| Item 1 - Readiness for discharge |
When you think about leaving the hospital, do you believe that you are ready to go home as planned? |
|
Sub-scale - Personal status
|
| Item 2 - Physical readiness |
How physically ready are you to go home? |
| Item 3 - Pain / discomfort |
How would you describe your pain or discomfort today? |
| Item 4 - Strength |
How would you describe your strength today? |
| Item 5 - Energy |
How would you describe your energy level today? |
| Item 6 - Stress |
How much stress do you feel today? |
| Item 7 - Emotional preparation |
How emotionally ready are you to go home today? |
| Item 8- Physical capacity for self-care |
How would you describe your physical ability to care for yourself today (for example: personal hygiene, walking, going to the bathroom)? |
|
Sub-scale - Knowledge
|
| Item 9 - Knowledge about self-care |
How much do you know about taking care for yourself, after you go home? |
| Item 10- Knowledge of personal needs |
How much do you know about taking care of your personal needs (for example: personal hygiene, taking a bath, going to the bathroom, feeding yourself) after you go home? |
| Item 11 - Knowledge of health needs |
How much do you know about taking care of your health-related needs (treatments, medications) after you go home? |
| Item 12 - Knowledge of complications |
How much do you know about any problems to which you must pay attention to after you go home? |
| Item 13 - Knowledge of who and when to call |
How much do you know about who to call and when to call if you have any problems after you go home? |
| Item 14 - Knowledge of restrictions |
How much do you know about any restrictions (what you can or cannot do) after you go home? |
| Item 15 - Knowledge of the next steps of treatment |
How much do you know about the next stage of your treatment after you go home? |
| Item 16 - Knowledge of resources |
How much do you know about the services and information available in your community after you go home? |
|
Sub-scale - Coping ability
|
| Item 17 - Ability to perform day-to-day tasks |
How well will you be able to cope with day-to-day life at home? |
| Item 18 - Ability to care for self |
Will you be able to perform your personal care properly (for example: personal hygiene, bathing, feeding yourself) when you are at home? |
| Item 19 - Ability to care for health |
How well will you be able to perform your own healthcare treatment (for example: caring for surgical wounds, respiratory treatments, exercise, rehabilitation, taking the right amount of medicine at the right time) at home? |
|
Sub-scale - Expected support
|
| Item 20 - Emotional support |
How much emotional support will you have after you go home? |
| Item 21- Help with personal care |
How much help will you have with your personal care after you go home? |
| Item 22 - Help with domestic activities |
When you go home, how much help will you have to perform household activities (for example: cooking, cleaning, shopping, childcare)? |
| Item 23 - Help with health-related needs |
How much help will you have to take care of your health-related needs (treatments, medications)? |
