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Personal Health Assessment and Health Promotion PlanRhonda JonesFerris State UniversityAbstractThe concept of this paper is to provide the reader with description on how a personal health promotion plan was developed and implemented. My personal account is detailed during the process to evaluate the need for behavior change using the Transtheoretical Model. A nursing wellness diagnosis was incorporated utilizing the nursing process. Several tools were assessed, implemented, and evaluated to assist with promoting behavior change. Short and long term goals were established, implemented, and evaluated to ensure that behavioral changes were occurring and continued to evolve. Keywords: Transtheoretical Model, behavior change, weight, exercise, nutritionPersonal Health Assessment and Health Promotion PlanThis paper will show the process that occurred as I assessed my health, developed a health promotion plan, and identified areas that needed to be improved to obtain my health promotion goals. Assessment tools were used to assess strengths and weaknesses, analyze data, develop, and implement a health promotion plan. Pender, Murdaugh and Parson stated, “Self-change is defined as new behaviors that clients willingly undertake to achieve self-selected goals or desired outcomes” (2011, p 37). I plan to take control and modify behaviors that have been detrimental to my health. This will include healthier eating habits and physical activity into my lifestyle to obtain my personal health goals. I started this project by completing a Health Belief Survey (Appendix A) that has a series of questions that were able to measure my personal health beliefs in three different categories. It measured how much I believed that I was in control of my health and how much I believed that others and outside forces controlled my health. A comparison of my scores against a normative mean indicated that I have a significantly higher belief that my health is controlled personally; a slightly higher belief that I think my health is controlled by chance and slightly lower belief that my health is controlled by others (Ursuy, 2012 p 22-23). I used the analysis of this information as a foundation to develop a health plan that would put me in control of outcomes.I focused on two areas, nutrition and exercise, that can be controlled with specific guidelines to result in a weight reduction and an improved body mass index (BMI) score. Obesity puts me at “higher risk for chronic conditions such as high blood pressure, diabetes and high cholesterol levels” (CDC, 2012). My diet has not been monitored or controlled and exercise has not been incorporated in my lifestyle for many years. These factors resulted in a sixty-seven pound weight gain, an increase in laboratory lipid screening values (Appendix B), and an increase in my BMI (Appendix B) during the last five to six years. I developed a food journal (Appendix C) and an exercise journal (Appendix D) both based on the teaching of Weight Watchers International (WWI). These assessment tools were to assist in the plan of achieving desired goals of decreased weight and a lower BMI score.Instrument Tool SelectionI recently participated in a wellness challenge offered by my employer that has been developed to encourage employees to be aware of personal biometric values. Prior to this the last time my laboratory values were checked was in July 2007. I created a personal biometric log that incorporates the results from 2007 and the most recent results from June 2012 (Appendix B). I also included current weight and BMI information that starts June 2012 and continues to present. These have all been retrieved from factual data, at various time points and tracks results of laboratory values, weight levels and BMI scores. This allows for a visual guideline that can be used as a reference.I choose to incorporate the teaching of WWI to track the amount and type of food being consumed as well as the amount of exercise being performed. The program I selected as the basis for my plan is the WWI program from 2002 titled Winning Points. I joined this program in July 2002 and lost eighty-five pounds in approximately one year but stopped following the program in 2006. The result of not maintaining the behavior change was weight gain, increased BMI, and an increase in my lipid profile. A 12 month study by Jebb et al. involved two groups, one that incorporated WWI into a weight loss program and one group that did not. The WWI group had a 61% loss of at least 5% of body weight compared to the other group that had a 32% loss of at least 5% of body weight. The study summarized that inclusion of a commercial weight management program was successful in weight