A.

Nursing Theories
1. Peplau’s Theory of Interpersonal Relationship

A. Personal Profile
Hildegard Peplau was born on September 1, 1909 in Reading,
Pennsylvania as daughter of immigrant parents of German decent. She was
raised in a paternalistic family and paternalistic society.

B. Educational Background
She graduated with a diploma from Pottstown Hospital School of Nursing
in 1931. In 1943, she received a Bachelor of Arts degree in interpersonal
psychology from Bennington College, Vermont, followed by a Master of Arts
degree in psychiatric nursing from Teachers College, Columbia University in
1947. In 1953, Peplau received an EdD. in curriculum development, also from
Columbia University.
I. Definition of terms

1. Psychodynamic Nursing
Psychodynamic nursing is being able to understand one’s own behavior to
help others identify felt difficulties, and to apply principles of human relations to
the problems that arise at all levels of experience.”

2. Nurse-patient relationship
Peplau (1992) pointed out that the Nurse-patient relationship is particular
kind of interaction. It is not a parent- child relationship. It is not a social
relationship of friend-to-friend. It is not a clerk-to-customer relationship. Nor, is it
a master-servant relationship. Rather, the nurse is a professional, which means a
person having a definable expertise. The expert knowledge pertains to the nature
of phenomena within the purview of nursing and to be reliable interventions
which have been research-tested and therefore have predictable, known
outcome.

Furthermore, Peplau explained that Nurse-Patient relationship “has a

starting point, proceeds through definable phases, and being time-limited, has
end point. Peplau regarded the three phases as distinct yet overlapping or
interlocking.

3. Interpersonal relations
Nursing can be viewed as an interpersonal process because it involves
interaction between two or more individuals with a common goal. In nursing, this
common goal provides the incentive for the therapeutic process in which the
nurse and patient respect each other as individuals, both of them learning and
growing as a result of the interaction. An individual learns when she or he selects
stimuli in the environment and then reacts to these stimuli.
 Harry Stack Sullivan (1953) considered the healthy person as a social
being with the ability to live effectively in relationships with others. Mental illness
was viewed as any degree of lack of awareness of processes in one’s
interpersonal relationships. Relationships were viewed as the source of anxiety
and maladaptive behaviors as well as personality formation.
II. Major Concepts:

Three (3) sequential phases of Nurse-Patient relationship:

1. Orientation
Orientation is the initial phase when the nurse and patient meet as two
strangers. The patient and /or the family has a “felt need”; therefore the
professional assistance is sought.
The phase in which the nurse first identifies herself by name and
professional status and states the purpose, nature, and time available for patient.
The phase in which the nurse conveys professional interest and receptivity
to the patient, begins to know the patient as person, obtains essential information
about the patient’s health condition, and sets the tone for further interactions.

2. Working
The phase which the major work occurs
i. Identification
Identification is the sub-phase during which the patient learns how to
make use of nurse-patient relationship. In this phase, the patient responds
selectively to people who can meet his or her needs. Each patient responds
differently in this phase. In identification phase, the perception and expectations
of the patient and nurse are even more complex than in the orientation phase.
The patient is now responding to the helper selectively. This requires a more
intense therapeutic relationship.

While working through the identification phase, the patient begins to have
feelings, the patient begins to have feelings of belonging and a capacity for
dealing with the problem. These changes begin to decrease feelings of
helplessness, creating an optimistic attitude from which inner strength ensues.

ii. Exploitation
Exploitation is the sub-phase during which the patient makes full use of
available professional services.

In exploitation phase, the patient takes advantage of all services available.

The degree to which these services are used is based upon the needs and
interests of the patient. The individual begins to feel as though he or she is an
integral part of the helping environment and begins to take control of the situation
by extracting help from the services offered.
During this phase, some patients may make more demands than they did
when they were seriously ill. They may make many minor requests or may us
other attention-getting techniques, depending on their individual needs. These
actions may often be difficult, if not impossible, for the health care provider to
completely understand. The nurse may need to deal with the subconscious
forces causing the patient’s actions, and may need to use interviewing
techniques as tool to explore, understand and adequately deal with underlying
patient’s problems. So that the nurse-patient rapport established to this point is
not damaged, a therapeutic relationship must be maintained by the nurse that
conveys an attitude of acceptance, concern, and trust. The nurse must
encourage the patient to recognize and explore the feelings, thoughts, emotions,
and behaviors by providing a non-judgmental atmosphere and a therapeutic
emotional climate.

In exploitation, the nurse uses communication tools such as clarifying,

listening, accepting, teaching, and interpreting to offer services to the patient.
The patient then, takes advantage of the services offered based upon his or her
needs and interests. Throughout this phase, the patient works collaboratively
 with the nurse to meet challenges and work toward maximum health. Thus, in
exploitation phase, the nurse aids the patient in using services to help solve
problem. Progress is made toward the final step- the termination/ resolution
phase.

3. Termination (resolution)
The phase in which the work accomplished is summarized and closure
occurs. The phase during which the nurse helps the patient to organize actions
so that he or she will want to be free for more productive social activities and
relationships.
The last phase in which the patient’s needs have already been met by the
collaborative efforts between the patient and nurse. The patient and the nurse
now need to terminate their therapeutic relationship and dissolve the links
between them.
During the successful termination, the patient drifts away from identifying
with the helping person, the nurse. The patient then becomes independent from
the nurse as the nurse becomes independent from the patient. As a result of this
process, both the patient and the nurse become stronger maturing individuals.
The patient’s needs are met, and movement can be made toward new goals.
Termination/ resolution occurs only with the successful completion of the
previous phases.

Figure 1: Factors influencing the blending of the Nurse-Patient Relationship

Figure 2: Overlapping Phase in the Nurse-Patient Relationship

4. Nursing roles:

1. Stranger
Peplau states that because the nurse and patient are strangers to each
other, the nurse should treat the patient with ordinary courtesy. In other words,
 the nurse should not prejudge the patient, but accept him or her as a person.
During this non-personal phase, the nurse should treat the patient as emotionally
able unless evidence indicates otherwise. This coincides with the identification
phase.

2. Teacher
The nurse is the one who imparts knowledge concerning a need or
interest. The nurse provides health teaching to effect behavior change which
focuses on acquiring new knowledge or technical skills. This role gives emphasis
on health promotion and health maintenance.

3. Resource person
One who provides specific, needed information that aids in understanding
of a problem or a new situation.

4. Counselor
The nurse is the one who, through the use of certain skills and attitudes,
aids another in recognizing, facing, accepting, and resolving problems that are
interfering with the other person’s ability to live happily and effectively.

The nurse helps the client to recognize and cope with stressful
psychological or social problems, to develop improved personal relationships and
to promote personal growth. This role includes providing emotional, intellectual
and psychological support.

5. Leader
The nurse is the one who carries out the process of initiation and
maintenance of group goals through interaction. The nurse through the process
of interpersonal influence helps the client to make decisions in establishing the
client through these phases.

