Theoretical Foundations in Nursing

Sunday, September 23, 2012

Imogene King

Goal Attainment Theory

Theory of goal attainment was first introduced by Imogene King in the early 1960’s.
Theory describes a dynamic, interpersonal relationship in which a person grows and develops to attain certain life goals.
Factors which affect the attainment of goal are: roles, stress, space & time

From the theory of goal attainment king developed predictive propositions, which includes:

If perceptual interaction accuracy is present in nurse-client interactions, transaction will occur
If nurse and client make transaction, goal will be attained
If goal are attained, satisfaction will occur
If transactions are made in nurse-client interactions, growth & development will be enhanced
If role expectations and role performance as perceived by nurse & client are congruent, transaction will occur
If role conflict is experienced by nurse or client or both, stress in nurse-client interaction will occur
If nurse with special knowledge skill communicate appropriate information to client, mutual goal setting and goal attainment will occur.

Many people believe King's theory of goal attainment to be a productive and empowering way for nurses and patients to interact. There has been some discussion about how well the theory applies across all groups of patients, as it is necessary for the patient to be able to interact with the nurse to develop and agree on goals, and on ways to work toward those goals. Others contend that King's theory can be applied to all groups because a large portion of communication involves nonverbal behavior, so being able to communicate through spoken language is not a prerequisite for transactions to occur.

Goal Attainment Theory Conceptual Framework

It includes:

Several basic assumptions
Three interacting systems
Several concepts relevant for each system

Basic assumptions

Nursing focus is the care of human being.
Nursing goal is the health care of individuals & groups.
Human beings: are open systems interacting constantly with their environment.
Interacting systems: Personal system, Interpersonal system, Social system
Concepts are given for each system:

Concepts for Personal System: Perception, Self, Growth & development, Body image, Space, Time
Concepts for Interpersonal System: Interaction, Communication, Transaction, Role, Stress
Concepts for Social System: Organization, Authority, Power, Status, Decision making

The theory of goal attainment, which lies at the heart of King's theory of nursing, exists in the context of her conceptual framework. The essence of goal attainment theory is that the nurse and the patient work together to define and reach goals that they set together. The patient and nurse each perceive, judge, and act, and together the patient and nurse react to each other and interact with each other. At the end of this process of communication and perceiving, if a goal has been set a transaction is said to have occurred. The nurse and patient also decide on a way to work toward the goal that has been decided upon, and put into action the plan that has been agreed upon. King believes that the main function of nursing is to increase or to restore the health of the patient, so then, transactions should occur to set goals related to the health of the patient. After transactions have occurred and goals have been defined by the nurse and patient together, both parties work toward the stated goals. This may involve interactions with other systems, such as other healthcare workers, the patient's family, or larger systems.

After the transaction has occurred, and the goal has been set, King believes that it is important for good documentation to be practiced by the nurse. She believes that documenting the goal can help to streamline the process of goal attainment, making it easier for nurses to communicate with each other and other healthcare workers involved in the process. It also helps to provide a way to determine if the goal is achieved. This assessment of whether or not the goal has been successfully achieved plays an important end stage in King's goal attainment theory.

Betty Neuman

Systems Model

"Health is a condition in which all parts and subparts are in harmony

with the whole of the client.”

KEY CONCEPTS

Viewed the client as an open system consisting of a basic structure or central core of energy resources which represent concentric circles
Each concentric circle or layer is made up of the five variable areas which are considered and occur simultaneously in each client concentric circles. These are:

Physiological - refers of bodily structure and function.
Psychological - refers to mental processes, functioning and emotions.
Sociocultural - refers to relationships; and social/cultural functions and activities.
Spiritual - refers to the influence of spiritual beliefs.
Developmental - refers to life’s developmental processes.

Basic Structure Energy Resources

This is otherwise known as the central core, which is made up of the basic survival factors common to all organisms. These include the following:

Normal temperature range – body temperature regulation ability
Genetic structure – Hair color and bodily features
Response pattern – functioning of body systems homeostatically
Organ strength or weakness
Ego structure
Knowns or commonalities – value system

The person's system is an open system - dynamic and constantly changing and evolving
Stability, or homeostasis, occurs when the amount of energy that is available exceeds that being used by the system.
A homeostatic body system is constantly in a dynamic process of input, output, feedback, and compensation, which leads to a state of balance

Flexible Lines of Defense

Is the outer boundary to the normal line of defense, the line of resistance, and the core structure.
Keeps the system free from stressors and is dependent on the amount of sleep, nutritional status, as well as the quality and quantity of stress an individual experiences.
If the flexible line of defense fails to provide adequate protection to the normal line of defense, the lines of resistance become activated.

