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Pender's Health Promotion Model- Critique of Theory Using Fawcett's Criteria

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Critique of Pender's Health Promotion Model using Fawcett's Criteria
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HEALTH PROMOTION MODEL Critique Using Fawcett’s Criteria Margaret Gibson, Ami Mehta, Lauren Renner, & Kaitlin Woike
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Page 1: Pender's Health Promotion Model- Critique of Theory Using Fawcett's Criteria

HEALTH PROMOTION MODELCritique Using Fawcett’s Criteria

Margaret Gibson, Ami Mehta, Lauren Renner, & Kaitlin Woike

Page 2: Pender's Health Promotion Model- Critique of Theory Using Fawcett's Criteria

SIGNIFICANCE

Definition: “context of the theory” (Fawcett, 2005)

Why is the theory important and how does it contribute to nursing practice? (Fawcett, 2005)

Questions: Are the metaparadigm concepts and propositions

addressed by the theory explicit? Are the philosophical claims on which the theory

is based explicit? Is the conceptual model from which the theory

was derived explicit? Are the authors of knowledge from from

adjunctive disciplines acknowledged and biographical citations given?

• (Fawcett, 1993)

Page 3: Pender's Health Promotion Model- Critique of Theory Using Fawcett's Criteria

METAPARADIGM

Definition: “global concepts specific to a discipline that are philosophically neutral and stable” (Peterson, 2009)

Reciprocal Interaction: person is holistic and interacts with environment; change occurs at differing rates at differing times on life and cannot be predicted (Fawcett, 1995)

Page 4: Pender's Health Promotion Model- Critique of Theory Using Fawcett's Criteria

PHILOSOPHICAL VIEWS

Reciprocal World View “Humans are viewed holistically, but parts can

be studied in the context of the whole. Human beings interact with their environment and shape it to meet their needs and goals.” (Pender, 2011)

Page 5: Pender's Health Promotion Model- Critique of Theory Using Fawcett's Criteria

CONCEPTUAL MODEL: PARENT THEORIES

Expectancy Value Theory Fishbein & Ajzen Patients will work

towards goal they see as beneficial and achievable (McCullagh, 2009)

Social Cognitive Theory Bandura Self- efficacy:

“confidence the patient has they can carry out an action” (McCullagh, 2009)

More self- efficacy means a patient will be more likely to do a behavior (McCullagh, 2009)

Page 6: Pender's Health Promotion Model- Critique of Theory Using Fawcett's Criteria

APPROPRIATE ACKNOWLEDGEMENT/CITATIONS

Pender recommends using established frameworks to assess patients and develop care plans North American Nursing Diagnosis Association Gordon’s functional health patterns Health Promoting Lifestyles Profile II The nursing process Prochaska et al.’s stages of change

Acknowledgement of parent theorists, Fishbein & Ajzen and Bandura

• (McCullagh, 2009)

Page 7: Pender's Health Promotion Model- Critique of Theory Using Fawcett's Criteria

INTERNAL CONSISTENCY

Definition: “context and content of the theory” (Fawcett, 2005)

Theorist’s work is congruent (Fawcett, 2005)

Questions: Are all elements of the work congruent? Do the concepts reflect semantic clarity and

consistency? Are there any redundant concepts? Do the propositions reflect structural

consistency? • (Fawcett, 1993)

Page 8: Pender's Health Promotion Model- Critique of Theory Using Fawcett's Criteria

ARE THE ELEMENTS CONGRUENT?

The philosophical claims, parent theories, and the resulting propositions are all congruent

Most nurses are familiar with health as the absence of disease and illness

Pender’s definition of health “actualization of

inherent and acquired human potential through goal-directed behavior, competent self- care, and satisfying relationships with others”

May be difficult for nurses to define health in this way, especially in acute care

• (McCullagh, 2009)

Page 9: Pender's Health Promotion Model- Critique of Theory Using Fawcett's Criteria

CLARITY AND CONSISTENCY

Semantics Terms used are

commonly understood and defined where necessary

Schematic is easy to follow and understand

(McCullagh, 2009)

There is no evidence of redundancy

The theory is structurally sound and based on well-accepted and published theories

Page 10: Pender's Health Promotion Model- Critique of Theory Using Fawcett's Criteria

PARSIMONY

Definition: “content of theory” ( Fawcett, 2005)

Theory is stated in “most economical way possible without oversimplifying the phenomena of interest.” (Fawcett, 2005)

Question: Is the theory stated clearly and concisely?

• (Fawcett, 1993)

Page 11: Pender's Health Promotion Model- Critique of Theory Using Fawcett's Criteria

CLARITY AND CONCISENESS

The model clearly explains the phenomena of interest: people’s perceptions and how their perceptions affect behavior

Page 12: Pender's Health Promotion Model- Critique of Theory Using Fawcett's Criteria

TESTABILITY

Definition: “content of the theory” (Fawcett, 2005)

“Concepts can have operational definitions and their propositions are amenable to direct empirical testing.” (Fawcett, 2005)

Questions: Can the concepts be observed empirically? Can the proposition be measured?

• (Fawcett, 1993)

Page 13: Pender's Health Promotion Model- Critique of Theory Using Fawcett's Criteria

OBSERVATION & MEASUREMENT

“Specific instruments and experimental protocols have been developed to observe the theory concepts and statistical techniques are available to measure the assertions made by the propositions.” (Fawcett, 2005)

Common instruments used with this model Questionnaires Lab results Blood pressure readings Scales

Page 14: Pender's Health Promotion Model- Critique of Theory Using Fawcett's Criteria

EMPIRICAL ADEQUACY

Definition: “requires the assertions made by the theory to be congruent with empirical evidence.” (Fawcett, 2005)

Should be supported by the literature and current evidence (Fawcett, 2005)

Question: Are the theoretical assertions congruent with

empirical evidence?

