Running head: PERSONAL HEALTH IMPROVEMENT PLAN 1 Personal Health Assessment and Plan for Improvement Amy Bradley Ferris State University
2 Abstract The intention of this paper is to develop the author s personal health improvement plan by examining her health beliefs. The author used the Health Belief Survey to discover her strong feelings for personal responsibility regarding her own health and incorporated the Transtheorectical Model to evaluate and support her readiness to change her current lifestyle. The author also implemented various tools to support her goal of weight loss which included, but was not limited to, a nursing wellness diagnosis, body mass index calculator, and weight loss journal.
3 Personal Health Assessment and Plan for Improvement The purpose of this paper is to examine the health practices of the author and develop a plan for improvement regarding weight loss in order to increase her overall health. As stated by 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). The author plans to start replacing old behaviors with new healthier behaviors such as eating nutritiously, exercising, and drinking plenty of water, with the ultimate goal of losing weight. Personal Health Assessment Prior to developing a plan for health improvement, the author utilized the Health Beliefs Survey (HBS) (Appendix A) to examine her personal attitude regarding health and the factors that may influence a person s capability of staying healthy. According to this survey there are three subscales that are believed to control health: Internal Items, Chance Items, and Powerfulothers Items. The internal items subscale refers to personal control over health outcomes. People who score highly in this subscale believe that their actions directly affect the state of their health. The higher the scores on the chance subscale and power[ful]-others subscale, the higher the beliefs in the importance of chance and others respectively in controlling personal health (Ursuy, 2011, p. 22). Upon reviewing the results of the survey, the author realizes that she has a strong belief in personal responsibility for one s own health, but she does realize that some things are out of her control and can be solely based on genetics or poor circumstances. Based on the results, the author seems to give little support for the idea of powerful-others being responsible for personal health. She feels they may give advice and help nurture during times of illness, but it is a person s ultimate responsibility to do what is necessary to maintain a good state of health.
4 After examining the results of the HBS, the author has created a health improvement plan in order to change the behaviors that she can control for the purpose of promoting a healthy lifestyle. The biggest area of concern for the author is being overweight. Being overweight has the potential to lead to other diseases and illnesses such as diabetes, heart disease, and hypertension. The author plans to make changes to her daily eating and exercising routines in order to reduce those risks. Currently, the author has no exercise regimen in place, but does remain active by doing housework, yard work, working outside of the home, and caring for two small children. She tries to set a good example for her children regarding diet and incorporates the food pyramid into meal planning. However, the author finds that she consistently makes poor food choices for herself by snacking after her children go to bed. She also realizes that she drinks considerably more coffee than water throughout the day. These realizations have led the author to seek out tools to support her plan for health improvement. Support Tools The first supportive tool utilized by the author was a Body Mass Index (BMI) calculator and a waist-to-height ratio measurement (Appendix B). These results allowed the author to visualize herself as being overweight, which provided her with the motivation to continue making her plan for weight loss and health improvement. The next tool that the author used was a Resting Metabolic Rate (RMR) calculator (Appendix C). By calculating the RMR it allowed the author to determine how many calories her body needs to maintain its proper function. Since, the author has made a goal to lose two pounds a week her calculated daily caloric intake should be 1200 calories and she should consume 64 ounces of water a day. (Appendix C). Along with eating better, the author has also made it an ambition to increase the amount of daily exercise she receives. In order to achieve weight loss and good cardiovascular strength it is important for the author to maintain a heart rate between 95 and 142 beats per minute (bpm) for at least for at least 20 minutes three days a week (Appendix C). The author will plan to start
5 jogging for 30 minutes three days a week starting August 1, 2012 and will begin her new dietary restrictions July 1, 2012. In order for the author to monitor her progress she will keep a journal; tracking how many calories are consumed a day, how much exercise is obtained in a week, what her heart rate is during exercise, and her weight loss progress each week. The journal should provide the author with enough positive feedback to keep her motivated and moving forward with her health improvement plan. Transtheoretical Model In order for the author to increase her chances of making positive healthy changes she explored the stage model of behavior change called the Transtheoretical Model (TM). The fundamental assumption underlying a stage model of change is that differences exist in people in their likelihood of action, and different explanations are necessary for different stages of change (Pender, Murdaugh, & Parsons, p. 51). The TM consists of five stages used to describe how individuals progress toward adopting and maintaining behavior change (Pender, Murdaugh, & Parsons, p. 51). The five stages are: a) Precontemplation b) Contemplation c) Planning or Preparation d) Action and e) Maintenance. The author used this model to assess her present state of health and define each stage and how it will correlate with her health improvement plan. The first stage, precontemplation, an individual is not thinking about quitting or adopting a particular behavior, at least not within the next six months (Pender, Murdaugh, & Parsons, p. 51). The author believes that she has completed this stage of the TM approximately two years ago. During that time she had just had her second son and was finding it to be a very difficult period of transition. As she became more comfortable and confident in her new role as the mother of a two year old boy and an infant, she began to shift into the next stage of the TM, contemplation.
