prevention…” (Sitzman & Eichelberger, 2004, p.124). Her model presents a process that can be used to assess and attend to any needs required by the patient in order to promote healthy behaviors. She believes that nurses have many opportunities to promote healthy behaviors, specifically when they relate to perceived
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health risks of a patient. There are many examples of health promoting behaviors including nutrition, hydration, physical activity, stress management, sleeping habits, spiritual health, and emotional health. Pender lists 11 factors that have the capability of having a positive influence on the health-promoting behaviors of clients (Sitzman & Eichelberger, 2004, p.124). This paper will explore Pender’s life and experiences that inspired her Health Promotion Model, the 11 factors that outline her model, how to apply her model into nursing practice as well as personal experiences that incorporate her model. Nursing Theorist and the Theory Dr. Nola J. Pender, PhD, RN, FAAN, was born on August 16, 1941, in Lansing, Michigan. Her chosen career path of nursing came to fruition at the age of 21, in 1962. She received her Bachelor of Science in Nursing from Michigan State University in 1964. Her focus on education and furthering her knowledge was evident when she received a Master’s degree from the same university in 1965, just one year later. In 1969, she went on to obtain her PhD in psychology and education from Northwestern University in Evanston, Illinois (“Nola J. Pender”, 2014). Shortly after becoming a ed nurse, Nola was made the head nurse for a medical-surgical unit at Ingham Medical Hospital in Lansing, Michigan. After two years of bedside nursing she became an instructor at Mercy School on Nursing (“Curriculum vita”, 2014). Nola worked for one year at Mercy School before moving to Grand Forks, North Dakota to teach at the University of North Dakota College of Nursing. After two years in Grand Forks, she eventually moved back to Illinois and taught at Northern Illinois University and Rush University nursing schools for the next 17 years.
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Dr. Pender’s interest in health promotion and health-promoting behaviors began in the 1970s. When questioned about her nursing model Dr. Pender (2010) states that from an early point in her career she began to realize that the Western health care system was mostly concerned or focused on the treatment of health problems after they had already developed. Although it was apparent that treatment received the most attention, she knew that quality of life could be drastically improved if that attention was instead shifted to prevention and promotion. She also knew that health care bills could be greatly reduced if individuals began to make healthier lifestyle choices (Pender, Murdaugh, & Parsons, 2011). Dr. Nola J. Pender’s beliefs about health promotion and prevention are what prompted her extensive work in the field of nursing research. From 1984-1990, she was the director of the Health Promotion Research Program, also located at Northern Illinois University. This program was designed to “help people choose healthier lifestyles, to make more efficient use of health services, to adopt self-care practices, and to participate actively in the design and implementation of programs that affect health” (“Public Health”, 2014). From 1990-1994, she acted as the director for the Center of Nursing Research at the University of Michigan School of Nursing in Ann Arbor, Michigan, where she also was a professor. While working in nursing research, she conducted testing on her Health Promotion Model with adolescents as well as children. She also created a program called “Girls on the Move” with her team of researchers, which began delving into the usefulness of the model in helping teens adopt or develop active lifestyles (“Nola J. Pender”, 2014). Dr. Pender held positions of authority and influence in nursing research until 2001. Even in retirement, Dr. Nola J. Pender continues to promote and assist with health promotion research both in the United States as well as in the international community (”Nola J. Pender”, 2014).
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While teaching and performing research she held the Associate Dean position at University of Michigan from 1994-2001. From that time until the present she has been a professor emerita at University of Michigan and from 2004 until the present, she has had the privilege of being a distinguished professor at Loyola University of Chicago School of Nursing in Chicago, Illinois. Throughout her forty plus years of being a nurse educator, she has taught all levels of education, including Baccalaureate, Masters, and Doctorate students. In addition she has also mentored post-doctoral fellows during this time (“Nola J. Pender”, 2014). Pender has authored, co-authored and contributed to 51 articles, starting in 1967 and publishing the most recent in 2006. While her interest in health promotion and healthpromoting behaviors began in the 1970s, she didn’t complete her book Health Promotion in Nursing Practice until 1982. Since then, the book has undergone several revisions and is now in its sixth edition. As stated by Dr. Pender in Health Promotion in Nursing Practice, the purpose of the book is emphasized with three goals: first, to present a summary of community and individual models or theories that guide health promotion interventions; second, to provide research proven strategies which can promote healthy life styles; and thirdly to facilitate critical thinking in regards to future health promotion research as well as beneficial interventions (2011). Along with her own book, she has authored several chapters in various other books, mainly focusing on community health, research and health promotion (“Curriculum vita”, 2014). Nursing Theory Concepts The 11 factors of Pender’s Health Promotion Model are prior related behavior, personal factors, perceived benefits of action, perceived barriers of action, perceived selfefficiency, activity related effect, interpersonal influences, situational influences, commitment to plan of action, immediate competing demand, and competing preferences (Sitzman &
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Eichelberger, 2004, p.124). Prior related behavior refers to the fact that patients learn behaviors through repetition. This means, that if a behavior was done often in the past, it will most likely continue into the future. Since the past cannot be changed, it is very difficult for a nurse to manipulate this factor, but can be valuable information for the nurse have (Sitzman & Eichelberger, 2004, p.124). Personal factors are aspects of the patient’s social, cultural, biological and psychological behaviors as they relate to health promoting behaviors. Examples of social and cultural factors include socioeconomic status, education background, race, ethnicity, and cultural background (Sitzman & Eichelberger, 2004, p.124). Perceived benefits of action refer to the result that is expected from the healthpromoting behavior that is being presented by the caregiver. An example of this is telling a patient they may increase their metabolism and have better weight control if they exercise regularly (Sitzman & Eichelberger, 2004, p.125). Perceived barriers of action are the barriers that prevent a patient access to health-promoting activities. These barriers can be real or imagined. For example, a person may feel that they have no time to exercise because they have such a busy schedule. In reality, the person has the time and is just anxious about the idea of starting a workout routine (Sitzman & Eichelberger, 2004, p.125). Perceived self-efficacy is the perceived personal judgment about an individual’s ability to stay organized and consistently complete new behaviors. If a person has a low selfefficacy, the result would be increased perceived barriers of action. A person with high selfefficacy would have little or no barriers to a positive outcome of health-promoting behaviors. For example, a person whose life is chaotic and disorganized may have a hard time getting
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motivated. A disorganized person will perceive many barriers that impede their progress with any new health-promoting behaviors (Sitzman & Eichelberger, 2004, p.125). Activity related effect relates to the positive and negative perceptions of completing health-promoting activities. An example would be of a person who lifts weights for the first time and then wakes up the next morning so stiff that they can hardly move. As a result, the person has a negative activity related effect of the health-promoting activity of lifting weights (Sitzman & Eichelberger, 2004, p.125). Interpersonal influences relate to the positive and negative motivational effects of the patient’s family . At a very young age we learn to model the behaviors of the people around us. These influences can have a huge effect on a patient’s health related outcome. For example, a child that eats fast food dinners in the car every night of the week is more likely to have a negative related health outcome when compared to a child who eats a home prepared meal with their family each night (Sitzman & Eichelberger, 2004, p.125). Situational influences are the external factors that influence a patient’s motivation toward a health promoting activity including how, when, and where the action is taking place. If a person were to attend a weight loss class in a building that is located across the street from a chocolate factory this person may have a hard time staying motivated to lose weight because of the constant distracting smell of chocolate (Sitzman & Eichelberger, 2004, p.125). Commitment to plan of action refers to a client’s dedication to improve their health and their ability to follow a plan of action in order to complete health-promoting behaviors. A person who sets specific goals about their perceived health outcome is more likely to achieve real benefits from the activity (Sitzman & Eichelberger, 2004, p.126).
