Personal Health Assessment and Health Promotion Plan Sarah Elser Ferris State University

2 PERSONAL HEALTH PLAN Abstract In this paper, I discuss both my personal health beliefs and my plan to promote the highest degree of health and wellness possible. The Transtheoretical Model is researched and explored to assess my willingness and motivation to adapt new, healthy behaviors. Several assessment tools were used to determine my current health practices, such as my fitness level along with stress management. Using the Transtheoretical Model, health assessment tools, and NANDA nursing diagnosis I developed several goals to aid in my quest to achieve a higher level of health. Keywords: personal health assessment, health promotion plan, Transtheoretical Model, nursing wellness diagnosis, exercise

3 PERSONAL HEALTH PLAN Personal Health Assessment and Health Promotion Plan There are several purposes to this paper. The first purpose is to assess my current level of health, including both physical and mental aspects. The second purpose is to develop a plan to achieve an optimal level of health and wellness. This assignment comes at a very interesting time for me, as I am nearing the end of a pregnancy so all aspects of my health have taken some major turns over the past few months and a plan for future health, fitness, and nutrition is much needed at this point. I used the Health Beliefs Survey (Appendix A) to begin to assess my personal health beliefs. The results were not completely surprising to me, as I scored highest on the internal subscale; the survey states that this means I feel as though I have control over my health and I believe this to be very true (Ursuy, 2011, p.23). I do believe that there are certain genetic and other factors that cannot be controlled, but for the most part I believe that my choices and habits have the most influence on my overall health which is exactly what my results indicated. Based on the results of the survey and my general health beliefs, I have set several goals in which I believe will enable me to be in the best state of wellness that I can be. These goals include increased exercise, improved nutrition, moderate weight loss, and maintaining low stress levels. I selected several tools to assist me in assessing my current level of health and wellness in order to set realistic and effective goals for myself. Instrument Selection My assessment instrument and tool selections are based on those that I feel would be most beneficial in assisting me to achieve my goals of increased exercise or physical fitness, improved nutrition, moderate weight loss, and maintaining a low level of stress.

4 PERSONAL HEALTH PLAN The first tool that I chose to use in order to adequately assess my current level of fitness is the Assessment of Muscular Strength and Endurance (Appendix B). I know that increasing the amount of exercise is the goal that will greatly help me in achieving the other goals; I feel that it is important to have a realistic knowledge of my fitness base, or starting point. The muscular strength and endurance assessment proved to be very useful in assessing my current fitness level. The only problem I found with it is that I was in my 30th week of pregnancy when I completed the exercises which may have given a slightly skewed representation of my general fitness level. I scored at an “average” level on the wall sit test, which seems to be a fairly accurate assessment of my lower body strength. I opted not to do the sit-up assessment, as sit-ups are generally not a recommended exercise during pregnancy. I excelled in the push-up assessment, completing 38 which is almost to the maximum amount for my age group. The 2-mile run was a little slower than I might normally complete it, as I finished it in just over 20 minutes. Overall, I think this gave me a good look at my overall fitness level, even completing the assessment at 30 weeks pregnant. The second tool that I chose to use is the Stress Management Journal (Appendix C). This tool enabled me to assess some of my current stressors, which is helpful to acknowledge with a goal of maintaining low levels of stress. After reviewing the journal at the end of the week, it was clear to me that the majority of my stress comes from everyday occurrences that cannot necessarily always be controlled. I think I handled most of the situations very effectively, but several of them significantly increased my overall stress level. As I am not always able to control the events that cause stress to me, I know that I need to have a plan to reduce this stress by other, controllable methods. Transtheoretical Model

5 PERSONAL HEALTH PLAN The Transtheoretical Model was designed to “describe how individuals progress toward adapting and maintaining behavior change” (Pender, 2011, pg. 51). It consists of five stages which are applicable to both those trying to quit a negative health behavior or start a healthy habit. The five stages are precontemplation, contemplation, planning or preparation, action, and maintenance. Precontemplation, or the first stage where one has no intention to consider changing a health behavior within the next six months, occurred for me when I first learned of my pregnancy. At this point, I knew that it was not an option to plan an extensive exercise regimen. Soon after learning of the pregnancy, I began experiencing extreme nausea throughout the day; exercising was the last thing I wanted to do, and I was happy if I could keep down any sort of food, let alone plan a nutritious meal. The next stage, contemplation, occurs when “an individual is seriously thinking about quitting or adopting a particular behavior in the next six months (Pender, 2011, pg. 51). About three months ago, as I was entering the third trimester, I started to feel a great deal better and began thinking about how I was going to change my behaviors once the baby was born. At this point, I had not yet made a plan or decided exactly what I intended to do, but I knew that a big change was going to occur. At this time, I will be delivering my baby any day and believe that I have entered the planning or preparation stage, when I plan on “engaging the contemplated change within the next month” (Pender, 2011, pg. 51). I have made a plan to run a full marathon in May 2013, improve my overall nutrition, and lose 20-25 pounds and am fully prepared to begin that journey shortly after the birth of my baby. I have taken small steps in beginning the process by daily walks and

