Abstract Wellness diagnoses are used to demonstrate an individuals readiness for change. First an area of change needs to be identified. This area is determined through an assessment. Assessments can be done in a variety of ways, verbal, physical or lab testing. Our method was an online quiz to identify areas in need of change. After the results are discussed the next step is to determine one or two wellness diagnoses. These diagnoses are areas in the individuals life that they view as areas they are ready to effect change. These steps walk along the Transtheoretical Model of Behavior process. Planning is an important step along this process. The individual develops a plan of change that is simple, easy to implement, and attainable. Once a plan is in place, it is implemented over a set period of time and evaluated. Evaluation measures the progress of the plan with possible adjustments for any areas that did not work. This process is done with hopes to instill permanent change for the individual.
PARTNER HEALTH PROMOTION 3
Partner Health Promotion Assessment After taking the real age self-assessment quiz, my partner discovered her real age to be 19.2, which is actually only three years less than her real age. The positive aspects of the quiz were weight, positive attitude, a partially nutritious diet, avoiding the sun, expressing love and interest in animals and others, and being a non-smoker. Some of the negative areas she needs to work on are diet (red meat and junk food), eat more of a variety of vegetables, find ways to deal with stress and financial issues, keep an eye on her low blood pressure, and stick with a sleep schedule. There were a couple areas I identified as being neutral rather than positive or negative. Those areas were to have her cholesterol tested, get hooked on fish, and to create a workout that works for you. After reviewing the assessment I noticed some categories that revolved around diet, exercise, social, sleep and stress. These are all important issues that make up ones environment and wellness and are a good start in defining a persons wellbeing. A couple categories to include in the quiz might be marital/relationship status, spiritual/religious beliefs, and financial/economic status. These areas have a tendency to affect a persons diet, sleep and overall mental and physical health status. Wellness Diagnosis After reviewing all the areas of the real-age quiz, and talking with my partner about the areas that were pointed out in the quiz, I was able to determine two wellness diagnoses for her. The first is readiness for enhanced sleep. This individual has a stated erratic sleep pattern and behavior with varying times to bed and awake. Several factors of environment also disrupt the ability for a routine sleep pattern. Temperature, environmental noise, location of bed/bedroom, and cats in the room are all playing a role in the disruptions as well as delayed times of falling PARTNER HEALTH PROMOTION 4
asleep and back to sleep. According to a study by Marhefka, (2011) sleep deprivation effects memory, computational speed, reduced cognitive achievement, and impaired performance on verbal creativity and abstract thinking. The study also concluded that lack of or poor sleep affects behavior and leads to cognitive difficulties, thereby reducing academic achievement and learning. This is the area that we decided to focus on. The second diagnosis I determined was readiness for health seeking behaviors related to diet and exercise. The individual has expressed that a consistent eating pattern is hard to achieve with her busy work and school schedule. The eating pattern is only one part of the diet equation. The choices made when she does eat play a big role in her overall health. Quick easy microwavable items and fast foods tend to be the main staples in the diet. Also finding time to stay fit and relieve stress by exercising is just another tough task to manage. She does belong to a gym that is open 24 hours but finds time is a hard thing to come by. Planning After reviewing the sleep wellness diagnoses with my partner, we worked together to devise a plan that could be easy to implement and achieve. First, I had her keep a journal for a week of her sleep habits. When she went to bed, woke, how many times awoke during the night, and when she did wake during the night what was the reason. After reviewing the journal, I noticed a sleep pattern emerge. The sleep pattern involved waking during the night due to environmental noise and temperature (cold) and also disturbances from the household cats. Another factor to her waking involved a busy head. Stress related waking due to school, financial, and social demands. Her sleep log showed an average of three times of waking during the night and an average of six hours a night of total sleep time. These are averages based on when she last looked at her clock or phone. Since it was not an option to PARTNER HEALTH PROMOTION 5