Normal Line of Defense

Represents client’s usual wellness level.
Can change over time in response to coping or responding to the environment, which includes intelligence, attitudes, problem solving and coping abilities. Example is skin which is constantly smooth and fair will eventually form callous over times.

Lines of Resistance

the last boundary that protects the basic structure
Protect the basic structure and become activated when environmental stressors invade the normal line of defense. An example would is that when a certain bacteria enters our system, there is an increase in leukocyte count to combat infection.
If the lines of resistance are effective, the system can reconstitute and if the lines of resistance are not effective, the resulting energy loss can result in death.

Stressors

Are capable of producing either a positive or negative effect on the client system.
Is any environmental force which can potentially affect the stability of the system:

Intrapersonal - occur within person, example is infection, thoughts and feelings
Interpersonal - occur between individuals, e.g. role expectations
Extrapersonal - occur outside the individual, e.g. job or finance concerns

A person’s reaction to stressors depends on the strength of the lines of defense.
When the lines of defense fails, the resulting reaction depends on the strength of the lines of resistance.
As part of the reaction, a person’s system can adapt to a stressor, an effect known as reconstitution.

Reconstitution

Is the increase in energy that occurs in relation to the degree of reaction to the stressor which starts after initiation of treatment for invasion of stressors.
May expand the normal line of defense beyond its previous level, stabilize the system at a lower level, or return it to the level that existed before the illness.
Nursing interventions focus on retaining or maintaining system stability.
By means of primary, secondary and tertiary interventions, the person (or the nurse) attempts to restore or maintain the stability of the system.

Prevention

Is the primary nursing intervention.
Focuses on keeping stressors and the stress response from having a detrimental effect on the body.

Primary prevention focuses on protecting the normal line of defense and strengthening the flexible line of defense. This occur before the system reacts to a stressor and strengthens the person (primarily the flexible line of defense) to enable him to better deal with stressors and also manipulates the environment to reduce or weaken stressors. Includes health promotion and maintenance of wellness.
Secondary prevention focuses on strengthening internal lines of resistance, reducing the reaction of the stressor and increasing resistance factors in order to prevent damage to the central core. This occurs after the system reacts to a stressor. This includes appropriate treatment of symptoms to attain optimal client system stability and energy conservation.
Tertiary prevention focuses on readaptation and stability, and protects reconstitution or return to wellness after treatment. This occurs after the system has been treated through secondary prevention strategies. Tertiary prevention offers support to the client and attempts to add energy to the system or reduce energy needed in order to facilitate reconstitution.

Ida Jean Orlando

Dynamic Nurse-Patient Relationship

"I can't move, I can't speak, I need help..."

An origami design is used to express Orlando-Pelletier’s Nursing Theory. The three large folds represents the three steps or processes of patient behavior, nurse reaction, and nurse action.

Subsequent smaller folds would include the assumptions associated with the theory. The finished object might resemble a silhouette of two people connected to one another, alluding to the ongoing nurse and client interaction required for deliberative care to effectively take place.

The focus of Orlando’s paradigm hubs the context of a dynamic nurse-patient phenomenon constructively realized through highlighting the key concepts such as : Patient Behavior, Nurse Reaction , Nurse Action.

1. The nursing process is set in motion by the Patient Behavior. All patient behavior, verbal ( a patient’s use of language ) or non-verbal ( includes physiological symptoms, motor activity, and nonverbal communication) , no matter how insignificant, must be considered an expression of a need for help and needs to be validated . If a patient’s behavior does not effectively assessed by the nurse then a major problem in giving care would rise leading to a nurse-patient relationship failure. Overtime . the more it is difficult to establish rapport to the patient once behavior is not determined. Communicating effectively is vital to achieve patient’s cooperation in achieving health.

Remember : When a patient has a need for help that cannot be resolved without the help of another, helplessness results.