6 PERSONAL HEALTH PLAN researching marathon running and training techniques to ensure I am adequately prepared to pursue my goals. The last two steps in the Transtheoretical Model are the action and maintenance steps, which I anticipate to occur in the next six months and beyond. The action phase will occur while I am training for the marathon through the next six months. Then, the maintenance phase will occur as I continue my exercise habits and maintain my fitness level. The Transtheoretical Model is a great way to determine one‟s willingness and progress in approach to a change in health behaviors and my quest for increased exercise is not an exception. Nursing Wellness Diagnosis The NANDA wellness nursing diagnosis that I feel best describes my current health promotion plan is Health Seeking Behaviors related to absence of aerobic exercise (Sparks & Taylor, 2007, pg. 842). Sparks and Taylor define this diagnosis by stating, “active seeking (by a person in stable health) of ways to alter personal health habits or the environment in order to move toward a higher level of health” (2007, pg. 842). This nursing diagnosis addresses my main goal of increasing my exercise habits to achieve a higher level of fitness, health, and wellness. Key components to this wellness nursing diagnosis include understanding the benefits of an exercise program, developing an exercise routine, and knowing personal guidelines for an exercise regimen. I have a very solid understanding of the benefits of an exercise program, as I have trained for a marathon previously and experienced those benefits first-hand. Increased energy, decreased stress levels, weight loss, and improved nutritional intake were just a few of the major benefits that I encountered. After thorough research, I have decided to use Hal Higdon‟s marathon training guide as my outline for developing my exercise routine and setting my personal health promotion goals (Appendix D).

7 PERSONAL HEALTH PLAN Personal Goals I have set goals for myself in order to achieve the level of health and fitness that I desire after the birth of my baby. The biggest goal is one that I believe will greatly assist me in achieving the other goals; I plan to run my second marathon at the end of May, 2013. I know that this is an attainable goal for me, as I have already completed one full marathon after the birth of my first daughter a couple years ago. However, it will still be a challenge as it requires a great deal of time, dedication, and commitment to adequately train for a 26.2 mile race. My plan for training includes a six month regimen of four to five runs a week building from ten to forty-five miles a week with a “long” run once a week peaking three weeks before the race (Appendix D). This is the training schedule I followed while training for my first marathon and it enabled me to sufficiently complete the race so I am confident in following it again. In order to safely and effectively train for a marathon, I have to address my nutrition and eating habits. I have had some pretty severe nausea and acid reflux throughout my entire pregnancy and unfortunately my eating habits have reflected this. I have only been able to stomach certain foods and often “healthy” choices are not the most tolerable. I am very much looking forward to getting back on track nutritionally and increasing my intake of fruits and proteins which are two categories I have not been able to enjoy for a while. I know that I will need to take in more calories while I am running high mileage in order to fuel my body for the longer runs and I plan to get these extra calories from sources such as complex carbohydrates and proteins. Being a mother of a toddler and a newborn, a wife, taking classes towards a BSN, working full-time, and running a semi-organized household will all contribute to potentially high stress levels as I set out to achieve my goals. In the past, I have discovered that the best way for

8 PERSONAL HEALTH PLAN me to keep my stress at a manageable level is by exerting it through physical exercise. This is another way that training for the marathon will assist me in achieving the highest level of health and wellness that I can. I believe that setting a goal to control my stress levels by maintaining an exercise routine will enable me to be the best that I can be in all of the above roles that I have taken on. The last goal that I have set for myself is to return to my pre-pregnancy weight, which will require losing about 20-25 pounds after my daughter is born. I think this will be most successful if I can lose two to three pounds a week. By logging a sufficient amount of mileage each week during training for the marathon and following my nutritional plan, losing this weight should be an easily met goal. Conclusion I have been contemplating and in the beginning stages of creating a health promotion plan for several months now and with the help of this class and assignment, my plan is becoming a reality. By using the personal health assessment to determine my personal health beliefs, I was able to confirm my beliefs that I am generally in control of my own health and wellness. With this information, I used the health assessment tools of muscular strength and endurance assessment (Appendix B) and a stress management journal (Appendix C) to formulate my goals of increasing physical exercise to decrease stress levels and weight and increase nutrition. I analyzed my motivation and progress towards change with the help of the transtheoretical model. In conclusion, I feel much more prepared to start my journey towards greater health and wellness after the end of this pregnancy and I am confident that achieving the goals that I have set for myself is not only possible, but highly likely.

