Thursday, July 17, 2008

Health Promotion Model: Heuristic Device for Health Care Professionals

Ourselves, our body, our health….. enhancing self usage towards prevention of illnesses & promoting well-being.

Nora J. Pender developed the Health Promotion Model that is proposed as a holistic predictive model of health-promoting behavior for use in research and practice. She is Professor Emeritus in the School of Nursing at the University of Michigan, and an advocate of health promotion.

“I committed myself to the proactive stance of health promotion and disease prevention with the conviction that it is much better to experience exuberant well-being and prevent disease than let disease happen when it is avoidable and then try and cope with it.”
Nola J. Pender, PhD, RN, FAAN

Health Promotion Model has given health care a new direction. According to her, Health Promotion and Disease Prevention should be the primary focus in health care, and when health promotion and prevention fail to prevent problems, and then care in illness becomes the next priority. She defined 2 concepts: health promotion & health protection.

Health promotion is defined as behavior motivated by the desire to increase well-being and actualize human health potential. It is an approach to wellness. On the other hand, health protection or illness prevention is described as behavior motivated desire to actively avoid illness, detect it early, or maintain functioning within the constraints of illness. (Kozier, 2004)

Figure 1 – Health Promotion Model

This model (Figure 1) is moving towards understanding multi-faceted nature of persons correlating with their interpersonal nature and interacting with their interpersonal & physical environments as they trail towards health.
Because of the model, nurses have already advanced their health approaches, addressing not only the curative side, but as well as prevention of diseases & promotion of well-being. Application of this theory is varied and substantive on its own.


Nursing Practice

“We are moving toward an era of science-based practice in nursing that incorporates the latest findings from the behavioral and biological sciences into practice to assist people of varying cultural backgrounds to adopt healthy lifestyles.” – Pender

As what they say, prevention is better than cure. Thus, health promotion is valued much. But how? Question seems hard…hard as if you don’t know how to solve the problems of the world…But how, again? If super heroes could save life using their super powers, we nurses could do more by using our caring touch, and therapeutic talks. Health teachings are always part of nurses’ experience in the workplace. Despite of various clinical & community health care settings, we nurses are always interacting with our patient/client.

Community health care setting is the best avenue in promoting health & preventing illnesses. Using Pender’s Health Promotion Model, community program may be focused on activities that can improve the well-being of the people. Health promotion and disease prevention can more easily be carried out in the community, as compared to programs that aim to cure disease conditions. This is because the people in the rural area tend to veer away from modern medical methods. Most of them, due to financial reasons, choose to avail of the services offered by “herbolarios” and other folk healers. In our local setting, promoting health to our fellow Filipinos is very crucial. Though, there are campaigns provided by our government’s health agency, which is the Department of Health (DOH), there’s still a big percentage in the population who live unhealthily and many are suffering from different type of diseases.

Nurses, though are scattered in different fields, have common primary concern: to promote health to every individual. The following are just examples of methods on how to promote health to our fellows.

Insight from an Academe nurse teaching CHN… A group of students taught the families the value of eating a balanced diet. They introduced the concept of including the different food groups in all their meals. They also stressed the benefits and advantages of the various vitamins and minerals found in those food. Another group encouraged the community to practice lifestyle modification. They discussed the disadvantages of vices such as smoking and drinking alcoholic beverages. For disease prevention and health protection, one group tried to inculcate the importance of early detection of illnesses. They taught the women the proper way and timing of self-breast examination. The mothers were also encouraged to avail of the vaccination services offered by the nearby health center. These programs proved to be very beneficial to the community. Because one can truly build a healthier tomorrow through good community health practice.

Insight from an ICU nurse… Although most patients admitted in the ICU are experiencing health problems, Health Promotion Model may still be applied in one way or another. This is projected towards improving health condition and prevention of further debilitating conditions. Diet modifications and performing passive & active range of motion exercises are examples of its application.

Nursing Education

“I believe that the future will be very bright and productive for nurses who direct their careers toward understanding disease prevention and health promotion processes.” – Pender

Nurses are expected to be adaptive. Indeed, changes are always constant. In health care settings, patients come & go. Meet & greet. Recover or expire. As this theory advocated, we should not allow our patients to experience severe conditions if we could only prevent them from encountering such. We are expected to know, if not in depth, the disease processes. Because of this know-how, we could apply health promotion and worsening prevention before the hands of the clock stop moving.

