NOLA PENDER – HEALTH PROMOTION
MODEL
The Health Promotion Model was designed to be a
“complementary counterpart to models of health
protection.” It develops to incorporate behaviors for
improving health and applies across the life span. Its
purpose is to help nurses know and understand the major
determinants of health behaviors as a foundation for
behavioral counseling to promote well-being and healthy
lifestyles. Pender’s health promotion model defines
health as “a positive dynamic state not merely the
absence of disease.” Health promotion is directed at
increasing a client’s level of wellbeing. It describes the
multi-dimensional nature of persons as they interact
within the environment to pursue health.
Major concepts and minor concepts/subjects
Health Pormotion -- process of empowering individuals
and communities to make healthy lifestyle choices to
improve overall health and wellness. Health can be
defined as the state of physical, mental, and social well-
being and not just the absence of disease. Wellness can
be defined as the attitudes and decisions made by an
individual that result in positive behaviors and health
outcomes.
THE MODEL FOCUSES ON FOLLOWING THREE
AREAS:
Individual characteristics and experiences – prior related
behaviour and personal factors
Behavior-specific cognitions and affect – perceived
benefits of action, perceived self-efficacy, activity-
related affect, interpersonal influences, and situational
influences.
Behavioral Outcomes – commitment to a plan of action,
immediate competing demands and preferences, and
health-promoting behaviour.
Personal Factors - are categorized as biological,
psychological, and socio-cultural. These factors are
predictive of a given behavior and shaped by the target
behavior’s nature being considered.
Personal Biological Factors – age, gender, body mass
index, pubertal status, aerobic capacity, agility, or
balance
Personal Psychological Factors -- self-esteem, self-
motivation, personal competence, perceived health
status, and definition of health.
Personal Socio-cultural Factors -- race, ethnicity,
acculturation, education, and socioeconomic status.
Behavior-specific cognitions and affect
-Perceived Benefits of Action Anticipated positive
outcomes that will occur from health behavior.
-Perceived Barriers to Action Anticipated, imagined, or
real blocks and personal costs of understanding a given
behavior.
-Perceived Self-Efficacy The judgment of personal
capability to organize and execute a
health-promoting behaviour -- erceived selfefficacy
influences perceived barriers to action, so higher
efficacy results in lowered perceptions of barriers to the
behavior’s performance. -Activity-Related Affect
Subjective positive or negative feeling occurs before,
during, and following behavior based on the stimulus
properties of the behavior itself.
-Activity-related affect influences perceived self-
efficacy, which means the more positive the subjective
feeling, the greater its efficacy. In turn, increased
feelings of efficacy can generate a further positive affect.
-Interpersonal Influences
Cognition concerning behaviors, beliefs, or attitudes of
others. Interpersonal influences include norms
(expectations of significant others), social support
(instrumental and emotional encouragement), and
modeling (vicarious learning through observing others
engaged in a particular behavior). Primary sources of
interpersonal influences are families, peers, and
healthcare providers.
-Situational Influences
Personal perceptions and cognitions of any given
situation or context can facilitate or impede behavior.
Include perceptions of options available, demand
characteristics, and aesthetic features of the environment
in which given health-promoting is proposed to take
place. Situational influences may have direct or indirect
influences on health behavior.
Behavioral Outcomes
Commitment to plan -- The concept of intention and
identification of a planned strategy leads to the
implementation of health behavior.
Immediate Competing Demands and Preferences –
competing demands arethose alternative behaviors over
which individuals have lw control because of
environmental contingencies such as work or family
care. Competring preferences are alternative behaviors
over which individuals exert relatively high control, such
as choice of ice cream or apple for a snack.
Health-promoting Behavior -- is an endpoint or
actionoutcome directed toward attaining positive health
outcomes such as optimal wellbeing, personal
fulfillment, and productive living.
JEAN WATSON – PHILOSOPHY AND THEORY
OF TRANSPERSONAL CARING/ THEORY OF
HUMAN CARING
“We are the light in institutional darkness, and in this
model we get to return to the light of our humanity”
Many people enters the nursing field because they see it
as a career that cares about the needy ones. Compassion
is often a trait required of nurses, since taking care of
patients’ needs is their primary purpose. Watson’s theory
addresses how nurses care for their patients and how that
caring translates into better health plan to help patient
