Use of Two Nursing Theories

¶ … Nursing Practice

The nursing field comprises different theories that are used to govern nursing practice through offering different perspectives and views of phenomena. A theory can be defined as the development of a link between concepts that create a certain view of a phenomenon (Jackson, n.d.). The theories in the nursing field focus on issues that are relevant to enhancing patient care, overall nursing practice, and nursing education. Moreover, these theories are used to define, create, and distribute existing knowledge in the profession as part of efforts towards improving nursing practice. The theories in nursing field are classified into different categories i.e. ground nursing theories, nursing practice theories, and mid-range nursing theories. Some examples of these various types of nursing theories include Nola J. Pender's Health Promotion Model (HPM) and Mid-Range Theory. These theories differ in terms of the theorists' backgrounds and their experiences, description of theory, assumptions, and application in nursing practice.

Health Promotion Model and Middle Range Theory

The Health Promotion Model was developed by Dr. Nola J. Pender and is used globally for nursing education, research, and practice. This theory helps nursing professionals and practitioners to understand the main determinants of health behaviors at the key for behavioral counseling to enhance health lifestyles. The Health Promotion Model was first introduced in nursing literature in 1982 and revised in 1996 due to changes in theoretical views and empirical findings (Pender, 2011). In contrast, Middle-range theories have become essential in nursing education and application to research given that one of the most significant expectations for nurses in the modern health sector. Middle-range theories are usually between working hypotheses emerging from daily research and the wider systemic initiatives to create unified theories. In essence, mid-range theory in nursing addresses scientific underpinnings that govern nursing research and practice.

Theorist's Background

Dr. Nola J. Pender developed the Heath Promotion Model following her scholarly expertise and activity in various aspects in nursing practice i.e. physical activity, health behavior counseling, adolescent health behaviors, and health promotion. She was born on August 16, 1941 in Michigan where she grew up for most of her childhood and adult life. Pender obtained a Bachelor's of Science in Nursing in 1964 from Michigan State University and a Master's Degree a year later from the same university. She then moved to Evanston, Illinois where she obtained her doctorate degree from Northwestern University in 1969. She developed the theory as a result of research in which she focused on health promotion behaviors. Actually, Dr. Pender carried out research testing on the Health Promotion Model with both adolescents and adults. She has worked as a nurse educator for more than 40 years where she has taught and mentored baccalaureate, masters, and PhD students. Pender is currently working as a Distinguished Professor at Loyola University School of Nursing in Chicago.

The greatest influence and experience that contributed to the development of this theory is the fact that Dr. Pender had a deep conviction that it is much better to have exuberant health and wellness and prevent illnesses instead of letting disease happen. As a result, she adopted a proactive stance towards disease prevention through health promotion. Through the theory, Dr. Pender specifically focuses on promoting health and well-being in order to prevent diseases rather than wait for the disease to occur, especially when it is avoidable and attempt to cope with it.

Therefore, this theory postulates that health and well-being goes beyond the absence of disease or illness and incorporates activities that focus on well-being. The theory suggests that good health entails an overall and holistic state of wellness, personal health initiatives, and a balanced, fulfilling lifestyles ("Nola Pender Health Promotion Model," n.d.). The phenomenon addressed by the Health Promotion Model is the steps through which an individual can pursue improved or ideal health. Consequently, the theory considers personal characteristics and experiences, particular behavior cognitions, and the impact and behavioral results of a person.

The major experience or influence in the development of mid-range theories is the need to translate nursing research into daily practice towards patient care and improved health outcomes. The other factors that have influenced the creation of these theories include the need to go beyond descriptive studies to test links between nursing care and desired patient outcomes in large populations and creating scientific evidence to confirm the effect of nursing on patient outcomes. Moreover, mid-range theories were developed to conceptualize the productivity of nursing practice on these patient outcomes and being prepared with theory-based data that support visionary and relevant policy formulation (Kolcaba, 2001, p.86).

The main concern or phenomenon addressed by these theories is the challenges of the 21st Century in the nursing profession and practice. As a result, the theories are made of fewer concepts and relationships that make them applicable to a broad range of practice and experience. They are also easy to build from a variety of sources and strong enough to be tested when being applied to nursing practice. The theories address the 21 Century problems or issues in nursing by directing relevant questions and promoting significant, positive outcomes given the congruency brought by working within a theory.

