Running head: PERSONAL HEALTH PLAN

Personal Health Assessment and Health Promotion Plan Holly Leveille Ferris State University

PERSONAL HEALTH PLAN Abstract The purpose of this paper is to outline the authors development of a health promotion plan. It has identified the areas the author needs to improve in in her life. The author has included a Health Belief Survey, Self-Esteem Questionnaire, a physical journal, and a nutritional journal in the appendixes. The author used the Transtheoretical Model to help develop a plan to lead towards long term success. The author used tools such as a web based and free downloadable

application for smart phones called Lose It! The author has had several long term successes over the past few years however still struggles with self-esteem and self-confidence levels. Keywords: gastric bypass, nutrition, exercise, Transtheoretical Model, health promotion, self-esteem, self-confidence

PERSONAL HEALTH PLAN Personal Health Assessment and Health Promotion Plan This intention of this paper is to identify areas of improvement in the authors life and to develop a plan to make the necessary improvements. A number of areas were identified as

needing improvement, however it was determined by the author that by focusing on a few areas, results could be seen across other areas. The author decided the best results could be obtained by completing a Health Belief Survey and self-esteem questionnaire. The author then started an exercise journal and a nutritional journal. The Health Belief Survey (Appendix A) is a survey that looks at the ways in which people view certain important health-related issues. Either the author agrees with the statement or disagrees, and then rates the statement on a scale from strongly disagree (1) to strongly agrees (6). Once completed the values are added, then multiplied by two. The higher the score on the internal subscale, the more personal control clients believe they have over their own personal health. The higher the score on the chance and powerful-others subscale, the higher the beliefs in chance or that others control the survey takers personal health. The authors results concluded that there was an overwhelming internal belief present. This means that health is controlled by the individual. The author has very strong opinions that each individual is in charge of their own health and destiny. A higher score was also noted in the powerful-others category which goes along with the belief of the author that genetics play an important role in health. Another survey was completed by the author which was the Self-Esteem Questionnaire (Appendix B). Pender, Murdaugh, & Parsons (2011) state self-esteem is the value how one feels about themselves based on a persons concept of his or her desirable and undesirable attributes, strengths and weakness, achievements, and success in interpersonal relationships. The author

PERSONAL HEALTH PLAN completed the survey and found that she placed in the low-normal range. After careful thought the author was able to identify reasons why she had lower self-esteem then the average person. A health promotion plan was then developed by the author to identify ways to help increase a low self-esteem. These areas that were focused on were increasing physical fitness levels (Appendix C) and starting a nutritional journal (Appendix D). In May 2012 the author used to have a body mass index (BMI) of 48.7 (severely obese) however through gastric bypass and changing her lifestyle she has decreased her BMI to 28.2 (overweight). She still struggles with motivation to stay exercising on a regular basis. The nutritional intake for a gastric bypass patient should include foods that are low in fat but high in protein. The goal for the author is to maintain weight loss, increase exercise, and increase her self-esteem and self-confidence. Instrument Selection The tool the author used to track her weight, exercise, and nutritional values is a web based program and also an application that is available on smartphones called Lose It!. The application tracked calories, total protein consumed, total carbs consumed, and total fat consumed each day. It also tracked total exercise, how the authors friends are doing, and how the author is doing towards reaching their goals.

A physical fitness journal (Appendix C) was created by the author that would show what type of exercise was completed, on what date, and how many calories were burned. The authors goal was to exercise at least 3-4 times a week on a regular basis for approximately 60 minutes. The nutritional journal (Appendix D) was created to help the author focus on eating 60 grams of protein a day while maintaining a lower calorie count and lower fat count. Highprotein foods can help heal your wounds, regrow muscle and skin, and prevent hair loss