get healthy.
“Nursing is concerned with promoting health, preventing
illness, caring for the sick, and restoring health.” It
focuses on health promotion, as well as the treatment of
diseases. Additionally, caring is central to nursing
practice and promotes health better than a simple
medical cure.
The nursing model also states that caring can be
demonstrated and practiced by nurses. Caring for
patients promotes growth; a caring environment accepts
a person as they are and looks to what they may become.
THE TEN CARATIVE FACTORS:
1. The formation of a humanistic-altruistic system of
values -- “Practice of loving-kindness and equanimity
within the context of caring consciousness.”
2. The instillation of faith and hope -- “Being
authentically present and enabling and sustaining the
deep belief system and subjective life-world of self and
one being cared for.”
3. The cultivation of sensitivity to one’s self and to
others -- “Cultivation of one’s own spiritual practices
and transpersonal self going
beyond the ego-self.”
4. The development of a helping – trust relationship --
“Developing and sustaining a helping trusting, authentic
caring relationship.”
5. The promotion and acceptance of the expression of
positive and negative feelings -- “Being present to, and
supportive of, the expression of positive and negative
feelings as a connection with deeper spirit and self and
the onebeing-cared for.”
6. The systematic use of the scientific problem-solving
method for decision making -- “Creative use of self and
all ways of knowing as part of the caring process; to
engage in the artistry of caring-healing practices.”
7. The promotion of interpersonal teaching-learning --
“Engaging in genuine teaching-learning experience that
attends to the unity of being and meaning, attempting to
stay within others’ frame of reference.”
8. The provision for a supportive, protective and
corrective mental, physical, sociocultural and spiritual
environment
9. Assistance with the gratification of human needs --
“Assisting with basic needs, with an intentional caring
consciousness, administering ‘human care essentials,’
which potentiate alignment of mind-body-spirit,
wholeness, and unity of being in all aspects of care.”
10. The allowance of existential-phenomenological
forces; became “allowance for existential-
phenomenological spiritual forces” (in 2004 Watson
website) -- “Opening and attending to spiritual-
mysterious and existential dimensions of one’s own life-
death; soul care for self and the one-being cared for”
Watson’s Ordering of Needs
Higher Order Needs (PSYCHOSOCIAL NEEDS) - The
need for achievement - The need for affiliation
Higher Order Needs
(INTRAPERSONALINTERPERSONAL NEEDS) - The
need for self - actualization
Lower Order Needs (BIOPHYSICAL NEEDS) - The
need for food and fluid - The need for elimination - The
need for ventilation
Lower Order Needs (PSYCHOPHYSICAL NEEDS) -
The need for activity-inactivity - The need for sexuality
PATRICIA BENNER – STAGES OF NURSING
EXPERTISE/ FROM NOVICE TO EXPERT
“Nursing is an integrative science that studies the
relationships between mind, body and human worlds.
Nursing is concerned with the social sentient body that
dwells infinite human worlds; that gets sick and
recovers; that is altered during illness, pain and
suffering.”
What is Novice?
✓ The person has no background experience of the
situation in which he or she is involved
✓ There is difficulty discerning between relevant and
irrelevant aspects of the situation
✓ Beginner to profession or nurse changing area of
practice
What is Advanced Beginner?
✓ In the Dreyfus model develops when the person can
demonstrate marginally acceptable performance having
coped with enough real situations
✓ These are the new graduates in their first job in which
they are guided by rules and oriented by task completion
✓ Still requires mentor or experienced nurse to assist
with defining situations, to set priorities and to integrate
practical knowledge
What is Competent ?
✓ After 2 -3 years in the same area of nursing, the nurse
moves into the competent stage of skills
✓ They recognize the patterns and nature of clinical
situations more quickly and accurately than advanced
beginners
✓ Competent nurse devises new rules and reasoning
procedures for a plan while applying learned rules for
action on the basis of the relevant facts of that situation
What is Proficient ?
✓ After 3 -5 years in the same area of nursing, the nurse
moves into the proficient stage
✓ At this level, nurses are capable to see situations as
“whole” rather than parts. They learned from
experiences what events typically occur and are able to
modify plans in response to different events
✓ The nurse possesses a deep understanding of
situations as they occur, less conscious planning is
necessary, critical thinking and decision -making skills
have developed
What is Expert?
✓ This stage occurs after 5 or more years in the same
area of nursing field
✓ Nurses who are able to recognize demands and
resources in situations and attain their goals. They knows
