▪ Lifestyle and Health Practices Profile

This is a very important

section of the health history
because it deals with the
client’s human responses,
which include nutritional
habits, activity and exercise
patterns, sleep and rest
patterns, use of medications
and substances, self-concept
and self-care activities, social
and community activities,
relationships, values and
beliefs system, education and
work, stress level and coping
style, and environment.
When assessing this area, use open-ended questions to promote a dialogue with the
client. Follow up with specific questions to guide the discussion and clarify the information
as necessary. Be sure to pay special attention to the cues the client may provide that point
to possibly more significant content. Take brief notes so that pertinent data are not lost
and so there can be follow-up if some information needs clarification or expansion. If
clients give permission and it does not seem to cause anxiety or inhibition, using an
audiocassette recorder frees the nurse from the need to write while clients talk.
✓ Description of Typical Day - This information is necessary to elicit an overview of
how the client sees his usual pattern of daily activity. The questions you ask should
be vague enough to allow the client to provide the orientation from which the day
is viewed. Encourage the client to discuss a usual day, which, for most people,
includes work or school. If the client gives minimal information, additional specific
questions may be asked to draw out more details.
Example: “Please tell me what an average or typical day is for you. Start with
awakening in the morning and continue until bedtime.”
✓ Nutrition and Weight Management - Ask the client to recall what consists of an
average 24-hour intake for her with emphasis on what foods are eaten and in what
amounts. Also ask about snacks, fluid intake, and other substances consumed.
Depending on the client, you may want to ask who buys and prepares the food and
when and where meals are eaten. These questions uncover food habits that are
health promoting as well as those that are less desirable. The client’s answers about
food intake should be compared with the guidelines illustrated in the “food
pyramid”.
Example: “What do you usually eat during a typical day? Please tell me the kinds of
foods you prefer, how often you eat throughout the day, and how much you eat.”
“Do you eat out at restaurants frequently?”
 “Do you eat only when hungry? Do you eat because of boredom, habit,
anxiety, depression?”
“Who buys and prepares the food you eat?”
“Where do you eat your meals?”
“How much and what types of fluids do you drink?”
✓ Activity Level and Exercise - Assess how active the client is during an average week
either at work or at home. Inquire about regular exercise. Some clients believe that
if they do heavy physical work at their job, they do not need additional exercise.
Make it a point to distinguish between activity done when working, which may be
stressful and fatiguing, and exercise, which is designed to reduce stress and
strengthen the individual. Compare the client’s answers with the recommended
exercise regimen of regular aerobic exercise for 20 to 30 minutes at least three
times a week. Explain to the client that regular exercise reduces the risk of heart
disease, strengthens heart and lungs, reduces stress, and manages weight.
Example: “What is your daily pattern of activity?”
“Do you follow a regular exercise plan? What types of exercise do you do?”
“Are there any reasons why you cannot follow a moderately strenuous
exercise program?”
“What do you do for leisure and recreation?”
“Do your leisure and recreational activities include exercise?”
✓ Sleep and Rest - Inquire whether the client feels he is getting enough sleep and
rest. Questions should focus on specific sleep patterns such as how many hours a
night the person sleeps, interruptions, whether the client feels rested, problems
sleeping (e.g., insomnia), rituals the client uses to promote sleep, and concerns the
client may have regarding sleep habits. Some of this information may have already
been presented by the client, but it is useful to gather data in a more systematic
and thorough manner at this time. Inquiries about sleep can bring out problems,
such as anxiety, which manifests as sleeplessness, or inadequate sleep time, which
can predispose the client to accidents. Compare the client’s answers with the
normal sleep requirement for adults, which is usually between 5 and 8 hours a
night. Keep in mind sleep requirements vary depending on age, health, and stress
levels.
Example: “Tell me about your sleeping patterns.”
“Do you have trouble falling asleep or staying asleep?”
“How much sleep do you get each night?”
“Do you feel rested when you awaken?”
“Do you nap during the day? How often and for how long?”
“What do you do to help you fall asleep?”
✓ Medication and Substance Use - The information gathered about medication and
substance use provides the nurse with information concerning lifestyle and a
client’s self-care ability. Medication and substance use can affect the client’s health
and cause loss of function or impaired senses. In addition, certain medications and
substances can increase the client’s risk for disease. Because many people use
 vitamins or a variety of herbal supplements, it is important to ask which and how
often. Prescription medications and these supplements may interact.
