Running head: RISK ASSESSMENT

Partner Risk Assessment and Planning Lisa N. Dust Ferris State University

RISK ASSESSMENT Abstract Assessment and evaluation of an individuals health patterns through the use of an online questionnaire, RealAge, was used to give feedback and results on the questions answered. Personalized recommendations were then generated to inform the client of the areas needing improvement or that are helping that individual to stay on track or to make them younger. Two key areas were identified for further attention: the clients nutrition and diet, and her ways of coping with and enduring stress. Plans were identified to address these areas: a dietary log to identify where the client should incorporate different food groups and colors, and promoting relaxation to decrease stress through the use of a breathing technique. Implementation of these

plans was to start slow and increase usage per week to allow for success to be felt early on and to promote continuation of the plans of care. Evaluation was showing signs that they were contributing to a healthier and happier lifestyle for her, however further examination would be needed to ensure that the plans of care were working.

RISK ASSESSMENT Partner risk assessment and planning

The RealAge assessment demonstrates components of the clients lifestyle that contribute to a younger body age, maintain current age, or increase body age in comparison to their biological age. Providers evaluate and analyze the clients responses and gain insight into how their genetics and environment influence their health and well-being, which can then be implemented in evaluations and diagnoses. Assessment As mentioned above, the RealAge online assessment was used to gain insight and compare the individuals biological age to their bodys physiological age. This information is then tallied, identifying how much younger or older the bodys physiological age is compared to their biological age. The results of the assessment displayed that the client was 5.4 years younger than her actual biological age (Sharecare, 2013). In the first category, health, the client had the following items identified as making her younger: her waist size is within a healthy zone; she avoids second-hand smoke; her sleep schedule is consistent. Items mentioned as helping to maintain her age were: keeping allergies under control; protecting her joints; having cholesterol tested. Conversely, factors making the client older: infrequent monitoring of blood pressure; sun exposure (Sharecare, 2013). The second categorys results are based on the clients feelings and emotions. Through staying in touch with friends, staying positive and maintaining her sense of purpose, a younger body age is achieved. Interaction with a pet is aiding her to stay on track. Factors that make her older are stress, dis-satisfying sex/relationship, financial worries, and unfavorable coping strategies (Sharecare, 2013).

RISK ASSESSMENT Within the diet tier eating more fruit and nuts, limiting red meat, and eating fish are contributing to making her younger. On the flip side, the elements making her older were

omission of a vitamin D supplement, a stagnant diet, junk food, not enough vegetables or grains, and not eating a healthy breakfast every morning. Finally, the fitness category disclosed that participating in cardiovascular/aerobic exercise, walking, performing flexibility exercises, staying active, and following a workout plan make her younger. Not participating in enough tightening and toning exercises instigate an older body age (Sharecare, 2013). The transtheoretical model evaluates an individuals readiness to change behaviors that they have talked about. In understanding the five stages associated with the model, the client was deduced to be on the preparation stage. In this stage the client is ready to take action within the next month. Once the RealAge assessment was used, its tangible results helped the client to realize that pieces of her life needed to change, not only to benefit her well-being and health, but also to benefit the people in her life (Cancer Prevention Research Center, 2013). Diagnosis Lifestyle has numerous elements that constantly interact and subsequently affect the individual at the present time and in the future. Taking into account the results of the RealAge assessment, the following adjustments will help to decrease the factors that compile years onto the body: monitoring cholesterol and blood pressure; controlling sun exposure; participating in a healthy, loving relationship, including satisfying sex; moderating stress using appropriate coping strategies; having a healthy morning meal; adding a vitamin D supplement; expanding the diet to include more whole grains, vegetables, and fish while limiting junk food and red meat (Sharecare, 2013).

RISK ASSESSMENT Through conversation and body language queues noticed when talking with the client, it was evident that stress from work affects her lifestyle at home. Ineffective coping related to situational crisis as evidence by her recently very stressful job was the nursing diagnosis. A

stress assessment was completed to determine how she handled the stress at work (see Appendix A). By implementing coping strategies for stress, like breath work or even yoga, the client can get her mind off of work and transition to an at home state of mind. The other area that was important to discuss was her diet; to illustrate what she was eating and how to improve it, it was suggested to use a food diary. Readiness for enhanced nutrition related to increased knowledge on a healthy diet as evidence by RealAge assessment on diet was the nursing diagnosis (Sharecare, 2013; Ladwig & Ackley, 2011). Planning and Implementation A trusting relationship between the client and healthcare provider allows for information to be discussed freely and empowers the client to feel comfortable describing both their strengths and weakness for their healthcare. A personalized plan of care can be developed, which should greatly help the client succeed when compared to a generalized plan. For the client, stress management was important due to her hectic job overlapping into her home life. By pinpointing her job as the cause to her stress, the plan of care was when she arrived home from work, to change out of her work clothes and then sit down and perform the 47-8 breathing technique for at least ten minutes to promote relaxation. The breathing exercise was discussed verbally and the website was also provided to her, which allowed her to view it whenever she needed (Weil, 2011). The second healthcare plan included the use of a food diary (see Appendix B). By being a visual cue, the food diary allowed the client to see what food choices she was making and

