Running head: PERSONAL HEALTH PLAN

Personal Health Assessment and Health Promotion Plan Joella M. Show RN Ferris State University

PERSONAL HEALTH PLAN Abstract The purpose of this paper is to explain my personal health beliefs and to demonstrate the development of my health promotion plan. In this paper I will describe in detail the path I took through the Transtheoretical Model (TM) to develop an evidence-based exercise program in order to promote stress management, wellness, and to prevent injuries while working as a

professional nurse. I used a nursing wellness diagnosis, an adult fitness test, and an exercise log to monitor consistency and application of my health promotion plan. Keywords: health beliefs, health promotion, plan, Transtheoretical, exercise, wellness

PERSONAL HEALTH PLAN Personal Health Assessment and Health Promotion Plan This document was written to explain my health promotion plan and to help me find areas where I need improvements. I used several evidence-based resources including a nursing

wellness diagnosis, an exercise log, and stress management activities when I designed this health promotion plan. According to Pender, Murdaugh, and Parsons, Self-change is defined as new behaviors that clients willingly undertake to achieve self-selected goals or desired outcomes (2011, p. 37). I am willing and excited to attain my personally selected goals. I have a high level of perceived self-efficacy. I believe I have the ability to change my negative habits including my lack of exercising and form new health-promoting behaviors. These new healthpromoting behaviors include a purposeful, planned exercise program three to four mornings each week. I completed a Health Belief Survey (Appendix A) before I started my health promotion plan. The survey was designed to help me understand how I think about health related subjects (Doerr, 2013, p. 22). The questions related to my personal beliefs about what causes disease and how much influence I have on my own health (p. 22). The survey included three subscales, internal, chance, and powerful-others (p. 23). I scored a sixty four on the internal subscale. This means I have a very strong belief that I have control over my own health and wellbeing (p. 23). I scored an eighteen on chance and powerful-others (p. 23). I do not believe that my environment and the influence of others are able to have a strong influence on my health. I scored above average on the internal section and I scored below average on the chance and powerful-others section of this Health Beliefs Survey. The average individual does not believe they have as much personal control over their own health. This survey was a measure of personal health beliefs and there was no right or wrong answer to the questions on this survey (p. 22).

PERSONAL HEALTH PLAN After reviewing the results of the Health Belief Survey I have constructed a health promotion plan that focuses on adult physical fitness. I have never followed a consistent

exercise program. I tend to keep my schedule busy. I am a mom of two young boys. One of my boys has mild special needs and requires extra time and care. I am going to school, working full time nights, preparing for a certification exam, and teaching a healthy lifestyle seminar. My body often suffers the consequences of my being too busy to take time to care for personal needs. I recognize that I need to learn about and practice better exercise habits. To address my fitness needs my health promotion plan includes an adult fitness test (Appendix B) and a Presidential Active Lifestyle Award Log (PALA) (Appendix C). The exercise log and assessment have provided me with information about my current state of aerobic fitness, muscular strength, body composition and endurance. With this information about myself I am able to set goals to increase my personal wellbeing. Instrument Selection I chose to use The Presidents Challenge Adult Fitness Test to evaluate my present state of physical fitness. This test includes four sections, personal information, aerobic fitness, muscular strength, and body composition. The test asked me to enter my state, gender, and age in a section called personal information. The aerobic fitness section asked me to run one and a half miles or walk a mile and then check my heart rate. I was unable to complete the aerobic section because I did not have access to a place where the distance has been marked out for me. The muscular strength section asked me to count how many half sit-ups and push-ups I could do in one minute. The flexibility section measured how far I could sit and reach beyond my feet. The final section is called body composition. This section asked for my height, weight, and waist measurement. I completed the personal information, muscular strength, flexibility, and

