HOW OFTEN? | HOW DIFFICULT? | |||||||||
EVENT | 1 = Never 2 = Rarely 3 = Sometines 4 = Often 5 = Very often |
| 1 = Not at all 2 = A little 3 = Somewhat 4 = Very much 5 = Extremely | |||||||
1. Difficulty Sleeping | 1 | 2 | 3 | 4 | 5 | 1 | 2 | 3 | 4 | 5 |
2. Bringing my child to the clinic or hospital | 1 | 2 | 3 | 4 | 5 | 1 | 2 | 3 | 4 | 5 |
3. Being unable to go work/job | 1 | 2 | 3 | 4 | 5 | 1 | 2 | 3 | 4 | 5 |
4. Waiting for my childs test results | 1 | 2 | 3 | 4 | 5 | 1 | 2 | 3 | 4 | 5 |
5. Trying not to think about my family’s difficulties | 1 | 2 | 3 | 4 | 5 | 1 | 2 | 3 | 4 | 5 |
6. Trying to attend to the needs of other family members | 1 | 2 | 3 | 4 | 5 | 1 | 2 | 3 | 4 | 5 |
7. Seeing my child sad or scared | 1 | 2 | 3 | 4 | 5 | 1 | 2 | 3 | 4 | 5 |
8. Talking with the nurse | 1 | 2 | 3 | 4 | 5 | 1 | 2 | 3 | 4 | 5 |
9. Making décisions about medical care or medicines | 1 | 2 | 3 | 4 | 5 | 1 | 2 | 3 | 4 | 5 |
10. Having little time to take care of my own needs | 1 | 2 | 3 | 4 | 5 | 1 | 2 | 3 | 4 | 5 |
11. Thinking about other children who have been seriously ill | 1 | 2 | 3 | 4 | 5 | 1 | 2 | 3 | 4 | 5 |
12. Speaking with my child about his/ her illness | 1 | 2 | 3 | 4 | 5 | 1 | 2 | 3 | 4 | 5 |
13. Speaking with family members about my child’s illness | 1 | 2 | 3 | 4 | 5 | 1 | 2 | 3 | 4 | 5 |