2. The Patient behavior stimulates a Nurse Reaction. In this part, the beginning of the nurse-patient relationship takes place. It is important to correctly evaluate the behavior of the patient using the nurse reactions steps to achieve positive feedback response from the patient. The steps are as follows:

The nurse perceives behavior through any of the senses -> The perception leads to automatic thought -> The thought produces an automatic feeling ->The nurse shares reactions with the patient to ascertain whether perceptions are accurate or inaccurate -> The nurse consciously deliberates about personal reactions and patient input in order to produce professional deliberative actions based on mindful assessment rather than automatic reactions.

Remember : Exploration with the patient helps validate the patient’s behavior.

3. Critically considering one or two ways in implementing Nurse Action. When providing care, nursing action can be done either automatic or deliberative.

Automatic reactions stem from nursing behaviors that are performed to satisfy a directive other than the patient’s need for help.

For example, the nurse who gives a sleeping pill to a patient every evening because it is ordered by the physician, without first discussing the need for the medication with the patient, is engaging in automatic, non-deliberative behavior. This is because the reason for giving the pill has more to do with following medical orders (automatically) than with the patient’s immediate expressed need for help.

Deliberative reaction is a “disciplined professional response” It can be argued that all nursing actions are meant to help the client and should be considered deliberative. However, correct identification of actions from the nurse’s assessment should be determined to achieve reciprocal help between nurse and patient’s health. The following criterias should be considered.

Deliberative actions result from the correct identification of patient needs by validation of the nurses’s reaction to patient behavior.
The nurse explores the meaning of the action with the patient and its relevance to meeting his need.
The nurse validates the action’s effectiveness immediately after compelling it.
The nurse is free of stimuli unrelated to the patient’s need (when action is taken).

Remember : for an action to have been truly deliberative, it must undergo reflective evaluation to determine if the action helped the client by addressing the need as determined by the nurse and the client in the immediate situation.

DULCIUS EX ASPERIS

(sweetness after difficulties)

‘Use the word nursing for want of a better. It has been limited to signify little more than the administration of medicines and the application of poultices. It ought to signify the proper use of fresh air, light, warmth, cleanliness, quiet, and the proper selection and administration of diet — all at the least expense of vital power to the patient.’

Florence Nightingale - Notes on Nursing (1860)

The Lady with the Lamp and the Nursing Profession

The Nursing profession—a science and an art practiced by both man and women—Tiring, arduous, demanding, tough, eye-bag forming, yet fulfilling, a vocation of honor and dignity entwined with humility.

When??...

It was in mid 1800’s with the leadership of Florence Nightingale that organized nursing started. Before her era, nursing care was done by paupers and drunkards: persons unfit for any type of work. Hospitals were placed where the poor frequently suffered more from the environment than from the disease that brought them there.

‘No man, not even a doctor, ever gives any other definition of what a nurse should be than this — 'devoted and obedient'. This definition would do just as well for a porter. It might even do for a horse. It would not do for a policeman.’

Nightingale’s efforts to uplift the nursing profession were indeed admirable. At that time, nursing was viewed as a kind of work that requires menial tasks or routinely actions but Nightingale saw it as a vocation aided by proper use of assessment and empowered by skills, knowledge and attitude acquired from proper schooling. In her book, she takes limelight away from the Physicians, and places it on the nurses.

Notes on Nursing — What It is and What It is not

Her most frequently cited work, Notes on Nursing, was written not as a nursing text but to “give hints for thoughts of women who have personal charge of the health of others.”

Nightingale’s notes on nursing covers all the basic necessities of human lives. It explains how to deal with sick people which can be applied not just to simple cough, colds and flues but to all types of human illnesses. And yes if one can read between the lines (as we always do), the book offers tips on how to survive a hospital experience.

Nightingale’s environmental model has always been applied in the hospital setting. One setting would include the care of our patients in the Intensive Care Unit wherein all chapters of the book can be applied—ventilation and warming, noise management, observation of the sick etc. And even if we are not in the hospital setting whether we are just in our office or at home, Nightingale’s vision of nursing is always present. We can even relate it to a song by Chris Brown and Jordin Sparks entitled No Air… and the lyric goes like this

“Tell me how I’m supposed to breathe with no air? Can’t live, can’t breath with no air That’s how I feel whenever ain’t there There’s no air, no air”

See? Nightingales contribution is so wide that the realization of her vision is not only limited to us nurses. And with that, her vision should inspire, motivate and direct every interaction we make and every intervention we do to be able to provide a wholistic nursing care to our patients and help them in their need for identifying their health concerns without them telling us what we can do for them but doing it automatically.