management.The WWI program incorporates the use of a food journal to keep track of the amount and type of foods that are consumed (Appendix C). The foods are converted to a point scale and points are totaled at the end of the day. There is a range of points that can be used for different weight levels. This program also involves many areas to consider while obtaining a health weight goal that includes but is not limited to: serving sizes, water consumption, and fruit/vegetable intake. Exercise is encouraged and addition points can be earned for different levels of activity (Appendix D). This concept promotes exercise to earn additional points for food that may be consumed during the day. Extra points can be banked and used at the end of the week for a special day if more points are needed. Transtheoretical ModelAs part of my health promotion plan I have included my steps in behavior change as it relates to the transtheoretical model. I will use this model to evaluate my readiness and likelihood of incorporating behavior changes in my life. This model states that to develop any behavior change, trying to get rid of a behavior or gain a new behavior, you must progress through five stages. The stages are: Pre-contemplation, Contemplation, Planning or Preparation, Action and Maintenance (Pender et al., 2011, p51) During the first stage pre-contemplation a person has no desire to change the behavior within the next six months (Pender et al., 2011, p 51). I was in this stage prior to my physician appointment in June 2012. I knew I had gained weight over the last five to six years. I rarely got on a scale to weigh myself and had no desire to think about losing weight. I did not consider this a problem in my life and was not experiencing visible adverse effects. The second stage of contemplation occurs when a person is intending on making a behavior change within the next six months (Pender et al., 2011, p 51). I began this phase in June 2012 when I went to see my physician for a wellness check. The actual weight number I obtained at that visit was the first indicator that caused me to start thinking that change was needed. One week later when I received my laboratory results (Appendix B) it further cemented the concept that change had to occur. My laboratory values continued to be within normal limits but when comparing them to laboratory values performed five years previously a marked increase was observed. I knew that from past experiences that I needed to reduce my dietary intake and increase my activity to reduce my biometric numbers. The third stage of the model is planning or preparation which occurs when a person is going to make changes in the next month or is beginning small sporadic changes (Pender et al., 2011, p 51). This stage occurred very closely if not at the same time as the contemplation stage. I started making better nutritional choices, reducing portion sizes, and drinking more water. I had not developed a full plan of action but was thinking about making several changes including restarting the WWI program. I gathered all the information, booklets, and reading material I had put away five years ago and started reading the information from WWI. The fourth stage of the transtheoretical model is action. At this stage a person is actively involved in a behavior change and it has been less than six months (Pender et al., 2011, p 51). I am currently in this phase. This process began in September 2012. I decided to restart the 2002 WWI program rather than join the new WWI program. I am participating in the WW1 program with food and exercise journals and weigh myself every morning. I am seeing positive results which encourage me to continue these behavior changes. The last stage maintenance occurs when a behavior change has lasted over six months and is sustained (Pender et al., 2011, p 51). I have not reached this stage and have only been performing these behavior changes consistently for the last three weeks. I felt I had reached this stage with my previous weight loss but realized I had regressed to the first stage and needed to start at the beginning. Nursing Wellness DiagnosisI have selected the following nursing wellness diagnosis to address my current issues: Health Seeking Behaviors related to inadequate nutritional intake and inadequate physical activity (Sparks and Taylor, 2010, p 842-844). This diagnosis will assist in the development of a health plan to achieve the desired outcome of weight loss and reduction of my BMI score. With the use of the diagnosis I was able to evaluate and assess risk factors, current health status, motivation, potential gains, and understanding the implications of risk modification. I developed short and long term goals for gradually increasing