Example: “What medications have you used in the recent past and currently, both
those that your doctor prescribed and those you can buy over the counter at a drug
or grocery store? For what purpose did you take the medication? How much (dose)
and how often did you take the medication?”
“How much beer, wine, or other alcohol do you drink on the average?”
“Do you drink coffee or other beverages containing caffeine (e.g., cola)?” If
so, how much and how often?
“Do you now or have you ever smoked cigarettes or used any other form of
nicotine? How long have you been smoking/did you smoke? How many packs per
week? Tell me about any efforts to quit.”
“Have you ever taken any medication not prescribed by your healthcare
provider? If so, when, what type, how much, and why?”
“Have you ever used, or do you now use, recreational drugs? Describe any
usage.” “Do you take vitamins or herbal supplements? If so, what?”
✓ Self-Concept and Self-Care Responsibilities - This includes assessment of how the
client views herself and investigation of all behaviors that a person does to promote
her health. Examples of subjects to be addressed include sexual responsibility; basic
hygiene practices; regularity of health care checkups (i.e., dental, visual, medical);
breast/testicular self-examination; and accident prevention and hazard protection
(e.g., seat belts, smoke alarms, and sunscreen). You can correlate answers to
questions in this area with health-promotion activities discussed previously and
with risk factors from the family history. This will help to point out client strengths
and needs for health maintenance. Questions to the client can be open-ended but
the client may need prompting to cover all areas.
Example: “What do you see as your talents or special abilities?”
“How do you feel about yourself? About your appearance?”
“Can you tell me what activities you do to keep yourself safe, healthy, or to
prevent disease?”
“Do you practice safe sex?”
“How do you keep your home safe?”
“Do you drive safely?”
“How often do you have medical checkups or screenings?”
“How often do you see the dentist or have your eyes (vision) examined?”
✓ Social Activities - Questions about social activities help the nurse to discover what
outlets the client has for support and relaxation and if the client is involved in the
community beyond family and work. Information in this area also helps to
determine the client’s current level of social development.
Example: “What do you do for fun and relaxation?”
“With whom do you socialize most frequently?”
“Are you involved in any community activities?”
“How do you feel about your community?”
“Do you think that you have enough time to socialize?”
 “What do you see as your contribution to society?”
✓ Relationships - Ask clients to describe the composition of the family into which they
were born and about past and current relationships with these family members. In
this way, you can assess problems and potential support from the client’s family of
origin. In addition, similar information should be sought about the client’s current
family. . If the client does not have any family by blood or marriage, then
information should be gathered about any significant others (including pets) that
may constitute the client’s “family.”
Example: “Who is (are) the most important person(s) in your life? Describe your
relationship with that person.”
“What was it like growing up in your family?”
“What is your relationship like with your spouse?”
“What is your relationship like with your children?”
“Describe any relationships you have with significant others.”
“Do you get along with your in-laws?”
“Are you close to your extended family?”
“Do you have any pets?”
“What is your role in your family? Is it an important role?”
“Are you satisfied with your current sexual relationships? Have there been
any recent changes?”
✓ Values and Belief System - Assess the client values. In addition, discuss the clients’
philosophical, religious, and spiritual beliefs. Some clients may not be comfortable
discussing values or beliefs. Their feelings should be respected. However, the data
can help to identify important problems or strengths.
Example: “What is most important to you in life?”
“What do you hope to accomplish in your life?”
“Do you have a religious affiliation? Is this important to you?”
“Is a relationship with God (or another higher power) an important part of
your life?”
“What gives you strength and hope?”
✓ Education and Work - Questions about education and work help to identify areas
of stress and satisfaction in the client’s life. If the client does not perceive that he
has enough education or his work is not what he enjoys, he may need assistance or
support to make changes. Sometimes discussing this area will help the client feel
good about what he has accomplished and promote his sense of life satisfaction.
Questions should bring out data about the kind and amount of education the client
has, whether the client enjoyed school, whether he perceives his education as
satisfactory or whether there were problems, and what plans the client may have
for further education, either formal or informal.
Example: “Tell me about your experiences in school or about your education.”
