¶ … 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).

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…