Week 5 assignment 5.1: application of a health promotion assessment

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Conduct a health promotion assessment using the Health Promotion Assessment Worksheet Download Health Promotion Assessment Worksheet found under the Practicum Assignment tab and the grading rubric as your guide.


Denver College of Nursing


NUR 335 Practicum Assignment 5.1


Health Promotion Assessment Worksheet

A health promotion assessment is a targeted assessment where the nurse assesses for health risks and education gaps that can be improved through health promotion interventions

Use this worksheet to interview an individual. There is a section at the bottom for you to add additional assessment information. Document your findings on the worksheet


Demographics


Initials: ________________


Age:___________________


Sex: ___________________


Primary Language Spoken: _______________


Cultural Background:____________________



______________________________________



General Health

How would you rate your general health?

Have you had a wellness checkup with a healthcare provider in the past year?

Have you ever been told by a health care provider that you have a chronic disease such as hypertension, diabetes, heart disease, stroke, arthritis or kidney disease?

In the past month, have you had pain on more than three days that impacted your ability to perform your normal daily activities?

If yes:

· Where was the pain located?

· What have you tried to relieve the pain?

How would you rate the quality of your sleep?

· How many hours do you regularly sleep in a night?

· Do you ever wake up before you wanted to?

· Do you have problems falling asleep?


Medications

Are you currently taking medicine for any chronic condition?

· Do you know what the medication is used to treat?

· Have you missed doses of your medication in the last week?


Women Only:

Are you pregnant or planning on becoming pregnant in the next year?

A mammogram is an x-ray of each breast to look for breast cancer. Have you ever had a mammogram?

· If yes, when was your last mammogram?

A Pap test is a test for cancer of the cervix. Have you ever had a Pap test?

· If yes, when was your last Pap test?


Men Only:

A PSA test is a test for cancer of the prostate. Have you ever had a PSA test?

· If yes, when was your last PSA test?


Lifestyle

Do you now smoke cigarettes every day, some days or not at all?

· If you are currently smoking, have you tried to quit?

· If yes, what methods have you used to quit smoking?

· Were the methods successful?

For the questions below consider the past week in your answer:

How many times did you take part in physical activity of at least 30 minutes during the past week?

· If yes, what type of physical activity?

· If no, why?

· Was the past week representative of your normal level of physical activity?

How many hours a day in the past week do you think you spent on sedentary activities where you remained sitting for extended periods of time?

· What activities were you doing during these times?

To the best of your recollection, what food items have you eaten for breakfast in the past week?

To the best of your recollection, what food items have you eaten for lunch in the past week?

To the best of your recollection, what food items have you eaten for dinner in the past week?

What beverages do you routinely drink?

· How many times per week did you drink soda or pop?

· How many glasses of water do you drink in a day?

Do you eat snacks throughout the day?

· If yes, what snacks do you routinely eat?

· What time in the day do you regularly eat snacks?

How many times per week have you skipped meals?

For the questions below consider the past 30 days in your answer:

What is the largest number of alcoholic drinks you had on any occasion in the past 30 days?

Have you used any drugs or other substances, other than those that are prescribed for medical reasons?

· If yes, what substance(s) did you take?

· How many times have you used this substance in the past 30 days?

In the past 30 days, how many times have you eaten a meal outside of the home; at a restaurant or other venue?

For the question below, consider all lifestyle behaviors (combined) in your answer:

Do you believe you lead a healthy lifestyle?

Please explain your answer?


Mental Well-Being

How often do you experience stress that exceeds your ability to cope?

· What strategies do you use to control stress?

How often do you get the emotional and social support you need?

· Who would you describe as your support system?

Over the last two weeks, how many days have you felt down, depressed or hopeless?

· If you have felt these feelings, what actions did you take to make yourself feel better?


Access to Preventative Services

Do you feel you have access to preventative health screenings and education?

· Do you have health insurance?

· Have you ever skipped care (Prescriptions, therapy, specialist visits etc.) that was recommended to you because of concerns regarding the cost of the care?


Education

Where do you normally receive health information? Examples could be the internet, health care provider, family or friends, etc.

What health topic(s) would you like to have more information on, if available?


Other Assessment Information

To be filled out by the participant:

Which of the following describes you, regarding each of these activities?

Adapted from the CDC National Healthy Worksite Program (NHWP) Employee Health Assessment (CAPTURETM)

Copyright 2005, Institute for Community Health Promotion, Brown University, Providence, RI. All Rights Reserved.

RN to BSN Program – 180 Credits

RN-BSN Syllabus – Reviewed and Revised March 2021 20

Grading Rubric for Week 5 Practicum Assignment: 70 points

Criteria Excellent
(9-10 points)

Needs Some
Improvement
(5-9 points)

Needs Significant
Improvement
(2-5 points):

Poor
(0-2 points)

Identify
language,
cultural

background,
age and sex
of the client

Clearly identifies
language, cultural
background, sex and
age of the client.

Somewhat identifies
language, cultural
background, sex and
age of the client.

Limitedly identifies
language, cultural
background, age and
sex of the client OR
missing 1 demographic.

Does not identify
language, cultural
background age or sex
of the client OR
Missing 2 or more
demographics
development.

Describe the
findings of

the data
collected.

Clearly describes the
findings of the data
collected.

Somewhat describes the
findings of the data
collected.

Limitedly describes the
findings of the data
collected.

Does not describe the
findings of the data
collected OR is limited
in development.

Identify
health risks
of the client

Clearly identifies
health risks of the
client.

Somewhat identifies
health risks of the
client.

Limitedly identifies
health risks of the
client.

Does not identify health
risks of the client OR is
limited in development.

Identify
priority topic
of concern

Clearly identifies a
topic of concern.

Somewhat identifies a
topic of concern.

Limitedly identifies a
topic of concern.

Does not identify a
topic of concern OR is
limited in development.

Identify
health

education
need related
to the topic
of concern

Clearly identifies a
health education
need related to the
topic of concern.

Somewhat identifies a
health education need
related to the topic of
concern.

Limitedly identifies a
health education need
related to the topic of
concern.

Does not identify a
health education need
related to the topic of
concern OR is limited
in development.

Develops a
nursing

diagnosis
that is based

on
assessment

data

Clearly develops a
nursing diagnosis
based on assessment
data.

Somewhat develops a
nursing diagnosis based
on assessment data.

Limitedly develops a
nursing diagnosis based
on assessment data.

Does not include a
nursing diagnosis OR
diagnosis not based on
assessment data.

Mechanics
and

Grammar
AAPA

formatting

No errors in usage,
capitalization,
punctuation and
spelling. No errors
in APA format, in-
text citation(s), or
reference page.

Minor errors in usage,
capitalization,
punctuation, and
spelling that do not
interfere with reading/
understanding. Minor
errors in APA format,
in-text citation(s),
and/or reference page.

Some errors in usage,
capitalization,
punctuation and
spelling that interfere
with reading/
understanding. Some
errors in APA format,
in-text citation(s),
and/or reference page.

Numerous errors in
usage, capitalization,
punctuation and
spelling that interfere
with reading/
understanding.
Numerous errors in
APA format, in-text
citation(s), and/or
reference page.

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