PERSONAL HEALTH PLAN

body composition section of this assessment. I entered all the data into an online form. You can view my results in (Appendix B). After I completed the Adult Fitness Test, the Presidents Challenge Program invited me to complete an eight week fitness challenge called the Presidential Active Lifestyle Award. My physical activity goal is to complete thirty minutes of aerobic movement five days a week for a total of six out of eight weeks. My healthy eating goal requires me to complete six out of eight of their healthy eating goals by the end of the eight weeks. You can see a copy of my Presidential Active Lifestyle Award (PALA) log in (Appendix C). There is an online tracker that I am also filling out for this award. In eight weeks, after I have completed the requirements I will be eligible to order the PALA award. Transtheoretical Model Research-based theories and models of health behavior are used by health care professionals to try and explain why a person does or does not participate in health promoting activities (Pender, Murdaugh, & Parsons, 2011, p. 37). Understanding the mechanisms for behavior change and sustainability of these changes is necessary to develop and evaluate health promotion and prevention interventions (Pender et al., 2011, p. 37). I have chosen to use the research-based Transtheoretical Model (TM) in my health promotion plan. The TM model has been used to explain how people accomplish and maintain a health promoting behavior (Pender et al., 2011, p. 37). This model states that a health-related behavior progresses through five states, regardless of whether the client is trying to quit a health-threatening behavior or adopt a healthy behavior (Pender et al., 2011, p. 51). The five stages of the TM model include precontemplation, contemplation, planning or preparation, action, and maintenance (Pender, et al., 2011, p. 51). Self-efficacy, the belief that I have the ability to change my behavior, is a central

PERSONAL HEALTH PLAN part of the TM model. According to the health belief survey I have a high level of belief that I am responsible for my own health. I have a high level of self-efficacy (Doerr, 2013, p. 22). I have used the five stages of the TM model in the development of my health promotion plan. Pre-contemplation is the first stage of the TM model. During this stage an individual is not thinking about quitting or adopting a particular behavior, at least not within the next six

months (Pender, Murdaugh, & Parsons, 2011, p. 51). Almost one year ago I returned to college, stopped being an at home mom, and started working full time nights as a nurse. I have two busy young boys who I work to make time for. Recently I started teaching a healthy lifestyle seminar at a local church and my manager asked me to study for a certification exam. I am busy and exhausted most of the time. I struggle to find the energy to add anything more into my schedule. I have realized that I am not strong enough to do all the lifting and maneuvering of patients that I need to do. I worry that I am at risk of an injury because I have weak muscles. I have also read that exercise helps with stress management. These realizations helped me enter the contemplation phase of the TM model. Contemplation is the second stage of the TM model. During this stage an individual is seriously thinking about quitting or adopting a particular behavior in the next six months (Pender, Murdaugh, & Parsons, 2011, p. 51). I have exercised a few times a month for the past few years. In the last few months however I have been trying to make exercise a more regular part of my schedule. Even so I am only fitting a thirty minute exercise routine into my schedule once or twice a week. I have realized that I need a more consistent exercise routine. I have begun to research options for how I can fit an exercise routine into my daily schedule. I am now entering the planning or preparation stage of the TM model.

PERSONAL HEALTH PLAN The planning or preparation stage is the third stage of the TM model. In this stage an individual is seriously thinking about engaging in the contemplated change within the next month and has taken some steps in this direction (Pender, Murdaugh, & Parsons, 2011, p. 51). I have asked to have my schedule changed and was told that is not an option at this time. I am

attending school online and have found that my most effective study time is when the boys are in bed. I have established 7:00-8:00 am as my early morning exercise time. When I am not working, I will wake up and study early in the morning and then the boys wake up and exercise with me at 7:00 am. We are making exercise part of our quality family time. I found a program called The Presidents Challenge Adult Fitness Test which is part of the Presidential Active Lifestyle Award. There is a Presidential Youth Fitness Program that my boys can do while I do the adult program. When I work several nights in a row I plan on walking the stairs several times during my shift. I work on the fifth floor and will get significant exercise from taking the stairs instead of using the elevator. I am getting ready to move into the action phase of the TM model. The action phase is the fourth phase of the TM model. In this phase an individual has made the behavior change and it has persisted for less than six months (Pender, Murdaugh, & Parsons, 2011, p. 51). I have a plan and am beginning to make it happen. These will be the most grueling weeks when I work to make regular exercise a habit. I look forward to the maintenance phase of the TM model. The maintenance phase is the fifth phase of the TM model. In this last phase the change has been in place for at least six months and is continuing (Pender, Murdaugh, & Parsons, 2011, p. 51). I have not entered this phase of the TM model yet. In this phase I will have formed a habit to exercise at 7:00 am on each day that I am home.

