Running head: HEALTH PROMOTION 1. Health Promotion: Stress Management. Patricia Miller. Ferris State University

Transcription

1 Running head: HEALTH PROMOTION 1 Health Promotion: Stress Management Patricia Miller Ferris State University

2 HEALTH PROMOTION 2 Abstract A personalized health promotion plan can help an individual to assess their own health and identify areas of needed improvement. Often the first step in analyzing one s own health is to consider his or her own beliefs about health. The following is my own personalized health promotion plan based on my belief that is the individual themselves that have the most control over their own health. In this plan, I focus on management of stress in order to create an overall improvement in well-being.

3 HEALTH PROMOTION 3 Health Promotion: Stress Management Prior to this assignment I had not spent a lot of time thinking about my beliefs about health or, more specifically, my individual locus of control. That s not to say that I haven t considered or thought about causes of illness or attempted to promote health in either myself or others. I just can t say that I have spent a great deal of time analyzing my beliefs. The term locus of control is used to describe an individual s sense of control over events. Individuals with an internal locus of control are more likely to believe that they can influence events, whereas those with an external locus of control tend to believe it is fate that influences events (Taber s Cyclopedic Medical Dictionary, 2009). I d tend to believe I fall into both categories; however, as noted in Appendix 1, the results of the health belief survey by Wallston, Wallston, and Devellis (1978) are not indicative of this. The results of the survey showed the highest scoring to be in the internal subscale. The chance subscale was the second highest and the powerful/others subscale was the lowest. After consideration of this scoring, I do feel it to be accurate. In first thinking about the internal items, I do definitely believe that it is the individual, specifically myself, that has the most control over health. If I take care of myself by working to maintain my health physically, mentally, and spiritually I am more likely to stay healthy or recover more quickly if I do become ill. I think that an individual who eats a nutritious diet, exercises, maintains a clean environment, gets plenty of rest, has healthy relationships, and engages in spirituality with the higher power of his or her choice is far more likely to be healthy and avoid illness than the individual who does not. However, in expressing my beliefs about the power of the individual to control their own health, I had to consider the question: What about those individuals who are diagnosed with diseases despite all efforts to prevent them, such as those affected by certain types of cancer? I

4 HEALTH PROMOTION 4 recognize that some cancers are definitely influenced by health behaviors such as lung cancer due to smoking or skin cancer due to sun exposure but there are also those individuals affected by cancers such as leukemia or breast cancer for example in which there seems to be an unknown correlation to health behaviors. My answer to this is that an individual s health is also influenced by chance. There will always be the possibility of being affected by a disease or illness regardless of my own efforts to stay in the best health. I do believe though if I were to unfortunately be diagnosed with a disease, I would have some control over my recovery and health maintenance by engaging in positive health behaviors. The third and final scoring item in the survey was the powerful/other subscale. I scored the lowest in this area, which I found to be interesting since I would be considered one of those other individuals as a nurse. I think that, for myself personally, my health is influenced by my own actions and by my higher power. Others, such as health care professionals can provide care and education but in the end it is my responsibility to maintain my health. Therefore, my biggest job as a nurse is to promote and encourage others to engage in healthy behaviors. However, in contradiction to this, there are also going to be times when another individual s health is solely in the hands of the health care professional, such as in surgery or with the individual who is unable to care for themself. To sum up my overall beliefs about health, I believe the largest factor in one s health is what he or she does to maintain or promote it. I also believe that there will be individuals who are affected by disease or illness regardless of their actions and the main role of the health care professionals is to help individuals manage their illness and maintain their own health by engaging in healthy behaviors. Because of my belief in the ability of the individual to control one s own health, my individual health promotion plan focuses largely on my own actions. Personalizing an individual

