MISHEL UNCERTAINTY IN ILLNESS SCALE (Community) SAMPLE ...
MISHEL UNCERTAINTY IN ILLNESS SCALE (Community) SAMPLE ...
MISHEL UNCERTAINTY IN ILLNESS SCALE (Community) SAMPLE ...
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ID Number____________<strong>MISHEL</strong> <strong>UNCERTA<strong>IN</strong>TY</strong> <strong>IN</strong> <strong>ILLNESS</strong> <strong>SCALE</strong> (<strong>Community</strong>) <strong>SAMPLE</strong>Do not administer.<strong>IN</strong>STRUCTIONS:Please read each statement. Take your time and think about what each statement says. Thenplace an “X” under the column that most closely measures how you are feeling TODAY. If youagree with a statement, then you would mark under either “Strongly Agree” or “Agree.” If youdisagree with a statement, then mark under either “Strongly Disagree” or “Disagree.” If you areundecided about how you feel, then mark under “Undecided” for that statement. Please respondto every statement.1. I am unsure if my illness is getting better or worse.Strongly Agree Agree Undecided Disagree Strongly Disagree(5) (4) (3) (2) (1)_______ ______ ______ ______ ______2. The doctors say things to me that could have many meanings.Strongly Agree Agree Undecided Disagree Strongly Disagree(5) (4) (3) (2) (1)_______ ______ ______ ______ ______3. It is difficult to know if the treatments or medications I am getting are helping.Strongly Agree Agree Undecided Disagree Strongly Disagree(5) (4) (3) (2) (1)_______ ______ ______ ______ ______4. Because of the unpredictability of my illness, I cannot plan for the future.Strongly Agree Agree Undecided Disagree Strongly Disagree(5) (4) (3) (2) (1)_______ ______ ______ ______ ______5. The seriousness of my illness has been determined.Strongly Agree Agree Undecided Disagree Strongly Disagree(5) (4) (3) (2) (1)_______ ______ ______ ______ ______
ID Number____________<strong>MISHEL</strong> <strong>UNCERTA<strong>IN</strong>TY</strong> <strong>IN</strong> <strong>ILLNESS</strong> <strong>SCALE</strong> (Adult) —<strong>SAMPLE</strong>Do not administer.<strong>IN</strong>STRUCTIONS:Please read each statement. Take your time and think about what eachstatement says. Then place an “X” under the column that most closelymeasures how you are feeling TODAY. If you agree with a statement, thenyou would mark under either “Strongly Agree” or “Agree.” If you disagreewith a statement, then mark under either “Strongly Disagree” or “Disagree.”If you are undecided about how you feel, then mark under “Undecided” forthat statement. Please respond to every statement.1. I have a lot of questions without answers.Strongly Agree Agree Undecided Disagree Strongly Disagree(5) (4) (3) (2) (1)____ ____ ____ ____ ____2. I understand everything explained to me.Strongly Agree Agree Undecided Disagree Strongly Disagree(5) (4) (3) (2) (1)____ ____ ____ ____ ____3. The doctors say things to me that could have many meanings.Strongly Agree Agree Undecided Disagree Strongly Disagree(5) (4) (3) (2) (1)____ ____ ____ ____ ____
4. There are so many different types of staff, it’s unclear who is responsiblefor what.Strongly Agree Agree Undecided Disagree Strongly Disagree(5) (4) (3) (2) (1)____ ____ ____ ____ ____5. The purpose of each treatment is clear to me.Strongly Agree Agree Undecided Disagree Strongly Disagree(5) (4) (3) (2) (1)____ ____ ____ ____ ____
ID Number____________<strong>MISHEL</strong> <strong>UNCERTA<strong>IN</strong>TY</strong> <strong>IN</strong> <strong>ILLNESS</strong> <strong>SCALE</strong> (Parent/Child) —<strong>SAMPLE</strong>Do not administer.<strong>IN</strong>STRUCTIONS:Please read each statement. Take your time and think about what eachstatement says. Then place an “X” under the column that most closelymeasures how you are feeling TODAY. If you agree with a statement, thenyou would mark under either “Strongly Agree” or “Agree.” If you disagreewith a statement, then mark under either “Strongly Disagree” or “Disagree.”If you are undecided about how you feel, then mark under “Undecided” forthat statement. Please respond to every statement.1. It is unclear how bad my child’s pain will be.Strongly Agree Agree Undecided Disagree Strongly Disagree(5) (4) (3) (2) (1)____ ____ ____ ____ ____2. I can predict how long my child’s illness will last.Strongly Agree Agree Undecided Disagree Strongly Disagree(5) (4) (3) (2) (1)____ ____ ____ ____ ____3. Because of the unpredictability of my child’s illness, I cannot plan for thefuture.Strongly Agree Agree Undecided Disagree Strongly Disagree(5) (4) (3) (2) (1)____ ____ ____ ____ ____
4. It’s vague to me how I will manage the care of my child after he/sheleaves the hospital.Strongly Agree Agree Undecided Disagree Strongly Disagree(5) (4) (3) (2) (1)____ ____ ____ ____ ____5. I’m certain they will not find anything else wrong with my child.Strongly Agree Agree Undecided Disagree Strongly Disagree(5) (4) (3) (2) (1)____ ____ ____ ____ ____
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