………………

Although Nightingale’s book was more of a lecture, a sermon, or even a plea put into writing, she backed up her concepts with well researched studies to prove her points.

She is also a skilled statistician- used statistics to present her case for hospital reform. According to Cohen, “the idea of using statistics for such a purpose- to analyze social conditions and the effectiveness of public policy- is common place today, but at that time it was not” (Marie L. Lobo: NURSING THEORIES; The Base for Professional Nursing Practice; Fourth Edition; 1995)

The notes on nursing by Nightingale repeatedly emphasize on its aim to empower women to take control of the care not only the sick but also the healthy members of the family especially the children. We understand that this highlight is because the children are ought to be the foundation of the future. She used statistics to support her claims. These lines are lifted from the first pages of Notes on Nursing to show how extensive Nightingale’s research is for her to come up with such data; “--- do you know that in every seven infants in this civilized land of England perishes before it is one year old? That in London, two in every five die before they are five years old? And, in the other great cities of England, nearly one out of two?----More than 25,000 children die every year in London under 10 years of age” These are just some but they prove that Nightingale’s craft is based on thorough research and statistics.

Basing on today’s world, though advance techniques are being used in the nursing profession, still Nightingales thoughts are being applied. In a hospital in Dubai where one of our groupmates work (Ms. Elvie Abanico), still-life paintings are displayed in the patient’s room and nurses look at how long tentatively patients will stay in the hospital, the longer they stay the nurses will plan to give a room with a view—where flowers and tress can be seen from the patients window since basing on research variety of colors and pictures can help to make a patient feel well. As supported by Nightingales Notes on Nursing variety section page 44: "Variety of form and brilliancy of colors in objects presented to patients are actual means of recovery and that "Variety is just like food for a starving stomach, just like a sick patient who wants to see a variety, just like a starving eye”.

Indeed, one could simply say that Florence Nightingale is Nursing and Nursing is Florence Nightingale. So would it not be sensible if we also try to looked at her well-known work—‘Notes in Nursing’, in a whole new perspective that goes beyond the scope of Nursing?

No Place for a Woman: The Femme Fatal

During Nightingales time, women are considered second class in short they have no right to assert something—near helpless with lethargic lifestyle—a life of thoughtless comfort for the world of social service. During her time, she encountered a lot of problem just because she is a woman. Though she took part on influencing the decisions of the War Department by providing information to Sir Sidney Herbert by giving any of the position papers and reports, because of the position of women in Victorian England, she was not permitted to submit her findings under her own name.

(-Marie L. Lobo: NURSING THEORIES; The Base for Professional Nursing Practice; Fourth Edition; 1995)

In her book entitled Cassandra, she wrote:

“Women are never supposed to have any occupation of sufficient importance not to be interrupted, except ‘suckling their fools’; and women themselves have accepted this”

The above quote shows the displeasure of Nightingale on how women of her times accepted their roles at the society without even exerting an effort to show what they are capable of. In fact, she stated that there were even books written on the acceptance of role that women play in the society then. But Nightingale never conformed to the society nor did she accept. In fact, her writings as well as actions showed her firm disagreement with how society regarded women. So Nightingale was also one of great women in history who did her part to lobby for the rights of women.

Nightingale had a strong conviction that woman have the mental capacities to achieve whatever they wish to achieve. Out of this conviction came her resolve and action to establish nursing as a profession wherein women could develop the intellectual abilities to contribute meaningful service to society.

With her book—Notes on Nursing, a glimpse of feminism can be seen since the book empowers women to have personal charge of the health of others though it does not teach them how, but it asks women to teach herself. Thanks to Florence Nightingale, women now realize that they must gain control over their own time in order to change the social and political structures over their lives—it can be observed that majority of the nurses of today are women living what Florence Nightingale had stated in her book though it is a fact that men also share her vision of what nursing is.

Voluminous texts were written on Florence Nightingale and her contribution to the Nursing profession. What many nurses fail to realize is that she did more than just that. We hope our little blog could help them see and appreciate another aspect of her life and her contributions not just to nursing, but to the world.