what needs to be done
BETTY NEUMAN – SYSTEM MODEL THEORY
“Health is a condition in which all parts and subparts are
in harmony’’ (Betty Neuman 1972)
The aim of Neuman model ‘’is to set forth a structure
that depicts the parts and subparts and their
internrationshipsfor the whole of the client as complete
system’’( Nueman,2002)
The Neuman’ssystems model has two major components
-stress and reactions to stress.
The client in the Neuman’s model is viewed as an open
system in which repeated cycles of input, process output
and feedback, constitute a dynamic organizational
pattern. The client may be an individual, a group,a
family, a community, or an aggregate.
MAJOR CONCEPTS
CONTENT- variables of the person in interaction with
the environment
BASIC STRUCTURE OR CENTRAL CORE-degree to
reaction
ENTROPY- process of energy disorganization moving
the client toward illness
FLEXIBLE LINE OF DEFENSE -normal line of
defense
NEGENTROPY- process of energy conservation that
increases organization and complexity
PREVENTION AS INTERVENTION- focuses on
keeping stressors and the stress response for having
detrimental effect on the body
STABILITY – state of balance or harmony requiring
energy exchanges as the client adequately copes with
stressors
STRESSORS - are intra-, inter-, and extra personal in
nature and arise from the internal, external, and created
environments
WELLNESS- on a continuum of available energy to
support the system in an optimal system stability state. 
ILLNESS- When needs are not satisfied, illness exists
PREVENTION - Primary prevention occurs before the
stressor invades the system; secondary prevention occurs
after the system has reacted to an invading stressor;
tertiary prevention occurs after secondary prevention as
reconstitution is being established.
INPUT-OUTPUT – The matter, energy, and information
exchanged between the client and environment entering
or leaving the system at any point in time.
OPEN SYSTEM
A system in which there is a continuous flow of input
and process, output and feedback. It is a system of
organized complexity, where all elements are in
interaction.
FLEXIBLE LINE OF DEFENSE
A protective accordion-like mechanism that surrounds
and protects the normal line of defense from invasion by
stressors.
NORMAL LINE OF DEFENSE
An adaptational level of health developed over time and
is considered normal for a particular individual client or
system; it becomes a standard for wellness-deviance
determination.
LINES OF RESISTANCE
Protection factors are activated when stressors have
penetrated the normal line of defense, causing reaction
symptomatology.
DOROTHEA OREM – SELF-CARE DEFICIT
MODEL
 “ The act of assisting others in the provision and
management of the self-care to maintain or
improve human functioning at home level of
effectiveness.”
 caring approach that uses experiential and
specialized knowledge(Science) to design and
produce nursing care(Art)
3 CONCEPTUAL THEORIES OF SELF-CARE
DEFICIT THEORY
THEORY OF SELF-CARE
THEORY OF SELF-CARE DEFICIT
THEORY OF NURSING SYSTEM
SELF-CARE
• Self-Care begins with a nursing assessment
to identify activities that the patient initiates
and performs independently to maintain life,
health and well-being.
✓ Going to the bathroom, Eating, Perform hand hygiene
SELF-CARE
1. Self-care agency-- "the ability
for engaging in self care" condition
by age developmental state, life
experience, sociocultural orientation
health, and available resources.
2. Therapeutic self-care demand -- Evaluates total
activity needed to meet
the individual self-care need at the
moment or even over a period of time
3. Self-care requisites -- Action directed towards
provition of self care
SELF-CARE DEFICIT THEORY
1. Self-Care limitations
• Restrictions of knowing
• Restrictions on judgment and decision making
• Restrictions on result-achieving actions
2. Self-Care deficits -- results when self-care agency is
not adequate to meet the known self-care demand.
THREE KINDS OF REQUISITES
UNIVERSAL SELF-CARE REQUISITES
• Air, Water, Food, Elimination, Activity and rest,
Solitude and social interactions, Safety and normalcy
Developmental self-care requisites -- Provision of
condition that promotes
development
Health-deviation self-care requisites -- Seeking and
securing appropriate medical
Assistance, Being aware of and attending to the effects
and results of pathologic conditions and state,
Effectively carrying out, medically prescribed
diagnostic, therapeutic, and rehabilitative
measures.
Five methods of helping
• Acting or doing for others. Guiding, Teaching,
Supporting, Providing an environment that promotes the
individual's abilities to meet current and future demands.
THEORY OF NURSING SYSTEMS
-the nursing interventions needed when individual are
unable to perform the necessary self-care activities.
-It describes the nursing responsibilities, roles of
the nurse and patient, rationales for the nursepatient
relationship, and the types of actions
needed to meet the patient's demands.
Nursing System
-Wholly compensatory is a nurse need
to provide full self-care for the patient,
