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Critique of Pender's Health Promotion Model using Fawcett's Criteria
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HEALTH PROMOTION MODELCritique Using Fawcett’s Criteria
Margaret Gibson, Ami Mehta, Lauren Renner, & Kaitlin Woike
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)
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)
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)
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)
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)
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)
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)
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
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)
CLARITY AND CONCISENESS
The model clearly explains the phenomena of interest: people’s perceptions and how their perceptions affect behavior
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)
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
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?
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
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)
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
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)
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
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
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
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
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