Promoting health and preventing disease are two of the core objectives of the nursing practice. To attain them, adequate approaches to the organization and performance of care practices should be implemented, and it is possible to say that Pender’s health promotion model (HPM) can successfully guide practitioners in selecting the right and highly effective methods allowing them to reach the best possible outcomes. According to Heydari and Khorashadizadeh (2014), the HPM is developed by Pender based on the principles of social cognitive theory, and it comprises three types of factors affecting health-related behaviors: individual features, behavior-specific cognitions and emotions, and immediate circumstances influencing behaviors. The model demonstrates how these factors impact individuals’ behaviors and engagement in self-care, in particular. Considering this, the purpose of the present paper is to demonstrate how nurses can choose and design patient care strategies based on the major assumptions of the HPM and how they can implement the main model characteristics in order to perform the roles of educators, healthcare providers, and advocates in a more efficient and effective way.
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Model Characteristics and Their Application to Nursing Roles
|Model Characteristics for the HPM||Application to Your Advanced Practice Role|
|Characteristic 1: Individuals’ inherited and acquired features affect their health-related beliefs and attitudes to health-promoting behaviors (Petiprin, 2016).||Patients are strongly influenced by their social and cultural environments in terms of perceptions of self-care and other health-related practices (Iwelunmor, Newsome, & Airhihenbuwa, 2014). Thus, nurses should strive to evaluate patients’ attitudes to health and barriers to better health outcomes within a socio-cultural context. They must aim to develop their multicultural competence to understand the motivations and values of people from diverse backgrounds better.|
|Characteristic 2: Perceived barriers to compliance with self-care and favorable health outcomes limit one’s commitment to action, while greater perceived self-efficacy increases one’s aspiration to act (Petiprin, 2016).||Various perceived barriers, such as the lack of immediate positive results and unpleasant taste of food during the salt restriction interventions for high blood pressure, decrease individuals’ motivation to follow practitioners’ recommendations (Kamran, Azadbakht, Sharifirad, Mahaki, & Mohebi, 2015). Therefore, nurses should educate patients in a way that empowers and motivates patients. For example, they may conduct one-on-one educational sessions and establish trustful and highly informative dialogues to resolve the problem of perceived barriers, provide patients with needed psycho-emotional support and knowledge, and make them feel more competent on the matters of disease and health (Varming, Hansen, Andrésdóttir, Husted, & Willaing, 2015).|
|Characteristic 3: A person’s motivation and commitment to action increase when they expect to receive significant personally valued benefits from it (Petiprin, 2016).||A significant percentage of people are not motivated and do not show any intention to engage in self-care. For instance, Hardcastle et al. (2015) report that 60% of smokers do not want to quit and 30% of individuals have no interest in exercising. Thus, when dealing with patients who lack motivation, it is essential to help them realize values that they may gain after committing to healthier lifestyles or suggested interventions. It is recommended to implement various motivational interviewing techniques (for instance, shifting focus and emphasizing autonomy) and encourage patients to consciously consider different pros and cons, expectancies and values of different behaviors affecting their health status during communication sessions (Hardcastle et al., 2015).|
|Characteristic 4: Individuals’ behaviors and decisions are often affected by situational factors in their external, physical environments (Petiprin, 2016).||Detrimental environmental factors, including the excess level of pollution, limited access to healthy food options, and the lack of areas for walking and exercising in different neighborhoods, put individuals’ health at risk and reduce their ability to adhere to healthier lifestyles. Thus, nurses should encourage patients to modify their environments and also promote environmental changes at the community and higher levels. To do so, a nurse should embrace their role of a patient advocate: identify and investigate the most important problems in the community environments, gather credible data, and use evidence to arrange disease prevention and promotion campaigns, as well as more substantial social, economic, and healthcare-related changes (Davoodvand, Abbaszadeh, & Ahmadi, 2016).|