PERSONAL HEALTH PLAN (MayoClinic, 2013). Maintaining a healthy lifestyle is essential in life after gastric bypass surgery otherwise the weight can come right back. Transtheoretical Model The Transtheoretical Model is used to describe how individuals progress towards adopting and maintain behavior change (Pender, Murdaugh, & Parsons, 2011). Pender, Murdaugh, & Parsons (2011) state that health-related behavior change progresses through five

stages, regardless of whether the client is trying to quite a health-threatening behavior or adopt a healthy behavior. The five stages are 1) precontemplation 2) contemplation 3) planning/preparation 4) action and 5) maintenance. Pender, Murdaugh, and Parsons (2011) state that precontemplation is where the individuation has no intention of taking actions in the next six months. The author saw herself in this stage of her life approximately three years ago when she thought that she was happy and healthy. The author didnt realize all the medical problems that went along with being overweight and unhealthy. The author was working approximately 60-70 hours a week, night shift, and eating mostly fast food. Nursing school lead the author to the next stage, contemplation. Contemplation is described as intending to change a particular behavior in the next six months (Pender, Murdaugh, and Parsons, 2011). The author had the opportunity to learn about different types of gastric bypass procedures while in nursing school. The author then had the opportunity to take care of various patients who were post op gastric bypass patients. While during this semester, the author was invited to the operation room and had the opportunity to watch Dr. Gluck perform a Roux-N-Y procedure on a patient and a Vertical Sleeve. Many opportunities were available for the author to ask questions and participate with the surgeon in

PERSONAL HEALTH PLAN teaching with the patients in pre-op and post-op education. Because of this opportunity, the author decided to look into improving her own life surgically since other methods of diet and exercise were not working. Planning and preparation then happened. Planning and preparation was the next step in the TM model. Pender, Murdaugh, and Parsons (2011) state that the individual seriously thinks about engaging in the change within the next month and takes steps in the direction. The author made an appointment to attend a gastric

bypass seminar and then received an appointment with Dr. Gluck. A financial deposit was made to guarantee a commitment. Multiple different appointments were attended with nutritionists, a psychologists, and doctors in order to make sure that the author qualified for the surgery. The author had to wait 6 months and attend monthly meetings with the doctor to prove she was able to follow a plan and be successful. Once the surgery was approved it was time for action. Action is described by Pender, Murdaugh, and Parsons (2011) as making the behavior change and it has persisted for less than six months. By May 2012 the author was already committed to a healthy lifestyle and received the gastric bypass as a tool to help lose the weight. Maintenance is the last step in the TM model. Pender, Murdaugh, and Parsons (2011) state the change has been in place for at least six months and is continuing. The author believe she is somewhere between action and maintenance. The author has developed a plan with eating healthy and exercising however does struggle sometimes with maintaining that plan. Sometimes the author has to go back to the plan and has to reanalyze the plan and make a new plan. The plan seems to never stay the same however it tends to hover around the same basic concepts of maintaining the 60 grams of protein a day and exercising at least three to four times per week of 60 minutes.

PERSONAL HEALTH PLAN Nursing Wellness Diagnosis The author chose Readiness for Enhanced Coping as evidenced by seeks social support, seeks knowledge of new strategies, and is aware of possible environmental changes (Carpenito,

2010). The author thought this NANDA diagnosis best represented her because although she has lost a lot of weight, she has a distorted self-image and poor self-esteem. When the author looks in the mirror she sees what years of damage has done to her body and feels very guilty about this. The author has a support system that includes church, friends, and family. Personal Goals The author has set multiple personal goals for herself. The first goal is to maintain a healthy lifestyle by exercising three to four times per week at least 45 to 60 minutes at a time. The second goal is to consume 60 grams of protein a day and maintain a low fat diet. The third goal is to improve her self-esteem and self-confidence. The first goal of exercising three to four times per week of at least 45 to 60 minutes at a time was monitored by the app Lose It! In January 2013 the author was having a hard time finding motivation to exercise and stay in shape because of the cold weather and short days. The author decided as part of the health promotion plan to join Anytime Fitness in Grand Haven that has access to weights and cardiovascular equipment 24 hours a day 7 days a week. Part of the membership their also allows for travel benefits at any Anytime Fitness nationwide, which works out well for the authors job. The plan has been in effect for the past three weeks. Prior to the plan the author was exercising approximately 3-4 times per month. With the plan the author is now able to focus on exercising on a regular basis, for 60 minutes, prior to going to work. The second goal of consuming a high-protein, low-fat choices remain a good long-term diet option after your surgery, as well (Mayoclinic, 2013). The authors surgeon recommends 60