because the patient's self-care agency
has exceeded the limitation that he or
she must depend on others (nurse) for
well-being.
-Partial compensatory it is used when a patient can meet
some selfcare requisites but needs a nurse to help meet
other needs.
-Supportive educative is a nurse's action of using
knowledge, support and encouragement to develop the
self-care abilities of patient in terms of decision making
or behavior control.
IMOGENE KING – THEORY OF GOAL
ATTAINMENT
“Focuses on the continuing ability of individuals to meet
their basic needs so that they may function in their
socially defined roles, as well as on individual’s
interaction within three open, dynamic, interacting
systems”.
 PERSONAL SYSTEM 1. Perception 2. Self 3.
Growth and development 4. Body Image 5. Learning
6. Time 7. Personal Space 8. Coping
 INTERPERSONAL SYSTEM 1.Communication
2.Interaction 3.Role 4.Stress 5.Stressors
6.Transaction
 SOCIAL SYSTEM 1.Organization 2.Authority
3.Power 4.Status 5.Decision Making
MARTHA ROGER – SCIENCE OF UNITARY
HUMAN BEINGS
“ The purpose of nurses is to promote health and well-being
for all persons wherever they are. The area of nursing is
creative use of the science of nursing for human-betterment. ”
SCOPE OF NURSING
Nursing aims to assist people in achieving their maximum
health potential. Maintenance and promotion of health,
prevention of disease, nursing diagnosis, intervention, and
rehabilitation encompass the scope of nursing’s goals.
ENVIRONMENTAL FIELD ENERGY FIELD
“An irreducible, indivisible, pandimensional energy field
identified by pattern and integral with the human field.”
The energy field is the fundamental unit of both the living and
the nonliving. It provides a way to view people and the
environment as irreducible wholes. The energy fields
continuously vary in intensity, density, and extent.\
PATTERN -- the distinguishing characteristic of an energy
field seen as a single wave. It is an abstraction and gives
identity to the field.
PANDIMENTIONAL -- “non-linear domain without spatial or
temporal attributes.” Humans’ parameters to describe events
are arbitrary, and the present is relative; there is no temporal
ordering of lives.
OPENNESS -- There are no boundaries that stop energy flow
between the human and environmental fields, openness in
Rogers’ theory. It refers to qualities exhibited by open
systems; human beings and their environment are open
systems.
3 Principles of Homeodynamics
1.Resonance
2. Helicy
3. Integrality
It identifies the human field and the environmental field by
wave patterns manifesting continuous change from longer
waves of a lower frequency to shorter waves of higher
frequency. The human environment field is a dynamic, open
system in which change is continuous due to the constant
interchange between the human and environment. Because of
the inseparability of human beings and their environment,
sequential changes in the life processes are continuous
revisions occurring from the interactions between human
beings and their environment.
3 Steps in Nursing Process
Assessment, Voluntary Mutual Patterning, Evaluation
Focus of Nursing Curriculum
Transmission of body of knowledge, Teaching, Practicing
Therapeutic Touch, Conducting Regular in-service Education
SISTER CALLISTA ROY – ADAPTATION
MODEL
SYSTEM -- “a set of parts connected to function as a
whole for some purpose and that does so by virtue of the
interdependence of its parts”. In addition to having
wholeness and related parts, “systems also have inputs,
outputs, and control and feedback processes”
ADAPTATION LEVEL -- the condition of the life
processes described on three levels as integrated,
compensatory, and compromised”
ADAPTATION PROBLEMS -- “broad areas of concern
related to adaptation. These describe the difficulties
related to the indicators of positive adaptation
FOCAL STIMULUS CONTEXTUAL STIMULI -- all
the environmental factors that present to the person from
within or without but which are not the center of the
person’s attention and/or energy”
RESIDUAL STIMULI -- environmental factors within
or without the human system with effects in the current
situation that are unclear
COPING PROCESSES -- innate or acquired ways of
interacting with the changing environment”
INNATE COPING MECHAN ISMS – coping
mechanisms that are natural to human
ACQUIRED COPING MECHANISMS -- developed
through strategies such as learning and experiences
REGULATOR SUBSYSTEM – involves the neural,
chemical, and endocrine systems
COGNATOR SUBSYSTEM -- “a major coping process
involving four cognitive-emotive channels
DOROTHY JOHNSON – BEHAVIORAL SYSTEM
MODEL
Sexual subsystem -- dual functions of procreation and
gratification. Including, but not limited to, courting and
mating, this response system begins with the development of
gender role identity and includes a broad range of sex-role
behaviors.
Aggressive subsystem -- protection and self-preservation,
generating a defense response
Achievement subsystem -- control or mastery an aspect of self
or environment to some standard of excellence

