Health Promotion Theory Description and

Health Promotion Theory Description and purpose of the Health Promotion Model (HPM) / Theory The health promotion model of nursing was originally developed out of frustration by the nurse Nola J. Pender when again and again, she witnessed that "health professionals intervened only after people developed acute or chronic disease and experienced compromised lives. Attention was devoted to treating them after the fact. This reactive approach did not reflect the philosophical beliefs of our predecessors in nursing who focused on maintaining conditions of healthy interaction between self and the environment" (Pender, 2003).

The purpose of the theory was to reintroduce the concept into nursing, of a need for patients to maintain a healthy lifestyle before chronic ailments took root in the patient's body. Healing the patient's lifestyle as well as healing the sick is the cornerstone of the model's mission. Assumptions The Health Promotion Model (HPM) is grounded in both its founder's nursing background and her academic study of the behavioral sciences.

First and foremost, it holds that everyone, including patients, "seek to create conditions of living through which they can express their unique human health potential," and have the capacity for reflective self-awareness, including assessment of their own competencies and ability to change negative behaviors if they can perceive the positive benefits of such changes (Pender, Murdaugh & Parsons, 2002).

People intuitively "value growth in directions viewed as positive" and will willingly seek to actively regulate their own behavior (rather than need to have it determined by others if they know how (Pender, Murdaugh & Parsons, 2002). Also, "individuals in all their biopsychosocial complexity interact with the environment, progressively transforming the environment and being transformed over time," and "health professionals constitute a part of the interpersonal environment, which exerts influence on persons throughout their lifespan Pender, Murdaugh & Parsons, 2002).

In other words, a patient must take proactive steps change his or her daily food habits -- can change the contents of his or her refrigerator, turn off the television and go for a walk, even though a healthcare provider can give helpful advice about a balanced nutrition plan for weight loss and exercise goals. But the patient is always 'in control' of his or her own life. Fundamentally, the HPM assumes that "self-initiated reconfiguration of person-environment interactive patterns is essential to behavior change" (Pender, Murdaugh & Parsons, 2002).

In short, there is a vital place for the nurse, but the HPM stress is on patient autonomy and the patient's fundamental desire to live a healthy lifestyle, rather than upon the nurse engineering the patient's environment. Concept The underlying concept behind the HPM is that people will engage in positive behaviors if they perceive they can gain positive rewards for those behavioral changes, and when positive emotions become associated with the behavior. This can be as simple as the endorphin rush from a long, brisk walk.

However, perceived barriers can constrain and prevent individuals from changing their behaviors just as much if not more so real barriers. However, once positive benefits in the short-term begin to accrue, greater perceived self-efficacy results in fewer perceived barriers to a specific health behavior and results in long-term changes. The more the person sees him or herself as capable of changing, the greater the likelihood of positive changes over time.

When small changes yield positive results, people will be more likely to repeat those behaviors, and gain a sense of greater self-efficacy. A health care provider can give a needed push to make a change, but it is up to the individual as well as the provider to take note of the results of those changes, for it is the patient who must feel the ultimate sense of reward, and make the behavioral change a habit and a change in lifestyle.

Relationships Within the model's framework the nurse in the patient are not the only 'involved parties' in changing the individual's state of health. Pender stresses that healthy habits are more likely to take root if "significant others," including family and friends "model the behavior, expect the behavior to occur, and provide assistance and support to enable the behavior (Pender & Parsons 2002).

Families and peers, the overall social and external environment of the subject, as well as the health care providers "are important sources of interpersonal influence that can increase or decrease commitment to and engagement in health-promoting behavior" (Pender, Murdaugh & Parsons, 2002). Thus although Pender stresses enforcing a sense of self-efficacy, she does acknowledge that other environmental influences, including friends and family, can destabilize this sense of self-efficacy in a negative fashion and create competing demands that decrease the likelihood of commitment to a healthy lifestyle.

But fundamentally, "persons can modify cognitions, affect, and the interpersonal and physical environment to create incentives for health actions" (Pender, Murdaugh & Parsons, 2002). Definitions Self-empowerment is a critical part of the definition of the theory. Patients are not simply defined as sick, as lacking in a state of health, nor are individuals invariably in a state of self-care deficit. Rather, everyone is a potential patient, as everyone has an interest in health promotion, along with the nurse.

Furthermore, health promotion is not something that can end, like a course of treatment from a medication model; rather it is something everyone must work on throughout their lives -- and can work on throughout their lives. Structure The patient, the external environment, and external influences such as family and friends underline the complex, dynamic nature of the structures that influences health within the HPM framework.

Analysis Health is somewhat narrowly defined in this theory -- when Pender speaks of health she seems to be speaking more of healthy habits or lifestyle choices. A person can make healthy lifestyle choices, moreover, but still be lacking in heath. Pender places such a strong stress upon self-efficacy that the idea that there might be circumstances beyond the individuals' control that negatively impact health is not acknowledged. Not everyone who has diabetes, cancer, heart disease, or high cholesterol, eschewed a healthy diet and exercise before they suffered their ailment.

However, the model does seem to have limited, but important use in dealing with lifestyle related health issues. Much of Pender's work has been focused on encouraging individuals, particularly sedentary adolescent girls, to take a more proactive role in dietary and exercise regulation.

It is easy how changing the individual's thinking can create positive changes -- 'I have control over what I eat,' as opposed to 'I can't hurt my grandmother's feelings I have to eat her cookies' is a more positive psychological profile for a patient to assume and more conducive to dietary changes.

Also, feeling as if exercise can make a difference in one's overall well-being, and making a conscientious choice to exercise is more cognitively useful than assuming -- 'I can't do anything, I've always been tubby / bad at sports.' Additionally, having a family that supports weight loss and exercise is easier to live with in a healthy fashion than a family that unconsciously subverts behavioral changes, or gives negative or exclusionary reinforcement ("you're looking too skinny; women in our family have always had meat on their bones").

Furthermore, despite the stress on self-efficacy, the author does acknowledge that environment.