NRS 429 Describe a health promotion model used to initiate behavioral changes

NRS 429 Describe a health promotion model used to initiate behavioral changes

NRS 429 Describe a health promotion model used to initiate behavioral changes

Patient Engagement through using every available resource is a Health Promotion Model that assists nurses with implementing behavioral changes in patients. This model has been found to be effective due to the actual patient and caregiver experience of participating in all of the actual steps of the procedure or process that they are asked to complete. Engagement and “hands on” experience assists the patient and caregiver in developing confidence in performing the new skill or task.

Behavioral changes can occur when a patient and caregiver first see everything they need to do. The second part of this process involves using their hands to touch the new equipment and to perform the new skill, with a nurse acting as a coach to provide anticipatory guidance. The nurse essentially models the behavior or skill and asks the patient or caregiver to repeat the skill. This is known as a “return demonstration.” The return demonstration allows a nurse to assess for any knowledge gaps and areas that the patient may need further instruction or reinforcement of education. (Smith and Zsohar, 2013.)

There can be multiple barriers to a patient’s ability to learn. In the Emergency Room setting where I work,

NRS 429 Describe a health promotion model used to initiate behavioral changes
NRS 429 Describe a health promotion model used to initiate behavioral changes

sometimes a barrier can be that no new learning can take place due to a patient’s high stress level about their condition. There are times where I have to give a patient some time to process what has happened to them. As an astute nurse, I have to always look for windows of opportunity when the patient is ready and also capable of learning something new.

Other barriers that patients may face include the following: Educational level, life experience level, emotional maturity level, distraction level, preoccupation with stressors not related to or exacerbating the health condition, and Caregiving for others. These barriers can often be assessed on admission to the department, and they often become apparent when a nurse tries to teach her patient about their condition. This is an important reason to begin discharge planning on admission. (Winters and Echeverri, 2012.)

A patient’s readiness to learn is related to their overall level of motivation and concern. In my experience, most patients have a strong desire to learn about their conditions and improve their outcomes. They welcome the information and resources that I provide as a Complex Care Manager. However, not all patients are in a place where they are ready to learn. Some of them have been told about the need to make changes, and they are not quite ready to make those changes for reasons they do not always share with me. Some of the reasons could be that they are in denial about their condition, or they do not want to be “bothered” with the tasks they need to complete. They may be role-overloaded or have a temperament which is fearful and avoidant. People cope in a variety of ways, and some coping skills and styles are maladaptive. (Thompson, et al. 2010.)

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The skilled nurse’s duty is to inform, but she cannot always convince patients to do the right thing. In every case, we are tasked with providing patients with a complete understanding of what they need to do, along with a demonstration of any new skills or tasks to complete, where possible. Patient education packets and “kits” are very helpful in assisting nurses in performing demonstrations and patients in performing return demonstrations. The nurse is responsible for ensuring a thorough understanding of medical care needed, and for setting patients up for success. Patients then have the freedom of choice about whether they will adhere to the plan or become noncompliant with care. A follow-up call can be an effective way to assess if teaching strategies are working in the context of the patient’s daily environment.


  1. Smith, Jackie A. PhD; Zsohar, Helen PhD, RN. Patient-education tips for new nurses. Nursing: October 2013 – Volume 43 – Issue 10 – p 1-3 doi: 10.1097/01.NURSE.0000434224.51627.8a
  2. “Teaching Strategies to Support Evidence-Based Practice,” by Winters and Echeverri, from Critical Care Nurse (2012).
  3. Thompson RJ, Mata J, Jaeggi SM, Buschkuehl M, Jonides J, Gotlib IH. Maladaptive coping, adaptive coping, and depressive symptoms: variations across age and depressive state. Behav Res Ther. 2010 Jun;48(6):459-66. doi: 10.1016/j.brat.2010.01.007. Epub 2010 Feb 10. PMID: 20211463; PMCID: PMC2872051.

I definitely agree, at the end of the day, it is up to the patient to implement the new information and skill that have been taught to them. As a nurse, we must try our best to inform our patients about the importance of the education that we provide. We are tasked with assessing the patients learning needs and any potential barriers the patient may have. Following that assessment, it is also our duty to find the best learning style for the patient. “Health education benefits not just the patient but healthcare organizations too. Knowledgeable patients spend less time in the hospital, saving the facility valuable resources.” (Arkansas State University, 2022) Unfortunately, to their own detriment, patients sometimes as much as we may try, the patient may not be willing/ready to implement the new information that they have received.


Nurses at the forefront of Patient Education: A-state online. Arkansas State University Online. (2022, April 13). Retrieved October 1, 2022, from

Trans-theoretical health promotion model helps initiate a behavioral change by helping to account for the individual’s readiness to accept change and make and sustain the changes in the behavior (Scott & Andrewes, 2021). The health promotion model is helpful for health promotion planners to design sustainable health programs to determine the readiness, motivation, and ability to complete the health promotion.

According to the trans-theoretical model, individuals are expected to move through six stages of change. The trans-theoretical model shows that behavioral change in individuals happens when they move through a series of steps and not through a single event that appears to be sudden (Scott & Andrewes, 2021). This means that change in behavior for individuals needs to be a process and not an event. The focus of this behavioral health promotion model is to help individuals achieve higher than their initial well-being. According to Mansuroğlu & Kutlu, the behavioral health promotion model encourages the behavioral professional to provide the assistive resources and environment to initiate and sustain the change (2022).

According to the trans-theoretical health promotion model, the common barriers that hinder behavioral change include time, lack of access to the right resources, or affordance (Scott & Andrewes, 2021). In addition, according to the health promotion model, social environment and cultural norms also dictate interpersonal influences to model behavioral change.

According to the trans-theoretical model, patients that exhibit readiness to learn or change as they progress through the stages of modeling behavior will find it easy to be receptive to the teachings and the lessons (Mansuroğlu & Kutlu, 2022). This means that when the willingness to learn and change is present, patients will have an effort to change their behavior.


Mansuroğlu, S., & Kutlu, F. Y. (2022). The Transtheoretical Model-based psychoeducation’s effect on healthy lifestyle behaviors in schizophrenia: A randomized controlled trial. Archives of Psychiatric Nursing41, 51-61.

Scott, L., & Andrewes, T. (2021). Using the transtheoretical model of behavior change to analyze the impact of stopping exercise: a reflection. British Journal of Nursing30(20), 1203-1205.