6. Surrogate
One who takes the place of another

7. Technical expert
One who provides physical care by displaying clinical skills and operating
equipment in this care.

8. Change agent
The nurse initiates changes and assists the client make modifications in
the lifestyle to promote health. These roles involve identifying the problem,
assessing the client’s motivation and capabilities for change, determining
alternatives, exploring the possible outcomes of the alternatives, assessing
resources, determining appropriate helping phases of the change process, and
guiding the client through these phases.

9. Researcher
The nurse participates in scientific investigation and uses research
findings in practice. The nurse helps develop knowledge about health and the
promotion of health over the full life span; care of persons with health problems
and disabilities; and nursing actions to enhance people’s ability to respond
effectively to actual or potential health problems.

10. Advocate
The nurse promotes what is best for the client, ensures that the client’s
needs are met, and protects the client’s rights.
 Figure 3: Phases & changing role in the Nurse-Patient relationship

5. Comparison of Nursing Process & Peplau’s Process

Nursing Process Peplau’s Interpersonal Process

Assessment Orientation
 Data Collection and analysis  Nurse and patient come
 Need not necessarily be a “ together as strangers;
felt need”; may be nurse meeting initiated by patient
initiated who expresses a “felt need”;
work together to recognize,
clarify, and define facts
related to need ( Note: Data
collection is continuous)

Nursing Diagnosis Working:

 Summary statement based on  Patient clarifies “felt need”
nurse analysis, with possible
patient involvement
 Outcomes and Planning
 Mutually set outcomes and
goals

Outcome & Planning Identification

 Mutually set outcomes and  Interdependent goal setting
goals  Patient has the feeling of
belonging and selectively
responds to those who can
meet his needs. Patient
initiated.

Intervention/ Implementation Exploitation

 Plans initiated that move  Exploitation is the sub-phase
 toward achievement of during which the patient
mutually set goals makes full use of available
 May be accomplished by professional services.
patient, health care
professional, or patient’s
family
Evaluation Termination
 Based on mutually  Occurs after other phases are
established expected successfully completed
behaviors  Leads to termination of the
 May lead to termination of relationship
relationship or initiation of
new plans

Metaparadigm (Matrix format)

Person Health Environment Nursing

Peplau defines Peplau defines Peplau implicitly Peplau describes
person in terms health as “ a word defines the nursing as “a
of a man. “Man symbol that environment in significant,
is an organism implies forward terms of therapeutic,
that lives in an movement of “existing forces interpersonal
unstable personality and outside the process. It
equilibrium” other ongoing organism and in functions
“ Man is an human processes the context of cooperatively with
organism that in the direction of culture,” from other human
strives in its own creative, which mores, processes that
way to reduce constructive, customs, and make health
tension productive, beliefs are possible for
generated by personal, and acquired. individuals and
needs” community living.” “However, general communities.”
Health is defined conditions that are When
as “a word symbol likely to lead to professional
that implies health always health teams offer
forward include the health services,
movement of interpersonal nurses participate
personality and process.” in the
other ongoing organization of
human processes conditions that
in the direction of facilitate natural
creative, co, ongoing
productive, tendencies in
constructive, human
personal, and organisms.
community living” “Nursing is an
educative
instrument, a
maturing force
that aims to
promote forward
movement of
personality, in the
direction of
creative,
constructive,
productive,
personal, and
 community living.”
Peplau consider
nursing tont, to be
a “significant,
therapeutic,
interpersonal
process” She
defines it as “
human
relationship
between an
individual who is
sick, or in need of
health services,
and the nurse
especially
educated to
recognize and
respond to the
need of help”

2. Orlando’s Theory of Deliberative Nursing Process

Orlando's Nursing Process Theory

This page was last updated on February 4, 2012

INTRODUCTION

About the Theorist

 Ida Jean Orlando - born in 1926.

 wrote about the nursing process.
 Nursing diploma - New York Medical College
 BS in public health nursing - St. John's University, NY,
 MA in mental health nursing - Columbia University, New York.
 Associate Professor at Yale School of Nursing and Director of the Graduate Program in Mental Health Psychiatric
Nursing.
 Project investigator of a National Institute of Mental Health grant entitled: Integration of Mental Health Concepts in
a Basic Nursing Curriculum.
 published in her 1961 book, The Dynamic Nurse-Patient Relationship and revised 1972 book: The Discipline and
Teaching of Nursing Processes
 A board member of Harvard Community Health Plan.

Major Dimensions

 The role of the nurse is to find out and meet the patient's immediate need for help.
 The patient's presenting behavior may be a plea for help, however, the help needed may not be what it appears to
be.
 Therefore, nurses need to use their perception, thoughts about the perception, or the feeling engendered from their
thoughts to explore with patients the meaning of their behavior.
 This process helps nurse find out the nature of the distress and what help the patient needs.

Terms

 Distress is the experience of a patient whose need has not been met.
 Nursing role is to discover and meet the patient’s immediate need for help.
o Patient’s behavior may not represent the true need.
o The nurse validates his/her understanding of the need with the patient.
 Nursing actions directly or indirectly provide for the patient’s immediate need.
 An outcome is a change in the behavior of the patient indicating either a relief from distress or an unmet need.
o Observable verbally and nonverbally.

CONCEPTS

 Function of professional nursing - organizing principle

 Presenting behavior - problematic situation
  Immediate reaction - internal response
 Nursing process discipline – investigation
 Improvement - resolution

Function of professional nursing - organizing principle

 Finding out and meeting the patients immediate needs for help

"Nursing….is responsive to individuals who suffer or anticipate a sense of helplessness, it is focused on the process of care
in an immediate experience, it is concerned with providing direct assistance to individuals in whatever setting they are found
for the purpose of avoiding, relieving, diminishing or curing the individuals sense of helplessness." - Orlando

Presenting behavior - problematic situation

 To find out the immediate need for help the nurse must first recognize the situation as problematic
 The presenting behavior of the patient, regardless of the form in which it appears, may represent a plea for help
 The presenting behavior of the patient, the stimulus, causes an automatic internal response in the nurse, and the
nurses behavior causes a response in the patient

Immediate reaction - internal response

 Person perceives with any one of his five sense organs an object or objects
 The perceptions stimulate automatic thought
 Each thought stimulates an automatic feeling
 Then the person acts
 The first three items taken together are defined as the person’s immediate reaction

Nu r s i n g p r o c e s s d i s c i p l i n e  – i n v e s t i g a t i o n

 Any observation shared and explored with the patient is immediately useful in ascertaining and meeting his need
or finding out that he is not in need at that time
 The nurse does not assume that any aspect of her reaction to the patient is correct, helpful or appropriate until she
checks the validity of it in exploration with the patient
 The nurse initiates a process of exploration to ascertain how the patient is affected by what she says or does .
 When the nurse does not explore with the patient her reaction it seems reasonably certain that clear
communication between them stops

Improvement - resolution

 It is not the nurses activity that is evaluated but rather its result : whether the activity serves to help the patient
communicate her or his need for help and how it is met.
 In each contact the nurse repeats a process of learning how to help the individual patient.

