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Partner Health Promotion and Risk Reduction PaperMaria A. HallFerris State UniversityAbstractCare plans are used by nurses to identify a client’s needs and plan interventions to remedy those needs. A client with desire to achieve an improved health outcome may fall under a wellness diagnosis. The process of working through the nursing care plan resulted in a diagnosis of readiness for enhanced coping related to seeking knowledge about stress management techniques. Stressors were identified through questionnaires. A plan was put into place to achieve the outcome of demonstrating readiness to develop enhanced strategies for coping with stress within two months’ time through two different tactics. The first included a workout scaling up in time duration each week. The second included evaluating stress levels before and after the workout. The plan was implemented and weekly meetings were conducted to see progress and offer encouragement to the client. At the end, an evaluation of the data found positive results in managing stress levels.Partner Health PromotionThe purpose of this assignment is interpreting results from the “Real Age Test” and addressing a need for positive change in a certain area of health. Once the need has been established a plan for change is created and implemented. After a period of time, feedback is taken to evaluate the progress in reaching the goal set in place.. In reviewing the results of the real age test, positive and negative factors were examined. Negative factors were those that added to calendar age, whereas positive factors subtracted from calendar age. The sum total of the responses resulted in the person’s “Real Age” based on lifestyle habits, emotional bonds, sleep patterns, overall health, and physical fitness. My client’s “Real Age” was a positive age, 4 years younger than her chronological age. Positive results of the real age quiz included good social support, a healthy weight, along with regular strenuous exercise several times weekly. Nutrition also was a positive finding with healthy cholesterol levels, a nutritious breakfast, and consuming fruits and vegetables daily.The areas of growth that were identified were feeling high levels of stress and poor sleeping patterns. Due to the client attending a baccalaureate nursing program full time, stress is unavoidable and lack of sleep is an understandable deficiency. Alterations in sleep are a symptom of the body’s stress response. (Braun p.288) The focus became on identifying sources of stress and finding coping skills to handle the stressors.AssessmentThe client taking the test is a 21 year old Caucasian female pursuing a career in nursing. The client is able to handle all self- care tasks and has positive social interactions among her family and friends. She has no prior medical history or current health conditions that exclude her from participating in physical activities. The strengths for this client include her high level of health knowledge and its relationship to body functioning.In order to better understand the sources of stress for the client, two questionnaires were used. A stress management survey from Iowa State University is included in appendix A which helps to identify a person’s vulnerability to stress. The College Undergraduate Stress Scale provided some specific stressors related to college life which is included in appendix B. The results focused in what was causing the stress and how the stress was currently being managed. This allowed for understanding what the stressors were and how the client was coping with those stressors. When asked about current coping strategies, the client was unable to provide any specific techniques, yet expressed emotional readiness to engage in interventions that will help her reach the next level.Wellness DiagnosisThe next phase of the nursing process involves a diagnosis. A wellness diagnosis is the most appropriate diagnosis in this instance due to the client demonstrating a desire to improve her level of wellness. Taken from the Nursing Diagnosis Reference Manual (Sparks and Taylor 2010), the following wellness diagnosis is prepared. Readiness for enhanced coping related to seeking knowledge about stress management techniques. Different stress management techniques are researched based on best practices and are included here. One study conducted among 443 college students showed listening to music, physical exercise, and talking with someone about the stressors were the most effective strategies to cope.