Page 15: Pender's Health Promotion Model- Critique of Theory Using Fawcett's Criteria

CONGRUENCY WITH CURRENT EVIDENCE AND LITERATURE

Model has been used in multiple settings and is found in the literature Example from the literature

Hearing protective devices: Kerr, Saik, Monsen, & Lusk (2007) Sample: construction workers Intervention: pre-test to assess knowledge on

hearing protection Test group received tailored education based on pre-test

responses Other group received conventional education

Outcome: increase in number of construction workers using hearing protection overall

Page 16: Pender's Health Promotion Model- Critique of Theory Using Fawcett's Criteria

PRAGMATIC ADEQUACY

Definition: “utility of the theory for nursing practice.” (Fawcett, 2005)

Questions: Are education and special/skill training required prior

to application of the theory in clinical practice? For what clinical problems is the theory appropriate? Is it feasible to implement clinical protocols derived

from the theory? Are the nursing actions compatible with expectations

for nursing practice? Does the clinician have the legal ability to implement

the nursing actions? Do the nursing actions lead to favorable outcomes?

• (Fawcett, 1993)

Page 17: Pender's Health Promotion Model- Critique of Theory Using Fawcett's Criteria

EDUCATION AND SKILL REQUIREMENT

No special education would be required, since assessment, intervention development and application, and outcome measurement are all a part of the nursing process

Page 18: Pender's Health Promotion Model- Critique of Theory Using Fawcett's Criteria

APPROPRIATE APPLICATIONS TO PRACTICE & FEASIBILITY

Within the nursing scope of practice

Health planning is essential, and including patient input can be useful Reinforce strengths Address facilitators

and barriers Helps the patient

stay committed to goal(s)

• (McCullagh, 2009)

Feasible because it allows interventions to be personal to each patient and increase likelihood of success of achievement of goals

• (McCullagh, 2009)

Page 19: Pender's Health Promotion Model- Critique of Theory Using Fawcett's Criteria

EXAMPLE FOR CARDIOVASCULAR DISEASE

Williams, Wold, Dunkin, Idleman, & Jackson (2004)

Sample: low income rural and urban African American women (LAAW) working for small companies (less than 50 employees)

Intervention: Pre-test with Healthier

People Health Risk Appraisal using participants’ answers and objective data (i.e. blood pressure)

Compared to American Heart Association (AHA) national sample

Risk reduction interventions took lifestyle and culture into consideration

Page 20: Pender's Health Promotion Model- Critique of Theory Using Fawcett's Criteria

RESULTS

Pre-intervention Larger percentages

of urban and rural LAAW had higher fat intake and greater BMI than AHA sample

Significantly larger percentage of rural LAAW had elevated cholesterol level than AHA sample

No difference between any groups in blood pressure and physical activity

Urban LAAW had significantly lower mean cholesterol and significantly smaller percentages with elevated cholesterol or high dietary fat intake than rural LAAW

Page 21: Pender's Health Promotion Model- Critique of Theory Using Fawcett's Criteria

RESULTS

Post- intervention Rural LAAW had

significant drop in mean cholesterol, significantly fewer with elevated cholesterol, and significant decrease in percentage with high dietary fat intake

No differences in mean blood pressure and percentage of physical activity

No significant change in BMI

Urban LAAW made not significant changes on any measures risk factors

Page 22: Pender's Health Promotion Model- Critique of Theory Using Fawcett's Criteria

IMPLICATIONS FOR PRACTICE

Using customized interventions are useful and help to make interventions the patient feels in valuable and attainable

More research and replication of these types of studies are needed to test the intervention on a larger scale

Interventions need to be followed long term to determine effectivness

Page 23: Pender's Health Promotion Model- Critique of Theory Using Fawcett's Criteria

REFERENCES

Fawcett, J. (2005). Criteria for evaluation of theory. Nursing Science Quarterly, 189(2), 131-135. doi: 10.1177/0894318405274823

Fawcett, J. (1995). Analysis and evaluation of conceptual models of nursing (3 rd Ed.) Philadelphia: F.A. Davis Company.

Fawcett, J. (1993). Analysis and evaluation of nursing theories. Philadelphia: F.A. Davis (36)

‘Health Promotion Model’ (2012). Nursing theories: A companion to nursing theories and models. Retrieved from

http://nursingplanet.com/health_promotion_model.html

Kerr, M.J., Savik, K., Monsen, K.A., & Lusk, S.L. (2007). Effectiveness of computer-based tailoring versus targeting to promote use of hearing

protection. Journal of Nursing Research, 39, 80-97.

McCullagh, M.C. (2009). Health Promotion. In S.J. Peterson & T.S. Bredow (3rd Ed), Middle Range Theories: Application to Nursing Research.

(pp.224-234). Philadelphia: Lippincott, Williams, & Wilkins.

Pender, N. (2011). The health promotion model manual. Retrieved from

http://deepblue.lib.umich.edu/bitstream/2027.42/85350/1/HEALTH_PROMOTION_MANUAL_Rev_5-2011.pdf

Peterson, S.J. (2009) Introduction to the nature of nursing knowledge. In S.J. Peterson & T.S. Bredow (3 rd Ed), Middle Range Theories:

Application to Nursing Practice. (pp.1-37). Philadelphia: Lippincott, Williams, & Wilkins.

Williams, A., Wold, J., Dunkin, J., Idleman, L., & Jackson, C. (2004) CVD prevention strategies with urban and rural african american women.

Applied Nursing Research, 17(3), 187-194. doi: 10.1016/j.apnr.2004.06.003


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