“Are you satisfied with the level of education you have? Do you have future
educational plans?”
“What can you tell me about your work? What are your responsibilities at
work?” “Do you enjoy your work?”
 “How do you feel about your coworkers?”
“What kind of stress do you have that is work related? Any major
problems?” “Who is the main provider of financial support in your family?”
“Does your current income meet your needs?”
✓ Stress Levels and Coping Styles - To investigate the amount of stress clients
perceive they are under and how they cope with it, ask questions that address what
events cause stress for the client and how they usually respond. In addition, find
out what the client does to relieve stress and whether these behaviors or activities
can be construed as adaptive or maladaptive. To avoid denial responses,
nondirective questions or observations regarding previous information provided by
the client may be an easy way to get the client to discuss this subject.
Example: “What types of things make you angry?”
“How would you describe your stress level?”
“How do you manage anger or stress?”
“What do you see as the greatest stressors in your life?”
“Where do you usually turn for help in a time of crisis?”
✓ Environment - Ask questions regarding the client’s environment to assess health
hazards unique to the client’s living situation and lifestyle. Look for physical,
chemical, or psychological situations that may put the client at risk. These may be
found in the client’s neighborhood, home, work, or recreational environment. They
may be controllable or uncontrollable.
Example: “What risks are you aware of in your environment such as in your home,
neighborhood, on the job, or any other activities in which you participate?”
“What types of precautions do you take, if any, when playing contact sports,
using harsh chemicals or paint, or operating machinery?”
“Do you believe you are ever in danger of becoming a victim of violence?
Explain.”

▪ Developmental Level
Determining the client’s developmental level is essential to complete the client’s
portrait. You do not need to ask the client additional questions unless major gaps in the
data collection were found or clarification is needed. Instead, group and analyze the data
obtained during the health history and compare them with normal developmental
parameters. This requires integrating all that has been learned about the client by the
health history and using critical thinking to position the client on a developmental
continuum. It helps to determine any developmental impairments. Standard growth charts
can be used to determine physical development. However, when assessing adults, the area
most likely to yield delays or unresolved problems occurs in the psychosocial domain of
development. The theorist Erik Erikson developed a psychosocial theory that identifies a
number of dichotomous concepts to describe growth from birth to death (Table 3-1).
Although there are implied age ranges attached to these stages and it is hoped that a
person might move through them in an orderly fashion, this does not always occur. Thus
it is important to look at the client’s behavior rather than age to identify the stage of
development currently in progress. Strong indicators that the client is functioning much
below the usual behavior for her age range point to areas for possible nursing diagnoses
(developmental delay) and nursing intervention. Sometimes a person skips one or more
developmental levels and, at a later stage of maturity, goes back and successfully works
through the missed levels. A thorough knowledge of the behaviors and approximate age
levels provides the nurse with a powerful tool for assessing and helping a client grow to his
or her full potential. Although accomplishment of all of the tasks in the stage before moving
on is ideal, it is believed that partial resolution is adequate for health, growth, and

development.
✓ Young Adult: Intimacy Versus Isolation - The young adult should have achieved self-
efficacy during adolescence and is now ready to open up and become intimate with
others. Although this stage focuses on the desire for a special and permanent love
relationship, it also includes the ability to have close, caring relationships with
friends of both sexes and a variety of ages. Spiritual love also develops during this
stage. Having established an identity apart from the childhood family, the young
adult is now able to form adult friendships with his parents. and siblings. However,
the young adult will always be a son or daughter. If the young adult cannot express
emotion and trust enough to open up to others, social and emotional isolation may
occur. Loneliness may cause the young adult to turn to addictive behaviors such as
alcoholism, drug abuse, or sexual promiscuity. Some people try to cope with this
developmental stage by becoming very spiritual or social, playing an acceptable
role, but never fully sharing who they are or becoming emotionally involved with
others. When adults successfully navigate this stage, they have stable and satisfying
relationships with important others. Does the client:
- Accept self: physically, cognitively, and emotionally?
- Have independence from the parental home?
- Express love responsibly, emotionally, and sexually?
- Have close or intimate relationships with a partner?
- Have a social group of friends?
- Have a philosophy of living and life?
- Have a profession or a life’s work that provides a means of contribution?