ASSUMPTIONS

 When patients cannot cope with their needs without help, they become distressed with feelings of helplessness
 Patients are unique and individual in their responses
 Nursing offers mothering and nursing analogous to an adult mothering and nurturing of a child
 Nursing deals with people, environment and health
 Patient need help in communicating needs, they are uncomfortable and ambivalent about dependency needs
 Human beings are able to be secretive or explicit about their needs, perceptions, thoughts and feelings
 The nurse – patient situation is dynamic, actions and reactions are influenced by both nurse and patient
 Human beings attach meanings to situations and actions that are not apparent to others
 Nurses are concerned with needs that patients cannot meet on their own

DOMAIN CONCEPTS

1. Nursing – is responsive to individuals who suffer or anticipate a sense of helplessness

2. Process of care in an immediate experience….. for avoiding, relieving, diminishing or curing the individuals
sense of helplessness. Finding out meeting the patients immediate need for help
3. Goal of nursing – increased sense of well being, increase in ability, adequacy in better care of self and
improvement in patients behavior
4. Health – sense of adequacy or well being . Fulfilled needs. Sense of comfort
5. Environment – not defined directly but implicitly in the immediate context for a patient
6. Human being – developmental beings with needs, individuals have their own subjective perceptions and feelings
that may not be observable directly
7. Nursing client – patients who are under medical care and who cannot deal with their needs or who cannot carry
out medical treatment alone
8. Nursing problem – distress due to unmet needs due to physical limitations, adverse reactions to the setting or
experiences which prevent the patient from communicating his needs
9. Nursing process – the interaction of 1)the behavior of the patient, 2) the reaction of the nurse and 3)the nursing
actions which are assigned for the patients benefit
10. Nurse – patient relations – central in theory and not differentiated from nursing therapeutics or nursing process
11. Nursing therapeutics – Direct function : initiates a process of helping the patient express the specific meaning of
his behavior in order to ascertain his distress and helps the patient explore the distress in order to ascertain the
help he requires so that his distress may be relieved.
12. Indirect function – calling for help of others , whatever help the patient may require for his need to be met
 13. Nursing therapeutics - Disciplined and professional activities – automatic activities plus matching of verbal and
nonverbal responses, validation of perceptions, matching of thoughts and feelings with action
14. Automatic activities – perception by five senses, automatic thoughts, automatic feeling, action

CHARACTERISTICS OF THE THEORY

 Orlando's theory interrelate concepts

 Orlando's theory has a logical nature
 Orlando's theory is simple and applicable in the daily practice.
 Orlando's theory contribute to the professional knowledge.
 Orlando's theory is applicable in clinical practice

STRENGTHS

 Use of her theory assures that patient will be treated as individuals and that they will have active and constant
input into their own care
 Prevents inaccurate diagnosis or ineffective plans because the nurse has to constantly explore her reactions with
the patient
 Assertion of nursing’s independence as a profession and her belief that this independence must be based on a
sound theoretical frame work
 Guides the nurse to evaluate her care in terms of objectively observable patient outcome

NURSING PROCESS

 Assessment
 Diagnosis
 Planning
 Implementation
 Evaluation

CONCLUSION TO THEORY

 Orlando's Deliberative Nursing Process Theory focuses on the interaction between the nurse and patient,
perception validation, and the use of the nursing process to produce positive outcomes or patient improvement.
Orlando's key focus was to define the function of nursing. (Faust C., 2002)
 Orlando's theory remains one the of the most effective practice theories available.
 The use of her theory keeps the nurse's focus on the patient.
 The strength of the theory is that it is clear, concise, and easy to use.
 While providing the overall framework for nursing, the use of her theory does not exclude nurses from using other
theories while caring for the patient.

REFERENCES

1. George B. Julia , Nursing Theories- The base for professional Nursing Practice , 3rd ed. Norwalk, Appleton &
Lange.
2. Wills M.Evelyn, McEwen Melanie (2002). Theoretical Basis for Nursing Philadelphia. Lippincott Williams& wilkins.
3. Meleis Ibrahim Afaf (1997) , Theoretical Nursing : Development & Progress 3rd ed. Philadelphia,  Lippincott.
4. Taylor Carol,Lillis Carol (2001)The Art & Science  Of Nursing Care 4th ed. Philadelphia,  Lippincott.
5. Potter A Patricia, Perry G Anne (1992) Fundamentals Of Nursing –Concepts Process & Practice 3rd ed. London
Mosby Year Book.
6. Vandemark L.M. Awareness of self & expanding consciousness: using Nursing theories to prepare nurse –
therapists Ment Health Nurs. 2006 Jul; 27(6) : 605-15
7. Reed PG, The force of nursing theory guided- practice. Nurs Sci Q. 2006 Jul;19(3):225.
8. Faust C. .Orlando's deliberative nursing process theory: a practice application in an extended care facility. J
Gerontol Nurs. 2002 Jul;28(7):14-8

http://currentnursing.com/nursing_theory/Orlando_nursing_process.html

3. Travelbee’s Human to Human Relationship

The Human to Human Relationship Model of Nursing deals with the interpersonal aspects
of nursing, focusing especially on mental health. Joyce Travelbee, who developed the
theory, explained that “human-to-human relationship is the means through which the
purpose of nursing is fulfilled.”
Travelbee based the assumptions of her model on the concepts of existentialism by
Kierkegaard and logotherapy by Frankl. Existentialism believes that humans constantly face
choices and conflicts and are accountable to the choices they make in life. Logotherapy is
meaning-centered psychotherapy based on the assumption that meaning fulfillment in life is
the best protection against emotional instability.