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Immediate competing demand is the necessary competing factors that impede a person from completing the health-promoting behaviors. These may be factors that a person has little control over such as family responsibilities and going to work. An example would be staying home to cook a dinner and eat with your family rather than going to the gym to exercise. The long-term benefits for the family may outweigh a trip to the gym (Sitzman & Eichelberger, 2004, p.126). Competing preferences are the choices a person makes that they do have a high degree of control over. A common example would be choosing fruit as an afternoon snack instead of eating a candy bar out of the vending machine. A patient’s education can have a high degree of influence on competing preferences. The more education a person has about health and nutrition should influence them to make better choices about health-promoting behaviors (Sitzman & Eichelberger, 2004, p.126). Pender’s model is based on seven assumptions about nursing and the behavior of patients (Pender et al., 2011). 1. People are unique individuals that express themselves through the way in which they interact with the environment around them. 2. Patients have the ability to assess their own competencies and have the ability of reflective self-awareness. 3. A patient values positive growth and strives to achieve a balance that is acceptable between stability and change. 4. A person actively seeks to control their own behavior.
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5. A person is a complex biophysical organism that has complex interactions with the environment around them. As a result, the environment and the person are constantly changing over time. 6. A patient has a relationship with a healthcare provider who is able to influence the patient throughout their lifespan. 7. A patient must initiate person-environment reconfiguration on order to illicit a behavioral change. The Health Promotion Model also contains 14 theoretical assertions about the biophysical process that encourages people to participate in behaviors that facilitate a healthier outcome. The model’s main theme is health promotion through the desire to enhance well-being of the client (Pender et al., 2011). The 14 theoretical assertions are: 1. Prior experiences influence the beliefs, affect, and implementation of the healthpromoting behaviors. 2. Patients will only commit to health related activities in which they anticipate personalized benefits. 3. A perceived barrier can negatively influence the commitment to any new health related behaviors. 4. Increased self-efficacy increases the likelihood of positive performance of health related activities. 5. Increased self-efficacy also decreases the perceived barriers to the health promotion behaviors. 6. A positive attitude toward a health related activity will result in a higher self-efficacy which leads to a more positive attitude.
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7. The probability of increased commitment to action is increased when positive emotions are present. 8. A patient is more likely to participate in healthy behaviors if their peers are modeling healthy behaviors. 9. Healthcare providers, peers, and family are powerful relationships that can provide both positive and negative influences about health related activities. 10. The environment and situational influences can cause an increase or decrease of health promotion. 11. The more committed the patient is to a plan of action, the more likely the healthy behavior will remain over time. 12. Competing demands that are out of a client’s control may result in less commitment to the plan resulting in a negative outcome. 13. When a more attractive action is competing with the health related concept, the healthy concept is less likely to succeed. 14. A patient has the ability to change their thought processes, personal beliefs, affect, relationships, and environment in order to create incentives for healthier actions. The concept of the Health Promotion Model is easy to understand, yet the structures of the individual factors are hard to relate to each other. A visualization of Pender’s Revised Health Promotion Model had been recreated in figure 1 below in order to facilitate understanding. The direct and indirect factors are laid out in a simple visual diagram in order to show their associations (Alligood & Tomey, 2010).
DR. NOLA J PENDER & THE HEALTH PROMOTION
Individual characteristics and experiences
Behavior-specific cognition and affect
related Perceive self-efficiency
behavior
Behavioral Outcome
Perceived benefits of action Perceived barriers to action
Prior
11
Immediate competing demands (low control) and preferences (high control)
Activity-related affect
Personal Interpersonal Influences (family, peers, providers), norms, , models
factors: Biological
Commitment to a plan of action
Healthpromoting behavior
Psychological Socio-cultural
Situational Influences: options, demand, characteristics, aesthetics
Figure 1. Revised Health Promotion Model. Adapted from (Alligood & Tomey, 2010). Analysis of How the Theory is Applied in Nursing Practice The following is a real life experience that follows the progress of a patient that we will refer to as Tito Ortiz for reasons of anonymity. It will track his progress and responses to Dr. Nola J. Pender’s theoretical statements along his path to sober living. Prior Behaviors Tito Ortiz grew up in a small, rural town, where opportunity was what each person made of it. The teachings of his parents were hard work, dedication, and a pursuit of excellence. Tito, on the other hand, had a different plan in mind. He acquired the dedication from his parents, but his dedication was to a different lifestyle, one filled with what he perceived
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as fun, one free from the constraints of society. The influences he followed were those of BMX bike riders, rock and roll artists of the early 1990s and twenty first century, and his friends that were closest to him. The effects of these influences would follow him for over a decade, leading to an epic downfall, one that he was not sure he would ever recover from. The effects of his behavior led to a path that devastated his physical and emotional health. The all-time low came when his alcoholism cost him his job, his much needed insurance, affected his liver and kidney function, his immune system, and he lost every shred of his personal dignity. He ended up covered in sores that would not heal, no money, no driver’s license, lapsing insurance, and unable to function without a blood alcohol level that would render most people comatose. Commitment to Engaging in Beneficial Behavior It was time for a change in Tito’s lifestyle but over a decade of learned behavior was not easily dissuaded. He believed in change but felt it was just out of his grasp. Despite multiple failures, the desire to reform his life endured through three inpatient programs and one long-term rehabilitation program. In order to do this, he pulled strength from every corner of his being. Among those that gave him strength was his mother and father, friends, and above all, his personal desires for himself. He believed deep down that he could change and that his life could have meaning beyond his addictions that had ruled over him for so long. He always valued strength and commitment and these valued beliefs helped pull him from his acquired path of destruction. Tito found a new strength in his belief in change. This opened a world he had long forgotten and brought about a new chapter in his life. His commitment to change endured and proved to be stronger than his learned behavior from the past decade. He began to value hard work, dedication, and a pursuit of excellence in the way his parents had intended. His road