RISK ASSESSMENT implementing. This diary is not concerned with the amount consumed; rather, it identifies her

choices, which will make her aware of eating habits to improve upon mainly varying the colors of food that are consumed (United States Department of Agriculture, 2013). The implementation of these steps started out slow; she was ready to make a change but was hesitant to change a lot at once taking just five minutes to relax and one food item to change per day. After the first two weeks that changed to ten minutes of relaxation per day and the consumption of seven different food varieties in the week. Evaluation By implementing the action stage of the transtheoretical model (lifestyle changes in minimal increments), my client was able to feel success at every week, resulting in a positive attitude and wanting to further application of the changes. The food diary was found to be very useful; being able to view her food consumption over the weeks and see what she should try to incorporate into her diet in a visual manner were very helpful. She was then able to see the staples in her eating habits and adapt food recipes to incorporate more food colors and varieties (Cancer Prevention Research Center, 2013; United States Department of Agriculture, 2013). Management of stress through the use of breathing techniques proved to be more of a challenge for her than the food diary. Possible causes of this were the fact that some days at work were not as stressful as others, leading her to feel that the 4-7-8 breathing technique was unnecessary. This meant that she would not progress toward her ideal ten minute relaxation maximum when arriving home, as her five minute sessions were not being performed as expected (Weil, 2011). Once evaluated she was informed to take care of herself first for ten minutes and then start cooking and doing house work. The transtheoretical model was used to discuss that

RISK ASSESSMENT regression happens, but it affects the stage the client is in both mentally and physically to continue with the plan of change. Maintenance is just as important as action within the transtheoretical model, because without keeping up on the changes that were implemented the client can then regress all the way back to stage one, which will deter them from continuing on their path to decreasing the risks that were assessed (Cancer Prevention Research Center, 2013). More time would be needed to make a complete assessment of how these lifestyle

changes have impacted her health. The timeframe for allowing these changes to impact her body started to show positive results. Full evaluation would need more time and a laboratory test to provide objective data in demonstrating that the lifestyle changes had a positive effect. Overall, she was already quite healthy as demonstrated by the RealAge below her biological age, but improvements can always be made. Conclusion By pinpointing areas of need within an individuals lifestyle, assessments help to establish personalized recommendations that will aid in promoting a healthier lifestyle for both a persons biological age and physiological age. Decreasing factors that contribute to adding years onto a persons life will help them to live longer and healthier, whereas establishing factors that make a person younger will help to decrease risk of chronic diseases as well as increase wellbeing. By improving just a few areas at a time, the success of implementing these positive lifestyle choices can increase, as gradual changes are easier to get adjusted to. One lifestyle change can then have positive impacts on multiple areas that were previously contributing to the clients age, really acting as a positive snowball effect. By decreasing her stress, the client was able to set aside time to think about her food choices, rather than just making a meal that was

RISK ASSESSMENT easy because she just wanted to be done for the day. All of these suggestions and changes need to come from somewhere, and a tool like the RealAge assessment is a great starting place.

RISK ASSESSMENT Appendix A Your Style Under Stress Score Your Style Under Stress score indicates how likely you are to move toward silence (masking, avoiding, or withdrawing) or violence (controlling, labeling, or attacking) during a crucial conversation. Both silence and violence had six statements. Your score in each can range from 0 to 6. The lower the score, the better. The higher the score, the more likely you are to move to silence and/or violence. Notice which aspects of silence or violence you use. All behaviors that move you toward silence or violence have consequences. The first step toward improvement is awareness. How often do you move towards silence? Silence Score Breakdown Masking: 0 Avoiding: 2 Withdrawing: 2 How often do you move towards violence? Violence Score Breakdown Controlling: 0 Labeling: 0 Attacking: 1

Now look at your score in using the crucial conversations skills. Each of the seven crucial conversations principles has three responses so you can score between 0 to 3 in each category. The higher the score, the better. To analyze your score in this area, notice the skills in which

RISK ASSESSMENT you've scored highestcongratulations. Continue those behaviors. Then notice your lowest scoresthese are the areas you need to improve. Crucial Conversations Score STATE My Path: 2 Explore Others' Paths: 3 Move To Action: 2 Start With Heart: 2 Learn To Look: 3 Make It Safe: 3 Master My Stories: 3 Consider the following resources to help you improve your Style Under Stress. Attend Training. Crucial Conversations Training is an award-winning, two-day course that teaches skills for fostering open dialogue around high-stakes, emotional, or risky topics. (VitalSmarts, 2013).

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RISK ASSESSMENT Appendix B Food Diary

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(Centers for Disease Control and Prevention, 2013).

RISK ASSESSMENT References Cancer Prevention Research Center. (2013). Transtheoretical model detailed overview of the transtheoretical model. Retrieved from http://www.uri.edu/research/cprc/TTM/detailedoverview.htm Centers for Disease Control and Prevention. (2013). Balancing calories. Retried from http://www.cdc.gov/healthyweight/pdf/food_diary_cdc.pdf Ladwig, G. B., Ackley, B. J. (2011). Mosbys guide to nursing diagnosis (3rd ed.). Maryland Heights, MO: Mosby/Elsevier.

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Sharecare. (2013). RealAge: Live life to the youngest. Retrieved from http://www.realage.com/ United States Department of Agriculture. (2013). MyPlate. Retrieved from http://www.choosemyplate.gov/ VitalSmarts. (2013). Your style under stress assessment. Retrieved from http://www.vitalsmarts.com/styleunderstress/ Weil, A. (2011). Spirit & Inspiration. Breathing: three exercises. Retrieved from http://www.drweil.com/drw/u/ART00521/three-breathing-exercises.html