(King 2012) Another looked at nursing students in their first clinical year. They found biofeedback techniques to be effective to maintain normal stress levels as compared to the control group (Ratanasiripong 2012). Another study evaluated Qigong as a stress reducer among nursing and midwifery students throughout a 10 week time frame. Biochemical indicators were also examined through the saliva and found that the students being taught Qigong techniques had lower cortisol concentration as compared to the control group (Chan 2013). PlanningThe nursing process moves on to the planning stage of the care plan for the client. Expected outcomes include the client demonstrating readiness to develop enhanced strategies for coping with stress within two months’ time. In listening to the client, different coping strategies were offered based on evidenced based practice as methods to try. Based on the client’s ability to engage in high levels of physical activity, the client decides on a workout session starting at 20 minutes 3 times a week. The goal is to increase the workout by 10 minutes each week until 3 sessions of 60 minutes are attained by week 5. The 60 minutes workout time shall be maintained from week 6 on.. The benefit of physical activity allows the body to use the cortisol that was produced by the body in response to the stress (Braun p.282). The client also wants to create a workout music mix of songs to motivate her through her progress. Other strategies included installing a mobile software application for smart phones known as De.stress.ify (Stress Refuse 2013). The app allows the user to formulate a custom plan which may include features such as goal setting, logging progress, tracking behaviors, scheduling, practice buddies and customization. The objective of the program is to provide cognitive behavior change. The app allows the user to rate their stress level prior to the workout and then again afterwards. This provides the user immediate feedback on levels of stress reduction. It also has an alert to signal when to go for the workout. It allows for logging the workout durations and charting that data into a visual plot graph.Throughout the 6 week process, there are weekly meetings to evaluate progress and focus on behavioral changes in coping with stressors. Adjustments can be made to the goals accordingly. Positive feedback is provided with each attainment and encouragement is offered when goals are not achieved.Transtheorectical ModelAccording to the article A ‘Stages of Change’ Approach to Helping Patients Change Behavior (Bosworth et. al 2000), the Transtheorectical Model or Stages of Change model allows for the process of change in a certain behavior throughout time or stages. Each stage, of which there are five, describes the person state of mind toward the proposed behavior change. The precontemplation and contemplation stages are when the client is moving into thinking about making a change in behavior. The preparation stage involves specific planning for the behavior change. When the action stage is reached, the client is ready to start the behavior modification within a month’s time. This was where the client began in the transtheorectial model. When asked about the time frame to make changes, she insisted on starting immediately once a plan was put into place. She appeared eager to start a new way of managing stress and seemed open to new ways of handling the pressures of a nursing student. Research on proven coping mechanisms was utilized in creating a plan. The challenge lied in consistently setting aside those 3 de-stress workouts per week to attain positive results. In moving through the next 6 weeks, the next stage of change was planned to be achieved, which is known as maintenance and relapse prevention. This is where the client will hopefully find what stress coping strategies work best for her and who she can rely on when setbacks occur in progressing to her goal. EvaluationThe time frame of 6 weeks was given for implementing the change. After the 6 weeks of weekly meetings and workouts, the evaluation process took place. The client examined her workouts logs where she did an excellent job of logging her days spent exercising. The 10 minute increase of time each week worked well for her. In week 4, she increased her workout by an additional 20 minutes instead of the 10. Week 5 and 6, she maintained the 60 minutes of workout time. The De.stress.ify app logged progress and stress levels as well. The stress levels consistently dropped after each workout, but the differences between the pre workout and post workout numbers increased as the weeks went on. In week 5 day 2, a stress level of 9 pre workout resulted in a level 2 post workout. See appendix C for workout and stress level logs. The client provided indications that the workouts provided positive coping techniques in managing stress. The client also stated she felt better physically and slept more soundly as a result of the exercise regimen. She plans on maintaining it throughout nursing school and into her career as well. -219075-28575000Appendix AAppendix BC 2002 Wadsworth Group. Wadsworth is an imprint of the Wadsworth Group, a division of Thomson Learning, Inc.COLLEGE UNDERGRADUATE STRESS SCALEPurpose: To give students a sense of their stress level and how it compares to the average college