amount, intensity and duration of exercise and amount of weight to be lost per week. By tracking information on a chart I am able to visually assess progress and readjust interventions as needed in areas that do not document progress. Evaluation is performed on a periodic basis to assess the progression toward short and long term goals with the knowledge that readjustment may be needed if progresses toward outcomes are not being met. Personal Short and Long Term GoalsI have set both short and long term goals. The short term goals will enable me to evaluate my progress on a weekly and monthly basis providing encouragement to continue behavior changes. The short term goals I have set are to lose one to two pounds per week and five pounds per month and participate in physical activity at least three times per week. Daily food journals (Appendix C) and exercise journals (Appendix D) allow me to keep track of my progress on a daily basis and is necessary to hold me accountable for any decisions that are made. I have established long term goals to lose a total of at least sixty-seven pounds and obtain a BMI score below twenty-five and maintain these for at least 6 months. The weight and BMI goal will take seven to twelve months to achieve. The use of dietary and exercise journals and celebrating achievement of my short term goals will make this journey achievable. It has been a total of approximately four months since I started the process of weight loss. It has only been three weeks since I implemented my proposed health plan. The first three months I experienced a weight reduction of eleven pounds and BMI reduction of 1.9 points. In the three week that I have implemented my health plan I have lost ten pounds and reduced my BMI by 1.7 points (Appendix B). In addition I have also noticed an increase in energy and emotional stability and reports for others that I appear to be a happier person. ConclusionOver the last five to six years I have observed a gradual weight gain that has accumulated to sixty-seven pounds of excess weight and a BMI that places me in a category of obese. In June 2012 I was confronted with the actual numbers that put me in a direction that action needed to take place to correct behavior issues. I have dissected the progression of my need to lose weight and reduce my BMI using the Transtheoretical Model for behavior change. The five stages involved in this model for behavior modification were applied to my situation and utilized in the development of a health promotion plan. The use of a nursing wellness diagnosis specific to my situation allowed me to develop a plan that incorporates the nursing process of assessing, analyzing, planning, implanting and evaluating. This allows for validation and accountability to achieve all desired goals and outcomes. These changes have all attributed to implantation of behavior modification and a healthier lifestyle. I have noted that slight modification by itself did result in weight and BMI reduction but with the use of a health promotion plan that can be monitored the weight and BMI reduction have been reduced the same amount in one-third the amount of time. I am able to validate and hold myself accountable with the instrument tools I have chosen to incorporate in my health promotion plan. Through one previously failed attempt years ago at this type of behavior modification I am also aware of the barriers that I must overcome to achieve personal long term goals and progress to the fifth stage in the Trantheoretical Model labeled maintenance for life long health promotion. ReferencesCenters for Disease Control and Prevention (2012). Adult BMI calculator. Retrieved from , S. A., Ahern, A. L., Olson, A. D., Aston, L. M., Holzapfel, C., Stoll, J., et al. (2011). Primary care referral to a commercial provider for weight loss treatment versus standard care: a randomized controlled trial. The Lancet, 378(9801), 1485–1492. doi: 10.1016/S0140-6736(11)61344-5.Pender, N. J., Murdaugh, C. L. & Parsons, M. A. (2011) Health promotion in nursing practice (6th ed.) Upper Saddle River, NJ: Person Education Inc.Sparks, S., & Taylor, C. (2010). Nursing diagnosis reference manual (8th ed.). Philadelphia, PA: Lippincott Williams & WilkinsUrsay, P. (2012). Ferris State University. Nursing 310 Population Based Health. Class syllabusWeight Watchers International (2002). Winning Points System. Woodbury, NY.Appendix AHealth Beliefs SurveyThe 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 is 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 2 34 56If I get sick, it is my own behavior that determines how soon I will get well again.??????XNo matter what I do, if I am going to get sick, I'll get sick.?????X?Having regular contact with my physician is