6 During the second stage of contemplation, an individual is seriously thinking about quitting or adopting a particular behavior in the next six months (Pender, Murdaugh, & Parsons, p. 51). While the author was in this phase, she decided to make small changes in her daily eating habits in order to promote a healthier diet, but had intentions of making bigger life changes later on. This led the author to the next stage of preparation or planning. Currently the author finds herself in the preparation or planning stage of the TM. Pender, Murdaugh, and Parsons state an individual is seriously thinking about engaging in the contemplated change within the next month and has taken some steps in the direction (2011, p. 51). The author has set goals concerning dietary changes, as outlined previously in the paper, to go into effect on the first of July and has also decided to start her exercise regimen the beginning of August. Action is the fourth stage of the TM and states an individual has made the behavior change and it has persisted for less than six months (Pender, Murdaugh, & Parsons, p. 51). The author has not yet reached this stage, but has made plans to monitor her progress throughout this phase with the hope that seeing her positive results will take her to the final stage of the TM, Maintenance. Maintenance means the change has been in place for at least six months and is continuing (Pender, Murdaugh, & Parsons, p. 51). The author feels that if she can continue her healthy changes for more than six months she can achieve her long-term goal of weight loss. Nursing Wellness Diagnosis The author believes the nursing wellness diagnosis of Health Seeking Behaviors related to lack of aerobic activity and unhealthy dietary intake (Sparks & Taylor, 2010, p. 842) best suits her plan for improving her health and losing weight. The author chose this diagnosis based upon the definition, assessment, and defining characteristics of the wellness diagnosis. The author feels she fits the definition of Health Seeking Behaviors by active[ly] seeking (by a person in stable health) of ways to alter personal health habits or the environment in order to move toward
7 higher level of health (Sparks & Taylor, 2010, p. 842). The author also chose this diagnosis because of the defining characteristics which include an expressed or observed desire to seek a higher level of wellness and a demonstrated or observed lack of knowledge about health promotion behaviors (Sparks & Taylor, 2010, p. 842). The author also felt she fit the assessment of a person with health-seeking behaviors which are: high risk factors (overweight, lack of exercise, and poor diet), relatively stable current health status, proper motivation, and the recognition and realization of potential growth, health, and autonomy (Sparks & Taylor, 2010, p. 842). Personal Goals The author has set the short term goal to lose two pounds a week by maintaining a healthy diet and instituting an exercise regimen. In order to accomplish this goal the author will only be allowed to consume 1200 calories a day and increase her water intake to 64 ounces a day. The author has also set a goal to wake-up early in the morning, three days a week, and start jogging for 30 minutes; making sure to hit her target heart rate for 20 minutes during her jog. Keeping a daily journal to carefully monitor her progress should keep her motivated and on target with her set goals. By accomplishing the short term goals the author hopes to achieve her long term goal which is lose 45 pounds in approximately six months and keep it off forever. The author plans to incorporate a large support system consisting of family and friends in order to help her achieve her long term goal. Conclusion Since completing the Health Belief Survey the author has realized that she is solely responsible for maintaining her own health and that has led her to making a health improvement plan for weight loss. The author has also utilized the Transtheorectical Model to evaluate and support her readiness to change her current lifestyle. The author has incorporated many tools to help create a strategy and set goals for change and to support her throughout the process of
8 changing her lifestyle. The author is currently in the planning stage of her health improvement plan, but is eager to put her plan into action and model healthier behavior for her sons.
9 References Pender, N. J., Murdaugh, C. L., & Parsons, M. A., (2011). Health promotion in nursing practice (6 th ed.). Upper Saddle River, NJ: Pearson Education. Sparks, S., & Taylor, C. (2010). Nursing diagnosis reference manual (8 th ed.). Philadelphia, PA: Lippincott Williams & Wilkins. Ursuy, P. (2012). NURS 310 Class Syllabus.