“Nurses we are love serves—this is the essence of nursing. For what ever reason we pursue this course, regardless of where we practice it, the essence of nursing should be internalized…”

Sister Callista Roy

ADAPTATION THEORY

“When push comes to a shove, we will seldom disappoint ourselves. We all harbour greater stores of strength than we think. Adversity brings the opportunity to test our mettle and discover for ourselves the stuff of which we are made.”

PHILOSOPHICAL UNDERPINNINGS OF THE THEORY

Johnson’s nursing model was the impetus for the development of Roy’s Adaptation Model. Roy also incorporated concepts from Helson’s adaptation theory, von Bertalanffy’s system model, Rapoport’s system definition, the stress and adaptation theories of Dohrenrend and Selye, and the coping model of Lazarus (Philips, 2002).

MAJOR ASSUMPTIONS, CONCEPTS AND RELATIONSHIPS ASSUMPTIONS

In the Adaptation Model, assumptions are specified as scientific assumptions or philosophical assumptions.

Scientific Assumptions

Systems of matter and energy progress to higher levels of complex self- organization.
Consciousness and meaning are constitutive of person and environment integration
Awareness of self and environment is rooted in thinking and feeling
Humans by their decisions are accountable for the integration of creative processes.
Thinking and feeling mediate human action
System relationships include acceptance, protection, and fostering of interdependence
Persons and the earth have common patterns and integral relationships
Persons and environment transformations are created in human consciousness
Integration of human and environment meanings results in adaptation (Roy&Andrew, 1999, p.35).

Philosophical Assumptions

Persons have mutual relationships with the world and God
Human meaning is rooted in the omega point convergence of the universe.
God is intimately revealed in the diversity of creation and is the common destiny of creation.
Persons use human creative abilities of awareness, enlightenment, and faith.
Persons are accountable for the processes of deriving, sustaining and transforming the universe (Roy & Andrew, 1999, p. 35).

The Four Modes of Adaptation

Physiologic-Physical : Mode Physical and chemical processes involved in the function and activities of living organisms; the underlying need is physiologic integrity as seen in the degree of wholeness achieved through adaptation to change in needs.
Self-concept : Group Identity ModeFocuses on psychological and spiritual integrity and sense of unity, meaning, and purposefulness in the universe.
Role Function Mode : Roles that individuals occupy in society, fulfilling the need for social integrity. It is knowing who one is in relation to others.
Interdependence Mode : The close relationships of people and their purpose, structure and development individually and in groups and the adaptation potential of these groups.

ROY’S THEORY AS APPLIED TO:

NURSING PRACTICE

Using Roy’s six –step nursing process, the nurse assesses first the behaviors and second the stimuli affecting those behaviors. In a third step the nurse makes a statement or nursing diagnosis of the person’s adaptive state and fourth, sets goals to promote adaptation. Fifth, nursing interventions are aimed at managing the stimuli to promote adaptation. The last step in the nursing process is evaluation. By manipulating the stimuli and not the patient, the nurse enhances the interaction of the person with their environment, thereby promoting health.

Hamner in 1989 discussed the Roy model and how it could be applied to nursing care in a cardiac unit (CCU). Hamner describes the model as enhancing care in the CCU and being consistent with the nursing process. Hamner found that the model assessed all patients’ behavior, so that none was excluded. The author discovered that the Roy model provides a structure in which manipulation of stimuli are not overlooked. The model puts emphasis on identifying and reinforcing positive behavior which speeds recovery.

EDUCATION

The adaptation model is also useful in educational setting. Roy states that the model defines for students the distinct purpose of nursing which is to promote man’s adaptation in each of the adaptive modes in situations of health and illness.

In the early 1980’s the School of Nursing at the University of Ottawa experienced a major curriculum change. This change included incorporating a nursing model by which to base their new curriculum. The change included incorporating a nursing model by which to base their new curriculum. The Roy adaptation model was one of the models to be included in the first year of the baccalaureate program. The professors had to meet four challenges during this change:

1. Adapting the course to be congruent with the Roy model,

2. Developing teaching tools suitable for student learning.

3. Sequencing of content for student learning

4. Obtaining competent role models.

RESEARCH

If research is to affect practitioners’ behavior, it must be directed at testing and retesting conceptual models for nursing practice. Roy has stated that theory development and the testing of developed theories are nursing’s highest priorities. The model must be able to regenerate testable hypotheses for it to be researchable.