Percentage of nurses is geared towards continuing professional education. Attending seminars & conventions. Enrolling to masteral & doctoral classes. All are goaled towards becoming competent nurses. Nursing education is not a one-phase process. It does not end after passing the licensing exam. It is continuous. Unending. Ever changing. We must be abreast with new technologies, new approaches, and new techniques. Because of this theory, we nurses could address more the needs and problems of the client before it progresses to exacerbation. This model could be a basis for structuring nursing protocols and interventions.

Nursing Research

“I was committed to health promotion and encouraged other scholars to move in that direction long before health promotion and risk reduction became popular.” - Pender

Research help Health Care provider to develop a systematic problem-solving approach to improve and develop strategies to promote good health to individuals. Through research we will be able to clarify and verify the phenomenon.

Evidenced-based practice is fast emerging because of its factual and substantive results. These researches yield fruitful outcome that of great help in addressing arising problems and in setting nursing protocols. Much more research must be done to tailor interventions to individuals rather than to group stereotypes.

If we could remember, common research topics in our nursing college days are health promotion techniques and disease prevention. To name a few, some geared their research on effectiveness of Expanded Program on Immunization, others on health practices of mothers and families, some on efficiency of early detection of common illnesses. These are all but few of the model’s application to research.

Of all the theories presented in the module, Health Promotion Model is the easiest of them, yet substantive & useful. In our day-to-day experiences as nurses, we are always promoting health, preventing illnesses, and upholding well-being. We are seen by the public as health advocates. We have knowledge on health & illnesses, thus, we are expected to share this to laymen and contribute to their well-being. As what Pender said, “We cannot continue to let people become ill when we have the means to keep many people well--particularly when problems are environmentally and behaviorally induced”. Thus, the theory of Pender on Health Promotion is indeed a great to advocate to prolong and preserve life. This theory really manifests the noble work of a NURSE. Remember, nurses we are LOVE SERVES.


N207 Students said...


AƱonuevo, C., Abaquin, C., Balabagno, A., Corcega, T., Dones, L., Kuan, L., et. al. (2000). Theoretical Foundation of Nursing. Philippines: UP Open University

Kozier, B., Erb, G., Berman, A., Snyder, S. (2004). Fundamentals of Nursing: Concepts, Process, and Practice. 7th Edition. Philippines: Pearson Education South Asia Pte Ltd

University of Michigan School of Nursing (2006). Nora J. Pender Site. Retrieved July 16, 2008 from

Thank you guys for the untiring cooperation.





N207 Students said...


PURPOSE AND MAJOR CONCEPTS:The HPM was proposed as a framework for integrating nursing and behavioral science perspectives on factors that influence health behaviors. The model is to be used as guide to explore the biophysical processes that motivate individuals to engage in behaviors directed toward health enhancement(PENDER, 1996). The model has been used extensively as a framework for research aimed at predicting health promoting lifestyles as well as specific behaviors.

Major concepts of the HPM are individual characteristics and experiences (prior related behavior and personal factors), behavior - specific cognitions and affect (perceived benefits of action, perceived self efficacy, activity related affect, interpersonal influences, and situational influences), and behavioral outcomes (commitment to a plan of action, immediate competing demands and preferences and health promoting behavior).

Health promotion services are essential for improving the health of populations everywhere. It is noted that people of all ages can benefit from the health promotion care, which should be delivered at sites where people spend much of their time (eg schools and workplaces). Nurses can develop and execute health promoting interventions to individuals, groups, and families in schools, nursing centers, occupational health settings and the community at large. Nurses should work toward empowerment for self care and enhancing the client's capacity for self care through education and development.

REFERENCE:Wills and McEwen(2007). Theoretical Basis for Nursing. 2nd Edition. Philadelphia: Lippincott Williams and Wilkins.

mayang said...

nice post... I am also an advocate of Pender's theory.

great job!

Valerie Wada said...

I appreciate Pender's theory. I have utilized it first as a Public Health Nurse and have found it useful throughout my nursing career thusfar. Valerie Wada, RN

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jerry john said...

Nora J. Pender developed the Health Promotion Model that is proposed as a holistic predictive model of health-promoting behavior for use in research and practice. She is Professor Emeritus in the School of Nursing at the University of Michigan, and an advocate of health promotion. James

aliena josph said...

The health promotion model (HPM) proposed by Nola J Pender (1982; revised, 1996) was designed to be a “complementary counterpart to models of health protection.” It defines health as a positive dynamic state not merely the absence of disease.

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