Theory Description

As evident in the previous discussion, Nola J. Pender's Health Promotion Model and Middle-range theories differ in the formulation and specific phenomena or concerns they seek to address. However, these theories also differ on the basis of their concepts, use of reasoning, and relationships between the major concepts in the theory.

Health Promotion Model (HPM)

The Health Promotion Model identifies the background factors that affect health behavior though its main emphasis is on eight beliefs that can be evaluated by the nurse. The theoretical foundations of the Health Promotion Model are the Expectancy Value Theory and Social Cognitive Theory. In light of Expectancy Value Theory, Nola J. Pender's Health Promotion Model postulates that people engage in activities to accomplish certain goals that are regarded as possible and contribute to valued outcomes. Through the Social Cognitive Theory, the model suggests that there are interactions between thoughts, behaviors, and the environment. Therefore, for a person to change his/her lifestyle, he/she must first change his/her ways of thinking. This implies that health promotion and disease prevention is a by-product of the interactions between thoughts, behaviors, and the environment.

There are three major of Pender's Health Promotion Model i.e. individual characteristics and experience, previous related behavior, and frequency of similar behavior in the past. The model classifies personal factor or individual characteristics and experience as biological, socio-cultural, and psychological aspects ("Health Promotion Model," 2012). The consideration of personal factors is based on the fact that they are predictive of certain behavior and are influenced by the nature of targeted behavior. The perceived benefit of action in relation to individual characteristics and experience in this model is positive outcomes that emerge from health behavior while perceived barriers are anticipated or imagined obstacles to understanding a specific behavior. Previous related behavior refers to behavior specific cognitions and affect with regards to developing a planned strategy that contributes to the enforcement of health behavior. The goal of health promoting behavior is achieving a positive health outcome like personal satisfaction, optimal wellness, and productive living.

The use of these concepts in the Health Promotion Model is consistent with the other terms in the theory. These concepts relate to the other terms especially health promotion behavior and disease prevention. Moreover, the concepts are also explicitly defined and can be easily understood by any individual who seeks to develop and maintain health promotion behavior. The author has explicitly defined the concepts of Health Promotion Model through providing specific steps that can be used to promote healthy and well-being behaviors. Therefore, the major concepts of the theory are defined operationally because of the ease of applicability by any individual towards promoting health and preventing disease. In addition to the explicit definition of the major concepts of Health Promotion Model, the author includes a comprehensive list of propositions that relate to these concepts. These theoretical propositions that act as the basis of the Health Promotion model are strongly linked to each of three concepts of the model.

The Health Promotion Model by Dr. Nola J. Pender utilizes retroductive reasoning, which entails the development of hypothetical models as a means of discovering the actual structures and mechanisms that are assumed to generate empirical phenomena. The use of retroductive reasoning in this model is evident in the fact that the theorist identifies the various characteristics affecting healthy living and well-being and uses them to develop health promotion and disease prevention structures and mechanisms. The theory is not based on certain observations or generalizations but is rather based on the identification real structures and mechanisms towards health promotion and disease prevention.

Middle Range Theory

Middle Range Theory can be described as a hypothesis that emerges at the intersection of nursing practice and research, which implies that it exists on the middle rung (Liehr, 2005, p.152). The focus of Middle Range Theory is to meet the current challenges in contemporary nursing environment since it occurs at the intersection between nursing research and practice. Since it is concrete, adaptable, and easy to use, Middle Range Theory is beneficial in dealing with the challenges of nursing in the 21st Century, especially with regards to nursing science.

The three major aspects through which nursing theories are based are human needs, adaptation, and the health/illness continuum (Kolcaba, 2001, p.86). Middle Range theory is based on patients' needs, which contributes to the fact that it is a representation of the expectations and aspirations of patients. In this case, the expectations of patients are the things they hope to obtain from nurses mandated to care for them. In essence, the main aspect of Middle range theory is caring, which has been used to develop various middle range theories that are applicable in a variety of settings and issues in the nursing profession and practice.

