Holistic Health Assessment

Spirituality • Do you have a formal religion or believe in a power higher than yourself? • If you have these beliefs, what do you believe about them? Is this power to be feared or is it good? • Do you believe that all life has meaning? • Is there an underlying order in the universe, or do events occur randomly and without purpose? • What do you value in life? • What do you need to bring about your best self and the traits you most admire? • Are you most motivated by faith, love, or fear? • Is hope important in your life? If so, in what way? • Do you perform any practices or rituals to help you connect with your spirituality? • Do you believe your actions are congruent with your values and beliefs? • Describe how your values/beliefs affect your health/health care. • Are you involved in activities that you feel contribute to the betterment of humanity? Nutrition • Are you currently at your ideal weight? • How do you perceive your current dietary habits? • In what areas would you like to improve your nutrition? • How many glasses of water do you drink daily? • How may servings of fruits and vegetables do you eat daily? • How many alcoholic beverages do you drink? • What is your source of protein and how many servings do you eat daily? • How many servings of dairy products/day? • How many servings of grains/day? • How many sweet/sugar containing foods and beverages do you consume daily? • How many caffeinated beverages do you consume daily? • How many servings of fried food do you consume? • Do you routinely salt your food? • Do you buy organic foods? Exercise • Do you currently exercise? • Rate your perception of your flexibility and strength. • How much endurance do you have during activities? • Are you able to complete your activities of daily living? • How much energy do you have? Is it enough to meet the requirements of your daily life activities? • Rate your perception of your current exercise habits? • How much exercise and what type do you get per week? • Are you ever short of breath during exercise or routine activities? Culture • Do you speak/read any other language besides English? • What are your family’s health beliefs? • Who makes major health decisions in the family? • Do you have any cultural dietary practices? • Do you seek the care of a physician as a first response or a last resort when you are ill? • What type of food do you prefer/dislike? • What do you believe promotes health? • What are your health/illness beliefs and practices? • What diseases/disorders are prevalent in your family? Alternative medicines and practices: • Do you take any dietary supplements such as vitamins or minerals? • Do you take any herbal medications? • Do you practice any alternative medicine for stress reduction or health promotion such as acupressure, acupuncture, massage therapy, guided imagery, reiki, meditation, etc • If you do not currently pursue alternative medicine practices, are you open to pursuing such practices? Stress reduction and psychosocial health • How many hours do you sleep at night on average? • Do you have difficulty falling asleep or remaining asleep? • Do you use sleep aids? • Do you wake up refreshed or tired? • Do you routinely incorporate relaxation into your day? How often and what type? • What do you do for fun and pleasure? • How would you describe your emotional response to stress? • Are you aware of your feelings when involved in a difficult situation? • Rate your ability to express your feelings, 10 being most able. • Are you able to share your feelings without seeking the approval of others or fearing the outcomes? • Are you satisfied with how you handle your feelings? • Do you tend to avoid difficult conversations or situations? Support systems • Describe your social contacts such as friends, coworkers, other activities. • Describe your closest relationships? • Do you have a life partner? • Are you satisfied with your relationships? • Are you satisfied with your level of social interaction? • To whom do you turn for support? Risk factors (client’s perception of own risk factors and current health concerns due to genetics, family health history, environment, current health practices, etc): • Obtain information from a family medical health genogram to identify familial health risks • Do you smoke? • Do you use drugs not prescribed by your doctor? • How much sun exposure do you get daily? • Do you wear a seat belt when driving? • Do you text and drive? • Are you regularly around hazardous equipment? • Are you around any pollutants, allergens, chemicals, or other irritants on a regular basis? • Are there any health concerns in your family history? • Recent hospitalizations or need for primary care provider visit? • Medications used to treat primary health concerns? • What are your most important goals as a result of this assessment?