9 PERSONAL HEALTH PLAN References Higdon, H. (2011) Marathon Training Guide-Novice 2. Hal Higdon 26.2. Retrieved 9-24-12 from http://www.halhigdon.com/training/51138/Marathon-Novice-2-Training-Program Pender, N. J., Murdaugh, C. L., Parsons, M. A., (2006). Health promotion in nursing practice (6th ed.). Upper Saddle River, NJ: Pearson Prentice Hall. Sparks, S., & Taylor, C. (2007). Nursing diagnosis reference manual (7th ed.). Philadelphia, PA: Lippincott Williams & Wilkins. Ursuy, P. (2011). NURS 310 Class Syllabus.

10 PERSONAL HEALTH PLAN Appendix A Health Beliefs Survey The questionnaire is designed to determine the way in which different people view certain important health-related issues. Each item is a belief statement, with which you may agree or disagree. Beside each statement is a scale that ranges from strongly disagree (1) to strongly agree (6). For each item, choose the number that represents the extent to which you disagree or agree. This is a measure of your personal beliefs; obviously, there are no right or wrong answers. Please answer these items carefully, but do not spend too much time on any one item. As much as you can, try to respond to each item independently. When making your choice, do not be influenced by your previous choices. It is important that you respond according to your actual beliefs and not according to how you feel you should believe or how you think we want you to believe. 1 – Strongly Disagree; 2 – Moderately Disagree; 3 – Slightly Disagree; 4 – Slightly Agree; 5 – Moderately Agree; 6 – Strongly Agree 1 1. If I get sick, it is my own behavior that determines how soon I will get well again. 2. No matter what I do, if I am going to get sick, I‟ll get sick. 3. Having regular contact with my physician is the best way for me avoid illness. 4. Most things that affect my health happen to me by accident. 5. Whenever I don‟t feel well, I should consult a medically trained professional. 6. I am in control of my health. 7. My family has a lot to do with my becoming sick or staying healthy. 8. When I get sick, I am to blame. 9. Luck plays a big part in determining how soon I will recover from an illness. 10. Health professionals control my health. X X X X X 2 3 4 5 6 X



11 PERSONAL HEALTH PLAN 11. My good health is largely a matter of good fortune. 12. The main thing that affects my health is what I myself do. 13. If I take care of myself, I can avoid illness. 14. When I recover from illness, it‟s usually because other people have been taking good care of me. (doctor, nurses, family) 15. No matter what I do, I‟m likely to get sick. 16. If it‟s meant to be, I will stay healthy. 17. If I take the right actions, I can stay healthy. 18. Regarding my health, I can only do what my doctor tells me to do. These three subscales, and the items included in each, are as follows:
  


Internal Items: 1, 6, 8, 12, 13, 17 Chance Items: 2, 4, 9, 11, 15, 16 Powerful-others items: 3, 5, 7, 10, 14, 18

The score on each subscale is the sum of the values for each item in that subscale multiplied by 2. Scores within each subscale can range from 12 to 72. The higher the score on the internal subscale, the more personal control clients believe that they exercise over their own health. The higher the scores on the chance subscale and power-others subscale, the higher the beliefs in the importance of chance and others respectively in controlling personal health. Normative means for adults on each subscale are as follows:

Internal, 50.4 Chance, 31.0 Powerful-others, 40.9

12 PERSONAL HEALTH PLAN Appendix B Assessment of Muscular Strength and Endurance The Wall Sit Women (20 yrs) 68 seconds 45 seconds 23 seconds <23 seconds Women‟s PT Test Minimum/Maximum Standards Push-ups Set-ups 2 mi. Run (Min/Max) (Min/Max) (Min/Max) 19/42 53/78 18:54/15:36 17/46 50/80 19:36/15:36 17/50 45/82 20:30/15:58 15/45 42/76 21:42/15:54 13/49 38/76 22:42/17:00 12/37 32/72 23:42/17:24 10/34 30/66 24:00/17:36 9/31 28/66 24:24/19:00