PERSONAL HEALTH PLAN Nursing Wellness Diagnosis The nursing wellness diagnosis that I believe fits the health promotion plan best is Readiness for Enhanced Decision Making related to inadequate strength training and aerobic activity (Sparks & Taylor, 2010, p. 835). This diagnosis relates to my desire to make better decisions about how I spend my time. I have decided to make exercise a priority as I plan my long term and short term goals for the future. According to the health belief survey, I believe I have great control over my health. I can make the decision to follow a routine exercise program and I have the power to meet my goal. Personal Goals I intend on completing the Presidential Active Lifestyle Award (PALA) over the next eight weeks. I have decided to make better time management decisions about my long term and short term goals. I plan on changing my morning habits. Recent research has shown that participants encouraged to perform a health-promoting behavior regularly in familiar contexts achieved increases in habit-related automaticity (Nilsen, Roback, Bronstrom, & Ellstrom, 2012). When I am home I will wake up early in the morning to do my homework before my

boys wake up. Then at 7:00 am I will start exercising and my boys will join me when they wake up. There is an exercise program called Body and Spirit by Dick Nunez that comes on http://3abn.org/media/3abn-broadcast/ at 7:00 am. This program alternates strength and conditioning with aerobic exercise every other day. I will follow the directions on this exercise program as part of my morning exercise regimen. I will also make the time to play hard outdoors with the boys. When at work I will walk the stairs instead of taking the elevator to the fifth floor where I work. I will exercise for a minimum of thirty minutes on at least five days every week. As part of the PALA I will also add a new healthy eating habit to my diet each

PERSONAL HEALTH PLAN week. At the beginning of each week I will continue to do the previous goal as well as adding a new healthy eating goal into my lifestyle plan. All of the above information will be logged on paper (Appendix C) and on the internet tracking form of the Presidents Challenge website.

When I complete the requirements for the PALA they will send me an email telling me I qualify to order the reward. According to the Presidents Challenge Adult Fitness Test results (Appendix B) I did well on the muscular strength part of the test and I did poor on the flexibility portion of the test. My muscular strength and flexibility score averages to 51.1% overall. My body mass index (BMI) is 20.4 and my waist circumference is 30 inches both of which are healthy and normal calculations. I look forward to seeing how I have improved when I retake this test in eight weeks. I was unable to complete the aerobic portion of this health assessment. I intend on completing the aerobic part of the assessment next week. I can fast walk and run with my children even without having the distance measured out. Conclusion Before I took this class I had not paid very close attention to my own health needs, specifically in regards to exercise. I was not aware of the small amount of time I spent exercising. With the Transtheoretical Model I looked at my current exercise habits and created a plan to take steps to increase the amount of exercise I am getting every week. Having to record the amount of exercise I am completing on a daily basis had made me aware of how sedentary I have been while at home. Exercise helps prevent disease and injury along with increasing my metabolism. I had only been exercising sporadically before this class started. When the class started I began exercising two or three times each week. I now plan to exercise thirty minutes

PERSONAL HEALTH PLAN per day, five times per week. When I completed the adult fitness test I could already tell that I have gotten stronger with the little exercise I have been doing.

10

PERSONAL HEALTH PLAN References Nilsen, P., Roback, K.., Brostrom, A., & Ellstrom P. (2012). Creatures of habit: accounting for

11

the role of habit in implementation research on clinical behavior change. Implementation Science, 7(53). doi: 10.1186/1748-5908-7-53 Nunez, D. (Producer). (2010). Body and spirit [Television series]. Black Hills: Black Hills Health and Education Center Pender, N. J., Murdaugh, C. L., & Parsons, M. A. (2011). Health promotion in nursing practice (6th ed.). Upper Saddle River, NJ: Pearson. Sparks, S., & Taylor, C. (2010). Nursing diagnosis reference manual(8th ed.). Philadelphia, PA: Lippincott Williams & Wilkins. The Presidents Challenge. (2012). Adult fitness test. Retrieved from http://www.adultfitnesstest.org/ Doerr, M. J. (2013). NURS 310 Class syllabus.