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was hard and the work arduous, but he remained strong in his desire to form a life he could be proud of. Perceived Barriers Along the road, there were many barriers Tito perceived to be imable, the largest being the desire to drink alcohol. Because he had spent the last decade drinking alcohol through the better part of each day, he learned how to function in daily life filled with it. Living a sober life was foreign to him and he lacked the ability to function without alcohol. This was no small thing as he equated living a sober life to that of learning to walk again. This is hard to comprehend, but one must that any new task is difficult, takes time, and requires dedication to master. His behavior had to change, and a new one adopted. Stresses were a new feeling that required adaptation because of his newfound lack of a coping mechanism. Forming Self-Efficacy Strength was in short supply but fortunately there were loved ones who offered it. These loved ones did not all come in the form of family and friends of the past. They came from new influences that gave him strength, not unlike the strength brothers-in-arms feel in the service to a just cause. He found strength in the words of those who had traveled the path he was facing now, and rallied in their war cries. These were not the cries of the 300 Spartans who stood at “The Hot Gates” in the battle of Thermopylae, but they rang as loud, and clear in his mind, as those of the free Greeks who fought against the tyranny of Persia. After his stay in rehabilitation, he was reborn a new person. The rebirth brought about a new confidence in his abilities and forged a new strength, a strength that would overcome any adversity. He was alive again with confidence and a zest for living. The little things started to bring him happiness and
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he found joy where he never expected it. With each ing day of sober living, he found his strength increasing, and with it, his perception of self-worth. Breaking the Barriers Along the road to sober living, as Tito’s self-worth increased, his perceived barriers began to break down. He began to trust his abilities to perform normal tasks without alcohol and learned to deal with the stress that comes from daily living. As he crossed each hurtle, the next became a little bit easier. Perceived Competence and Positive Affect Once he was ready to re the work force, he was filled with uncertainty. His previous decade of work experience revolved around working in a restaurant where the normal activities included working under the influence of alcohol and several other drugs. He knew he would not be able to re this type of environment, but it was all that was familiar to him, so he sought out work that did not excite his personal triggers and learned behaviors. This was difficult at first but only lead to an increased self-worth. His first job was working for a temp agency where he learned to think on his feet because he was expected to be a “jack-of-alltrades.” The plasticity of this environment only strengthened his resolve, and with each success his perceived self-worth improved, and the barriers began to fall. He learned he could handle anything thrown his way and received positive continually for his hard work and dedication. Not only were his employers impressed with him so were his family and friends. As he received positive , he continued to build confidence, which continually shrunk the barriers he believed to be in place. These positive effects started bleeding over into all aspects of his life and one of the biggest was when he began to become self-sufficient again. He previously took pride in knowing he could provide for himself. His addiction had robbed him of this pride
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and left him reliant on others, which affected his self-worth, but with each triumph and positive reinforcement, his perceived self-worth grew. Influences Promoting Healthy Behavior Battling a disease, such as alcoholism, requires a strong system. Tito’s system was made up of family , friends, and a new family of sorts that he found in Alcoholic Anonymous . He attended meetings four to five nights a week. When conditions did not permit him to attend these meetings it was apparent to him and all those close to him. Missing out on the much needed these meetings provided decreased his resolve and allowed doubt to enter his mind. The of family and friends was simply not enough. He needed the and strength that was provided through his bond and interactions with those that had either experienced or were going through similar experiences as him. He also found solace in speaking with the nurses, councilors, and the therapists that aided him through his rehabilitation program. These healthcare workers helped form the new person he is today and they touched his life forever through their caring, attentive, and, at times, assertive interactions with him. It was not only their guidance that touched his life, it was also the bonds formed, which created the system necessary for real change. External Influences There are many external influences that each person crosses paths with every day. For Tito, these experiences had the opportunity to make or break his recovery. Among the toughest external influences he experienced were the recent ones in his work place. For his job, he and his crew work closely with many other crews simultaneously. These workers are not always sensitive to the issues he was facing and at times would flaunt temptation in his face. He has recounted many experiences where people will drink on the job, at lunch around him, and
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invite him out for drinks after work. For a recovering alcoholic, this is one of the toughest experiences they will face. When an entire adult life revolves around alcohol, it only takes a minor slip to fall back into temptation. Thankfully, he has found his system and come to grips with his addiction. Without the and guidance he has received, and continues to receive, avoiding these temptations presented in the external environment would not be possible. Commitments to Action Part of change is forming goals and commitments to these goals. For Tito, the goal was to stay sober, learn new ways of coping, and stick to his plan of action. It only came after arriving at what those in AA refer to as “hitting rock bottom.” He formed these goals through meaningful connections with his family, friends, and from healthcare professionals. It was a long road and required intense introspection. He discovered what could be described as an awakening to self and the reality he wanted. Despite these commitments he had made to himself and others, there were contesting thoughts that would come to mind during times of stress, exposure to external temptations, and even to sights or smells. This required immediate action on his part to control his inner struggle and maintain the intended path. Modifying Cognition Any person wishing to change can benefit from skills in modifying their cognitive state and this was no different in Tito’s case. Part of maintaining control over his disease was learning a thought process to deal with the learned mental functioning from his past. This was a learned skill that took practice, focus, and dedication to acquire. The process involved modifying the cognitive process, interpersonal relationships, the physical environment a person is surrounded with, and creating incentives to reward healthy behaviors. For Tito, learning the mental aspect took the most time and would not have been possible without the and
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guidance of the healthcare workers he encountered. Next, he had to find incentives that were not triggers, which is part of altering the physical environment. He had to discover new and healthy things he enjoyed doing. These incentives came in the form of spending time with a rescue dog he obtained from the Humane Society and a newly discovered love of collecting and shooting firearms. These things might seem trivial and the norm for most people’s lives, but for Tito these were lifesaving distractions that aided in altering his cognitive functioning in times of distress. The Health Promotion Model defines health as “a positive dynamic state rather than simply the absence of disease.” (Pender, et al., 2010). The process of acquiring a complete state of health is multifaceted and involves a person’s characteristics, environment, experiences, physical health, and outcomes of cognition. This model is useful in many aspects of healthcare and was in Tito’s life. It explains the process for a person to follow to shape their life into a healthier self and what is necessary to do so. Today, Tito is still coming to with his disease but remains in good spirits and is as determined as ever to maintain his commitments for a better life. This was made possible through the interactions with family, friends, and the healthcare workers who touched his life. Varied Professional Nursing Experiences Experience 1: Psychiatric Nursing As a psychiatric nurse working in a residential treatment center for adolescents and teens with a multitude of struggles; including: alcohol, drug abuse, behavioral, mental or emotional problems, I am able to spend a great deal of time getting to know my patients. This is of great benefit and allows me to develop a relationship of trust with these adolescents and teenagers--that in turn facilitates unlimited opportunities for patient education and teaching, which is hopefully taken to heart more seriously.