The Human to Human Relationship Model of Nursing has seven basic concepts. They are:
 Suffering, which is “an experience that varies in intensity, duration and
depth…a feeling of unease, ranging from mild, transient mental, physical or mental
discomfort to extreme pain….”
 Meaning, which is the reason attributed to a person
 Nursing, which helps a person find meaning in the experience of illness and
suffering; has a responsibility to help people and their families find meaning; and
the nurse’s spiritual and ethical choices, and perceptions of illness and suffering,
which are crucial to help patients find meaning.
 Hope, which is a faith that can and will be a change that would bring
something better with it. Six important characteristics of hope are: dependence on
other people, future orientation, escape routes, the desire to complete a task or
have an experience, confidence that others will be there when needed, and the
acknowledgment of fears and moving forward towards its goal.
 Communication, which is “a strict necessity for good nursing care.”
 Self-therapy, which is the ability to use one’s own personality consciously
and in full awareness in an attempt to establish relatedness and to structure
nursing interventions. This refers to the nurse’s presence physically and
psychologically.
 Targeted intellectual approach by the nurse toward the patient’s situation.
 Travelbee’s theory defines health in two categories: subjective and objective.
Subjective health is an individually defined state of well being in accord with self-
appraisal of the physical-emotional-spiritual status. Objective health is an absence of
discernible disease, disability of defect as measured by physical examination,
laboratory tests and assessment by spiritual director or psychological counselor.
 Nursing is defined as “an interpersonal process whereby the professional nurse
practitioner assists an individual, family or community to prevent or cope with
experience or illness and suffering, and if necessary, to find meaning in these
experiences.”
 According to the model, nursing is accomplished through relationships between
humans beginning with an original encounter and then progressing through stages of
emerging identities, developing feelings of empathy and sympathy.
 The nurse and patient establish a rapport in the final stage. Meeting the nursing
goals requires the creation of a genuine human-to-human relationship, which can
only be established by an interaction process. This process has five phases: the
initial meeting or original encounter, the visibility of personal and emerging identities,
empathy, sympathy, and establishing mutual understanding and rapport.

https://nursing-theory.org/theories-and-models/travelbee-human-to-human-model-of-
nursing.php#:~:text=The%20Human%20to%20Human%20Relationship,purpose%20of%20nursing%20is
%20fulfilled.%E2%80%9D

4. Hall’s, CORE,CARE,CURE

Lydia Hall: Care, Cure, Core

Nursing Theory
Biography of Lydia E. Hall
Lydia Eloise Hall (September 21, 1906 – February 27, 1969) was a nursing theorist
who developed the Care, Cure, Core model of nursing. Her theory defined Nursing
as “a participation in care, core and cure aspects of patient care, where CARE is the
sole function of nurses, whereas the CORE and CURE are shared with other
members of the health team.”
She was an innovator, motivator, and mentor to nurses in all phases of their
careers and an advocate for chronically ill patients and worked to involve the
community in public health issues as well.

Early Life of Lydia Hall

Lydia Eloise Williams Hall

Lydia Hall was born on September 21, 1906 in New York City as Lydia Eloise
Williams. She was the eldest child of Louis V. Williams and Anna Ketterman Williams
and was named after her maternal grandmother. Her brother, Henry, was several
years younger. At a young age, her family decided to move to York, Pennsylvania,
where her father was a physician in general practice.

Care, Cure, Core Theory

Lydia Hall used her knowledge of psychiatry and nursing experiences in the Loeb
Center as a framework for formulating her theory. Also known as “the Three Cs of
Lydia Hall,” it contains three independent but interconnected circles: the core, the
care, and the cure.

The core is the patient receiving nursing care. The core has goals set by him or
herself rather than by any other person, and behaves according to his or her
feelings and values.

The cure is the attention given to patients by medical professionals. Hall explains in
the model that the cure circle is shared by the nurse with other health
professionals, such as physicians or physical therapists. These are the interventions
or actions geared toward treating the patient for whatever illness or disease he or
she is suffering from.

The care circle addresses the role of nurses, and is focused on performing the task
of nurturing patients. This means the “motherly” care provided by nurses, which
may include comfort measures, patient instruction, and helping the patient meet
his or her needs when help is needed.
Hall’s theory emphasizes the total patient rather than looking at just one part and depends
on all three components of the theory working together.

Lydia Hall’s: Care, Core, Cure

Nursing theory in line with Lydia Hall is nothing short of revolutionary. In the 1960s,
she put down in her own simple words, her thoughts about nursing. She did not
consider herself a nurse theorist but instead talked about her transparent thoughts
and remarkable ideas of nursing care as she learned it over the years. These lead to
the development of her “Care, Cure, Core Theory,” also known as the “Three Cs
of Lydia Hall.”

Description
Lydia Hall’s theory define Nursing as the “participation in care, core and cure aspects
of patient care, where CARE is the sole function of nurses, whereas the CORE and CURE
are shared with other members of the health team.” The major purpose of care is to
achieve an interpersonal relationship with the individual that will facilitate the
development of the core.

As Hall says; “To look at and  listen  to self is often too difficult without the help of a
significant figure (nurturer) who has learned how to hold up a mirror and sounding
board to invite the behaver to look and listen to himself. If he accepts the invitation, he
will explore the concerns in his acts and as he listens to his exploration through the
reflection of the nurse, he may uncover in sequence his difficulties, the problem area, his
problem, and eventually the threat which is dictating his out-of-control behavior.”

Major Concepts of Care, Core, Cure

The following the the major concepts of Lydia Hall’s Care, Core, Cure nursing theory
including their definitions.

Individual
The individual human who is 16 years of age or older and past the acute stage of
long-term illness is the focus of nursing care in Hall’s work. The source of energy
and motivation for healing is the individual care recipient, not the health care
provider. Hall emphasizes the importance of the individual as unique, capable of
growth and learning, and requiring a total person approach.

Health
Health can be inferred to be a state of self-awareness with a conscious selection of
behaviors that are optimal for that individual. Hall stresses the need to help the
person explore the meaning of his or her behavior to identify and overcome
problems through developing self-identity and maturity.
Society and Environment
The concept of society or environment is dealt with in relation to the individual. Hall
is credited with developing the concept of Loeb Center because she assumed that
the hospital environment during treatment of acute illness creates a difficult
psychological experience for the ill individual. Loeb Center focuses on providing an
environment that is conducive to self-development. In such a setting, the focus of
the action of the nurses is the individual, so that any actions taken in relation to
society or environment are for the purpose of assisting the individual in attaining a
personal goal.

Nursing
Nursing is identified as consisting of participation in the care, core, and cure
aspects of patient care.

Subconcepts
Lydia Hall’s theory has three components which are represented by three
independent but interconnected circles. The three circles are: the core, the care,
and the cure. The size of each circle constantly varies and depends on the state of
the patient.

The Care Circle

According to the theory, nurses are focused on performing the noble task of
nurturing patients. This circle solely represents the role of nurses, and is focused on
performing the task of nurturing patients. Nurturing involves using the factors that
make up the concept of mothering (care and comfort of the person) and provide
for teaching-learning activities.

The care circle defines the primary role of a professional nurse such as providing
bodily care for the patient and helping the patient complete such basic daily
biological functions as eating, bathing, elimination, and dressing. When providing
this care, the nurse’s goal is the comfort of the patient.

Moreover, the role of the nurse also includes educating patients, and helping a
patient meet any needs he or she is unable to meet alone. This presents the nurse
and patient with an opportunity for closeness. As closeness develops, the patient
can share and explore feelings with the nurse.

The Core Circle

The core, according to Hall’s theory, is the patient receiving nursing care. The core
has goals set by him or herself rather than by any other person and behaves
according to his or her feelings and values. This involves the therapeutic use of self
and is shared with other members of the health team.

