How are YOU doing? Your Caregiver Self Care Plan Worksheet ...
How are YOU doing? Your Caregiver Self Care Plan Worksheet ...
How are YOU doing? Your Caregiver Self Care Plan Worksheet ...
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<strong>How</strong> <strong>are</strong> <strong>YOU</strong> <strong>doing</strong>?<br />
<strong>Your</strong> C<strong>are</strong>giver <strong>Self</strong> C<strong>are</strong> <strong>Plan</strong> <strong>Worksheet</strong><br />
As c<strong>are</strong>givers of individuals living with MS, our self c<strong>are</strong> doesn’t just happen. It is<br />
something that we have to consciously think about and plan for in our daily lives.<br />
The first step in planning for your self c<strong>are</strong> is to take some time for yourself and ask<br />
yourself the question “<strong>How</strong> <strong>are</strong> <strong>YOU</strong> really <strong>doing</strong>?”. Do you have a healthy balance?<br />
What does your current self c<strong>are</strong> plan look like? What changes do you need to make to<br />
move towards a better balance?<br />
This worksheet reminds you to think holistically about your health and quality of life by<br />
developing a self c<strong>are</strong> plan that takes into consideration the emotional, physical, spiritual<br />
and social dimensions of self.<br />
<strong>Your</strong> <strong>Self</strong> C<strong>are</strong> <strong>Plan</strong>…<br />
List your current self c<strong>are</strong> strategies and activities:<br />
Emotional ___________________________<br />
___________________________<br />
Physical ____________________________<br />
_____________________________<br />
Social ______________________________<br />
______________________________<br />
Spiritual ______________________________<br />
______________________________<br />
Things you want to continue <strong>doing</strong> because they contribute to good health<br />
and quality of life<br />
Emotional ___________________________<br />
___________________________<br />
Physical ____________________________<br />
_____________________________<br />
Social ______________________________<br />
______________________________<br />
Spiritual ______________________________<br />
______________________________
Things you want to start <strong>doing</strong> to enhance your self c<strong>are</strong><br />
Emotional ___________________________<br />
___________________________<br />
Physical ____________________________<br />
_____________________________<br />
Social ______________________________<br />
______________________________<br />
Spiritual ______________________________<br />
______________________________<br />
Things you want to stop <strong>doing</strong> (i.e. those things for which you can ask for<br />
help with and/or those things which <strong>are</strong> optional and add to your current<br />
responsibilities and stresses<br />
Emotional ___________________________<br />
___________________________<br />
Physical ____________________________<br />
_____________________________<br />
Social ______________________________<br />
______________________________<br />
Spiritual ______________________________<br />
______________________________<br />
Strategies for overcoming challenges and barriers to <strong>doing</strong> what you have<br />
indicated above:<br />
_________________________________<br />
_________________________________<br />
_________________________________<br />
_________________________________<br />
_________________________________<br />
Please do not feel limited by the space provided on this worksheet. You may want to<br />
use a journal or additional sheets as you explore and develop your self c<strong>are</strong> plan.
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