Health Promotion in Theory and Practice (Essay Sample)

Health Promotion in Theory and Practice
Name of Student
Institution of Learning
Abstract
The prevention and management of chronic disease is an irrefutable priority in the United States making health promotion a major focus.The components of the nursing metaparadigm view the client holistically and account for their perspective regarding person, environment, health, and nurse. Utilizing select nursing theories allows the practitioner to frame these concepts and apply interventions that conform to the unique perspective of each client. Nola Pender’s Health Promotion Model (HPM) is a middle-range predictive nursing theory that may be utilized to care for clients in a holistic manner and promote healthy behaviors. However, applying this theory in the prevention and management of diabetes requires the application of best evidence to produce favorable outcomes. This paper describes the personal metaparadigm of the author as well as the perspective of Nola Pender. It also describes the clinical implications of the HPMand its application to the issue of diabetes prevention. Research is presented to support the recommendation of lifestyle modification and weight loss as primary preventative measures of type 2 diabetes mellitus(T2DM)and its relationship to the nursing metaparadigm.
Health Promotion in Theory and Practice
Since the mid twentieth century pioneers in nursing science have sought to encompass our multifaceted experiences within theories to better explain and predict health outcomes. The emphasis in nursing concept development and situational theories has driven evidenced-based research to expound on and improve current theories (Im& Chang, 2012). A major focus in healthcare is the prevention and management of chronic disease. Due to the complications and costs associated with chronic conditions, it is imperative to address the underlying modifiable risk factors associated with their onset and utilize evidenced-based interventions to minimize their impact.
The primary prevention and management of diabetes is of significant concern considering in 2005 diabetes complications accounted for 10% of the overall cost of healthcare in the U.S. (Madden, Loeb, & Smith, 2008).The purpose of this work is to expound on a personal metaparadigm that explores the virtues of Nola Pender’s HPM using evidence-based guidelines in the management of T2DM, and to outline the implications for advance practice nurses utilizing this framework.
Personal Metaparadigm
The nursing metaparadigm incorporates the concepts of person, environment, health, and nursing (Alligood, 2014). These concepts are independently significant, yet are interlaced to form a model of the nursing discipline. Considering the unique interpretation of each concept, the utilization of a particular nursing theory is contingent upon the worldview of the participant.
The concept of person is multidimensional and incorporates socioeconomic, cultural, biological, and psychological variances. Life experiences mold a person’s ability to overcome challenges as well as their ability to foresee the consequences of present behaviors. Each person holds a unique view of the world due to the overwhelming nuances that have crafted their personality and perceptions.
The link between a person and their environment can have a significant influence on their health. Access to nutritious foods, exposure to health hazards, and risky personal behaviors are discernible observations in a clinical setting. Impacts that are less readily apparent include living situations, cultural/societal norms, and social support systems.
The concept of health is considered a state of mind and may exist despite the presence of chronic illness or disease. Health is gauged on a continuum where periods of sickness can destabilize one’s ability to maintain homeostasis. Hence, in times of crisis, emphasis is placed on the disease process. However, the health status of a person can rise during a crisis as their behaviors change, creating marked improvements in their overall feeling of well-being. Health care deficits may either be exacerbated or aided by elements of the other components.
Nurses play an important role in facilitating patients’ ability to recognize and achieve a balance in life. To support the client in this endeavor the nurse should identify what is valuable to the client in the short-term while assisting the client in developing long-term goals. Empowering the client with knowledge and delivering nurse-specific interventions involves collaboration and introspection.
Nola J. Pender’s Health Promotion Model
The HPM is a middle-range predictive nursing theory proposed by Nola J. Pender in 1982 in an attempt to explain how people perceive their health and how personal background and environmental forces direct personal action; ultimately, its function is to predict the potential for positive health behaviors for an individual or group (Sakraida, 2014). Health promotion is ubiquitous in nursing; therefore, this model is applicable in a broad sense. However, it can be applied at an individual level while accounting for unique socio-cultural experiences to explain the phenomenon of health-promoting behavior (Kearney-Nunnery, 2008). Pender revised this model last in 2006 to further improve its usefulness in developing health-promoting nursing interventions (McCullagh, 2013). The revisions emphasized the role that expectations have in predicting the efficacy of nursing interventions and in improving the health status of clients (Ho, Berggren &Dahlborg-Lyckhage, 2010).
The HPM divides its major propositions into three main categories: individual characteristics and experiences, behavior-specific cognitions and affect, and behavioral outcomes (Kazer& Fitzpatrick, 2012). Major determinants are further categorized within these propositions to predict a health-promoting behavior. Behavior-specific cognitions are identified as perceived benefits of action, perceived barriers to action, perceived self-efficacy, activity-related affect, interpersonal influences, and situational influences (Sakraida, 2014). A person’s commitment to a plan of action, as well as competing demands and preferences are further gauged to predict an outcome (McCullagh, 2013).
McCullagh (2013) asserts that the core of the HPM is based on theories of human behavior, which analyze the dynamics of personal motivation; most influential are the social-cognitive theory (SCT) and expectancy-value theory (EVT). Barriers to action are amendable to nursing actions but highly dependent on the readiness to act by the patient (Stark, Chase, &DeYoung, 2010). Whether actual or perceived, barriers to action may include “time, inconvenience, difficulty of the behavior, and expenses as well as personal costs” (Stark et al., 2010, p. 176). Attentional demands such as the ability to multitask and process an overabundance of new information, as well as affective demands, which encompass emotional reactions to stress, loneliness, and loss must be considered as these may limit health-promoting behaviors, especially in elderly populations (Stark et al., 2010). According to McGuire & Anderson (2012), perceived barriers were identified as the most dominant factor affecting health-promoting behaviors.
Major assumptions of this theory focus on elements of Pender’s metaparadigm which describes the person as a holistic being who seeks to realize an optimal state of self-actualization with the use of innate and existential attributes to adapt to his environment and achieve balance (Sakraida, 2014). These transient cues guide a person toward a state of well-being along a continuum via the path of least resistance (Wood, 2008). Although the person is viewed as an independent self-regulator, the healthcare provider is influential in provoking lifestyle change by role-modeling and providing insight (Sakraida, 2014). Wood (2008) asserts that the HPM is driven by the client’s perception of efficacy; whether the behavior will produce a result that is desirable is dependent on the effort made and the level of difficulty required. Additionally, increasing the perceived benefits of action is positively correlated with health-promotion (Shu-Fen & Chiu-Chu, 2010).
Pender’s concept of the person is a sum of past experiences and categories of personal attributes including biological, psychological, and socio-cultural influences (Sakraida, 2014). More specifically, Pender seeks the most comprehensive and optimistic view of the person and defines his health status as a delicate state of balance between each person and his or her environment (McCullagh, 2013). The person strives for growth and adaptability in his or her environment. The environment in Pender’s work is defined as interpersonal and situational influences, rather than static forces.
Pender’s model views health as a state of being that varies in levels along a continuum, which is affected by both internal and external modifiers (Wood, 2008). “Pender defines health as the actualization of inherent and acquired human potential through goal-directed behavior, competent self-care, and satisfying relationships with others . . . to maintain structural integrity and harmony” (McCullagh, 2013, p. 226).
In Pender’s model the nurse plays a primary role in providing complete and accurate information to the client to promote self-efficacy, which is made more effective when the practitioner’s perceived confidence in his or her own skills/knowledge is elevated (Torrens & Swan, 2009). The ultimate goal of nurses is to help people care for themselves.
Clinical Issue
In the U.S., the economic cost to manage diabetes has risen 32% from 2002 to 2007 and this growing trend is predi...