Download Pender 1 Pender`s Theory Application Paper Heather Proffit

Pender Pender’s Theory Application Paper
Heather Proffit
00865762
Submitted in partial fulfillment of the requirements in the course
Nurs 306: Theoretical Foundations- Profession Nursing Practice
Old Dominion University
NORFOLK, VIRGINIA
Fall, 2013
1 Pender 2 Pender’s Theory Application Paper
The Health Promotion Model, founded by Nola J. Pender, has an “approach-oriented
focus” aimed at promoting health and preventing disease (Alligood & Marriner-Tomey, 2010,
pg. 459). Her theory revolves around the health care provider and their influence on promoting
wellness and change. Her seven assumptions and three concepts outline ways that, as a health
care professional, we can provide quality care as well as promoting wellness and primary
prevention measures.
Health Promotion Model Summary
Pender outlines seven “assumptions” that health care providers should assume about their
patients; these assumptions should be acknowledged as goals and treatment plans are established.
The first assumption concentrates on an individual’s need to “create conditions of living” where
they are able to express themselves and feel safe and comfortable, such as bringing photographs
or blankets from home. Individuals, we must assume, have the “capacity for reflective selfawareness”, or the ability to reflect on their strengths and limitations and determine whether a
task can or cannot be accomplished. People also “value growth” and generally strive to reach
goals and experience success; this can be seen often with patients in recovery where finally being
able to feed themselves after weeks of grueling physical theory is a huge accomplishment.
People also “seek to actively regulate their own behavior” and frequently respond better to active
participation when deciding on goals and treatment plans. Individuals, we must assume, “interact
with the environment, progressively transforming the environment and being transformed over
time”; this interaction allows people to mold their environment around their needs. Pender also
assumes that “health professionals constitute a part of the interpersonal environment, which
exerts influence on persons throughout their lifetimes”; thus shaping their views and expectations
Pender 3 of the health care provider and health care setting. The seventh assumption is that “self-initiated
reconfiguration of personal-environment interactive patterns is essential to behavioral change”;
which focuses on the fact that health promotion and change of behavior must be motivated by the
patient’s want to grow if real change is to occur (Alligood & Marriner-Tomey, 2010, pg. 459).
In addition to the seven assumptions, Pender’s Health Promotion Model also covers three
basic concepts. Pender believes that an individual’s behavior towards health promotion and
education is influenced by certain “Individual characteristics and experiences”. These influences
and experiences are broken down into “Prior related behaviors”, such as a bad experience with a
PIV insertion, and “Personal factors”, which could include biological, psychological, or social
factors that may influence an individual’s outlook on health promotion. “Behavior specific
cognition and affect”, the second concept, focuses on the individual’s ability to see a positive
gain from the behavior modification, despite the work that it will require to accomplish their
goal. Self-efficacy is the belief that they can obtain their goal, which makes starting the behavior
modification less daunting. “Behavioral Outcomes” is the third concept, which concentrates on
the actual plan to obtain the desired goal. Discussed between the nurse and the patient, the plan
must take into consideration life events and the patient’s situation in order to make it obtainable;
this goes back to the first concept that includes their experiences and previous behaviors
(Alligood & Marriner-Tomey, 2010, pg. 459-460).
Benefits vs. Limitations
The health promotion model is one that could easily be applied to many different nursing
fields because the main focus is primary prevention and education, which makes it applicable to
any age or gender. Pender’s model even outlines the health care provider’s role in promoting
health and modifying unhealthy behaviors. The three concepts remind the nurse to take into
Pender 4 consideration the patient’s character and experiences while presenting a modification that the
individual can believe is obtainable; through the plan of action that the patient and nurse devised
together. It is, however, limited in its influence because today’s medical sphere is more
interested in fixing the problem once it had risen, in contrast to promoting health before there is a
problem. Due to this, the Health Promotion Model has not been able to be as influential as it
potentially could be.
Nursing Literature
Dr. Angela Martinelli (1999) focused on the influence different variables can have on
promoting a healthy lifestyle on college smokers and nonsmoker. In her 1999 journal article in
Public Health Nursing, Pender’s Health Promotion Model was used as a guideline for
determining what factors lead to nonsmokers vs. smokers among young college adults
(Martinelli, 1999). The study interviewed men and women through a questionnaire, which asked
questions about demographics, tobacco use, and their participation in health promoting factors,
such as nutrition, stress management and exercise. Pender’s concept proposed that prior
behavior, personal factors, and self-efficacy affect the promotion of health and its outcome. This
study focused on identifying which, between the three, influences the participation of healthy
living the most. Results of the questionnaire found that self-efficacy, the ability to see that the
goal is obtainable, was the most influential factor affecting whether the college students were
nonsmokers, or had quit smoking. These individuals visualize and understand the positive
outcomes that result from a healthy lifestyle and are more likely to participate in health
promoting behaviors. This reiterates the need for health care professionals to include realistic
goals and plans of action that ensures the patients self-efficacy.