In comparison to grand nursing theories, Middle Range Theory is based on fewer concepts and relationships, which makes it applicable to a broad range of practice and experience. The concepts of Middle Range Theory differ depending on the specific type of theory that emerges from the intersection between nursing research and practice. Nonetheless, one of the major concepts in the theory is caring, which is influenced by several factors such as motivation, function, experience, cognition, culture, support, and access to care. According to Jaarasma, Riegel & Stromberg (2012), the major concepts of Middle Range Theory include self-care maintenance, self-care evaluation, and self-care management (p.194). In addition, the theory also incorporates the various care practices adopted by nurses towards promoting an individual's health and well-being when dealing with a disease or illness.

The major concepts of the theory are described operationally where self-care is regarded as the basic daily activities that individuals undertake to promote their health and wellness. Self-care is also described as a means of maintaining health by engaging in health promoting practices and developing and using appropriate disease management measures. In this case, the self-care practices are carried out in health and ill conditions. In contrast, self-care maintenance is defined as behaviors conducted to enhance physical and mental stability towards effective management of a disease or illness. While these behaviors may be self-determined and directed, they may also be based on some recommendations that are mutually agreed upon between the patient and caregiver. Self-care monitoring entails activities and procedures utilized to observe any changes in signs and symptoms during disease management. On the contrary, self-care management is described as the patient's response to occurring signs and symptoms relating to the specific disease. Nurses or health care providers play a crucial role in each of these concepts since the procedures and behaviors adopted by the patient may be based on their recommendations and advice.

The concepts of the Middle Range Theory are consistent with the terms used in the theory, especially caring. The concepts relate to the specific practices and processes a patient can utilize to manage a disease or illness. Caring is an important concept in disease management and the Middle Range Theory but entails various procedures and behaviors that are discussed in the other concepts and terms in the theory. Despite the lack or inexistence of a universal conceptualization or definition of caring, the concept relates to various terms in the Middle Range Theory. The other way through which the concepts relate to the other terms in the theory is through the inclusion of personal actions and professional relationships in disease or illness management (Swanson, 1991, p.161). Therefore, the concepts utilized in the theory relates to other terms like caregiving, receiving care, and observing care, which are vital perceptions of the concept and process of caring.

It is increasingly evident that the major concepts in the Middle Range Theory are defined explicitly regardless of the lack or absence of a universal conceptualization or definition of caring as an important concept in nursing practice. The explicit definition of the concepts of Middle Range Theory is evident in the ease of use of these concepts in disease management. Moreover, the concepts are defined in a manner that easily promotes personal actions and facilitate the establishment of professional relationships through which patients, nurses, and other stakeholders can engage in disease management.

Give the difference in Middle Range Theories, these theories utilize inductive, deductive, and retroductive reasoning. The use of these three types of reasoning in Middle Range Theory is attributed to various factors including the absence of a universal definition and conceptualization of caring. Secondly, the applicability of this theory in a variety of issues and settings implies that it can be based on a single type of reasoning. Therefore, the use of inductive, deductive, and retroductive reasoning in Middle Range Theory is dependent on the specific setting and type of issue being addressed using the theory.

Evaluation

There are several implicit and explicit assumptions underlying Nola J. Pender's Health Promotion Model including the belief that a person seeks to actively control his/her behavior and people interact with the environment which contributes to significant transformations ("Health Promotion Model," 2012). The other assumptions in this theory are the belief that self-initiated redevelopment of the interactions between a person and the environment is crucial towards behavior change and the belief that health professionals are part of the interpersonal environment. Moreover, the assumption that engaging in health promoting behaviors is the key to achieving optimal health and well-being is the main value or belief underlying this model.

The theory includes a description of the four metaparadigm concepts of nursing a person is considered as a biopsychosocial organism that is partly shaped by the environment. Therefore, individual characteristics and experiences shape behaviors such as health promotion behaviors. Secondly, the environment is described as the physical, social, and cultural context through life takes place and can be manipulated by a person to create health-promoting behaviors. Third, nursing is regarded as the relationships between people, families, and communities to generate most suitable optimal health and well-being conditions. HPM defines health as the realization of intrinsic and obtained human potential through behaviors directed towards a certain goal.

Given the explicit definitions of major concepts and inclusion of four metaparadigms of nursing, the Health Promotion Model is clear and consistent. The descriptions enable individuals and nursing practitioners to understand the various important health behaviors that promote optimal health and well-being. The clarity and consistency of HPM is evident in the link between its definition of health and well-being and the necessary measures and behaviors towards realizing such health and wellness.