Remodelling Of Nola Pender 1i81l

REMODELLING OF NOLA PENDER’S HEALTH PROMOTION MODEL A. The Health promotion Model by Nola Pender failed to provide a definition of the four most important concepts that a nursing theory namely: Man, Nursing, Environment and Health. As part of the remodelling, these concepts can be defined as: a. Man – A biopsychosocial being whether sick or well, which interacts with the environment for the transformation leading to health promotion. b. Nursing – the provision of care by the health professionals being a part of the interpersonal environment towards health promotion. c. Environment – All the factors that affect health of a person to include the nurse as part of the environment. d. Health – The result of a behavior motivated to increase a person’s well-being whether sick or well to actualize human health potential. B. Inclusion in its applicability to an individual currently experiencing a disease state. Addition of knowledge and attitudes on diagnosis/illness and treatment or management as part of the Behaviour-specific cognitions and affect. MAJOR CONCEPTS Health promotion is defined as behavior motivated by the desire to increase well-being and actualize human health potential whether sick or well. 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. 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, knowledge, attitude, interpersonal influences, and situational influences). Behavioral outcomes (commitment to a plan of action, immediate competing demands and preferences, and health-promoting behavior). C. Definition of knowledge and attitude as part of behaviour-specific cognitions and affect SUBCONCEPTS Personal Factors

Personal factors categorized as biological, psychological and socio-cultural. These factors are predictive of a given behavior and shaped by the nature of the target behavior being considered. a. Personal biological factors Include variable such as age gender body mass index pubertal status, aerobic capacity, strength, agility, or balance. b. Personal psychological factors Include variables such as self-esteem self-motivation personal competence perceived health status and definition of health. c. 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 Judgment of personal capability to organize and execute a health-promoting behavior. Perceived self efficacy influences perceived barriers to action so higher efficacy result in lowered perceptions of barriers to the performance of the behaviour. Activity Related Affect Subjective positive or negative feeling that occur before, during and following behavior based on the stimulus properties of the behavior itself. Activity-related affect influences perceived self-efficacy, which means the more positive the subjective feeling, the greater the feeling of efficacy. In turn, increased feelings of efficacy can generate further positive affect. Knowledge Relates to the person’s (sick or well) knowledge about his diagnosis or illness, treatment or management whether without knowledge or highly knowledgeable which greatly influences a

person’s commitment to a plan of action leading to the outcome behaviour of health promoting behaviour. Attitude Pertains to the person’s attitude towards his diagnosis or illness, treatment or management whether negative or positive which greatly influences a person’s commitment to a plan of action leading to the outcome behaviour of health promoting behaviour. Interpersonal Influences Cognition concerning behaviors, beliefs, or attitudes of the others. Interpersonal influences include: norms (expectations of significant others), social (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 that 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 implementation of health behavior Immediate Competing Demands and Preferences Competing demands are those alternative behaviors over which individuals have low control because there are 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. ASSUMPTIONS 

Individuals seek to actively regulate their own behaviour.

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Individuals in all their biopsychosocial complexity interact with the environment, progressively transforming the environment and being transformed over time.

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Health professionals constitute a part of the interpersonal environment, which exerts influence on persons throughout their life span.

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Self-initiated reconfiguration of person-environment interactive patterns is essential to behavior change.

PROPOSITIONS                

Prior behavior and inherited and acquired characteristics influence beliefs, affect, and enactment of health-promoting behavior. Persons commit to engaging in behaviors from which they anticipate deriving personally valued benefits. Perceived barriers can constrain commitment to action, a mediator of behavior as well as actual behavior. Perceived competence or self-efficacy to execute a given behavior increases the likelihood of commitment to action and actual performance of the behavior. Greater perceived self-efficacy results in fewer perceived barriers to a specific health behavior. Positive affect toward a behavior results in greater perceived self-efficacy, which can in turn, result in increased positive affect. When positive emotions or affect are associated with a behavior, the probability of commitment and action is increased. A person’s knowledge on illness/diagnosis and treatment or diagnosis greatly influence a person’s behaviour to commit to a healthy behaviour. The higher the knowledge, the better the commitment to a plan of action for health promotion. A person’s attitude towards his illness or diagnosis influence the commitment to a plan of action. The more positive the attitude, the more committed the person to the plan of action for health promotion. Persons are more likely to commit to and engage in health-promoting behaviors when significant others model the behavior, expect the behavior to occur, and provide assistance and to enable the behaviour. Families, peers, and health care providers are important sources of interpersonal influence that can increase or decrease commitment to and engagement in healthpromoting behavior. Situational influences in the external environment can increase or decrease commitment to or participation in health-promoting behavior. The greater the commitments to a specific plan of action, the more likely healthpromoting behaviors are to be maintained over time. Commitment to a plan of action is less likely to result in the desired behavior when competing demands over which persons have little control require immediate attention. Commitment to a plan of action is less likely to result in the desired behavior when other actions are more attractive and thus preferred over the target behavior. Persons can modify cognitions, affect, and the interpersonal and physical environment to create incentives for health actions.

INDIVIDUAL CHARACTERISTICS AND EXPERIENCES

BEHAVIOR-SPECIFIC COGNITIONS AND AFFECT

BEHAVIORAL OUTCOME

Perceived benefits of action Perceived barriers to action Prior related behavior

Perceived selfefficacy Activityrelated affect

Immediate competing demands (low control) and Preferences (high control)

Knowledge (Diagnosis/illn ess, treatment, etc.) Personal Factors (Biological, Psychological and Sociocultural )

Attitude (Diagnosis/illn ess, treatment, etc.)

Interpersonal influences (Family, peers, providers), norms, , models Situational influences (Options, Demands characteristics, Aesthetics)

Commitment to a plan of action

Health Promoting Behavior