TemplateforHealthRiskAssessmentAssignment xHealthRiskAssessmentAssignment20191 WELLNESSINVENTORY1 x
PERSONAL HEALTH RISK ASSESSMENT
Threat
barriers
evaluation
plan
Reference citation
NURS 314 – PERSONAL HEALTH RISK ASSESSMENT ASSIGNMENT
GUIDELINE/GRADING SHEET
Purpose:
The purpose of the assignment is to identify and explore a behavior in your current lifestyle that represents a significant threat to your health.
Guidelines:
1.
Complete the Wellness Inventory.
2.
From the Wellness Inventory, identify one (1) behavior in your current lifestyle that represents a threat to your health. Explore (using personal and professional perspectives) the health risk that the behavior represents and factors that make it difficult for you to change this behavior (barriers).
3.
Design a matrix/map that addresses the following topics OR may use sample template.
A. Threat to your health (30)
_____ 1.
Identify the behavior.
2.
Include the rationale for your selection.
3.
Describe the health risk that the behavior
represents.
B.
Barriers to behavioral change (10)
1.
Discuss/list the factors in your life which make it difficult to change the behavior that represents a threat to your life.
C.
Plan for behavioral change (40)
1.
Develop a detailed step-by-step strategy or plan to change this behavior.
2.
The plan must include specific objectives or goals the plan is designed to accomplish with established time frames. (How will you know when your goal/objectives are met?
D.
Evaluation (10)
1.
Discuss/list reasons for changing or not changing behaviors.
E.
Follow up (10)
1.
Locate one (1) reference from professional literature to support your plan and cite the source using APA format.
______
FINAL GRADE
WELLNESS INVENTORY
Instructions:
This tool will help you examine your lifestyle and wellness level. It will also give you ideas for areas in which you might improve. Please respond to these statements using the following choices. (If an item does not apply to you do not mark.)
Score
A. Almost always (90% or more of the time) 5
B. Very frequently (approximately 75% of the time) 4
C. Frequently (50% of the time) 3
D. Occasionally (approximately 25% of the time) 2
E. Almost never (less than 10% of the time) 1
Examine your scores and determine one (1) area of your lifestyle you would like to change.
Physical Exercise: Measures one’s commitment to maintaining physical fitness.
B 1. I exercise vigorously for at least 20 minutes three or more times per week.
D 2. I determine my activity level by monitoring my heart rate.
D 3. I stop exercising before I feel exhausted.
B 4. I approach exercise in a relaxed manner.
C 5. I stretch before exercising.
C 6. I stretch after exercising.
D 7. I walk or bike whenever possible.
A 8. When feeling tired, I arrange for sufficient sleep.
D 9. I participate in a strenuous sport (tennis, running, swimming, handball, basketball, etc.)
C 10. I use footgear of good quality, designed for the activity in which I participate.
D 11. If I am not in shape, I avoid sporadic (once a week or less often) strenuous exercise.
B 12. After vigorous exercise, I “cool down” (very light exercise such as walking) for at least 5 minutes before sitting or lying down.
___36__ AVERAGE SECTION SCORE
Physical/Nutritional: Measures the degrees to which one chooses foods that are consistent with the dietary goals of the United States published by the Senate Select Committee on Nutrition and Human Needs.
C 1. When choosing non-vegetable protein, I select lean cuts of meat, poultry, and fish.
A 2. I maintain an appropriate weight for my height and frame.
C 3. I minimize salt intake.
B 4. I eat fruits and vegetables fresh and uncooked.
C 5. I eat breakfast.
D 6. I intentionally include fiber in my diet on a daily basis.
C 7. I drink enough fluid to keep my urine light yellow.
C 8. I plan my diet to ensure an adequate amount of vitamins and minerals.
B 9. I minimize foods in my diet that contain large amounts of refined flour bleached white flour (typical store bread, cakes, etc.).
A 10. I minimize my intake of fats and oils including margarine and animal fats.
C 11. I include items from all four basic food groups in my diet each day (fruits and vegetables; milk group; breads and cereals; meat, fowl, fish, or vegetable proteins).
B 12. To avoid unnecessary calories, I choose water as one of the beverages I drink.
B 13. I avoid adding sugar to my food, and I minimize my intake of pre-sweetened foods such as sugar-coated cereals, syrups, chocolate milk, and most processed fast foods.
___46__ AVERAGE SECTION SCORE
WELLNESS INVENTORY (continued):
Physical/Self-Care: Measures the behaviors that help one prevent or detect early illness.
A 1. I record immunizations to maintain up-to-date immunization records.
E 2. I examine my breasts or testes on a monthly basis.
E 3. I have my breasts or testes examined yearly by a physician.
E 4. I have a Pap test annually (males – do not mark).
A 5. I take action to minimize my exposure to tobacco smoke.