She defines nursing as “an external regulatory force which

acts to preserve the organization and integration of the
patients’ behaviors at an optimum level under those conditions
in which the behavior constitutes a threat to the physical or
social health, or in which illness is found. ”

Johnson’s Behavioral System Model is a nursing care model

that advocates the fostering of efficient and effective
behavioral functioning in the patient to prevent illness. The
patient is identified as a behavioral system composed of seven
behavioral subsystems: affiliative, dependency, ingestive,
eliminative, sexual, aggressive, and achievement. Each
subsystem’s three functional requirements include protection
from noxious influences, provision for a nurturing
environment, and stimulation for growth. An imbalance in any
of the behavioral subsystems results in disequilibrium. It is
nursing’s role to assist the client in returning to a state of
equilibrium.

Equilibrium- state wherein the person is in harmony with

himself and with his environment
Stressor- A stimulus from the internal or external world that
results in stress or instability.
Tension- state of being strained & can be viewed as an end-
product of the disturbance in equilibrium

It is the nursing's role to return to a state of equilibrium.

Each subsystems have 3 funtional requirements

1. System must be “protected" from noxious influences
with which system cannot cope” .
2. Each subsystem must be “nurtured” through the input
of appropriate supplies from the environment.
3. Each subsystem must be “stimulated” for use to
enhance growth and prevent stagnation.

SUBSYSTEMS
Attachment or Affiliative subsystem -- “social inclusion
intimacy and the formation and attachment of a strong social
bond
Dependency subsystem -- approval, attention or recognition
and physical assistance.
Ingestive subsystem -- has to do with when, how, what, how
much, and under what conditions we eat
Eliminative subsystem -- addresses when, how, and under
what conditions we eliminate.