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As stated in Dr. Pender’s Health Promotion Model, each of us as individuals has a personal history and that history along with the situations experienced affects or directs our actions (“Health Promotion Model”, 2013). This is also true of the patients I come into with each day and why it is beneficial for me to gain an understanding their backgrounds. The majority of our 80+ patients come from challenging circumstances and had very little if any positive influences in their lives. Some have legal struggles due to past illegal decisions and actions; for example, attacking a police officer or stealing. Others came from single-parent homes where the parent struggled just to survive. Some of the patients were involved in gangs, while quite a few others were physically and/or sexually abused as younger children. All of these situations are compounded when the children become involved with drugs and alcohol, as many of them have done. These experiences have made it difficult for them to “actively regulate their own behavior” (“Health Promotion Model”, 2013). Many don’t understand simple concepts, such as personal hygiene or the importance of keeping your body hydrated, with water especially. Every opportunity I am presented as a nurse to employ a positive influence on these adolescents is seized and fortunately this occurs on a regular basis. In addition to hygiene classes I have been able to teach other health-promoting lifestyle choices and their resulting benefits. Some of the areas I have been able to educate the adolescents on include; eating well-balanced meals, drinking plenty of water, the importance of maintaining a healthy blood pressure, wound care, prevention of infection due to life choices, as well as the importance of active lifestyles spanning their lives. Much effort and time is used to do this is in the hope of enabling them to better regulate their own behavior in the future, which
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in turn will allow them to commit to these healthy behaviors with a bolstered perception of selfefficacy (“Health Promotion Model”, 2013). Conclusion Nola J. Pender developed the Health Promotion Model to help people take control of their own health. She wrote up seven assumptions nursing a patient care along with 14 theoretical assertions. Pender aimed to teach and allow patients to be their own advocate, along with inspiring others. She wanted health care to change and allow people to really understand that they have an influence in their own life. Sarah Pitcher, one of the authors of this paper, has experienced Dr. Pender’s Health Promotion Model for herself. She found out a few years ago of genetic gene that she carries, called the BRCA 2. This gene gives her a very high risk of breast cancer, along with a higher than average risk of ovarian, pancreatic and melanoma cancers. To say it has affected her life would be an understatement. She goes to see her oncologist every six months for different testing and has since she turned 25-years-old. Health promotion and prevention has taken on a whole new meaning for her. Dr. Pender’s dream involved nursing staff applying her model to their practice, which has become evident because of the success it has made in the nursing world. As in Tito’s case, we can see that when the medical staff can work together with families and friends in giving hope so that people can prevent or catch health problems while in the beginning stages. Pender’s Health Promotion Model has saved lives. Patients are now realizing the benefits of promoting their own heath on their own. We, as nurses, should continue to encourage our patients and be there to allow Pender’s model of health promotion have an impact on their life.
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References Alligood, M. R. & Tomey, A. M. (2010). Nursing theorists and their work (7th ed.). Maryland Heights, MO: Mosby Elsevier. Current nursing: open access nursing research and review articles. (2012). Retrieved from http://currentnursing.com/nursing_theory/ George, J. B. (2002). Nursing theories: the base for professional nursing practice. Upper Saddle River, NJ: Pearson Education. Health Promotion Model. (2012, January 31). Retrieved October 1, 2014, from http://nursingplanet.com/health_promotion_model.html Health Promotion Model. (2013). Retrieved October 26, 2014, from http://www.nursingtheory.org/theories-and-models/pender-health-promotion-model.php Pender, N. J., Murdaugh, C., & Parsons, M. A. (2010). Health promotion in nursing practice (6th ed.). Upper Saddle River, NJ: Pearson/Prentice Hall. Pender, N. J. (Interviewee). (2011). Health promotion model: Frequent questions. [Interview transcript]. Retrieved from University of Michigan Library: http://deepblue.lib.umich.edu/bitstream/handle/2027.42/85352/Health_Promotion_Model -Frequent_Questions.pdf?sequence=1 Sitzman, K. & Eichelberger, W. L. (2004). Understanding the work of nursing theorist: a creative beginning. Sudbury, MA: Jones and Bartlett Publishers. Northern Illinois University. (2014). Public health program specializations: Health promotion. Retrieved from http://www.chhs.niu.edu/public_health/mph/specialization.shtml University of Michigan School of Nursing. (2014). Nola J. Pender. Retrieved from http://nursing.umich.edu/faculty-staff/nola-j-pender
DR. NOLA J PENDER & THE HEALTH PROMOTION University of Michigan School of Nursing. (2014). Curriculum vita. Retrieved from http://nursing.umich.edu/sites/default/files/cv-pender-nola-2010.pdf
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Dr. Nola J. Pender and the Health Promotion Model Theory Fawn Beatty, Barlow Bird, Amanda Cooley, Doug Heizer, Cindy Olsen, Sarah Pitcher, Megan Stucki Dixie State University
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Nola J. Pender and the Health Promotion Model Theory Nursing theory has come a long way since the time of Florence Nightingale’s efforts to organize the profession. The amount of information on nursing theory can be overwhelming. Currentnursing.com (2012) lists more than 75 different nursing theories, models, and philosophies. Each theory has concepts or ideas that make it unique. A nursing theory can be presented as a model in order to provide a map or plan that details how to follow the ideas presented in the theory (George, 2002). Nola Pender presents her health promotion theory as a model. Her ideas can be summed by the quote, “An apple a day keeps the doctor away” (Sitzman & Eichelberger, 2004, p.128). The Health Promotion Model was designed by Nola J. Pender to be a "complementary counterpart to models of health protection" (nursingtheory.org, 2013). It defines a person’s health as not only being free from disease, but living a lifestyle that encourages optimal health. Health promotion focuses on encouraging behaviors that promote positive overall well-being. The Health Promotion Model describes the multidimensional nature of the individual and the factors that influence how they perceive and seek healthy behaviors as they interact in their environment. Pender’s model is based on encouraging patient behaviors that promote a desired outcome for the patient. Pender has been quoted as saying, “It became apparent to me that health professionals intervened only after people developed acute or chronic disease… I committed myself to a proactive stance of health promotion and disease prevention…” (Sitzman & Eichelberger, 2004, p.124). Her model presents a process that can be used to assess and attend to any needs required by the patient in order to promote healthy behaviors. She believes that nurses have many opportunities to promote healthy behaviors, specifically when they relate to perceived