Madeleine Leininger

Transcultural Nursing

Every human race has his/her different beliefs and culture may it be taught and passed on from one generation to the other. Even if we have the same language or dialect spoken we all have different culture and beliefs being followed as one of the norms in our society. And a part of our culture was our health beliefs and practices. In our group we categorize some of the health beliefs and practices into different age group based on experiences and research. This will give us awareness on how we could be able to render effective care to our clients, with certain age and background.

PRESCHOOL AND SCHOOL AGE

An ethnographic study of Latino pre-school children’s oral health in rural California revealed that, Latino children experienced a higher prevalence of caries than do children in any other racial groups in the U.S. The study conducted in 2005 focus on both recent immigrants and longer term residents of a small agricultural town in the central valley of California. Around 95% of the population of approximately 9,000 is of Latino largely Mexican origin.

Rural immigrant parents tend not to recognize dental caries in their children as a disease, but rather classified as visible discoloration on teeth and tend not to seek help unless this were accompanied with swelling and pain. Because tooth decay is viewed as a stain, when treatment is sought, parents often requested and expected cleaning. The high cost of restorative work therefore, is a surprise.

The mothers were educated by health care workers about baby bottle decay but claimed that the problem is the bottle nipple and not the sweet fluid content of the bottle. Many mothers claimed that as adults they never had a dental treatment nor dental caries when young and now their children have dental caries and they are unsure how to prevent it.

Migrant parent also reported major changes in diet since moving to the U.S., and also commented on how different their children’s diet is from their own when growing up. Major differences between their diets were the high consumption of sugar, sodas, and less access to fresh fruits and vegetable. Parents did not specifically associate these broad dietary changes with their children’s problems although they did connect the consumption of sweet substances with the subsequent advent of dental caries. Collectively all these understanding and actions on the part of care givers sets up Latino children for high rates of unrecognized and untreated oral disease.

ADOLESCENT

As depicted in Leininger’s Sunrise model culture, worldview, and social structure influences the individual’s care behaviors and beliefs which in turn affects their health and illness status. The nurse needs to clearly understand universal and specific cultural views of adolescents and clarify values in order to promote wellness in a culturally acceptable manner.

One of the most pressing problems of adolescence in many societies is engaging in risky sexual behaviors at an early age. In some societies, adolescent participation in risky sexual behaviours are treated as a measure of ‘manhood’, a sense of ‘belongingness’, a sign of ‘friendship’. The nurse through applying transcultural care concepts of Leininger should bear in mind these problems and study the deeply rooted societal and cultural origins of these.

Cultural beliefs and practices leading to risky sexual behavior do not only lead to this specific problem but to a myriad of problems related to such health practice including teenage pregnancy, sexually transmitted diseases, poor maternal and child health, etc. The nurse in these situations should devise a strategy in teaching adolescents about the effects of risky sexual behavior and actions to curb such incidents in ways that are meaningful to them.

There are a lot of universal and culture-specific issues concerning adolescents today. It is very important for a nurse applying transcultural care concepts to be sensitive not just to cultural and social background but also to the adolescent’s developmental issues and concerns.

Being an adolescent is indeed a big transition in our lives from an adventurous kid to a growing up girl/boy. We experience a lot of challenges like peer pressure and a lot of changes in our body. One of the things as an adolescent is when I have my menarche my mother asked me to jump in the stairs 3 times ,a part of our family’s culture I guess which I find very amusing.

As adolescents, we are expected to mingle with other person with the same age but some of us have a different upbringing so some tend not to "go with the flow" wherein others tend to be depressed and commit irrational behavior like suicide. Some committed suicide because of family problems, school, and failed relationships. Aside from personal and social challenges an adolescent faces, he/she also learn a lot of new things like drinking alcohol and smoking but it depends on how he/she will handle this, the parent's guidance will be of important issue here. Because not only this will affect personal relationships but also their health is at risk. I have this patient, 17 year old male who seek treatment in the emergency room who attempted to commit suicide by drinking sleeping pills because of a failed relationship with his girlfriend. As nurses we should understand them what they are experiencing now. We should treat them with empathy. Our responsibility is teaching them the importance of life and health. We should understand them because they behave differently depends on their family values, personal experiences and beliefs.

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.

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)

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.