10 Appendix A Health Beliefs Survey 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. If I get sick, it is my own behavior that determines how soon I will get well again. 1 2 3 4 5 6 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 x from an illness. 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
11 13. If I take care of myself, I can avoid illness. x 14. When I recover from illness, it's usually because other x people have been taking good care of me. (doctor, nurses, family) 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 x me to do. These three subscales, and the items included in each, are as follows: Internal Items: 1, 6, 8, 12, 13, 17 = 28x2 = 56 Chance Items: 2, 4, 9, 11, 15, 16 = 20x2 = 40 Powerful-others items: 3, 5, 7, 10, 14, 18 = 13x2=26 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, 50.4 Chance, 31.0 Powerful-others, 40.9
12 Appendix B WebMDBMI Plus Calculator Your Body Mass Index (BMI) is: 27.5 A BMI of 18.5 to 24.9 is considered healthy for adults. A BMI of 25 to 29.9 is considered overweight, while a BMI of 30 and above is considered obese. People with BMIs of 18.5 or less are considered underweight. Your Waist-to-Height Ratio is: 0.51 Your Body Shape Indicates: Increased Risk A waist-to-height ratio under.50 is generally considered healthy. This ratio may give a more accurate assessment of health for people who are muscular or for women who have a "pear" rather then an "apple" body shape. Be Careful: You have a thin shape and you may need to gain weight. Healthy: You have a healthy shape! Increased Risk: This measurement indicates a "pear" body shape. Excess fat is stored around the hips and thighs, which is less harmful to health than fat stored around the belly (an apple shape). Take Action: This measurement indicates an "apple" body shape. Excess fat stored in the stomach area increases your risk of serious conditions such as heart disease, stroke, type 2 diabetes, and some types of cancer. Retrieved from: http://www.webmd.com/diet/calc-bmi-plus
13 Appendix C Your RMR (Resting Metabolic Rate) is: 2016 Your body needs energy to function, and your resting metabolic rate (RMR) is the number of calories your body burns simply by living. Regular exercise increases your RMR and helps to keep your body healthy and feeling great! Your Daily Target Caloric Intake is: 1200 Weight goal you entered: Lose 2 pounds per week. About Your Weight and Caloric Recommendations Your BMI is higher than what's considered healthy, but your waist-to-tallness measurement indicates that you are healthy. Because your current weight is within normal limits, your goal should be to stay active and healthy, aiming for a dress size of no more than 40. Based on your weight goal, try to keep your daily caloric intake to about 1200 calories and combine this with regular exercise and physical activity. Exercise is essential to losing weight. Once you reach your weight goal, you will need to recalculate your daily caloric intake. Your healthy weight range is assessed using the body mass index (BMI) and waist-to-tallness formula. While these measurements do not give you a specific ideal weight, they do suggest an ideal weight range. Please Note: You should never allow your daily caloric intake to fall below 1,200 calories because you may not get enough nutrients. Also, excessive calorie restriction could slow your metabolism and hinder your weight goals. In addition to a low-calorie diet, exercising for at least 30 minutes per day at your target heart rate is the most effective way of losing weight and keeping it off. Your Target Heart Rate Zones While exercising or performing any sort of physical activity, you should count between 95 and 142 beats in 1 minute, and it should not exceed 189 per minute. Heart Rate Chart Your Personal Heart Rate Zones 0-95 bpm* Warm up 113-132 bpm Weight Management & Endurance Building 132-151 bpm Weight Loss & Improving Cardio Fitness 151-378 bpm Anaerobic. Don't stay here too long. *bpm = beats per minute Things to keep in mind when exercising: 1. Don't over-exert yourself. You should be able to maintain a short conversation without being out of breath. 2. Cardio or aerobic activities. Achieve the aerobic activity recommendation through one of the following options: A minimum of 30 minutes of moderate-intensity physical activity per day (such as brisk walking) most days of the week
14 OR A minimum of 20 minutes of vigorous-intensity physical activity (such as jogging or running) 3 days a week 3. Resistance, strength-building, and weight-bearing activities. At least two days a week, incorporate strength training into your routine. Strength training activities, such as weight lifting, burn calories and maintain and increase muscle strength and endurance. Aim for 6-8 strength training exercises with 8-12 repetitions per exercise. 4. Stretching/balancing exercises. Stretching and balancing exercises improve flexibility, balance, and posture. Review Our Recommendations You said that you want to lose weight by eating less and not exercising more. In order for you to lose 45lbs and meet your120lbs weight goal at a rate of 2lbs per week, you will need to: Limit your calories from FOOD to 1200 calories per day. Continue to burn 550 calories per day, or 3848 calories per week through FITNESS. If your current activity level declines, you will need to consume fewer calories than the recommended amount to meet your weight goal. This could slow your metabolism and hinder your results. Things like doing laundry, grocery shopping, and walking all count as fitness, so be sure to note them in your WebMD Food & Fitness Planner. Drink at least 64 oz of WATER every day. Drinking water helps the body flush out toxins, hydrates the skin, and helps curb your appetite. Be sure to drink even more water if you're increasing your activity level. Retrieved from: http://www.webmd.com/diet/food-fitness-planner/create-your-personal-plan