Health Promotion Model vs. Middle Range Theory in Nursing

Introduction to Nursing Theories

The nursing field comprises different theories used to govern nursing practice by offering varied perspectives and views of phenomena. A theory can be defined as the development of a link between concepts that creates a certain view of a phenomenon (Jackson, n.d.). Theories in the nursing field focus on issues 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 toward improving nursing practice.

Nursing theories are classified into different categories: grand nursing theories, nursing practice theories, and mid-range nursing theories. Examples of these various types include Nola J. Pender's Health Promotion Model (HPM) and Middle Range Theory. These theories differ in terms of the theorists' backgrounds and experiences, description of the theory, underlying assumptions, and application in nursing practice.

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 understand the main determinants of health behaviors—key for behavioral counseling aimed at enhancing healthy 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 research application, given that they address one of the most significant expectations for nurses in the modern health sector. Middle Range theories generally occupy a position between working hypotheses emerging from daily research and the broader systemic initiatives to create unified theories. In essence, mid-range theory in nursing addresses the scientific underpinnings that govern nursing research and practice.

Theorist Backgrounds and Origins

Dr. Nola J. Pender developed the Health Promotion Model drawing on her scholarly expertise and activity in various aspects of nursing practice, including 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 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 focused on health promotion behaviors, testing the Health Promotion Model with both adolescents and adults. She has worked as a nurse educator for more than 40 years, teaching and mentoring baccalaureate, master's, and doctoral students, and is a Distinguished Professor at Loyola University School of Nursing in Chicago.

The greatest influence contributing to the development of this theory was Dr. Pender's deep conviction that it is far better to pursue exuberant health and wellness and prevent illness than to allow disease to occur. As a result, she adopted a proactive stance toward disease prevention through health promotion. Through the theory, Dr. Pender specifically focuses on promoting health and well-being in order to prevent disease rather than waiting for illness to occur—especially when it is avoidable—and then attempting to cope with it.

This theory therefore postulates that health and well-being extend beyond the mere absence of disease or illness and incorporate activities that focus on wellness. The theory suggests that good health entails an overall, holistic state of wellness, personal health initiatives, and a balanced, fulfilling lifestyle ("Nola Pender Health Promotion Model," n.d.). The phenomenon addressed by the Health Promotion Model is the process through which an individual can pursue improved or optimal health. Consequently, the theory considers personal characteristics and experiences, specific behavior cognitions, and the impact and behavioral outcomes of a person.

The major experience driving the development of mid-range theories is the need to translate nursing research into daily practice toward patient care and improved health outcomes. Additional factors include the need to move beyond descriptive studies to test links between nursing care and desired patient outcomes in large populations, and the need to create scientific evidence confirming the effect of nursing on patient outcomes. Moreover, mid-range theories were developed to conceptualize the productivity of nursing practice on patient outcomes and to support visionary, relevant policy formulation (Kolcaba, 2001, p. 86).

The central concern addressed by these theories is the challenges of the 21st century in the nursing profession and practice. As a result, the theories are composed of fewer concepts and relationships, making them applicable across a broad range of practice settings and experiences. They are also easy to build from a variety of sources and robust enough to be tested in nursing practice. The theories address 21st-century nursing issues by directing relevant research questions and promoting significant, positive outcomes through the coherence brought by working within a theoretical framework.

Theory Description: Health Promotion Model

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 goals they regard as achievable and that contribute to valued outcomes. Through Social Cognitive Theory, the model suggests that there are interactions among thoughts, behaviors, and the environment. For a person to change his or her lifestyle, he or she must first change his or her ways of thinking. This implies that health promotion and disease prevention are by-products of the interactions among thoughts, behaviors, and the environment.

There are three major components of Pender's Health Promotion Model: individual characteristics and experience, previous related behavior, and the frequency of similar behavior in the past. The model classifies personal factors—or individual characteristics and experience—as biological, sociocultural, and psychological aspects ("Health Promotion Model," 2012). The consideration of personal factors is based on the fact that they are predictive of certain behaviors and are influenced by the nature of the targeted behavior. The perceived benefit of action in relation to individual characteristics and experience refers to the 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 regard to developing a planned strategy that contributes to the reinforcement of health behavior. The goal of health-promoting behavior is to achieve a positive health outcome such as 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 particularly to health promotion behavior and disease prevention. Moreover, the concepts are explicitly defined and can be understood by any individual seeking to develop and maintain health promotion behavior. The author explicitly defines the concepts of the Health Promotion Model by providing specific steps that can be used to promote healthy behaviors and well-being. The major concepts of the theory are therefore defined operationally because of the ease of applicability by any individual toward promoting health and preventing disease. In addition to the explicit definition of the major concepts, the author includes a comprehensive list of propositions that relate to these concepts. These theoretical propositions, which form the basis of the Health Promotion Model, are strongly linked to each of the three major components 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 assumed to generate empirical phenomena. The use of retroductive reasoning 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 simple observations or generalizations but rather on the identification of real structures and mechanisms oriented toward health promotion and disease prevention.