5 HEALTH PROMOTION 5 health promotion plan for oneself requires the gathering of both subjective and objective data. Seidel, Ball, Dains, and Benedict (2006) describe subjective data as the information, both positive and negative, that the patient offers (p. 861). This would include my own thoughts and feelings about my physical health as well as my view of my stressors, support systems, spirituality, etc. Seidel et al. (2006) explain objective data to be the findings resulting from direct observation (p. 861). My objective data includes my data such as weight, body mass index (BMI), laboratory values, etc. Performing an accurate personal assessment requires thorough analysis and thought to avoid any biases that may get in the way. Assessment In performing my physical assessment, I am in good physical condition. At 32 years of age, I have a BMI of 23 and a waist-to-hip ratio of 0.75 which put me at a lower risk for health problems. Waist-to-hip ratios greater than 0.85 in women indicate an increased risk of diabetes mellitus, hyperlipidemia, stroke, and ischemic heart disease (Seidel et al., 2006, p. 115). To assess my nutrition, I completed a dietary assessment at the Web site My Pyramid Tracker at (U.S. Department of Agriculture Human Nutrition Information Service, 2006). I recorded a dietary intake on a normal work day as well as on a day spent not working. Both intakes showed needed improvement. I was deficient in dairy and vegetables although my intake of these was better on my day off work. My fat and calorie intake was higher on the day that I worked versus my day off as well as my sodium intake. My fiber and water intake were slightly insufficient for both days. Pender, Murdaugh, and Parsons (2011) state that dietary risk factors for chronic disease are widespread (p. 101). In analyzing my nutrition, it is apparent that I tend to make healthier choices when I am not working and have more time to prepare nutritious meals.

6 HEALTH PROMOTION 6 Physical activity is an important aspect of my life. I have, over the past few years, engaged in exercise approximately three times per week. During a typical workout I would spend 30 to 45 minutes doing cardio exercise followed by strength exercises. I had also been attending a yoga class one day per week. However, I have recently been finding it very difficult to fit in the time for exercise due to school and increases in my work schedule. Thornton (2010) points out that exercise has many health benefits and improves the functioning of nearly every part of the body that stress adversely affects (p. 35). I know from my experience that exercise has helped to relieve tensions and improve my overall sense of well-being and energy levels. Based on my family health history, I am at higher risk for some diseases. Both my mother and my sister have hypertension with my sister being diagnosed prior to age 40. I am also at an increased risk for breast cancer due to my sister being diagnosed at age 40. Seidel et al. (2006) explain that having one first-degree relative (mother, sister, or daughter) with breast cancer approximately doubles a woman s risk (p. 497). They further explain that the risk for developing breast cancer is increased with having a relative on either side of the family that was diagnosed with breast cancer before 50 years of age (Seidel et al., 2006, p. 497). It is important for me to be diligent in performing self breast exams and having mammograms regularly beginning at age 35. Stress is big concern for me at this time in my life. In completing the Daily Hassles and Uplifts Scale, Appendix 2, the number of hassles is greater than the number of uplifts (Delongis, Folkman, & Lazurus, 1988). Although I have a great deal of uplifts and blessings in my life, stress is an issue for me with many psychological and physical symptoms. I am able to identify that my stressors are related to management of school and work while raising two children as a single mother. Pender et al. (2011) state that stress is a potential threat to mental health and

7 HEALTH PROMOTION 7 well-being and is associated with illnesses such as cardiovascular disease, cancer, and gastrointestinal disorders (p. 101). Stress warning signals are symptoms of stress and may be physical, behavioral, emotional, or cognitive (Pender et al., 2011, p. 103). After completing the stress warning signals questionnaire, Appendix 3, I am able to identify symptoms that I frequently experience including: headaches, tight neck/shoulders, edginess, anxiety, being easily upset, and an overwhelming sense of pressure Pender et al, 2011, p. 104). Assessment of my social supports leads to identification of a strong social support network. I have strong relationships with my parents, siblings, and children as well as some identified supportive friends. Although my children are young and I provide most of the support in the relationship they are strong sources of support for me. I talk with a family member or friend daily. Spiritual health, as defined by Pender et al. (2011), is the ability to develop one s inner being to its fullest potential (p. 104). Assessing spiritual health is important in a holistic approach to health assessment because spiritual beliefs affect a person s interpretation of life events and health (Pender et al., 2011, p. 105). Spirituality is very important to me as I use prayer in my life on a daily basis. My relationship with God is the strongest of my support systems. I try to make it a point to take a few moments at the beginning of my day for prayer. Thornton (2010) states that setting aside time when you first wake up to engage in a spiritual practice sets the tone for the entire day and will help you get through challenges (p. 35). After performing a thorough assessment and health history, the one weak component that I would like to improve is management of stress. I initially wanted to improve in the area of exercise and nutrition but I believe the three are interrelated and in improving one, the others