This area emphasizes the social, emotional, spiritual, and intellectual needs of the
patient in relation to family, institution, community and the world. This is able to
help the patient verbally express feelings regarding the disease process and its
effects by the use of the reflective technique. Through such expression, the patient
is able to gain self-identity and further develop maturity.

Reflective technique is used by the professional nurse in a way the he or she acts
as a mirror to the patient to help the latter explore his or her own feelings
regarding his or her current health status and related potential changes in lifestyle.

Motivations are discovered through the process of bringing into awareness the

feelings being experienced. With this awareness, the patient is now able to make
conscious decisions based on understood and accepted feelings and motivation.

The Cure Circle

The cure as explained in this theory is the aspect of nursing which involves the
administration of medications and treatments. Hall explains in the model that the
cure circle is shared by the nurse with other health professionals, such as
physicians or physical therapists.

In short, these are the interventions or actions geared toward treating the patient
for whatever illness or disease he or she is suffering from. During this aspect of
nursing care, the nurse is an active advocate of the patient.

Hall’s diagram showing interlocking circles that may change in size and overlap
As seen in the figure above, the three interlocking circles may change in size and
overlap in relation to the patient’s phase in the disease process. A nurse functions
in all three circles but to different degrees.

For example, in the care phase, the nurse gives hands-on bodily care to the patient
in relation in relation to the activities of daily living such as toileting and bathing. In
the cure phase, the nurse applies medical knowledge to treatment of the person,
and in the core phase, the nurse addresses the social and emotional needs of the
patient for effective communication and a comfortable environment.
Strengths
Lydia Hall’s model appears to be completely and simply logical. Her work may be
viewed as the philosophy of nursing.

The three Cs (care, core and cure) in this theory were unique. In all the circles of the
model, the nurse is present, although focus of the nurse’s role is on the care circle.

Weaknesses
Lydia Hall’s model is considered to be plain and simple in its presentation.
However, the receptiveness and resilience necessary for its utilization and function
may not be so simple for nurses whose personality, educational preparation, and
experience have not prepared them to function with minimal structure. This and
the self-imposed age and illness requirements limit the generalizability.

The age requirement for the application of her theory which is 16 years of age and
above limits the theory since it cannot be disregarded that nurses are faced with
pediatric clients every now and then.

The concept of a patient aggregate such as having families and communities as the
focus of nursing practice was not tackled. It is purely on the individual himself.
Although, the role of the family or the community within the patient’s environment
was modestly discussed.

5. Abdellah’s 21 Nursing Problems

FAYE GLENN ABDELLAH

Twenty-One Nursing Problems

Description of the Theorist

     In March 13, 1919 Faye Glenn Abdellah was born in new York city. She finished her basic
nursing education, magda cum lauda in 1942 from Fitkin Memorial Hospital School of Nursing,
in Neptune, New Jersey. She obtained her Bachelor of Science in 1945, Her Masters of Art in
1947 and her Doctor of education in 1955 from the Teacher’s college at Columbia University.
Faye Abdellah became famous and celebrated when she became the first nurse and first woman
to serve as Deputy Surgeon General of the United States. The surgeon general is basically the
leader of the United States public health service commissioned corps and thus the main
spokesperson on issues of public health.
     Due to her contributions in the field of education and nursing research, she was inducted into
the US National Women’s Hall of Fame in 2000. She is the beneficiary of both national and
international award and is a fellow, defined as an elite member of a group of people who went
together as peers in the American Academy of Nursing. Now retired, she has written and
discussed more than 100 publications related to nursing care, education for advanced practice in
nursing, and nursing research.
     It was in 1960 that she was profoundly influenced by the desire to promote client centered all-
inclusive nursing, care thus making the idea of nursing as a true humanitarian service to
individuals, to families, and therefore to society. According to her, nursing is grounded as an art
and science that molds the attitude, intellectual capabilities, and technical know-how of the
individual nurse into the desire and capacity to assist people, sick or well, and to deal with their
health needs. Nursing may be implemented under general or specific direction.
As a complete humanitarian service, nursing includes the following
         Be acquainted with the nursing problems of the patient.
         Choose the definite course of action to make in the scope of relevant nursing principles.
         Make available continuous care of the individual’s entire health needs.
         Give continuous care to relieve pain and discomfort and provide immediate security for the
individual.
         Regulate the total nursing care plan to meet the patient’s tailored needs.
         Serving the individual to become more self-determining in achieving maintaining a healthy state
of mind and body.
         Informing nursing personnel, family and support system to provide the individual act for oneself
with perceived limitation.
         Facilitate the individual to adapt to limitations and emotional problems.
         Team up with different allied health professions in working with the diagram for optimum
health on local, state, national and international levels.
         Engaging in nonstop evaluation and research to develop nursing techniques and to create new
techniques to serve the health needs of different people.
These original premises have gone into an evolutionary process. As an evidence of the dynamics
in the scope of nursing service, the third item “provides continuous care of the individual’s total
health needs” was eliminated in 1973. Although no reason was given, it can be hypothesized that
the words in ideas continuous and total make that service, for intent and purposes, impossible to
provide. From this precept and thought, Abdellah’s theory was made.

Metaparadigm

Person

Abdellah classified the beneficiary of care as individuals. However, she does not set standard
limits on the nature and essence of human beings. The twenty-one nursing problems relate wit
biological, psychological and social aspects of individuals and can be said to correspond to
concept of importance.
Health
In this theory, the concept of health is defined as the center and purpose of nursing service.
Although Abdellah does not give a definition of health, she speaks to a “total health needs” and a
“healthy state of mind and body” in her description of nursing as a comprehensive service.
Environment
The idea of environment is addressed by Abdellah and is included in the “planning for optimum
health on local, state, national and international levels.” However, as Abdellah elaborates her
ideas, the apex (core) of nursing service is the individual.
Nursing
The concept of nursing in this theory is generally grouped into twenty-one problem areas for
nurses to work out their judgement and appropriate care. Abdellah considers nursing to be an all-
inclusive service that is based on the discipline of arts and science that serves individuals, sick or
well, cope with their health needs.

Model of the Theory

Abdellah’s typology of twenty-one nursing problem is a conceptual model mainly concerned
with patient’s needs and the role of nurses in problem identification using a problem analysis
approach. According to the model, patients are described as having physical, emotional and
sociological needs. Faye Abdellah proposed a classificatory framework for identifying nursing
problems, based on her idea that nursing is basically oriented to meeting an individual client’s
total health needs. Her major effort was to differentiate nursing from medicine and disease
orientation.
Abdellah’s patient-centered approach to nursing was developed inductively from her practice
and is considered a human needs theory. Although it was intended to guide care of those in the
hospital, it also has relevance for nursing care in community settings. Abdellah was clearly
promoting the image of the nurse who was not only kind and caring, but also intelligent,
competent and technically well prepared to provide service to the patient.