High Average Below Average Low Age 17-21 22-26 27-31 32-36 37-41 42-46 47-51 52-56

13 PERSONAL HEALTH PLAN Appendix C Stress Management Journal Date/Time 9.22.12 @ 1230 Stressor What I Did About It Effectiveness of Action Babysitter cancelled at Called my mother-in-law Mother-in-law was able to watch last minute when I had to ask if my daughter her, and I was only a couple minutes to attend a meeting at could stay with her for a late for the meeting. work. couple hours. Babysitter again Waited until my husband Did not get as much sleep as I would cancelled at last got home from work to have liked before going into work, minute due to an sleep before going to but a little is better than none! illness. work. Got to work to learn Took an extra 5 minutes at The entire shift was still very hectic that not only were we start of shift to organize and crazy, but following my “map” short staffed, but ER myself and map out a plan was helpful to make sure I did not was full of admissions. to make sure all patients forgot any meds, scheduled were adequately cared for. interventions, etc. Another night of being Took a deep breath, I still ended up very far behind, but short staffed, plus I organized myself as best eventually caught up and was able to was floated to an as possible and worked prioritize patient needs and unfamiliar unit. quickly and efficiently so everything was taken care of by the I wouldn‟t fall too far end of the shift. behind. Paying bills. Paid bills due soonest first Unfortunately a couple bills were and left enough in bank late this week, but I was able to pay account for groceries, gas, them within a couple days on pay etc. for the rest of the day. week. Had a „family night‟ Took our supper out of the Missed our „family night‟ for the planned when my inoven and called my week, but supper tasted just as good laws called and asked husband to tell him to the following night. for help at their meet us uptown at his business for the parents‟ business. evening. My daughter let our Got my daughter dressed, After a stressful half-hour of dog out the front door; threw on another layer of dragging my daughter around the he was 2 blocks away clothes and jetted out the neighborhood yelling for the dog, before I even got to door with a leash, yelling we finally found him… sitting on the door. for the dog. the front steps to the house. While washing the Cleaned up the still water Probably stressed my husband out dishes, discovered a and stopped using the sink over it because I was so nervous it leak under the sink until my husband got would cost a lot to fix, but he was which had soaked the home to look at it. able to fix it without any major entire cupboard. Stressed all day about how expenses, thankfully. much it would cost to fix

9.23.12 @ 1300

9.23.12 @ 1900

9.24.12 @ 1900

9.25.12 @ 1430

9.25.12 @ 1715

9.26.12 @ 0800

9.26.12 @ 1030

14 PERSONAL HEALTH PLAN it, given our financial situation this week. Told her I needed to see a patient and we would work this out later.

9.27.12 @ 2300

Disagreement with a co-worker.

Gave us both time to realize it probably wasn‟t that big of a deal, either of our solutions would work fine.

15 PERSONAL HEALTH PLAN Appendix D Marathon Training Schedule

WEEK 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18

MON Rest Rest Rest Rest Rest Rest Rest Rest Rest Rest Rest Rest Rest Rest Rest Rest Rest Rest

TUE 3 m run 3 m run 3 m run 3 m run 3 m run 3 m run 4 m run 4 m run 4 m run 4 m run 5 m run 5 m run 5 m run 5 m run 5 m run 5 m run 4 m run 3 m run

WED 5 m pace 5 m run 5 m pace 6 m pace 6 m run 6 m pace 7 m pace 7 m run 7 m pace 8 m pace 8 m run 8 m pace 5 m pace 8 m run 5 m pace 4 m pace 3 m run 2 m run

THU 3 m run 3 m run 3 m run 3 m run 3 m run 3 m run 4 m run 4 m run 4 m run 4 m run 5 m run 5 m run 5 m run 5 m run 5 m run 5 m run 4 m run Rest

FRI Rest Rest Rest Rest Rest Rest Rest Rest Rest Rest Rest Rest Rest Rest Rest Rest Rest Rest

SAT 8 9 6 11 12 9 14 15 Rest 17 18 13 19 12 20 12 8 2 m run

SUN Cross Cross Cross Cross Cross Cross Cross Cross Half Marathon Cross Cross Cross Cross Cross Cross Cross Cross Marathon

Marathon training schedule. (Higdon, 2011).