| No | Question |
| 1 | Showing somatic symptoms |
| 2 | Displaying worthlessness feeling |
| 3 | Need for assistance to alleviate pain |
| 4 | Displaying physical strength weakening due to for being in bad condition or decrease in exercises |
| 5 | Appears dispirited |
| 6 | Need some assistance in daily activities |
| 7 | Presenting obstacles in daily life |
| 8 | Daily activities are limited due to treatment |
| 9 | It is difficult for patient to try to avoid risks such as falls by him/herself. (added “such as falls”) |
| 10 | Need to encourage patient to do something |
| 11 | Stopped doing what he/she was able to |
| 12 | Unable to accept the present situation where activity is limited due to treatment or obstacles to daily life |
| 13 | Need to make special arrangements for food types and/or eating style to increase the ingested volume of food |
| 14 | Patient is sometimes reluctant to eat or cannot eat even when encouraged. |
| 15 | Patient is sometimes reluctant to drink water or not drinking even when encouraged. |
| 16 | Complaining of being unable to sleep |
| 17 | Showing negative attitudes toward encouragements |
| 18 | Need to have a talk as a nursing aid |
| 19 | Need encouragement to interact with others |
| 20 | Reducing interactions with others |
| 21 | Rejecting interactions with others |
| 22 | Patient complains (“anxiety, dissatisfaction, and unspecified reasons” added). |
| 23 | Patient makes many complaints (“frequent nurse calls, overly talkative, etc.” added). |
| 24 | Need to identify the cause of depressed feeling |
| 25 | Unable to solve problems unassisted when depressed |
| 26 | Unstable in mood |
| 27 | Unable to switch moods unassisted |
| 28 | Being short-tempered and/or showing unstable feelings |
| 29 | Feeling irritated and/or restless |
| 30 | Showing feelings of desperation |
| 31 | Showing low self-esteem behaviors |
| 32 | Pessimistic |
| 33 | Expressionless |
| 34 | Need to maintain motivation |
| 35 | Decreasing motivation |
| 36 | Lack of comprehension |