Assumption 

Correct identification of nursing problems influences the judgement in selecting the next step in
solving the client’s nursing pronlem.
Philosophical  

The assumption Abdellah’s “twenty-one nursing problems theory” relates to change and
anticipated changes that affects nursing; the need to appreciate the interconnectedness of social
enterprises and social problems; the impact of problems such as poverty, racism, pollution,
education and so forth, health and healthcare delivery. Changing nursing education; continuing
education for professional nurses; and development of nursing leaders from undeserved groups.

Scientific

In Abdellah’s opinion, one of the greatest barriers that kept nursing from a professional status
was the lack of a scientific body of knowledge unique to nursing. The educational system was
not providing students and practitioners with a means to cope with clinical experiences based on
a service approach provided no measure of the quality of the experience. The delivery of care to
patients was organized around meeting the needs of the institution rather than the needs of the
patient. The typology of twenty-one nursing problems and skills was developed to constitute the
unique body of knowledge that is nursing.

Research Studies

The Practical Application of the Faye Glenn Abdellah's Theory in the Holistic Care of a
Patient with Terminal Stage Breast Cancer
Topics: Nursing, Breast cancer, Nursing theory Pages: 12 (2749 words) Published: August 18,
2010
INTRODUCTION

"Your mammogram is suspicious for breast cancer" "Your biopsy was positive for breast
cancer." These are among the most terrifying words a woman can hear from her doctor. Breast
cancer elicits so many fears, including those relating to surgery, death, loss of body image and
loss of sexuality. Managing these fears can be facilitated by information and knowledge so that
each woman can make the best decisions concerning her care. Optimally, these issues are best
discussed with the patient's doctor on an individual basis. What follows is a review of
information on breast cancer intended to aid patients and their families in their navigation
through the vast ocean of breast cancer issues.

Breast cancer is the most common cause of cancer in women and the second most common cause
of cancer death in women in the U.S and other countries. While the majority of new breast
cancers are diagnosed as a result of an abnormality seen on a mammogram, a lump or change in
consistency of the breast tissue can also be a warning sign of the disease. Heightened awareness
of breast cancer risk in the past decades has led to an increase in the number of women
undergoing mammography for screening, leading to detection of cancers in earlier stages and a
resultant improvement in survival rates. Still, breast cancer is the most common cause of death in
women between the ages of 45 and 55. (Stoppler, 2009)

RATIONALE

Breast cancer is a preventable disease but can be very chronic if it appears in a woman’s body,
especially if it metastasizes to other parts. When a woman has breast cancer, it is sometimes very
hard for them to accept the fact that they have cancer. According to an article by Gina Shaw,
2005 entitled," Metastatic Breast Cancer as a Chronic Condition”, the hardest part, for most
women, is the uncertainty. The uncertainty as to when they will stop suffering from this disease
and when they will ever get rid of it has always been the problem that breast cancer patients are
facing.

Faye Glenn Abdellah conducted research to identify ways to promote patient-centered

comprehensive nursing care. As a result of the first three of these studies, 21 basic nursing
problems were identified. Abdellah's 21 problems are actually a model describing the "arenas" or
concerns of nursing, rather than a theory describing relationships among phenomena. In this way,
the theory distinguished the practice of nursing, with a focus on the 21 nursing problems, from
the practice of medicine, with a focus on disease and cure. The problems may be overt or covert,
and problem solving is to used by the nurse. The nursing process as a problem-solving process is
compatible with this approach. (Copyright © 1995-2008, Pearson Education, Inc., publishing as
Pearson Prentice Hall)

SYNOPISIS OF THEORY

Abdellah spoke of the patient-centered approach, she wrote of nurses identifying and solving
specific problems. This identification and classification of problems was called the typology of
21 nursing problems. Abdellah’s typology was divided into three areas: (1) the physical,
sociological, and emotional needs of the patient; (2) the types of interpersonal relationships
between the nurse and the patient; and (3) the common elements of patient care. Abdellah and
her colleagues thought the typology would provide a method to evaluate a student’s experiences
and also a method to evaluate a nurse’s competency based on outcome measures. (Tomey &
Alligood, Nursing theorists and their work 4th ed., p. 115, 2002)

Abdellah's 21 problems are actually a model describing the "arenas" or concerns of nursing,
rather than a theory describing relationships among phenomena. In this way, the theory
distinguished the practice of nursing, with a focus on the 21 nursing problems, from the practice
of medicine, with a focus on disease and cure.
Reference:
 Tomey, A.M. and Alligood, M.R., 2008, nursing theorists and their work 4th ed

 Abdellah F.G. 1987, The federal role in nursing education, nursing outlook

Abdellah F.G. & Levine, E. 1994 Preparing nursing research for the 21st century

External links:

 http://nursingtheories.blogspot.com/2009/07/changing-world-one-step-at-time-faye-g.html

http://nursingtheories.blogspot.com/2009/07/changing-world-one-step-at-time-faye-g.html
http://article.sciencepublishinggroup.com/pdf/10.11648.j.sjcm.20160501.11.pdf

http://lormacollegesnursinginformatics2018.blogspot.com/2018/07/faye-abdellah.html

FAYE GLENN ABDELLAH (PATIENT-CENTERED APPROACHES) HUMAN BEINGS • describes the recipients
of nursing as individuals (and families, and thus, society), but does not delineate her beliefs or
assumptions about the nature of human beings HEALTH • Although Abdellah does not give a definition
of health, she speaks to “total health needs” and “a healthy state of mind and body” in her description
of nursing as a comprehensive service. SOCIETY • Included in “planning for optimum health on local,
state, national, and international levels”. • She indicates that by providing service to individuals and
families, society is served but does not discuss society as a patient nor define society. NURSING •
Abdellah considers nursing to be a comprehensive service that is based on an art and science and aims
to help people, sick or well, cope with their health needs. • Broadly grouped into the 21 problem areas
to guide care and promote the use of nursing judgment. ABDELLAH’S THEORY • States that nursing is the
use of the problem-solving approach with key nursing problems related to the health needs of people.
NURSING PROBLEMS • The patient’s health needs can be viewed as problems, which may be overt as an
apparent condition, or covert as a hidden or concealed one. • Nursing problem presented by a patient is
a condition faced by the patient or patient’s family that the nurse, through the performance of
professional functions, can assist them to meet. • Abdellah’s use of the term nursing problems can be
interpreted as more consistent with “nursing functions” or “nursing goals” than with patient-centered
problems; this viewpoint could lead to an orientation that is more nursingcentered than patient-
centered. • In her typology of basic nursing problems presented by patients, she includes three columns:
basic nursing problems presented by the patient, specific problem of patient, and common conditions

THE TWENTY-ONE NURSING PROBLEMS •

The crucial element within Abdellah’s theory is the correct identification of nursing problems. • These 21
nursing problems focus on the physical, biological, and sociopsychological needs of the patient and
attempt to provide a more meaningful basis for organization than the categories of the systems of the
body (see TABLE TABLE 1.