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grams of protein a day and not more than 5 grams of fat per serving. In January 2013, the author had lost focus on the end goal. The author started eating fast food again, eating too many carbohydrates, and not focusing on eating foods high in protein and low in fat. The author had no weight loss and plateaued all while noticing a change in her mood. While the plan has only been in effect for the past three weeks, the author has noticed a higher energy level and overall sense of well-being. The third goal of improving self-esteem and self-confidence has been slightly harder to accomplish. The author has lost 120.6 pounds from the gastric bypass and through changing her lifestyle. This amount of weight loss has left the author with an extreme amount of left over skin that affects the self-esteem and self-confidence of the author. The author was able to meet with a plastic surgeon while this plan was in effect that would be able to remove the physical part of distraction; however the author believes that there is also something more going on. The author was able to talk to her physician about her feelings and is currently setup to talk to a counselor about is going on and why she is contributing to the low self-esteem and low self-confidence. Conclusion Health promotion does not just include looking at diet and exercise but also looking at other parts of a persons life. When the author did this she was not all that surprised to find out the results. The author knew that there were issues with self-esteem and self-confidence but just didnt know how to address the issues with her doctor and what the next steps were to take. As part of this plan the author was able to start taking the right steps in addressing the issues herself. The author knows that she can control the diet and exercise component piece of the puzzle and is looking forward to working with a counselor to increase her self-esteem and self-confidence.

PERSONAL HEALTH PLAN References Carpenito-Moyet, L. (2010). Nursing Diagnosis (13th ed., pp. 820-821). Philadelphia, Pa: Lippincott Williams & Wilkins. Gastric Bypass Surgery. (2011). In Gastric bypass diet: What to eat after the surgery. Retrieved from http://www.mayoclinic.com/health/gastric-bypass-diet/my00827

Pender, N., Murdaugh, C., & Parsons, M. (2011). Health promotion in nursing practice (6th ed.). Upper Saddle River, New Jersey: Pearson Education. Ursuy, P. (2013). NURS 310 Class Syllabus. FSU.

PERSONAL HEALTH PLAN Appendix A

Health Beliefs Survey

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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 2 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 3 4 x 5 6

x x

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:

11 X
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:

Internal, 54 Chance, 30 Powerful-others, 38

PERSONAL HEALTH PLAN Appendix B

Self-Esteem Questionnaire

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The way you feel about yourself, your self-esteem, or self-assurance affects your life more than you know. It is a simple psychological fact that you cannot love anyone unless you first love yourself. Self-esteem leads to a better life for you and everyone with whom you come in contact. Do you have a healthy regard for yourself? To find out, just answer the 30 questions below. Remember, there are no right or wrong answers, only answers that will help to learn more about yourself. Each question can be answered with the word never, rarely, seldom, occasionally, or always. Select your answer, then write down the number that corresponds to the word you have chosen. 1 = Never 2 = Rarely 3 = Seldom 4 = Occasionally 5 = Always __4___ 1. If someone hurts my feelings I tell them so.

___4__ 2. People value my opinions. ___4__ 3. I feel intelligent. ___3__ 4. Nothing is too good for me. ___3__ 5. With few exceptions, I am satisfied with myself the way I am. ___3__ 6. I consider comparing myself with other people to see if I rate higher than they, or if they rate higher than me a waste of time. ___5__ 7. I enjoy meeting and talking with new people. __4___ 8. I feel at ease at parties. ___4__ 9. I am happy being me and, with few exceptions, wouldn't want to change places with others. __4__ 10. I don't want to be somewhere else, doing something else. __4__ 11. I am content with the way I live my life. __3__ 12. I like the place where I live. __3__ 13. I enjoy my work. __3__ 14. People generally admire me. __4__ 15. I am a kind person. __3__ 16. I enjoy getting up in the morning. __5__ 17. I can take care of myself. __5__ 18. Other people need me.