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health risks of a patient. There are many examples of health promoting behaviors including nutrition, hydration, physical activity, stress management, sleeping habits, spiritual health, and emotional health. Pender lists 11 factors that have the capability of having a positive influence on the health-promoting behaviors of clients (Sitzman & Eichelberger, 2004, p.124). This paper will explore Pender’s life and experiences that inspired her Health Promotion Model, the 11 factors that outline her model, how to apply her model into nursing practice as well as personal experiences that incorporate her model. Nursing Theorist and the Theory Dr. Nola J. Pender, PhD, RN, FAAN, was born on August 16, 1941, in Lansing, Michigan. Her chosen career path of nursing came to fruition at the age of 21, in 1962. She received her Bachelor of Science in Nursing from Michigan State University in 1964. Her focus on education and furthering her knowledge was evident when she received a Master’s degree from the same university in 1965, just one year later. In 1969, she went on to obtain her PhD in psychology and education from Northwestern University in Evanston, Illinois (“Nola J. Pender”, 2014). Shortly after becoming a ed nurse, Nola was made the head nurse for a medical-surgical unit at Ingham Medical Hospital in Lansing, Michigan. After two years of bedside nursing she became an instructor at Mercy School on Nursing (“Curriculum vita”, 2014). Nola worked for one year at Mercy School before moving to Grand Forks, North Dakota to teach at the University of North Dakota College of Nursing. After two years in Grand Forks, she eventually moved back to Illinois and taught at Northern Illinois University and Rush University nursing schools for the next 17 years.
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Dr. Pender’s interest in health promotion and health-promoting behaviors began in the 1970s. When questioned about her nursing model Dr. Pender (2010) states that from an early point in her career she began to realize that the Western health care system was mostly concerned or focused on the treatment of health problems after they had already developed. Although it was apparent that treatment received the most attention, she knew that quality of life could be drastically improved if that attention was instead shifted to prevention and promotion. She also knew that health care bills could be greatly reduced if individuals began to make healthier lifestyle choices (Pender, Murdaugh, & Parsons, 2011). Dr. Nola J. Pender’s beliefs about health promotion and prevention are what prompted her extensive work in the field of nursing research. From 1984-1990, she was the director of the Health Promotion Research Program, also located at Northern Illinois University. This program was designed to “help people choose healthier lifestyles, to make more efficient use of health services, to adopt self-care practices, and to participate actively in the design and implementation of programs that affect health” (“Public Health”, 2014). From 1990-1994, she acted as the director for the Center of Nursing Research at the University of Michigan School of Nursing in Ann Arbor, Michigan, where she also was a professor. While working in nursing research, she conducted testing on her Health Promotion Model with adolescents as well as children. She also created a program called “Girls on the Move” with her team of researchers, which began delving into the usefulness of the model in helping teens adopt or develop active lifestyles (“Nola J. Pender”, 2014). Dr. Pender held positions of authority and influence in nursing research until 2001. Even in retirement, Dr. Nola J. Pender continues to promote and assist with health promotion research both in the United States as well as in the international community (”Nola J. Pender”, 2014).
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While teaching and performing research she held the Associate Dean position at University of Michigan from 1994-2001. From that time until the present she has been a professor emerita at University of Michigan and from 2004 until the present, she has had the privilege of being a distinguished professor at Loyola University of Chicago School of Nursing in Chicago, Illinois. Throughout her forty plus years of being a nurse educator, she has taught all levels of education, including Baccalaureate, Masters, and Doctorate students. In addition she has also mentored post-doctoral fellows during this time (“Nola J. Pender”, 2014). Pender has authored, co-authored and contributed to 51 articles, starting in 1967 and publishing the most recent in 2006. While her interest in health promotion and healthpromoting behaviors began in the 1970s, she didn’t complete her book Health Promotion in Nursing Practice until 1982. Since then, the book has undergone several revisions and is now in its sixth edition. As stated by Dr. Pender in Health Promotion in Nursing Practice, the purpose of the book is emphasized with three goals: first, to present a summary of community and individual models or theories that guide health promotion interventions; second, to provide research proven strategies which can promote healthy life styles; and thirdly to facilitate critical thinking in regards to future health promotion research as well as beneficial interventions (2011). Along with her own book, she has authored several chapters in various other books, mainly focusing on community health, research and health promotion (“Curriculum vita”, 2014). Nursing Theory Concepts The 11 factors of Pender’s Health Promotion Model are prior related behavior, personal factors, perceived benefits of action, perceived barriers of action, perceived selfefficiency, activity related effect, interpersonal influences, situational influences, commitment to plan of action, immediate competing demand, and competing preferences (Sitzman &
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Eichelberger, 2004, p.124). Prior related behavior refers to the fact that patients learn behaviors through repetition. This means, that if a behavior was done often in the past, it will most likely continue into the future. Since the past cannot be changed, it is very difficult for a nurse to manipulate this factor, but can be valuable information for the nurse have (Sitzman & Eichelberger, 2004, p.124). Personal factors are aspects of the patient’s social, cultural, biological and psychological behaviors as they relate to health promoting behaviors. Examples of social and cultural factors include socioeconomic status, education background, race, ethnicity, and cultural background (Sitzman & Eichelberger, 2004, p.124). Perceived benefits of action refer to the result that is expected from the healthpromoting behavior that is being presented by the caregiver. An example of this is telling a patient they may increase their metabolism and have better weight control if they exercise regularly (Sitzman & Eichelberger, 2004, p.125). Perceived barriers of action are the barriers that prevent a patient access to health-promoting activities. These barriers can be real or imagined. For example, a person may feel that they have no time to exercise because they have such a busy schedule. In reality, the person has the time and is just anxious about the idea of starting a workout routine (Sitzman & Eichelberger, 2004, p.125). Perceived self-efficacy is the perceived personal judgment about an individual’s ability to stay organized and consistently complete new behaviors. If a person has a low selfefficacy, the result would be increased perceived barriers of action. A person with high selfefficacy would have little or no barriers to a positive outcome of health-promoting behaviors. For example, a person whose life is chaotic and disorganized may have a hard time getting