ABDELLAH’S 21 NURSING PROBLEMS

1. To maintain good hygiene and physical comfort
2. To promote optimal activity; exercise, rest and sleep
3. To promote safety though the prevention of accident, injury, or other trauma and through the
prevention of the spread of infection
4. To maintain good body mechanics and prevent and correct deformities
5. To facilitate the maintenance of a supply of oxygen to all body cells
6. To facilitate the maintenance of nutrition of all body cells
7. To facilitate the maintenance of elimination
8. To facilitate the maintenance of fluid and electrolyte balance
9. To recognize the physiological responses of the body to disease conditions – pathological,
physiological, and compensatory
10.To facilitate the maintenance of regulatory mechanisms and functions
11.To facilitate the maintenance of sensory functions
12.To identify and accept positive and negative expressions, feelings and reactions
13.To identify and accept the interrelatedness of emotions and organic illness
14.To facilitate the maintenance of effective verbal and non-verbal communication
15.To promote the development of productive interpersonal relationships
16.To facilitate progress toward achievement of personal spiritual goals
17.To create and/or maintain a therapeutic environment
18.To facilitate awareness of self as an individual with varying physical, emotional, and developmental
needs
19.To accept the optimum possible goals in the light of limitations, physical and emotional
20.To use community resources as an aid in resolving problems arising from illness
21. To understand the role of social problems as influencing factors in the cause of illness

6. Henderson’s Need Theory

Virginia A. Henderson "basic human

needs"
July 29, 2018

VIRGINIA A. HENDERSON"14 Basic Human Needs"

"The unique function of the nurse is to assist the individual, sick or well, in the performance of those
activities contributing to health or its recovery (or to peaceful death) that he would perform unaided  if he
had the necessary strength, will or knowledge"

I. Description of the Nursing Theorist

Virginia A. Henderson was born on November 30 1897, she is the fifth of the eight children
of Daniel and Lucy Henderson. In her early education she studied at home with her aunt
and her uncle, at his uncle's "All-Boys School".  She was studying in the US Army School of
Nursing  in the year 1921, got her Bachelor in Science in the year 1932,and later on got her
Master's degree in Teacher's College, Columbia University.
In the year 1921, she started working as a Public Health Nurse at the Henry Street
Settlement in Manhattan, New York. She also worked for the Visiting Nurse Association of
Washington, D.C. (1921 to 1923). Between year 1924-1925 she was the first full time
nursing instructor in Virginia while working at Norfolk Presbyterian Hospital. Henderson
taught at a University called Teacher's College in Columbia in the year 1934-1948.In 1953
at Yale School of nursing She became a research associate then being transitioned to
emeritus status in 1971 and until the year 1996. Henderson traveled the world in her whole
career not only to help and inspire nurses but other health care provider as well.

II. Meta-paradigm
Person- she defined person as someone who is in need of basic health component, and
someone that requires assistance and also known as someone who does not have
autonomy. In person she stated that mind and body are connected in any aspect of a
human being, this include components like biological, psychological, sociological, spiritual
and etc.

Environment- she defined environment as a setting that would contribute to the person

discovering different pattern for living, in short an influence. It also affect the life and growth
development of the person. The environment does not only apply to the literal environment,
it also includes the relationship between person and families. Of course this has a big
impact on her theory because almost all of the 14 human needs are affected by
environment.

Health- she defined health as the ability of a person to perform task independently relating
to her theory "14 Basic Human Needs". She also stated that we should stress out on
disease prevention and health promotion of our client. Lastly, achieving good health is a
challenge, why? Because there are tons of factors that hinders us from reaching it, these
are age, cultural background, lifestyle, gender, emotional balance etc.

Nursing- Nursing for Henderson is the assistance to an individual to achieve the 14 basic

human needs if they are not able to do it independently. Primary goal would be to nurse
them to autonomy or to basically make them independent.

III. Model of the Theory

Henderson's was more of a result of an individual coming from hospital, because the nurses
expected task is to nurse the individual get back to his healthy state, healthy meaning
performing task independently in the 14 basic human needs component:
The 14 Basic Human Needs:

1. Breathe normally. 
2. Eat and drink adequately.
3. Eliminate body wastes.
4. Move and maintain desirable postures.
5. Sleep and rest.
6. Select suitable clothes-dress and undress.
7. Maintain body temperature within normal range by adjusting clothing and modifying
environment
8. Keep the body clean and well groomed and protect the integument
9. Avoid dangers in the environment and avoid injuring others.
10. Communicate with others in expressing emotions, needs, fears, or opinions.
11. Worship according to one’s faith.
12. Work in such a way that there is a sense of accomplishment.
13. Play or participate in various forms of recreation.
14. Learn, discover, or satisfy the curiosity that leads to normal development and health
and use the available health facilities.

These 14 human needs are actually holistic cause not only does it include the biological
health it also includes spiritual, social, mental, emotional and etc. If we try to look at a bigger
picture this model is actually quite identical with Maslow's Hierarchy of Needs Theory.

IV. General Assumption

The Assumptions for this Theory are :Nurses care for patients until they can care for
themselves once again. Although not precisely explained, patients desire to return to health.
Nurses are willing to serve and that “nurses will devote themselves to the patient day and
night.” Henderson also believes that the “mind and body are inseparable and are
interrelated.” (nurseslabs.com)Nurses are willing to serve and that “nurses will devote
themselves to the patient day and night.” (Henderson, 1991).Nurses should be educated at
the university level in both arts and sciences.Henderson also believes that mind and body
are inseparable. It is implied that the mind and body are interrelated. (Henderson, 1966,
1991)(nursingtheories.weebly.com)

V. How is this Theory used in Research Studies

This theory is being used in our NCP's assessment, planning, implementation, and
evaluation(APIE). In assessment, questions will be asked based on the data provided we
can also assume some of the activities that the patient cannot perform anymore or cannot
perform routinely. In planning, we are tasked to follow the order of the doctor like the
medicine prescription in order to meet the need or the goal of this theory. Implementation,
this is the part where we can actually perform intervention relevant to the wellness of our
client. Lastly, evaluation it helps us whether we have met the goal or not.
This theory is also applied in the nursing practice in order for us nurses to reach the desired
outcome or goal. Our goal is based on the 14 components, this basis will be of good help to
us because it opens our eyes and see what is the target for our client's performance to be
better.

By: Joshelle Alvarado and Butch Salazar

VI. References

https://nurseslabs.com/virginia-hendersons-need-theory/

https://prezi.com/8qwxg61ku0lw/14-basic-human-needs-virginia-avenel-henderson/

https://en.wikipedia.org/wiki/Virginia_Henderson

http://nursingtheories.weebly.com/virginia-henderson.html

https://www.ukessays.com/essays/nursing/virginia-henderson-theory-of-nursing-nursing-
essay.php
http://lormacollegesnursinginformatics2018.blogspot.com/2018/07/virginia-henderson-basic-human-
needs.html

7. Pender’s Health Promotion Model: Nursing Theories

Health Promotion Model

This page was last updated on April 15, 2011

INTRODUCTION

 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. Health promotion is directed at increasing a client’s level of well
being.
 The health promotion model describes the multi dimensional nature of
persons as they interact within their environment to pursue health.