alter the cats behavior or lock them out of the area, we focused on changing the environment and using sleep techniques. First, we agreed on the use of an electric blanket and second we decided on the use of a noise machine which mimics the ocean, forest, white noise, insects, and so forth. Also I suggested she try word or phrase repetition as a form of relaxation to relieve stress and help her fall asleep faster. If she found herself thinking of school or work, she should refer back to the phrase. This method has been proven to reduce heart rate, blood pressure, decrease breathing rates and increase alpha brain waves. (Maville & Huerta, 2013, p. 239) Transtheoretical Model The Transtheoretical Model of Behavior encompasses five stages of change. Stage one is precontemplation, stage two is contemplation, stage three is preparation, stage four is action, and stage 5 is maintenance. (Maville & Huerta, 2013, p. 45) When my partner began the real-age self-assessment quiz, she began her journey up the steps of this model. Taking the quiz and reading the results started her in the precontemplation stage. It made her think about the answers she gave in the quiz that resulted in the recommendations given by the quiz. Since I know my partner well, we discussed the results. I questioned her on what areas of her lifestyle she thought could use change while using the quiz as a guide. This jumped her up to the contemplation stage because I made her think about what changes she wanted to make. We then discussed the changes she thought could be most useful in her life and easy to achieve. With some minor change in habits we formed a plan that could be easy to implement and achieve. By forming this plan she advanced to the preparation stage. Preparation included the plan, obtaining a noise machine and electric blanket. Once the plan was in place, it was implemented and we tracked her progress for the following week. With action being taken on our plan collaboration, my partner advanced to stage four which is action. The last stage, maintenance, involves PARTNER HEALTH PROMOTION 6
processing the effects of the change, with possible modifications, and long term continuation of the plan. The time frame for the first four stages evolved over a week. Since our objective was of a simpler nature, the time frame seems appropriate. Depending on the goal one hopes to achieve, the stages may take weeks to months to move through. Evaluation After implementing the plan of the electric blanket, noise machine, and repetitive phrase/word I spoke with my partner again to discuss how she felt the changes were working. She made comment of feeling a little more rested in the morning with fewer episodes of waking during the night and also stated she noticed a shorter response time falling asleep when using the word/phrase repetition technique. This technique also helped when she awoke during the night with a busy head. She referred back to the phrase and found she was able to fall back asleep faster. According to her journal she kept, her continued bed times ranged between 10-12pm, she noticed an average sleep time of 7.5 hours, and an average time to fall sleep was estimated between 10-15 minutes. This again was based on when she went to bed and the last time she looked at her clock or cell phone. The number of times awakening during the night was down to 1, but approximated time to fall back asleep was estimated to be 20 minutes, again estimated by last time she looked at the clock or her cell phone. This shortened time she said was attributed to the word or phrase repetition method for relaxing and clearing her busy head. She also commented on staying warm throughout the night and the use of the noise machine helped to drowned out environmental noises. The night awakenings were still primarily attributed to the household cats. At this point we did not see or feel any changes in the plan were warranted since noticeable change was achieved. She did inform me that she had recently accepted a third-shift PARTNER HEALTH PROMOTION 7
work position which will dramatically affect her sleep pattern and schedule, so we talked about the coming change and set-up a new set of guidelines for when this happens. On the nights she was going to work, when she returned home, she would sleep in an upstairs bedroom to help alleviate environmental noise and reduce interruptions from the household animals and other family members. We also chose to continue the use of the noise machine and electric blanket if necessary. Another change to implement was the use of a sleeping mask to reduce outside light and placing darkening curtains or blinds in the room she was going to use. These changes we felt would help her to achieve a relaxing dark environment for optimal quality sleep. Further evaluation can be done once this change has taken place and the new plan has had a chance to be implemented.
PARTNER HEALTH PROMOTION 8
References Marhefka, J. K. (2011, September). Sleep Deprivation: Consequences for Students. Journal of Psychosocial Nursing and Mental Health Services, 49(9), 20-25. http://dx.doi.org/10.3928/02793695-2011
Maville, J. A., & Huerta, C. G. (2013). Health Promotion in Nursing (third ed.). Clifton Park, NY: Delmar.