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motivated. A disorganized person will perceive many barriers that impede their progress with any new health-promoting behaviors (Sitzman & Eichelberger, 2004, p.125). Activity related effect relates to the positive and negative perceptions of completing health-promoting activities. An example would be of a person who lifts weights for the first time and then wakes up the next morning so stiff that they can hardly move. As a result, the person has a negative activity related effect of the health-promoting activity of lifting weights (Sitzman & Eichelberger, 2004, p.125). Interpersonal influences relate to the positive and negative motivational effects of the patient’s family . At a very young age we learn to model the behaviors of the people around us. These influences can have a huge effect on a patient’s health related outcome. For example, a child that eats fast food dinners in the car every night of the week is more likely to have a negative related health outcome when compared to a child who eats a home prepared meal with their family each night (Sitzman & Eichelberger, 2004, p.125). Situational influences are the external factors that influence a patient’s motivation toward a health promoting activity including how, when, and where the action is taking place. If a person were to attend a weight loss class in a building that is located across the street from a chocolate factory this person may have a hard time staying motivated to lose weight because of the constant distracting smell of chocolate (Sitzman & Eichelberger, 2004, p.125). Commitment to plan of action refers to a client’s dedication to improve their health and their ability to follow a plan of action in order to complete health-promoting behaviors. A person who sets specific goals about their perceived health outcome is more likely to achieve real benefits from the activity (Sitzman & Eichelberger, 2004, p.126).
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Immediate competing demand is the necessary competing factors that impede a person from completing the health-promoting behaviors. These may be factors that a person has little control over such as family responsibilities and going to work. An example would be staying home to cook a dinner and eat with your family rather than going to the gym to exercise. The long-term benefits for the family may outweigh a trip to the gym (Sitzman & Eichelberger, 2004, p.126). Competing preferences are the choices a person makes that they do have a high degree of control over. A common example would be choosing fruit as an afternoon snack instead of eating a candy bar out of the vending machine. A patient’s education can have a high degree of influence on competing preferences. The more education a person has about health and nutrition should influence them to make better choices about health-promoting behaviors (Sitzman & Eichelberger, 2004, p.126). Pender’s model is based on seven assumptions about nursing and the behavior of patients (Pender et al., 2011). 1. People are unique individuals that express themselves through the way in which they interact with the environment around them. 2. Patients have the ability to assess their own competencies and have the ability of reflective self-awareness. 3. A patient values positive growth and strives to achieve a balance that is acceptable between stability and change. 4. A person actively seeks to control their own behavior.
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5. A person is a complex biophysical organism that has complex interactions with the environment around them. As a result, the environment and the person are constantly changing over time. 6. A patient has a relationship with a healthcare provider who is able to influence the patient throughout their lifespan. 7. A patient must initiate person-environment reconfiguration on order to illicit a behavioral change. The Health Promotion Model also contains 14 theoretical assertions about the biophysical process that encourages people to participate in behaviors that facilitate a healthier outcome. The model’s main theme is health promotion through the desire to enhance well-being of the client (Pender et al., 2011). The 14 theoretical assertions are: 1. Prior experiences influence the beliefs, affect, and implementation of the healthpromoting behaviors. 2. Patients will only commit to health related activities in which they anticipate personalized benefits. 3. A perceived barrier can negatively influence the commitment to any new health related behaviors. 4. Increased self-efficacy increases the likelihood of positive performance of health related activities. 5. Increased self-efficacy also decreases the perceived barriers to the health promotion behaviors. 6. A positive attitude toward a health related activity will result in a higher self-efficacy which leads to a more positive attitude.
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7. The probability of increased commitment to action is increased when positive emotions are present. 8. A patient is more likely to participate in healthy behaviors if their peers are modeling healthy behaviors. 9. Healthcare providers, peers, and family are powerful relationships that can provide both positive and negative influences about health related activities. 10. The environment and situational influences can cause an increase or decrease of health promotion. 11. The more committed the patient is to a plan of action, the more likely the healthy behavior will remain over time. 12. Competing demands that are out of a client’s control may result in less commitment to the plan resulting in a negative outcome. 13. When a more attractive action is competing with the health related concept, the healthy concept is less likely to succeed. 14. A patient has the ability to change their thought processes, personal beliefs, affect, relationships, and environment in order to create incentives for healthier actions. The concept of the Health Promotion Model is easy to understand, yet the structures of the individual factors are hard to relate to each other. A visualization of Pender’s Revised Health Promotion Model had been recreated in figure 1 below in order to facilitate understanding. The direct and indirect factors are laid out in a simple visual diagram in order to show their associations (Alligood & Tomey, 2010).