PERSONAL HEALTH PLAN Appendix A Health Beliefs Survey

12

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. 11. My good health is largely a matter of good fortune. 12. The main thing that affects my health is what I myself do. X X X X X X X X X 2 3 4 5 6 X

PERSONAL HEALTH PLAN 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:

13 X X X X X X

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: My Personal Score Compared with the Normative Mean Internal, 50.4 Chance, 31.0 Powerful-others, 40.9 18 64 18

PERSONAL HEALTH PLAN Appendix B Adult Fitness Test The following chart shows results for the data you submitted. For more comprehensive results, please submit data for all of the testing elements. Fitness Component Muscular Strength Flexibility Test Event Half Sit-Ups Push-Ups Sit-and-Reach Overall Score (based on percentile average) Body Composition BMI: 20.4 Your Results 47 30 14 Your Score 80%ile 60%ile 15%ile 51%ile Normal

14

Waist Circumference 33 *Normative data for VO2max are based on a population that is 20 years of age and older and are re-printed from the 2006 Physical Fitness Specialist Course and Certification Manual, with permission of The Cooper Institute, 12330 Preston Road, Dallas, TX 75230 When evaluating your performance on this test, you should look at your results on each of the tests and consider how the individual tests contribute to your overall fitness. Your percentile scores are based on normative data, which represent the average achievement of people in your age group performing the test. For example, if your score is in the 75%ile (read as 75th percentile) that means that 75% of the scores among people your age fall below your score. In general, the better you score on each test, the more fit you are. On the other hand, it is not necessary to score at the very highest level on all of the tests in order to be at reduced risk for a number of diseases. Scoring poorly on one test may help you identify specific fitness activities you need to do to improve your fitness score on that test. However, this does not mean you should ignore the fitness activities associated with the tests on which you performed well. Your goal should be to score well on as many of the fitness test items as possible, maintain your fitness level in those you did well, and improve the rest. Calculated from: http://www.adultfitnesstest.org/testResults.aspx

PERSONAL HEALTH PLAN Appendix C Presidential Active Lifestyle Award Log

15

Healthy Eating Weekly Goal Week 1 2 3 4 5 6 7 8 Healthy Eating Habit Make half your plate fruits and vegetables. Make half your grains whole grains. Drink water instead of sugary drinks Choose lean sources of protein. Choose foods with less sodium. Eat smaller portions. Extra Goal Extra Goal Completed (Yes/No) Yes Yes

Physical Activity Log Week/Day Sunday Monday Sick/Slept Slept 1 Tuesday 30 Min. Exercise Video Work/ Stairs Wednesday Thursday Friday 30 Min. Work/ Work/ Exercise Stairs Stairs Video Slept 30 Min. Exercise Video 30 Min. Exercise Video Saturday Played in Snow / Hiked 2 Hours Work/ Stairs

Work/ Stairs

Work/ Stairs

3 4 5 6 7 8

PERSONAL HEALTH PLAN

Personal Health Assessment and Health Promotion Plan Grading Rubric STUDENT NAME_____Joella Show________________________________ DATE__________March 2013_______________

16

ASSESSMENT CRITERIA

POINTS

POSSIBLE 10 Assessment tools appropriate for the area to be assessed. 10 10 Rationale provided and sourced for tools in first area to be 10 assessed. 5 Rationale provided and sourced for Readiness for Change 5 instrument. 10 Analysis is appropriate, reflects critical thinking. 10 10 Wellness diagnosis/diagnoses congruent with assessment 10 findings. 10 Health plan follows principles of health promotion. Includes 10 all stages of change. 10 Implementation is appropriate for time period. Is 10 documented with reliable evidence. 5 Outcome measures are recorded and appropriate. 5 5 Long-term outcomes are included. 5 10 APA: Title page, Running Head, Margins, Headers with 10 page numbers, Use of headings. 5 Grammatical: Spelling, Typing, Grammar, Neatness, 5 Sentence Structure & Paragraphing. 10 Critical Thinking using elements of reasoning and 10 Intellectual Standards. (Not to be used as outline points). 100 TOTAL POINTS 100 COMMENTS: Very well written. All required areas were covered. It sounds like you have a great plan and I hope you continue forward with it. Good luck to you!! Jo

POINTS EARNED