Appendix Pre-plan sleep log: bed times between 10-12pm, average approximated time to fall asleep 30 minutes, this was based on looking at clock or cell phone, average number of times waking during the night 3, length of time awake during the night when awoke, 30-45 minutes, this was also based on looking at clock or cell phone, and average amount of sleep time per night 6.5 hours depending on school and work schedule. Post-plan sleep log: bed times between 10-12pm, average approximated time to fall asleep 15 minutes, average number of times awakened during the night 1, length of time awake during the night when awoke 15 minutes, average hours of sleep during the night 7.5. Your Sleep Quality Quiz Results Your sleep quality has room for improvement. You scored 10 out of 21 You're lacking a little in the sleep department, and there are areas of your health and beauty that you may not realize are being negatively affected as a result. But don't stress! We can help you solve your shut-eye issues. Follow your personalized action steps, then come back and take the quiz again to see the positive effects of better sleep. SUBJECTIVE SLEEP QUALITY What it is: How you rate your sleep. This can help: Determine whats keeping you up (racing thoughts, kids, headaches) and commit to working it out. SLEEP LATENCY What it is: How long it takes you to fall asleep. This can help: Give your brain a break right before bed. For instance, scrambling to finish emails in bed or frantically going over the next day's presentation right before you sleep sets you up for failure. SLEEP DURATION PARTNER HEALTH PROMOTION 10
What it is: How many hours of sleep you get at night. This can help: If youre getting too little sleep (less than 6.5 hours) because of a hectic schedule, try penciling your bedtime into your daily calendar, and then treating it as a priority. If youre getting more than 8.5, that can be bad, too. HABITUAL SLEEP EFFICIENCY What it is: Your pattern of going to bed and waking up in the morning. This can help: Stick to a sleep schedule (go to sleep and wake up at the same times every day)your body will get its most efficient, beautifying sleep that way. SLEEP DISTURBANCES What it is: The things that disturb you while youre sleeping. This can help: Dont underestimate stuff that wakes you up even once during the night. Figure out whats bothering you (dogs, snoring, room temperature) and take care of it. USE OF SLEEP MEDICATION What it is: Prescribed and over-the-counter medication use. Nothing wrong here! DAYTIME DYSFUNCTION What it is: How your sleep is affecting your daytime activities. This can help: Daytime sleepiness can be downright dangerous if youre driving a car! If at all possible, take a 30-minute nap around 3 p.m. It will recharge your brain and refresh you for the rest of the day. The diet pattern that emerged involved evening meals. There was no consistency to her evening diet and time, ranging from frozen pizza and bag noodles to Jimmy Johns and other various fast foods and from times of 5pm to 9pm. Dietary calcium intake is crucial for young woman since it can lead to bone mineral loss and the weakening of bones in later life (Maville & Huerta, 2013, p. 238). For her evening meal plan we came to the decision to join the family PARTNER HEALTH PROMOTION 11
for dinner when possible and also to invest in single serving chicken/steak as well as small quantities of fresh vegetables that can be either steamed or mixed for salad. Since she already eats Greek yogurt on a regular basis which is a good source of calcium, the fresh vegetables with meals will help enhance her intake. These meals she could take to work with her for lunch/dinner times. She then kept track on her app so she could personally view the results.
PARTNER HEALTH PROMOTION 12
Assessment and Diagnosis Rubric Total Possible Points =200 Points Earned Assessment 60 Real age test completed, results interpreted and discussed in paper; summarize both positive and negative
Area of risk focus discussed in depth
One Wellness diagnosis for area of focus; supported by data and research ; EBP
Planning and Intervention Rubric 60 Points Earned One SMART obtainable goals should be able to measure progress
Interventions based on EBP ~ includes one peer reviewed journal article as a reference for at the minimum two interventions
Includes information re: TTM and readiness for change