DR. NOLA J PENDER & THE HEALTH PROMOTION
Individual characteristics and experiences
Behavior-specific cognition and affect
related Perceive self-efficiency
behavior
Behavioral Outcome
Perceived benefits of action Perceived barriers to action
Prior
11
Immediate competing demands (low control) and preferences (high control)
Activity-related affect
Personal Interpersonal Influences (family, peers, providers), norms, , models
factors: Biological
Commitment to a plan of action
Healthpromoting behavior
Psychological Socio-cultural
Situational Influences: options, demand, characteristics, aesthetics
Figure 1. Revised Health Promotion Model. Adapted from (Alligood & Tomey, 2010). Analysis of How the Theory is Applied in Nursing Practice The following is a real life experience that follows the progress of a patient that we will refer to as Tito Ortiz for reasons of anonymity. It will track his progress and responses to Dr. Nola J. Pender’s theoretical statements along his path to sober living. Prior Behaviors Tito Ortiz grew up in a small, rural town, where opportunity was what each person made of it. The teachings of his parents were hard work, dedication, and a pursuit of excellence. Tito, on the other hand, had a different plan in mind. He acquired the dedication from his parents, but his dedication was to a different lifestyle, one filled with what he perceived
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as fun, one free from the constraints of society. The influences he followed were those of BMX bike riders, rock and roll artists of the early 1990s and twenty first century, and his friends that were closest to him. The effects of these influences would follow him for over a decade, leading to an epic downfall, one that he was not sure he would ever recover from. The effects of his behavior led to a path that devastated his physical and emotional health. The all-time low came when his alcoholism cost him his job, his much needed insurance, affected his liver and kidney function, his immune system, and he lost every shred of his personal dignity. He ended up covered in sores that would not heal, no money, no driver’s license, lapsing insurance, and unable to function without a blood alcohol level that would render most people comatose. Commitment to Engaging in Beneficial Behavior It was time for a change in Tito’s lifestyle but over a decade of learned behavior was not easily dissuaded. He believed in change but felt it was just out of his grasp. Despite multiple failures, the desire to reform his life endured through three inpatient programs and one long-term rehabilitation program. In order to do this, he pulled strength from every corner of his being. Among those that gave him strength was his mother and father, friends, and above all, his personal desires for himself. He believed deep down that he could change and that his life could have meaning beyond his addictions that had ruled over him for so long. He always valued strength and commitment and these valued beliefs helped pull him from his acquired path of destruction. Tito found a new strength in his belief in change. This opened a world he had long forgotten and brought about a new chapter in his life. His commitment to change endured and proved to be stronger than his learned behavior from the past decade. He began to value hard work, dedication, and a pursuit of excellence in the way his parents had intended. His road
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was hard and the work arduous, but he remained strong in his desire to form a life he could be proud of. Perceived Barriers Along the road, there were many barriers Tito perceived to be imable, the largest being the desire to drink alcohol. Because he had spent the last decade drinking alcohol through the better part of each day, he learned how to function in daily life filled with it. Living a sober life was foreign to him and he lacked the ability to function without alcohol. This was no small thing as he equated living a sober life to that of learning to walk again. This is hard to comprehend, but one must that any new task is difficult, takes time, and requires dedication to master. His behavior had to change, and a new one adopted. Stresses were a new feeling that required adaptation because of his newfound lack of a coping mechanism. Forming Self-Efficacy Strength was in short supply but fortunately there were loved ones who offered it. These loved ones did not all come in the form of family and friends of the past. They came from new influences that gave him strength, not unlike the strength brothers-in-arms feel in the service to a just cause. He found strength in the words of those who had traveled the path he was facing now, and rallied in their war cries. These were not the cries of the 300 Spartans who stood at “The Hot Gates” in the battle of Thermopylae, but they rang as loud, and clear in his mind, as those of the free Greeks who fought against the tyranny of Persia. After his stay in rehabilitation, he was reborn a new person. The rebirth brought about a new confidence in his abilities and forged a new strength, a strength that would overcome any adversity. He was alive again with confidence and a zest for living. The little things started to bring him happiness and
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he found joy where he never expected it. With each ing day of sober living, he found his strength increasing, and with it, his perception of self-worth. Breaking the Barriers Along the road to sober living, as Tito’s self-worth increased, his perceived barriers began to break down. He began to trust his abilities to perform normal tasks without alcohol and learned to deal with the stress that comes from daily living. As he crossed each hurtle, the next became a little bit easier. Perceived Competence and Positive Affect Once he was ready to re the work force, he was filled with uncertainty. His previous decade of work experience revolved around working in a restaurant where the normal activities included working under the influence of alcohol and several other drugs. He knew he would not be able to re this type of environment, but it was all that was familiar to him, so he sought out work that did not excite his personal triggers and learned behaviors. This was difficult at first but only lead to an increased self-worth. His first job was working for a temp agency where he learned to think on his feet because he was expected to be a “jack-of-alltrades.” The plasticity of this environment only strengthened his resolve, and with each success his perceived self-worth improved, and the barriers began to fall. He learned he could handle anything thrown his way and received positive continually for his hard work and dedication. Not only were his employers impressed with him so were his family and friends. As he received positive , he continued to build confidence, which continually shrunk the barriers he believed to be in place. These positive effects started bleeding over into all aspects of his life and one of the biggest was when he began to become self-sufficient again. He previously took pride in knowing he could provide for himself. His addiction had robbed him of this pride
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and left him reliant on others, which affected his self-worth, but with each triumph and positive reinforcement, his perceived self-worth grew. Influences Promoting Healthy Behavior Battling a disease, such as alcoholism, requires a strong system. Tito’s system was made up of family , friends, and a new family of sorts that he found in Alcoholic Anonymous . He attended meetings four to five nights a week. When conditions did not permit him to attend these meetings it was apparent to him and all those close to him. Missing out on the much needed these meetings provided decreased his resolve and allowed doubt to enter his mind. The of family and friends was simply not enough. He needed the and strength that was provided through his bond and interactions with those that had either experienced or were going through similar experiences as him. He also found solace in speaking with the nurses, councilors, and the therapists that aided him through his rehabilitation program. These healthcare workers helped form the new person he is today and they touched his life forever through their caring, attentive, and, at times, assertive interactions with him. It was not only their guidance that touched his life, it was also the bonds formed, which created the system necessary for real change. External Influences There are many external influences that each person crosses paths with every day. For Tito, these experiences had the opportunity to make or break his recovery. Among the toughest external influences he experienced were the recent ones in his work place. For his job, he and his crew work closely with many other crews simultaneously. These workers are not always sensitive to the issues he was facing and at times would flaunt temptation in his face. He has recounted many experiences where people will drink on the job, at lunch around him, and
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invite him out for drinks after work. For a recovering alcoholic, this is one of the toughest experiences they will face. When an entire adult life revolves around alcohol, it only takes a minor slip to fall back into temptation. Thankfully, he has found his system and come to grips with his addiction. Without the and guidance he has received, and continues to receive, avoiding these temptations presented in the external environment would not be possible. Commitments to Action Part of change is forming goals and commitments to these goals. For Tito, the goal was to stay sober, learn new ways of coping, and stick to his plan of action. It only came after arriving at what those in AA refer to as “hitting rock bottom.” He formed these goals through meaningful connections with his family, friends, and from healthcare professionals. It was a long road and required intense introspection. He discovered what could be described as an awakening to self and the reality he wanted. Despite these commitments he had made to himself and others, there were contesting thoughts that would come to mind during times of stress, exposure to external temptations, and even to sights or smells. This required immediate action on his part to control his inner struggle and maintain the intended path. Modifying Cognition Any person wishing to change can benefit from skills in modifying their cognitive state and this was no different in Tito’s case. Part of maintaining control over his disease was learning a thought process to deal with the learned mental functioning from his past. This was a learned skill that took practice, focus, and dedication to acquire. The process involved modifying the cognitive process, interpersonal relationships, the physical environment a person is surrounded with, and creating incentives to reward healthy behaviors. For Tito, learning the mental aspect took the most time and would not have been possible without the and
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guidance of the healthcare workers he encountered. Next, he had to find incentives that were not triggers, which is part of altering the physical environment. He had to discover new and healthy things he enjoyed doing. These incentives came in the form of spending time with a rescue dog he obtained from the Humane Society and a newly discovered love of collecting and shooting firearms. These things might seem trivial and the norm for most people’s lives, but for Tito these were lifesaving distractions that aided in altering his cognitive functioning in times of distress. The Health Promotion Model defines health as “a positive dynamic state rather than simply the absence of disease.” (Pender, et al., 2010). The process of acquiring a complete state of health is multifaceted and involves a person’s characteristics, environment, experiences, physical health, and outcomes of cognition. This model is useful in many aspects of healthcare and was in Tito’s life. It explains the process for a person to follow to shape their life into a healthier self and what is necessary to do so. Today, Tito is still coming to with his disease but remains in good spirits and is as determined as ever to maintain his commitments for a better life. This was made possible through the interactions with family, friends, and the healthcare workers who touched his life. Varied Professional Nursing Experiences Experience 1: Psychiatric Nursing As a psychiatric nurse working in a residential treatment center for adolescents and teens with a multitude of struggles; including: alcohol, drug abuse, behavioral, mental or emotional problems, I am able to spend a great deal of time getting to know my patients. This is of great benefit and allows me to develop a relationship of trust with these adolescents and teenagers--that in turn facilitates unlimited opportunities for patient education and teaching, which is hopefully taken to heart more seriously.
