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

Critique of Pender's Health Promotion Model using Fawcett's Criteria

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  • 1. HEALTH PROMOTION MODELCritique Using Fawcett’s CriteriaMargaret Gibson, Ami Mehta, Lauren Renner, & KaitlinWoike
  • 2. 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)
  • 3. 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)
  • 4. 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)
  • 5. CONCEPTUAL MODEL: PARENT THEORIES Expectancy Value  Social Cognitive Theory Theory  Fishbein & Ajzen  Bandura  Patients will work  Self- efficacy: towards goal they see “confidence the patient as beneficial and has they can carry out achievable (McCullagh, 2009) an action” (McCullagh, 2009)  More self- efficacy means a patient will be more likely to do a behavior (McCullagh, 2009)
  • 6. APPROPRIATEACKNOWLEDGEMENT/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)
  • 7. 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)
  • 8. ARE THE ELEMENTS CONGRUENT? The philosophical  Pender‟s definition of health claims, parent theories, and  “actualization of inherent the resulting propositions and acquired human are all congruent potential through goal- Most nurses are familiar directed with health as the absence behavior, competent of disease and illness self- care, and satisfying relationships with others”  May be difficult for nurses to define health in this way, especially in acute care • (McCullagh, 2009)
  • 9. CLARITY AND CONSISTENCY Semantics  There is no evidence of  Terms used are redundancy commonly understood  The theory is and defined where structurally sound and necessary based on well-  Schematic is easy to follow and understand accepted and  (McCullagh, 2009) published theories
  • 10. 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)
  • 11. CLARITY AND CONCISENESS The model clearly explains the phenomena of interest: people‟s perceptions and how their perceptions affect behavior
  • 12. 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)
  • 13. 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
  • 14. 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?
  • 15. CONGRUENCY WITH CURRENT EVIDENCE ANDLITERATURE 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
  • 16. 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)
  • 17. 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
  • 18. APPROPRIATE APPLICATIONS TO PRACTICE &FEASIBILITY Within the nursing  Feasible because it scope of practice allows interventions to Health planning is be personal to each essential, and including patient and increase patient input can be likelihood of success of useful achievement of goals • (McCullagh, 2009)  Reinforce strengths  Address facilitators and barriers  Helps the patient stay committed to goal(s) • (McCullagh, 2009)
  • 19. EXAMPLE FOR CARDIOVASCULAR DISEASE Williams, Wold, Dunkin, I  Intervention: dleman, & Jackson  Pre-test with Healthier (2004) People Health Risk Appraisal using Sample: low income rural participants‟ answers and and urban African objective data (i.e. blood American women pressure) (LAAW) working for small  Compared to American companies (less than 50 Heart Association (AHA) employees) national sample  Risk reduction interventions took lifestyle and culture into consideration
  • 20. RESULTS Pre-intervention  No difference between  Larger percentages of any groups in blood urban and rural LAAW pressure and physical had higher fat intake activity and greater BMI than  Urban LAAW had AHA sample significantly lower mean  Significantly larger cholesterol and percentage of rural significantly smaller LAAW had elevated percentages with cholesterol level than elevated cholesterol or AHA sample high dietary fat intake than rural LAAW
  • 21. RESULTS Post- intervention  No significant change in  Rural LAAW had BMI significant drop in mean  Urban LAAW made not cholesterol, significantly significant changes on fewer with elevated any measures risk cholesterol, and factors significant decrease in percentage with high dietary fat intake  No differences in mean blood pressure and percentage of physical activity
  • 22. 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
  • 23. REFERENCESFawcett, J. (2005). Criteria for evaluation of theory. Nursing Science Quarterly, 189(2), 131-135. doi: 10.1177/0894318405274823Fawcett, J. (1995). Analysis and evaluation of conceptual models of nursing (3rd 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, 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, S.J. (2009) Introduction to the nature of nursing knowledge. In S.J. Peterson & T.S. Bredow (3rd 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