A 6. When I’m experiencing illness or injury, I take necessary steps to correct the problem.
A 7. I brush my teeth after eating.
A 8. I floss my teeth after eating.
D 9. My resting pulse is 60 or less.
C 10. I get an adequate amount of sleep.
C 11. I engage in activities that keep my blood pressure in a range that minimizes my chances of disease (e.g., stroke, heart attack, and kidney disease).
B 12. I select foods that keep my cholesterol level, high-density lipids, and triglycerides in a range that minimizes my chances of disease.
B 13. If I were to engage in sex and didn’t want children at that time, I would use a contraceptive method.
A 14. I take action to prevent contracting and/or transmitting venereal disease.
Physical/Vehicle Safety: Measures one’s ability to minimize chances of injury or death in a vehicle accident.
A 1. I do not operate vehicles under the influence of alcohol or other drugs.
B 2. I do not ride with vehicle operators who are under the influence of alcohol of other drugs.
B 3. I stay within the speed limit.
A 4. I use the information I learned in driver education or a defensive-driving course.
C 5. when traffic lights change from green to yellow, I prepare to stop.
A 6. I maintain a safe driving distance between cars based on speed and road conditions.
A 7. Vehicles that I drive are maintained to assure safety.
B 8. Because they are safer, I use radial tires on cars that I drive.
C 9. I use caution when riding bicycles or motorcycles (e.g. helmets, adequate lights, etc.).
__38___ AVERAGE SECTION SCORE
Physical/Drug Abuse: Measures the degree to which one is able to function without the unnecessary use of chemicals.
A 1. I use drugs only when necessary.
A 2. I avoid the use of tobacco.
E 3. I consume two alcoholic drinks per day or less.
B 4. Because of the potentially harmful effect of caffeine (e.g. coffee, tea, cola, etc.), I limit my consumption.
A 5. I avoid using marijuana.
A 6. I avoid the use of hallucinogens (LSF, PCP, MDA, etc.).
A 7. I avoid the use of stimulants (“uppers” – e.g. cocaine, amphetamines, “pep pills”, etc.)
A 8. I avoid the use of depressants (“downers” – e.g. barbiturates, minor tranquilizers, etc.).
A 9. I avoid using a combination of drugs unless under medical supervision.
A 10. I follow the instructions provided with any drug I take.
A 11. I avoid using drugs obtained from unlicensed sources.
A 12. I understand the expected effect of drugs I take.
A 13. I consider alternatives to drugs.
__60___ AVERAGE SECTION SCORE
WELLNESS INVENTORY (continued):
Social/Environmental: Measures the degree to which one contributes to the common welfare of the community. This emphasizes interdependence with others and nature.
A 1. I take steps to conserve energy in my place of residence.
A 2. I consider energy conservation when choosing a mode of transportation.
A 3. I offer support to members of my family when appropriate.
A 4. I contribute to the feelings of acceptance within my family.
B 5. I do my part to promote clean air.
C 6. When I see a safety hazard, I take action (warn others or correct the problem).
A 7. I avoid unnecessary radiation.
D 8. I report criminal acts I observe.
B 9. I contribute time and/or money to community projects.
D 10. I actively seek to become acquainted with individuals in my community.
C 11. I use my creativity in constructive ways.
A 12. My behavior reflects fairness and justice.
A 13. When possible, I choose an environment that is free of noise pollution.
A 14. When possible, I choose an environment that is free of air pollution.
D 15. I participate in volunteer activities benefiting others.
C 16. I go out of my way to help others.
C 17. I beautify those parts of my environment under my control.
___66__ AVERAGE SECTION SCORE
Emotional Awareness and Acceptance:
Measures the degree to which one has awareness and acceptance of one’s feelings. This includes the degree to which one feels positive and enthusiastic about oneself and life.
B 1. I have a good sense of humor.
B 2. I feel positive about myself.
B 3. I feel there is a satisfying amount of excitement in my life.
B 4. My emotional life is stable.
A 5. I am aware of my needs.
B 6. I trust and value my own judgment.
A 7. When I make mistakes, I learn from them.
A 8. I feel comfortable when complimented for jobs well done.
A 9. It’s okay for me to cry.
A 10. I have feeling of sensitivity for others.
A 11. I feel enthusiastic about life.
B 12. I find it easy to laugh.
A 13. I am able to give love.
A 14. I am able to receive love.
B 15. I enjoy my life.
B 16. I have plenty of energy.
A 17. My sleep is restful.
C 18. I trust others.
B 19. I feel other trust me.
A 20. I accept my sexual desires.
B 21. I understand how I create my feelings.
A 22. At times I can be both strong and sensitive.
A 23. I am aware when I feel anger.
A 24. I can accept my anger.
B 25. I am aware when I feel sad.
B 26. I can accept my sadness.