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As stated in Dr. Pender’s Health Promotion Model, each of us as individuals has a personal history and that history along with the situations experienced affects or directs our actions (“Health Promotion Model”, 2013). This is also true of the patients I come into with each day and why it is beneficial for me to gain an understanding their backgrounds. The majority of our 80+ patients come from challenging circumstances and had very little if any positive influences in their lives. Some have legal struggles due to past illegal decisions and actions; for example, attacking a police officer or stealing. Others came from single-parent homes where the parent struggled just to survive. Some of the patients were involved in gangs, while quite a few others were physically and/or sexually abused as younger children. All of these situations are compounded when the children become involved with drugs and alcohol, as many of them have done. These experiences have made it difficult for them to “actively regulate their own behavior” (“Health Promotion Model”, 2013). Many don’t understand simple concepts, such as personal hygiene or the importance of keeping your body hydrated, with water especially. Every opportunity I am presented as a nurse to employ a positive influence on these adolescents is seized and fortunately this occurs on a regular basis. In addition to hygiene classes I have been able to teach other health-promoting lifestyle choices and their resulting benefits. Some of the areas I have been able to educate the adolescents on include; eating well-balanced meals, drinking plenty of water, the importance of maintaining a healthy blood pressure, wound care, prevention of infection due to life choices, as well as the importance of active lifestyles spanning their lives. Much effort and time is used to do this is in the hope of enabling them to better regulate their own behavior in the future, which
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in turn will allow them to commit to these healthy behaviors with a bolstered perception of selfefficacy (“Health Promotion Model”, 2013). Conclusion Nola J. Pender developed the Health Promotion Model to help people take control of their own health. She wrote up seven assumptions nursing a patient care along with 14 theoretical assertions. Pender aimed to teach and allow patients to be their own advocate, along with inspiring others. She wanted health care to change and allow people to really understand that they have an influence in their own life. Sarah Pitcher, one of the authors of this paper, has experienced Dr. Pender’s Health Promotion Model for herself. She found out a few years ago of genetic gene that she carries, called the BRCA 2. This gene gives her a very high risk of breast cancer, along with a higher than average risk of ovarian, pancreatic and melanoma cancers. To say it has affected her life would be an understatement. She goes to see her oncologist every six months for different testing and has since she turned 25-years-old. Health promotion and prevention has taken on a whole new meaning for her. Dr. Pender’s dream involved nursing staff applying her model to their practice, which has become evident because of the success it has made in the nursing world. As in Tito’s case, we can see that when the medical staff can work together with families and friends in giving hope so that people can prevent or catch health problems while in the beginning stages. Pender’s Health Promotion Model has saved lives. Patients are now realizing the benefits of promoting their own heath on their own. We, as nurses, should continue to encourage our patients and be there to allow Pender’s model of health promotion have an impact on their life.
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References Alligood, M. R. & Tomey, A. M. (2010). Nursing theorists and their work (7th ed.). Maryland Heights, MO: Mosby Elsevier. Current nursing: open access nursing research and review articles. (2012). Retrieved from http://currentnursing.com/nursing_theory/ George, J. B. (2002). Nursing theories: the base for professional nursing practice. Upper Saddle River, NJ: Pearson Education. Health Promotion Model. (2012, January 31). Retrieved October 1, 2014, from http://nursingplanet.com/health_promotion_model.html Health Promotion Model. (2013). Retrieved October 26, 2014, from http://www.nursingtheory.org/theories-and-models/pender-health-promotion-model.php Pender, N. J., Murdaugh, C., & Parsons, M. A. (2010). Health promotion in nursing practice (6th ed.). Upper Saddle River, NJ: Pearson/Prentice Hall. Pender, N. J. (Interviewee). (2011). Health promotion model: Frequent questions. [Interview transcript]. Retrieved from University of Michigan Library: http://deepblue.lib.umich.edu/bitstream/handle/2027.42/85352/Health_Promotion_Model -Frequent_Questions.pdf?sequence=1 Sitzman, K. & Eichelberger, W. L. (2004). Understanding the work of nursing theorist: a creative beginning. Sudbury, MA: Jones and Bartlett Publishers. Northern Illinois University. (2014). Public health program specializations: Health promotion. Retrieved from http://www.chhs.niu.edu/public_health/mph/specialization.shtml University of Michigan School of Nursing. (2014). Nola J. Pender. Retrieved from http://nursing.umich.edu/faculty-staff/nola-j-pender
DR. NOLA J PENDER & THE HEALTH PROMOTION University of Michigan School of Nursing. (2014). Curriculum vita. Retrieved from http://nursing.umich.edu/sites/default/files/cv-pender-nola-2010.pdf
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