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404 UNIT IV Nursing Theories

life span and is useful in a variety of settings (Pender, its application to include global health-promotion
1996; Pender, Murdaugh, & Parsons, 2002). The model strategies.
applies the formation of community partnerships
with its consideration of the environmental context
and extends to global health promotion (Pender, Further Development
Murdaugh, & Parsons, 2010). The model continues to be refined and tested for its
Clinical interest in health behaviors represents a power to explain the relationships among factors be-
philosophical shift that emphasizes quality of lives lieved to influence changes in a wide array of health
alongside the saving of lives. In addition, there are behaviors. Sufficient empirical support for model
financial, human, and environmental burdens upon variables now exists for some behaviors to warrant
society when individuals do not engage in preven- design and conduct of intervention studies to test
tion and health promotion. The HPM contributes a model-based nursing interventions. Lusk and col-
nursing solution to health policy and health care leagues (Lusk, Hong, Ronis, et al., 1999; Lusk, Kwee,
reform by providing a means for understanding Ronis, & Eakin, 1999) used important predictors of
how consumers can be motivated to attain personal construction workers’ use of hearing protection from
health. the HPM (self-efficacy, barriers, interpersonal influ-
ences, and situational influences) to develop an inter-
Education active, video-based program to increase use. This
The HPM is used widely in graduate education large, multiple-site study found that the intervention
and increasingly in undergraduate nursing education increased the use of worker hearing protection by
in the United States (Pender, personal communi- 20% compared with the group without intervention—
cation, May 24, 2000). In the past, health promotion a statistically significant improvement from baseline
was placed behind illness care, because clinical edu- (Lusk, Hong, Ronis, et al., 1999). Additional interven-
cation was conducted primarily in acute care settings tion studies represent the next step in the use of the
(Pender, Baraukas, Hayman, et al., 1992). Increas- model to build nursing science.
ingly, the HPM is incorporated in nursing curricula
as an aspect of health assessment, community health Critique
nursing, and wellness-focused courses (N. Pender,
personal communication, May 24, 2000). Growing Clarity
international efforts across a number of countries are The conceptual definitions provide clarity and lead to
working to integrate the HPM into nursing curricula greater understanding of the complexity of health
(Pender, personal communication, May 6, 2004; Pender, behavior phenomena. Visual diagrams illustrate the
Murdaugh, & Parsons, 2002). relationships clearly (see Fig. 21–2).
Research Simplicity
The HPM is a tool for research. Pender’s research The HPM is easy to understand. The factors in
agenda and that of other researchers have tested each set are linked logically and the relationships are
and report the empirical precision of the model. The clarified in the theoretical assertions. The sets of
Health Promoting Lifestyle Profile, derived from the factors, which are direct or indirect influences, are
model, serves as the operational definition for health- clear in visual diagrams that display their associa-
promoting behaviors. Drawing upon the HPLP, the tions. Factors are seen as independent, but the sets
Adolescent Lifestyle Profile demonstrates the adapt- have an interactive effect that results in action.
ability of the HPM to the life span (Hendricks,
Murdaugh, & Pender, 2006). The HPM model has Generality
applications emphasizing the importance for the The model is middle range in scope. It is highly
assessment of factors believed to influence health generalizable to adult populations. The research used
behavior changes. Further research is indicated to to derive the model was based on male, female, young,
examine the environmental context and expand old, well, and ill samples. The research agenda includes