Emotional Awareness and Acceptance: (continued):
A 27. I am aware when I feel happy.
A 28. I can accept my happiness.
A 29. I am aware when I feel frightened.
C 30. I can accept my feelings of fear.
__134___ AVERAGE SECTION SCORE
Emotional Management: Measures the capacity to appropriately control one’s feelings and related behaviors, including the realistic assessment of one’s limitations.
B 1. I am able to be open with those with whom I am close.
B 2. I can express my feeling of anger.
A 3. I can express my feelings of sadness.
A 4. I can express my feelings of happiness.
B 5. I can express my feelings of fear.
A 6. I can compliment myself for a job well done.
B 7. I accept constructive criticism without reacting defensively.
B 8. I recognize that I can have wide variations of feeling about the same person (such as loving someone even though you are angry with her/him at the moment).
A 9. I am able to develop close, intimate relationships.
A 10. I make conscious decisions about my sexual activity based on personal/
spiritual values.
B 11. I stick to the limit I set for myself.
C 12. I can say “no” without feeling guilty.
B 13. I would feel comfortable seeking professional help to better understand and cope with my feelings.
A 14. I set realistic objectives for myself.
A 15. I can relax my body and mind (without using drugs).
B 16. I can be alone without feeling lonely.
B 17. I am able to be spontaneous in expressing my feelings.
A 18. I accept responsibility for my actions.
B 19. I am willing to take the risks that come with making change.
A 20. I manage my feeling to avoid unnecessary suffering.
B 21. I make decisions with a minimum of stress and worry.
A 22. I accept the responsibility for creating my own feelings.
__97___ AVERAGE SECTION SCORE
Intellectual: Measures the degree to which one engages his/her mind in creative, stimulating mental activities, expanding knowledge, and improving skills.
E 1. I read a newspaper daily.
E 2. I read 12 books or more yearly.
D 3. I read on the average one or more national magazines weekly.
D 4. When I watch TV, I choose educational programs.
D 5. I visit a museum or art show at least three times yearly.
E 6. I attend lectures, workshops, and demonstrations at least three times yearly.
B 7. I regularly use some of my time participating in hobbies such as photography, gardening, woodworking, sewing, painting, baking, art, music, writing, pottery, etc.
C 8. I read about local, state, national, and international political/public issues.
Intellectual: (continued):
C 9. I make an effort to learn the meaning of new words.
___E___10. I engage in some type of writing activity such as a regular journal, letter writing,
preparation of papers or manuscripts.
A 11. I am interested in understanding the views of others.
D 12. I devote time to sharing ideas, concepts, thoughts, or procedures to advance the knowledge of others.
B 13. I gather information to enable me to make independent decisions.
C 14. I regularly listen to radio and/or TV news.
_32____ AVERAGE SECTION SCORE
Occupational: Measures the satisfaction from one’s work and the degree to which one is enriched by that work. Please answer these items from your primary frame of reference (e.g., your job, student, homemaker, etc.). If you are unemployed or retired, do not mark this section.
B 1. I enjoy my work.
A 2. My work contributes to my personal needs.
A 3. I feel that my job in some way contributes to others and/or society.
A 4. I interact cooperatively with others in my work.
B 5. I take advantage of opportunities to learn new skills in my work.
B 6. My work is challenging.
A 7. I feel my job responsibilities are consistent with my values.
B 8. I find satisfaction from the work I do.
9. I find healthy ways of reducing excessive stress when it occurs in my job.
A 10. I take recommended health and safety precautions.
B 11. I make recommendations for improving occupational health and safety.
A 12. I am satisfied with the degree of freedom I have in my job to exercise independent judgments.
B 13. I am satisfied with the amount of variety in my work.
B 14. I believe I am competent in my job.
A 15. My co-workers and supervisors respect me as a competent individual.
___63__ AVERAGE SECTION SCORE
Spiritual: Measures one’s ongoing involvement in seeking meaning and purpose in human existence. It includes an appreciation for the depth and expanse of life and national forces that exist in the universe.
C 1. I feel good about my spiritual life.
B 2. Prayer, meditation, and/or quiet personal reflection is/are important part(s) of my life.
A 3. I contemplate my purpose in life.
B 4. I reflect on the meaning of events in my life.
A 5. My values guide my daily life.
A 6. My values and beliefs help me to meet daily challenges.
B 7. I recognize that my spiritual growth is a lifelong process.
C 8. I am concerned about humanitarian issues.
C 9. I enjoy participating in discussions about spiritual values.
A 10. I feel a sense of compassion toward others in need.
B 11. I seek spiritual knowledge.
B 12. My spiritual awareness occurs other than at times of crisis.
____B_ 13. I believe in something greater or that I am part of something greater than myself.
____B_ 14. I share my spiritual values.
___57__ AVERAGE SECTION SCORE
THE END!