Nola Pender Theory Health Promotion: Background, Theoretical

Nola Pender theory Health promotion: background, Theoretical assertions propositions, concepts, Relevant nursing practice.

Nola Pender's health promotion model

Nola Pender's health promotion model

Nola Pender's model of health promotion was intended to address what Pender saw as a deficit in existing nursing theories, namely the failure to promote wellness as well as cure sickness. The Pender model defines health as a positive and dynamic state, not merely the absence of disease. Pender identifies her rubric as a model, rather than a meta-theory, and states that it is complementary to a variety of nursing disciplines and perspectives. "The model focuses on following three areas: individual characteristics and experiences; behavior-specific cognitions and affect; behavioral outcomes" (Health promotion model, 2011, Nursing Theories). Health may mean different things for different people at different life stages. 'Health' for a young, athletic adolescent may be defined in a different manner than for someone at the end of their life. "Health promoting behaviors should result in improved health, enhanced functional ability and better quality of life at all stages of development" (Health promotion model, 2011, Nursing Theories).

Theoretical assertions and propositions

Pender's model assumes a constant state of interaction between the complex psychology of the individual and the external environment. It is assumed that individuals have a responsibility and a desire to regulate and govern their own health-related behaviors and can promote their own wellness. However, the theory also allows for the fact that individuals possess "biopsychosocial complexity" which may affect their ability to sustain their state of health (Health promotion model, 2011, Nursing Theories). Biopsychosocial complexity also allows individuals to change their environment. Even a family with, for example a genetic predisposition to develop heart disease can seek to change that environment in a health-promoting fashion by altering their diet and embarking upon lifestyle changes. Individuals are changed by the environment (as can be seen in the dramatic increase in weight amongst a large percentage Americans, because of changes in the food system, infrastructure and lifestyle) but patients can also change the environment. By progressively transforming their environment they transform themselves over time. Getting a gym membership, buying healthy food, throwing away all cigarettes in the home, are simple examples of proactive steps the individual can take to improve health, even if there may be a family history of heart disease, diabetes or certain cancers.

Another assumption of the model which is critical in terms of its conception of 'nursing' is that "health professionals constitute a part of the interpersonal environment, which exerts influence on persons throughout their life span" (Health promotion model, 2011, Nursing Theories). But the health professional is always a facilitator, more than the primary initiator of the change, according to Pender. "Self-initiated reconfiguration of person-environment interactive patterns is essential to behavior change" (Health promotion model, 2011, Nursing Theories). Being told, for example, that it is necessary to eat fewer calories and move more to weigh less is not enough, there must be a motivational desire on the part of the individual to enjoy the benefits and changes that will result.

The health professional can encourage the individual to perceive the benefits gained from health changes and overcome perceived barriers. For example, if a person says: "I can't lose weight and improve my health because I have no time and no money to buy healthy food," the nurse can change that perception by showing the individual how to create household budget and personal schedule for healthy food, healthy cooking, and exercise. The nurse strives to create positive emotions through health-promoting behaviors, through praise, suggestions that make the healthy behaviors palatable (like listing healthy foods complementary with the individual's culture) and also encouraging significant others to model the patient's behavior in a health-promoting manner.

When an individual is trying to quit smoking, to 'treat' and improve the general environment and facilitate self-efficacy, the nurse might suggest that both the patient and his or her significant other quit smoking, rather than focus on the patient in isolation. If the patient works in a place where smoking is very common, helping him or her find alternative ways of enjoying break times and dealing with pressure to smoke should be part of the patient's treatment plan. "Families, peers, and health care providers are important sources of interpersonal influence that can increase or decrease commitment to and engagement in health-promoting behavior….Situational influences in the external environment can increase or decrease commitment to or participation in health-promoting behavior" (Health promotion model, 2011, Nursing Theories).

Concepts

The major concepts of the model revolve around "individual characteristics and experience" which are intimately connected to "prior related behavior" (Health promotion model, 2011, Nursing Theories). Individual characteristics determine negative and positive behavior patterns but behavior and environment also shapes an individual's character. An individual raised in an environment where physical activity is very important is more apt to engage in exercise. The "frequency of the similar behavior in the past" due to personal and environmental characteristics can facilitate health-promotional activities in the future (Health promotion model, 2011, Nursing Theories). In other words, even if someone is not 'born into' a health-promoting environment, the Pender model views health behavior as dynamic, and open to change. The more frequently one engages in positive as well as negative behaviors, the greater the chances of permanent changes. By making a commitment to run every day for a year, for example, a person is more apt to become a 'runner for life,' just like negative behaviors can be habit-forming.