8 HEALTH PROMOTION 8 areas will benefit as well. I think the most critical area of my assessment is stress and continued stress will begin to create many adverse health problems. Theoretical Model Readiness for change can be best assessed with a stage model of change. The fundamental assumption underlying a stage model of change is that differences exist in individuals in their likelihood of action, and different explanations are needed for different stages of change (Pender et al., 2011, p. 51). The best model to use to assess readiness for change is the transtheoretical model. This model is derived from psychotherapy and theories of behavior change to explain how individuals progress toward adopting and maintaining behavior change (Pender et al., 2011, p. 51). The basis of the model is that the health related behavior change progresses through five stages: precontemplation, contemplation, planning or preparation, action, and maintenance (Pender et al., 2011, p. 51). The precontemplation stage occurs when an individual is not thinking about a behavior change and has no intention to within the next six months (Pender et al., 2011, p. 51). I have moved beyond this stage because I have already thought about making changes in management of my stress. The contemplation stage is when an individual is seriously thinking about a behavior change and intends to change within the next six months (Pender et al., 2011, p. 51). I have also moved beyond this stage because I have been seriously thinking that I need to try to better manage my stress and I plan to start taking steps to doing this. The planning or preparation stage occurs when an individual is seriously thinking about engaging in the contemplated change within the next month and has taken some steps in this direction (Pender et al., 2011, p. 51). I believe my readiness to change fits within the planning or preparation stage because I plan to engage in actions to reduce or manage my stress within the next month and I have already taken some steps, such as making time for exercise and

9 HEALTH PROMOTION 9 sleep. The action stage occurs when the individual has made the change and it has persisted for less than six months and the maintenance stage is when the change has been in place in for at least six months (Pender et al., 2011, p. 51). Karen Horneffer-Ginter, PhD, 2008, explains in her article that a key finding based on the transtheoretical model is that health interventions that are matched to a person s stage of change are more effective than implementing a traditional action-oriented health initiative (p. 352). Based on this, my health promotion plan will include interventions that focus on the preparation stage of change. Diagnosis In choosing a wellness diagnosis for my plan I was a little conflicted between Healthseeking behaviors related to stress as a risk factor for coronary artery disease and Readiness for enhanced coping (Sparks & Taylor, 2008). Although Readiness for enhanced coping was fitting in that it listed defines stressors as manageable as a defining characteristic, I found the alternative option to be more congruent with my assessment findings (Sparks & Taylor, 2008, p. 834). Health-seeking behaviors related to stress as a risk factor for coronary artery disease is defined as active seeking (by a person in stable health) of ways to alter personal health habits or the environment in order to move toward a higher level of health (Sparks & Taylor, 2008, p. 853). One defining characteristic that stuck out to be within this diagnosis is expressed or observed desire to seek a higher level of wellness (Sparks & Taylor, 2008, p. 853). I chose this diagnosis because I currently experience high levels of stress notable by physiological symptoms and I have a desire for an increased level of wellness. I also chose this diagnosis because I am aware that stress is a risk factor for many diseases, with coronary artery disease included, and I have a familial history of diabetes, hyperlipidemia, and hypertension.

10 HEALTH PROMOTION 10 Plan The next step towards development of a health promotion plan is to identify health goals. Pender et al. (2011) explain that long- and short-term goals help individuals to stay on course with their plan (p. 205). Long-term goals set the direction for change and short-term goals allow for immediate success (Pender et al., 2011, p. 205). My short-term goal will be to engage in at least two stress management techniques each day. My long-term goal will be a decreased incidence of physiological indicators of stress (headaches, tension, irritability, etc.) and a notable improvement in stress management after one month. There are a variety of techniques in the literature that can aid in the process to better management of stress. Pender et al. (2011) discuss that interventions for stress management should aim to achieve the following: minimize the frequency of stress-inducing situations, increase resistance to stress, and avoid physiological arousal resulting from stress (p. 201). Time management is one approach to stress management. Pender et al. (2011) explain that lack of time is a frequent reason for not participating in health promoting activities and time-pressured individuals are particularly in need of time-management skills (p. 203). They go on further to describe some specific ways of addressing time-management: say no to demands of others that are unrealistic or of low personal or family priority, reduce overwhelming tasks into smaller segments, and delegate responsibilities to other and ask for assistance (Pender et al., 2011, 203). Another technique to stress management is exercise. Exercise increases resistance to stress by increasing feelings of well-being and contributes to overall good mental health (Pender et al., 2011, 204). Exercise also improves the functioning of nearly every part of the body that stress adversely affects (Thornton, 2010, p. 35).