the best ways for me avoid illness.??????XMost things that affect my health happen to me by accident.??X????Whenever I don't feel well, I should consult a medically trained professional.????X??I am in control of my health.??????XMy family has a lot to do with my becoming sick or staying healthy.?????X?When I get sick, I am to blame.??X????Luck plays a big part in determining how soon I will recover from an illness.?X?????Health professionals control my health.?X?????My good health is largely a matter of good fortune.????X??The main thing that affects my health is what I myself do.XIf I take care of myself, I can avoid illness.XWhen I recover from illness, it's usually because other people have been taking good care of me. (doctor, nurses, family)XNo matter what I do, I'm likely to get sick.XIf it's meant to be, I will stay healthy.XIf I take the right actions, I can stay healthy.X?Regarding my health, I can only do what my doctor tells me to do.?X??????These three subscales, and the items included in each, are as follows:Internal Items: 1, 6, 8, 12, 13, 17Chance Items: 2, 4, 9, 11, 15, 16Powerful-others items: 3, 5, 7, 10, 14, 18The 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 personal score 62.0Chance 31.0 personal score 36.0Powerful-others 40.9 personal score 38.0Appendix BPersonal Biometrics LogTarget Weight: 145 pounds Target BMI: Below 25June 13, 2012 – physician office visitHeight: 5’4” Weight: 212 pounds BMI: 36.4Blood Pressure: 120/78 Pulse: 83 Respirations: 16 Laboratory ResultsDate collected July 3, 2007Date collected June 14, 2012Normal RangeTriglyceride79 mg/dl106 mg/dl<150 mg/dlCholesterol130 mg/dl174 mg/dl<200 mg/dlLDL67 mg/dl105 mg/dl<100 mg/dlHDL47 mg/dl48 mg/dl> 40 mg/dlCholesterol/HDL Risk2.83.60-4.0Fasting glucose87 mg/dl106 mg/dl65-100 mg/dlSeptember 19, 2012 (start of project) Weight: 201 pounds BMI: 34.5Current Weight and BMI as of October 10, 2012For the information you entered:Calculate again: English | MetricHeight: 5 feet, 4 inchesWeight: 191 poundsYour BMI is 32.8, indicating your weight is in the Obese category for adults of your height.For your height, a normal weight range would be from 108 to 145 pounds.People who are overweight or obese are at higher risk for chronic conditions such as high blood pressure, diabetes, and high cholesterol.Retrieved from: BMIWeight StatusBelow 18.5Underweight18.5—24.9Normal25.0—29.9Overweight30.0 & aboveObeseAppendix CFood Journal(Condensed for sample: first and last day) Date: September 19, 2012 Date: October 10, 2012Weight WatchersInternationalBreakfast 2 cups black coffee1 c. ?% milk1 c. Cheerios1 Tbsp. sugar1 bananaSnack1 large appleLunchMcDonalds1 Hamburger1 small French fry1 large ice teaSupper1 c. cooked whole wheat spaghetti noodles? c. spaghetti Sauce1 c. cooked green beans1 piece cooked frozen garlic breadDessert1 c. sherbetPoints02212265032044Breakfast2 cups black coffee2 scrambled eggs1 English muffin2 slices crisp bacon1 c. ?% milkSnack1 c. raw carrotsLunch1 Thinwich whole wheat bun? c. low-fat chicken salad spread? c. apple cider1 c. raw carrotsSupper3 oz. boneless skinless chicken breast, baked1 c. cooked broccoli1 large baked potato2 tsp. butterDessert? c. light vanilla yogurt? c. frozen strawberriesPoints0522201510303221Food Points Used33Food Points Used29Food Points “Banked”0Food Points “Banked”0Activity Points Earned1Activity Points Earned3 Milk Products (2-3) ■■ (□) Milk Products (2-3) ■■ (□) Water (6) ■■■■■■ Water (6) ■■■■■■■ Fruits and Vegetables (5) ■■■■□ Fruits and Vegetables (5) ■■■■■Appendix DExercise JournalLegend for amount of Weight Watcher points that can be earned for my current weight range20 minutes of Light exercise (non-aerobic) = 1 points20 minutes of Moderate exercise (mixture of non-aerobic and aerobic) = 2 points20 minutes of Heavy exercise (aerobic) = 3 pointsDate/TimeType of ExerciseTime Spent ExercisingWeight Watcher Activity Points Earned9/19/2012Light – walking20 minutes1 points9/20/2012Light – walking20 minutes1 points9/21/2012Light – walking40 minutes2 points9/22/2012Light – walking40 minutes2 points9/23/2012Light – walking60 minutes3 points9/24/2012Moderate – Zumba dance20 minutes2 points9/25/2012None9/26/2012Moderate – Zumba dance20 minutes2 points9/27/2012None9/28/2012Moderate – Zumba dance20 minutes2 points9/29/2012Light – walking40 minutes2 points10/01/2012Heavy – Zumba dance20 minutes3 points10/02/2012None10/03/2012Heavy – Zumba dance20 minutes3 points10/04/2012None10/05/2012Heavy – Zumba dance20 minutes3 points10/06/2012Light – walking40 minutes2 points10/07/2012Light – walking40 minutes2 points10/08/2012Heavy Zumba dance20 minutes3 points10/09/2012None10/10/2012Heavy – Zumba dance40 minutes3 points ................
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