- Solve problems of life that accompany independence from the parental
home?
✓ Middlescent: Generativity Versus Stagnation - During this stage, the middle-aged
adult is able to share self with others and establish nurturing relationships. The
adult will be able to extend self and possessions to others. Although traditionalists
tend to think of generativity in terms of raising one’s children and guiding their
lives, generativity can be realized in several ways even without having children.
Generativity implies mentoring and giving to future generations. This can be
accomplished by producing ideas, products, inventions, paintings, writings, books,
films, or any other creative endeavors that are then given to the world for the
unrestricted use of its people. Generativity also includes teaching others, children
or adults, mentoring young workers, or providing experience and wisdom to assist
a new business to survive and grow. Also implied in this stage is the ability to guide
then let go of one’s creations. Without this important step, the gift is not given and
the stage does not come to successful completion. Stagnation occurs when the
middle-aged person has not accomplished one or more of the previous
developmental tasks and is unable to give to future generations. Sometimes severe
losses may result in withdrawal and stagnation. In these cases, the person may have
total dependency on work, a favorite child, or even a pet, and be incapable of giving
to others. A project may never be finished, or schooling completed because the
person cannot let go and move on. Without a creative outlet, a paralyzing
stagnation sets in. Successful movement through this stage results in a fuller and
more satisfying life and prepares the mature adult for the next stage. Does the
client
- Have healthful life patterns?
- Derive satisfaction from contributing to growth and development of
others?
- Have an abiding intimacy and long-term relationship with a partner?
- Maintain a stable home?
- Find pleasure in an established work or profession?
- Take pride in self and family accomplishments and contributions?
- Contribute to the community to support its growth and development?
✓ Older Adult: Ego Integrity Versus Despair - When the middle-aged adult has
accomplished at least partial resolution of the previous developmental tasks, she
moves into the ego integrity versus despair stage. According to Erikson, a person in
this stage looks back and either finds that life was good or despairs because goals
were not accomplished. This stage can extend over a long time and include
excursions into previous stages to complete unfinished business. Successful
movement through this stage does not mean that one day a person wakes up and
says, “My life has been good”; rather, it encompasses a series of reminiscences in
which the person may be able to see past events in a new and more positive light.
This can be a very rich and rewarding time in a person’s life, especially if there are
others with whom to share memories and who can assist with reframing life
experiences. For some people, resolution and acceptance do not come until the
final weeks of life but this still allows for a peaceful death. If the older person cannot
feel grateful for his or her life, cannot accept those less desirable aspects as merely
 part of living, or cannot integrate all of the experiences of life, then the person will
spend his or her last days in bitterness and regret and will ultimately die in despair.
Obviously mental or physical developmental delays can affect the smooth
movement through Erikson’s tasks. In fact, some may be entirely unachievable.
However, it is important not to assume data not in evidence and assign a person to
a lower level just because of other problems in development. Many such people
are quite capable of advancing through all psychological stages. Rely on data
collected, not on age or physical/mental accomplishments. Does the client
- Adjust to the changing physical self?
- Recognize changes present as a result of aging, in relationships and
activities?
- Maintain relationships with children, grandchildren, and other relatives? •
- Continue interests outside of self and home?
- Complete transition from retirement at work to satisfying alternative
activities?
- Establish relationships with others his or her own age?
- Adjust to deaths of relatives, spouse, and friends?
- Maintain a maximum level of physical functioning through diet, exercise,
and personal care?
- Find meaning in past life and face inevitable mortality of self and significant
others?
- Integrate philosophical or religious values into self-understanding to
promote comfort?
- Review accomplishments and recognize meaningful contributions he or she
has made to community and relatives?
SUMMARY
Collecting subjective data is a key step of nursing health assessment. Subjective data
consist of information elicited and verified only by the client. Interviewing is the means by which
subjective data are gathered. Two types of communication are useful for interviewing: nonverbal
and verbal. Variations in communication, such as gerontologic, cultural, and emotional variations,
may be encountered during the client interview.
The complete health history is performed to collect as much subjective data about a client
as possible. It consists of eight sections: biographic data, reasons for seeking health care, history
of present health concern, past health history, family health history, review of body systems (ROS)
for current health problems, lifestyle and health practices, and developmental level.