11 HEALTH PROMOTION 11 Adequate rest and sleep is a very important component of stress management. Thornton (2010) explain this by saying that maintaining a regular time to go to bed each night will help regulate your biorhythm and make you more resilient to stressors in life (p. 36). The adoption of a healthy diet will give the body the added nutrients needed in times of stress. In addition to the above techniques there are a variety of alternative therapies known to help individuals cope with stress. Some common alternative therapies include: yoga, meditation, relaxation therapy, and mindfulness-based stress reduction. Relapse prevention strategies are important in relation to stress management because it is very easy to discontinue the stress management techniques once goals are met and stress reduction is apparent. In order to prevent this from happening I will continue to maintain healthy activities and manage my time efficiently. If stress should begin to be problematic again I will set goals and work towards achievement of healthy stress levels. Implementation In implementing my personal health promotion plan to improve stress management I plan to incorporate several of the above techniques into my daily lifestyle. My belief that I am in control of my own health is evident in many of the intervention listed; however, it is also apparent that reliance on a higher power and others is adopted. One technique that I have already begun to use is exercise. I will continue to make exercise a priority by engaging in minutes of physical activity at least four to five days per week. In addition to my exercise plan, I will continue to attend my yoga class on Saturdays as often as I am available to. Another main aspect of my stress management will be spirituality. I will set aside 5-10 minutes each day, preferably in the mornings, to connect spiritually with my higher power and engage in quiet reflection.

12 HEALTH PROMOTION 12 Time management is a big issue for me due to school and works demands along with parenting on my own. I will try to implement some of the suggested strategies by prioritizing demands of others and taking on tasks that are only of high personal or family priority. I will also accept assistance with responsibilities when it is available. An excellent resource that I have identified is Encompass, a service offered through my employer. Encompass is a confidential service that addresses a variety of issues that may affect the quality of work or personal life including stress, depression, anxiety, grief, and relationship conflicts (Encompass, LLC., 2011). The service provides counseling, education, and resources for areas such as parenting, finances, and balancing work and personal life as well as many other areas. Evaluation In evaluating my progress towards my goals, I will address each one individually. My short-term goal is to engage in at least two stress management techniques each day. I am currently meeting this goal some days but not all. The one technique that I have been consistent with is prayer. I try to take at least 5 minutes each day to engage in quiet prayer or meditation. Other techniques for stress management have been very difficult to find time for lately. I was consistently fitting in time for exercise but over the past few weeks I have been unable to do this due to increasing commitments with family and at work and inability to find time. I have also been unable to attend my yoga class in several weeks. My long-term goal is a decreased incidence of physiological indicators of stress (headaches, tension, irritability, etc.) and a notable improvement in stress management after one month. This goal, too, remains unmet. Physiological indicators of stress are present and I have little to no improvement in stress management.

13 HEALTH PROMOTION 13 Although my goals have not been met, I have gained a very important insight in my own health. Because this is a personal health promotion plan, I can evaluate my goals and rewrite them or adjust the time frames. I can foresee a reduction in stress after completion of school and because of this very thorough examination of myself, I can continue to work towards my goals and strive towards overall better management of stress.

14 HEALTH PROMOTION 14 Appendix 1 Appendices 1 - Strongly Disagree; 2 - Moderately Disagree; 3 - Slightly Disagree; 4 - Slightly Agree; 5 - Moderately Agree; 6 - Strongly Agree 1. If I get sick, it is my own behavior that determines how soon I will get well again X 2. No matter what I do, if I am going to get sick, I'll get sick. X 3. Having regular contact with my physician is the best way for me avoid illness. X 4. Most things that affect my health happen to me by accident. X 5. Whenever I don't feel well, I should consult a medically trained professional. X 6. I am in control of my health. X 7. My family has a lot to do with my becoming sick or staying healthy. X 8. When I get sick, I am to blame. X 9. Luck plays a big part in determining how soon I will recover from an illness. X 10. Health professionals control my health. X 11. My good health is largely a matter of good fortune. X 12. The main thing that affects my health is what I myself do. X Continued on next page