student. Scale is comparable to Social Readjustment Ratings Scale.Instructions: This is an individual assignment to be completed outside of class. For each question, choose the answer that best applies to your beliefs. Please answer questions to best of your ability. There are no correct answers on this assignment so the instructor will not read your specific answers but will evaluate whether you completed the assignment in a?timely manner in order to assign points. Please score this scale before submitting it.Copy the “stress rating” number into the last column for any item that has happened to you in the last year, then address these.EventStress RatingsYour ItemsBeing raped100Finding out that you are HIV-positive 100Being accused of rape 98Death of a close friend 97Death of a close family member 96Contracting a sexually transmitted disease (other 94Than AIDS)Concerns about being pregnant91Finals week 90 90Concerns about your partner being pregnant90Oversleeping for an exam89Flunking a class89Having a boyfriend/girlfriend cheat on you85Ending a steady dating relationship85Serious illness in a close friend or family member85Financial difficulties84 Writing a major term paper8383Being caught cheating on a test83Drunk driving82Sense of overload in school or work8282Two exams in one day8080Cheating on a boyfriend/girlfriend77Getting married76Negative consequences of drinking/drug use75Depression or crisis in your best friend73 Difficulties with parents73 Talking in front of a class7272Lack of sleep6969Change in housing situation (hassles, moves)6969Competing or performing in public6969Getting in a physical fight66Difficulties with a roommate66 Job changes (applying, new job, work hassles)65Declaring a major or concerns about future plans6565A class you hate6262Drinking or use of drugs61Confrontations with professors6060Starting a new semester5858Going on a first date5757Registration5555Maintaining a steady dating relationship5555Commuting to campus, work, or both5454Peer pressures53 53Being away from home for the first time53 53Getting sick52 52Concerns about your appearance 5252Getting straight A’s5151A difficult class that you love4848Making new friends; getting along with friends4747Fraternity or sorority rush47Falling asleep in class40Attending an athletic event (e.g. football game)2020TOTAL 1456SCORING THE UNDERGRADUATE STRESS SCALEAlong with criticisms of Holmes and Rahe’s Social Readjustment Rating Scale (SRRS), Renner & Mackin (1998) pointed out that the SRRS does not include events that typically occur in the lives of college students. They also noted that some of the items are quite dated, given that the scale is over 30 years old. To remedy these problems, Renner & Mackin developed the College Undergraduate Stress Scale (CUSS). They found a mean total stress rating of 1247 with a standard deviation of 441 (range: 182-2571). Simply sum your score for a total overall stress rating.C 2002 Wadsworth Group. Wadsworth is an imprint of the Wadsworth Group, a division of Thomson Learning, Inc.Appendix CWorkout log minutes and stress levels measured 0-10 (0=no stress, 10= highest stress possible) WeekWorkout time (min)Pre work out stressPost work out stress1/Day 120981/Day 2201091/Day 320872/Day 130862/Day 230862/Day 330753/Day 1401053/Day 240753/Day 340744/Day 160844/Day 260834/Day 360725/Day 160725/Day 260925/Day 360516/Day 160626/Day 260616/Day 36082ReferencesBosworth, M. F., Olsen, C. G., & Zimmerman, G. L. (2000, March 1). A 'Stages of Change' Approach to Helping Patients Change Behavior. American Family Physician, 61(5), 1409. Retrieved from , C.A., Andeson, C.m.(2011) Pathophysiology:a clinical approach(2nd ed.). Philadelphia, PA: Lippincott Williams & WilkinsChan, E., Koh, D., Teo, Y., Hj Tamin, R., Lim, A., & Fredericks, S. (2013). Biochemical and psychometric evaluation of Self-Healing Qigong as a stress reduction tool among first year nursing and midwifery students. Complementary Therapies In Clinical Practice, 19(4), 179-183. doi:10.1016/j.ctcp.2013.08.001De.stress.ify. (2013). Stress Refuge, Inc (Version 1.0.5) [Mobile application software]. Retrieved from , K. A., Singh, M., Bernard, A., Merianos, A. L., & Vidourek, R. A. (2012, Fall). Employing the health belief model to examine stress management among college students. American Journal of Health Studies, 27(4), 192+. Retrieved from , L. H. & Smith, A.D. (n.d.). Stress Management: How Sensitive are You to Stress? Retrieved from , P., Ratanasiripong, N., & Kathalae, D. (2012). Biofeedback Intervention for Stress and Anxiety among Nursing Students: A Randomized Controlled Trial. ISRN Nursing, 2012, Article ID 827972. doi:10.5402/2012/827972Real Age Test.(n.d.). Retrieved from , S. & Taylor, C. (2010.) Nursing diagnosis reference manual. New York, NY: Lippincott & Williams.Wadsworth Group. (2002). College Undergraduate Stress Scale. Retrieved from (CUSS).doc ................
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