|Characteristic 5: Positive emotions associated with a certain behavior or action increase one’s willingness act (Petiprin, 2016).||According to Cohn, Pietrucha, Saslow, Hult, and Moskowitz (2014), positive effect is correlated with a greater likelihood for engagement in physical activity and adherence to healthy eating patterns, as well as lower chances for tobacco use. At the same time, negative affect and depressive moods lead to contrary outcomes. Considering that many patients with chronic conditions have depression and similar physiological problems (Cohn et al., 2014), they may be reluctant to commit to self-care. Thus, a nurse should educate such patients about the importance of positive affect and instruct them on how to implement simple positive affect skill interventions, including savoring and gratitude, in their daily lives, and help them to connect those positive affect skills to relevant self-care practices (Cohn et al., 2014).|
|Characteristic 6: Interpersonal relationships and behaviors of a person’s family members and friends play a significant role in his or her own behavioral choices (Petiprin, 2016).||Considering that individuals are influenced through interpersonal relationships, observation of others’ behaviors, and such relational influences as expectations, encouragement, disapproval, there is a need to engage family members in patient interventions and also strive to promote positive behavioral changes at the community level. To fulfill the first task, nurses can utilize the principles of family-centered care; although it is most commonly applied to pediatric populations, this approach reflects the importance of collaborating with patients’ immediate relatives, involving them in interventions, and providing them with necessary information and other resources needed to support patients in their behavioral changes (Coyne, 2015).|
As the results of the HPM review demonstrate, nurses can implement many of its characteristics and principles in order to improve the quality of care and interactions with patients. Overall, the selected model can be applied primarily to such nursing roles as educator, patient advocate, and care provider. It is suggested that a practicing nurse should aim to learn more about individual features of patients and environmental factors that may affect their health-related beliefs, as well as actual health outcomes. It means that, as a healthcare provider, a practitioner should utilize the patient-centered care approach and strive to develop trustful relationships with individuals. Secondly, a nurse must apply the knowledge about an individual patient to build effective education strategies and motivate them to lead healthier lifestyles and adhere to prescribed interventions. Lastly, as an advocate, a nurse should promote the well-being of individuals and communities by researching existing detrimental environmental factors, developing campaigns and policies targeting those problems. In this way, a practitioner will be able to make a significant contribution to the advancement of the profession and the improvement of patients’ quality of life.
Cohn, M. A., Pietrucha, M. E., Saslow, L. R., Hult, J. R., & Moskowitz, J. T. (2014). An online positive affect skills intervention reduces depression in adults with type 2 diabetes. The Journal of Positive Psychology, 9(6), 523-534.
Coyne I. (2015). Families and health-care professionals’ perspectives and expectations of family-centred care: Hidden expectations and unclear roles. Health Expectations, 18(5), 796-808.
Davoodvand, S., Abbaszadeh, A., & Ahmadi, F. (2016). Patient advocacy from the clinical nurses’ viewpoint: A qualitative study. Journal of Medical Ethics and History of Medicine, 9, 5.
Hardcastle, S. J., Hancox, J., Hattar, A., Maxwell-Smith, C., Thøgersen-Ntoumani, C., & Hagger, M. S. (2015). Motivating the unmotivated: How can health behavior be changed in those unwilling to change? Frontiers in Psychology, 6, 835.
Heydari, A., & Khorashadizadeh, F. (2014). Pender’s health promotion model in medical research. Journal of the Pakistan Medical Association, 64(9), 1067-1074.
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Iwelunmor, J., Newsome, V., & Airhihenbuwa, C. O. (2014). Framing the impact of culture on health: a systematic review of the PEN-3 cultural model and its application in public health research and interventions. Ethnicity & Health, 19(1), 20-46.
Kamran, A., Azadbakht, L., Sharifirad, G., Mahaki, B., & Mohebi, S. (2015). The relationship between blood pressure and the structures of Pender’s health promotion model in rural hypertensive patients. Journal of Education and Health Promotion, 4, 29.
Petiprin, A. (2016). Health promotion model. Web.
Varming, A. R., Hansen, U. M., Andrésdóttir, G., Husted, G. R., & Willaing, I. (2015). Empowerment, motivation, and medical adherence (EMMA): The feasibility of a program for patient-centered consultations to support medication adherence and blood glucose control in adults with type 2 diabetes. Patient Preference and Adherence, 9, 1243-1253.