15 HEALTH PROMOTION If I take care of myself, I can avoid illness. X When I recover from illness, it's usually because other people have been taking good care of me. (doctor, nurses, family) X 15. No matter what I do, I'm likely to get sick. X 16. If it's meant to be, I will stay healthy. X 17. If I take the right actions, I can stay healthy. X 18. 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, 12, 13, 17 = 24 Chance Items: 2, 4, 9, 11, 15, 16 = 17 Powerful-others items: 3, 5, 7, 10, 14, 18 = 10

16 HEALTH PROMOTION 16 Appendix 2 How much of a hassle was this item for you today? HASSLES How much of an uplift was this item for you today? UPLIFTS 0 = None or not applicable 0 = None or not applicable 1 = Somewhat 1 = Somewhat 2 = Quite a bit 2 = Quite a bit 3 = A great deal 3 = A great deal DIRECTIONS: Please circle one number on the left-hand side and one number on the right-hand side for each item Your child(ren) Your parents or parents-in-law Other relative(s) Your spouse Time spent with family Health or well-being of a family member Sex Intimacy Family-related obligations Your friend(s) Fellow workers Clients, customers, patients, etc Your supervisor or employer The nature of your work

17 HEALTH PROMOTION Your work load Your job security Meeting deadlines or goals on the job Enough money for necessities (food, clothing, housing, health) Enough money for education Enough money for emergencies Enough money for extras (entertainment, recreation, vacations) Financial care for someone who doesn t live with you Investments Your smoking Your drinking Mood-altering drugs Your physical appearance Contraception Exercise(s) Your medical care Your health Your physical abilities The weather News events Your environment (e.g., quality of air, noise level, greenery) Political or social issues Your neighborhood (e.g., neighbors, setting) Conserving (gas, electricity, water, gasoline, etc.)

18 HEALTH PROMOTION Pets Cooking Housework Home repairs Yardwork Car maintenance Taking care of paperwork (e.g., paying bills, filling out forms) Home entertainment (e.g., TV, music, reading) Amount of free time Recreation and entertainment outside the home Eating (at home) Church or community organizations Legal matters Being organized Social commitments

19 HEALTH PROMOTION 19 Appendix 3 STRESS WARNING SIGNALS Physical Symptoms Headaches Indigestion Stomachaches Sweaty palms Sleep difficulties Dizziness Back pain Tight neck, shoulders Racing heart Restlessness Tiredness Ringing in ears Behavioral Symptoms Excess smoking Bossiness Compulsive gum chewing Attitude critical of others Grinding of teeth at night Overuse of alcohol Compulsive eating Inability to get things done Emotional Symptoms Crying Nervousness- anxiety Boredom- no meaning to things Edginess-ready to explode Anger Feeling powerless to change things Loneliness Easily upset Overwhelming sense of pressure Unhappiness for no reason Cognitive Symptoms Trouble thinking clearly Forgetfulness Inability to make decisions Lack of creativity Memory loss Thoughts of running away Constant worry Loss of sense of humor Circle those that you experience when under stress. These are your stress warning signs. Can you think of others? When such symptoms occur, consider using stress management techniques.

20 HEALTH PROMOTION 20 References DeLongis, A., Folkman, S., & Lazarus, R. (1988). The impact of daily stress on health and mood: Psychological social resources as mediators. Journal of Personality and Social Psychology, 54, Encompass LLC,. (2011). Encompass Services. Retrieved from Horneffer-Ginter, K. (2008). Stages of change and possible selves: 2 tools for promoting college health. Journal of American College Health, 56(4), Pender, N. J.., Murdaugh, C. L., & Parsons, M. A. (2011). Health promotion in nursing practice (6th ed.). Upper Saddle River, NJ: Pearson Education, Inc. Seidel, H. M., Ball, J. W., Dains, J. E., & Benedict, G. W. (2006). Mosby s Guide to Physical Examination 6 th ed. St. Louis, Missouri: Mosby Elsevier. Sparks, S. M. & Taylor, C.M. (n.d.). Nursing Diagnosis Manual. Lippincott Williams & Wilkins: USA. Taber s Cyclopedic Medical Dictionary 21ed. (2009). Philadelphia, PA: F.A. Davis Company. Thornton, L. (2010). Self-Care: Your Tool for Empowerment. NSNA, February/March, U.S. Department of Agricultural Human Nutrition Information Service. (2006). My Pyramid Tracker. Retrieved from Wallston, Wallston, &Devellis. (1978). Multidimensional Health Locus of Control (MHLC) Scales. Health Education Monographs. 6,