ABOUT THE THEORIST

 Nola J. Pender, PhD, RN, FAAN - former professor of nursing at the

University of Michigan
 Visit her page at University of Michigan
website: http://www.nursing.umich.edu/faculty-staff/nola-j-pender

The model focuses on following three areas:

 · Individual characteristics and experiences

 · Behavior-specific cognitions and affect
 · Behavioral outcomes

The health promotion model notes that each person has unique personal
characteristics and experiences that affect subsequent actions. The set of
variables for behavioral specific knowledge and affect have important motivational
significance. These variables can be modified through nursing actions. Health
promoting behavior is the desired behavioral outcome and is the end point in the
HPM. Health promoting behaviors should result in improved health, enhanced
functional ability and better quality of life at all stages of development. The final
behavioral demand is also influenced by the immediate competing demand and
preferences, which can derail an intended health promoting actions.

ASSUMPTIONS OF THE HEALTH PROMOTION

MODEL

The HPM is based on the following assumptions, which reflect both nursing and
behavioral science perspectives:

1.  Individuals seek to actively regulate their own behavior.

2.  Individuals in all their biopsychosocial complexity interact with the
environment, progressively transforming the environment and being
transformed over time.
3.  Health professionals constitute a part of the interpersonal environment,
which exerts influence on persons throughout their life span.
4.  Self-initiated reconfiguration of person-environment interactive patterns
is essential to behavior chang

THEORETICAL PROPOSITIONS OF THE HEALTH

PROMOTION MODEL

Theoretical statements derived from the model provide a basis for investigative
work on health behaviors. The HPM is based on the following theoretical
propositions:

1.  Prior behavior and inherited and acquired characteristics influence

beliefs, affect, and enactment of health-promoting behavior.
2. Persons commit to engaging in behaviors from which they anticipate
deriving personally valued benefits.
3. Perceived barriers can constrain commitment to action, a mediator of
behavior as well as actual behavior.
4. Perceived competence or self-efficacy to execute a given behavior
increases the likelihood of commitment to action and actual performance
of the behavior.
5. Greater perceived self-efficacy results in fewer perceived barriers to a
specific health behavior.
6. Positive affect toward a behavior results in greater perceived self-
efficacy, which can in turn, result in increased positive affect.
 7.  When positive emotions or affect are associated with a behavior, the
probability of commitment and action is increased.
8. Persons are more likely to commit to and engage in health-promoting
behaviors when significant others model the behavior, expect the
behavior to occur, and provide assistance and support to enable the
behavior.
9.  Families, peers, and health care providers are important sources of
interpersonal influence that can increase or decrease commitment to and
engagement in health-promoting behavior.
10.  Situational influences in the external environment can increase or
decrease commitment to or participation in health-promoting behavior.
11.  The greater the commitments to a specific plan of action, the more likely
health-promoting behaviors are to be maintained over time.
12.  Commitment to a plan of action is less likely to result in the desired
behavior when competing demands over which persons have little
control require immediate attention. 13. Commitment to a plan of action
is less likely to result in the desired behavior when other actions are
more attractive and thus preferred over the target behavior.
13.  Persons can modify cognitions, affect, and the interpersonal and
physical environment to create incentives for health actions.

THE MAJOR CONCEPTS AND DEFINITIONS OF THE

HEALTH PROMOTION MODEL

 Individual Characteristics and Experience

 Prior related behaviour
 Frequency of the similar behaviour in the past. Direct and indirect effects
on the likelihood of engaging in health promoting behaviors.

PERSONAL FACTORS

Personal factors categorized as biological, psychological and socio-cultural. These

factors are predictive of a given behavior and shaped by the nature of the target
behaviour being considered.

Personal biological factors

 Include variable such as age gender body mass index pubertal status,
aerobic capacity, strength, agility, or balance.

Personal psychological factors

 Include variables such as self esteem self motivation personal

competence perceived health status and definition of health.

Personal socio-cultural factors

 Include variables such as race ethnicity, accuculturation, education and

socioeconomic status.
 Behavioural Specific Cognition and Affect

PERCEIVED BENEFITS OF ACTION

 Anticipated positive out comes that will occur from health behaviour.

PERCEIVED BARRIERS TO ACTION

 Anticipated, imagined or real blocks and personal costs of understanding

 a given behaviour

PERCEIVED SELF EFFICACY

Judgment of personal capability to organise and execute a health-promoting

behaviour. Perceived self efficacy influences perceived barriers to action so higher
efficacy result in lowered perceptions of barriers to the performance of the
behavior. 

ACTIVITY RELATED AFFECT

Subjective positive or negative feeling that occur before, during and following
behavior based on the stimulus properties of the behaviour itself. Activity-related
affect influences perceived self-efficacy, which means the more positive the
subjective feeling, the greater the feeling of efficacy. In turn, increased feelings of
efficacy can generate further positive affect.

INTERPERSONAL INFLUENCES

Cognition concerning behaviours, beliefs, or attitudes of the others. Interpersonal

influences include: norms (expectations of significant others), social support
(instrumental and emotional encouragement) and modelling (vicarious learning
through observing others engaged in a particular behaviour). Primary sources of
interpersonal influences are families, peers, and healthcare providers.

SITUATIONAL INFLUENCES

Personal perceptions and cognitions of any given situation or context that can
facilitate or impede behaviour. 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 behaviour.

Behavioural Outcome 

COMMITMENT TO PLAN OF ACTION

The concept of intention and identification of a planned strategy leads to

implementation of health behaviour. 

IMMEDIATE COMPETING DEMANDS AND PREFERENCES

Competing demands are those alternative behaviour over which individuals have
low control because there are environmental contingencies such as work or family
care responsibilities. Competing preferences are alternative behaviour over which
individuals exert relatively high control, such as choice of ice cream or apple for a
snack

HEALTH PROMOTING BEHAVIOUR

Endpoint or action outcome directed toward attaining positive health outcome such
as optimal well-being, personal fulfillment, and productive living.

REFERENCES

1. Marriner TA, Raile AM. Nursing theorists and their work. 5th ed.
Sakraida T.Nola J. Pender. The Health Promotion Model. St Louis:
 Mosby; 2005
2. Polit DF, Beck CT. Nursing research:Principles and methods. 7th ed.
Philadelphia: Lippincott Williams & Wilkins; 2007
3. Black JM, Hawks JH, Keene AM. Medical surgical nursing. 6th ed.
Philadelphia: Elsevier Mosby; 2006.
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