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__4__ 19. I enjoy watching what I eat, getting proper exercise, and taking good care of myself. __4__ 20. I try to make sure I lead a balanced life, enough sleep, enough work, enough play. __2__ 21. I don't mind being alone. __1__ 22. I enjoy my time alone. __3__ 23. I like myself. ___3_ 24. I respect myself. __3__ 25. I value myself. __3__ 26. I see myself as a good-looking person. __3__ 27. I see myself as a sexual person. __3__ 28. I see myself as a loving person.. __5__ 29. I see myself as a sharing person. __3__ 30. I see myself as a confident person. 105 TOTAL

How to Evaluate Your Score 150 Points If your score adds up to 150, it means you have answered every question "always and given yourself 5 points for each answer. This indicates that you have very high self-esteem. All your relationships would be very rewarding. Keep up the good work. 149 - 120 Points Your self-esteem is in the high-normal range. You can take people and situations in stride. You also have enough confidence to improve if you need to. You are in the low-normal range. Try to raise your selfesteem; you have the confidence to do it yourself. Your self-esteem is low. You can build it up yourself if you are willing to work hard. You may need help to raise your self-confidence level. How to Raise Your Self-Esteem If your score indicated that you must raise your level of confidence and that you can do it yourself, here are some ways to do it.

119 - 90 Points

89 - 60 Points

59 - 30 Points

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1) First, recognize the areas in which help is needed. Look back at the quiz and recheck those questions you answered never (1) or rarely (2). Is your answer fair or are you being too hard on yourself? Most people who lack self-esteem do so because they are too hard on themselves. 2) Try this exercise: Stand before a full-length mirror. Look at the person you see there. Tell that person they are a very special person who deserves the best break. 3) Every chance you get, take advantage of your good nature and treat yourself better. Give yourself credit for the things you do right; don't just criticize yourself when things go wrong. Remember, you have the power to see the positive as well as the negative. You can see the good as well as the bad.

PERSONAL HEALTH PLAN Appendix C Exercise Journal

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Date/Time

Type of Exercise

Amount of Time Spent 20 minutes 45 minutes 45 minutes 15 minutes 30 minutes 35 minutes 30 minutes 35 minutes 90 minutes 45 minutes 50 minutes 45 minutes 20 minutes 90 minutes 45 minutes 20 minutes

Aerobic / Non-Aerobic Non-Aerobic Aerobic Aerobic Aerobic Aerobic Aerobic Aerobic Aerobic Aerobic Non-Aerobic Aerobic Aerobic Aerobic Aerobic Aerobic Aerobic

Related to work? Before work Day off Before work Before work After work Before work Day off Day off Day off Day off

6/07 5p 6/09 12p 6/11 430p 6/13 430p 6/15 7a

Weight lifting Treadmill Treadmill Elliptical Treadmill Elliptical Treadmill Elliptical Outdoor hiking Yoga

6/17 1p Running 6/19 2p 6/21 3p 6/22 5p 6/23 5p Soccer Running Treadmill Elliptical Soccer

PERSONAL HEALTH PLAN Appendix D

FOOD JOURNAL

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Date 6/07 6/09 6/11 6/13 6/15 6/17 6/19 6/21 6/22 6/23

Protein 61.6 61.8 73.2 63.2 59.3 62.6 63.6 64.3 63.2 66.1

Carbs 107.1 90.4 95.2 107.2 100.2 90.2 100.2 101.3 90.2 88.2

Fat 22.4 26.2 44.2 25.3 25.9 22.8 20.3 24.1 24.0 22.0

**Numbers obtained from Lose It! where food was recorded daily

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Personal Health Assessment and Health Promotion Plan Grading ASSESSMENT CRITERIA EARNED 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: Excellent work on your paper! Be proud of your accomplishments and keep up the great effort to reach your goals.
POINTS POINTS

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