The article, “Promoting Participation: Evaluation of a Health Promotion Program for
Pender 5 Low Income Seniors”, focuses on evaluating the Seniors Active Living in Vulnerable Elders
(ALIVE) program’s health promotion ideals over a ten month stretch at a low income elderly
apartment complex (Buijs et al., 2003). Pender’s health promotion model was used as a guideline
to dissect the participating senior’s motivation for health promotion relating to prior behaviors,
such as self-efficacy, and personal factors, like group support. Pender’s concept of prior related
behaviors and self-efficacy proved to be true when analyzing the data regarding the participation
of seniors in the exercise portion of the ALIVE program. Reportedly, 85% of individuals that
attended the exercise classes did so because they knew that they could physically accomplish the
workout regimen before attending the class. In addition, the majority of individuals who attended
the class reported to have been very active when younger, making the task familiar and less
intimidating. Between the exercise classes and education regarding healthy living, the seniors
within the complex reported a success in the promotion of health by concentrating on Pender’s
health promotion model and it’s concepts regarding behavior modification (Buijs et al., 2003).
Clinical Practice Issue
Due to the patient population at the Children’s Hospital of the King’s Daughter’s, the
incidence of unnecessary emergency room visits related to pediatric fevers is astounding. While
there are times where fevers can warrant an emergency room visit, such as with sickle cell
patients, there are plenty of children seen and treated daily in our “minor care” unit that could
have easily been medicated at home, such as a child who is teething or was immunized. This
rampant abuse, often accidental, of the healthcare system is primarily due to the lack of parental
education. The treatment of fevers not only overloads the healthcare system with unnecessary ER
visits, but also exposes children to an environment full of potential illnesses such as RSV and the
flu. Often times children with mild to moderate fevers could have safely been treated at home
Pender 6 with over the counter medications.
After studying Pender’s Health Promotion Model, I feel as though my attitude and
approach to certain situations has shifted from one of exasperation to one centered on the need to
educate parents of a better plan of care. For example, an adequate plan of action would include
teaching them that instead of bringing their child to the emergency room when “they feel warm”
they could buy a thermometer, check the temperature, medicate with appropriate pediatric
antipyretics, and see the pediatrician in the morning. This care plan also hits on a few of
Pender’s assumptions regarding how patients interact with their environment. For instance,
Pender’s assumptions tell me that people have the capacity to gauge whether a particular task is
or is not obtainable for them, and I should mold the plan of care accordingly. Therefore, if a
parent told me that they could not administer liquid Tylenol to their toddler, I would recommend
and curve my teachings to focus on the suppository form instead. In addition, Pender’s model
has made me assume that the parents value growth and indeed want to take an active role in their
child’s care. Due to this assumption, I now always educate parents on treatment options along
with preventative measures for fevers. For example, one of the most common causes of fevers in
children results from a Urinary Tract Infection, which can be prevented with adequate hygiene
and appropriate hydration.
Personal Philosophy
I choose Pender’s Health Promotion Model because I felt that her teachings were most
similar to my own personal philosophy. I believe that adequate primary intervention and
promotion of health could decrease the need for secondary and tertiary intervention tenfold.
Though I think that it is a shame that our health care industry is not more focused on prevention,
I know that as a nurse I have a huge influence on my patient’s plan of care and I try to make it
Pender 7 my mission to educate them as much as possible about how to prevent illness as well as how to
promote wellness. At CHKD, I interact with a lot of young adults and new parents who just need
the resources to make the correct decisions for their child’s care. I believe wholeheartedly in
education and I feel that Pender’s assumptions have shown me what I should be able to expect
from my patients, while her concepts let me know how to structure care plans to make them
successful in health promotion and behavior modification.
Learning
What began as a rough idea of Pender’s model has now became a huge part of my
personal philosophy and practice. While I have always coveted education, I feel that Pender’s
assumptions gave me a guideline of what I can assume my patient wants from their care and I
can structure our relationship around those assumptions. For example, I now just assume that my
patients have previously encountered a healthcare provider; therefore, I now approach these
children with the knowledge that the last time they saw a nurse or doctor might not have been
pleasant and I need to strive even harder to make sure they take away a positive experience.
Overall, I really enjoyed taking a more in-depth look into Pender’s theory and I feel that I have
become a better nurse by incorporating her teachings into my practice.
Reference List
Pender Alligood, M. R., & Tomey, A.M. (2010). Nursing theorists and their work. (7th ed.).
Maryland Heights, MO: Elsevier
Buijs R., Ross-Kerr J., O'Brien Cousins S., Wilson D., (2003). Promoting
Participation: Evaluation of a Health Promotion Program for Low Income
Seniors. Journal Of Community Health Nursing, 20 (2):93-107.
Martinelli, A. (1999). An Explanatory Model of Variables Influencing Health
Promotion Behaviors in Smoking and Nonsmoking College Students. Public Health
Nursing August, 16 (4):263-269.
Honor Code:
8 Pender 9 I pledge to support the Honor System of Old Dominion University. I will refrain from any form of academic dishonesty or deception, such as cheating or plagiarism. I am aware that as a member of the academic community it is my responsibility to turn in all suspected violations of the Honor Code. I will report to a hearing if summoned. Name: Heather Proffit