Self-Care Inventory

Sleep, hydration, meals, movement, mindfulness, social support, hobbies, values, boundaries, spirituality, and rest.

Rate consistency, confidence, obstacles, and one low-burden improvement.

Administration: clinician_administered
Status: active
Variant: adult
Lookback days: 30
Item Responses
Instrument version: pss-10-adult-v1

Not Provided/40 Score

Upset by unexpected events

01234

Unanswered

Unable to control important things

01234

Unanswered

Felt nervous or stressed

01234

Unanswered

Confident handling personal problems

01234

Unanswered

Things were going your way

01234

Unanswered

Could not cope with all demands

01234

Unanswered

Able to control irritations

01234

Unanswered

Felt on top of things

01234

Unanswered

Angered by things outside your control

01234

Unanswered

Difficulties were piling up

01234

Unanswered

WHO-5 Administered

WHO-5 Below Threshold

Determinants Spokes

Item 1

Label: Sleep and Rest
Spoke ID: sleep-rest

Item 2

Label: Nutrition
Spoke ID: nutrition

Item 3

Label: Movement
Spoke ID: movement

Item 4

Label: Stress Load
Spoke ID: stress-load

Item 5

Label: Relationships
Spoke ID: relationships

Item 6

Label: Environment
Spoke ID: environment

Item 7

Label: Purpose
Spoke ID: purpose

Item 8

Label: Community
Spoke ID: community

Item 9

Label: Resilience
Spoke ID: resilience

Item 10

Label: Access and Resources
Spoke ID: access-resources

Status

active

Variant

adult

Who5 Items

Item 1

Label: Cheerful and in Good Spirits
Item ID: who5-1

Item 2

Label: Calm and Relaxed
Item ID: who5-2

Item 3

Label: Active and Vigorous
Item ID: who5-3

Item 4

Label: Fresh and Rested
Item ID: who5-4

Item 5

Label: Daily Life Filled with Interest
Item ID: who5-5

Who5 Instrument Version

who5-v1

Promis10 Instrument Version

promis10-adult-v1

Self-Care Behavior Inventory

Sleep routine:

Hydration:

Protein / meals:

Movement:

Mindfulness / stress practice:

Social connection:

Hobbies / restorative time:

Boundary / workload change:

PSS-10 captures perceived stress; these fields capture concrete self-care behaviors.

Plan and Follow-Up

Focus	Documentation
Goal / readiness	Record patient goal, importance, confidence, readiness, barriers, and supports. Goal: Readiness / confidence: Barriers / supports:
Action plan	Choose the smallest realistic next step, resources needed, and how success will be measured. Next action: Resources / accountability: Success measure:
Review	Set review date, expected obstacles, adjustment plan, and escalation or referral needs. Review date: Adjustment plan: Referral / escalation:

Focus

Documentation

Goal / readiness

Record patient goal, importance, confidence, readiness, barriers, and supports.

Goal:

Readiness / confidence:

Barriers / supports:

Action plan

Choose the smallest realistic next step, resources needed, and how success will be measured.

Next action:

Resources / accountability:

Success measure:

Review

Set review date, expected obstacles, adjustment plan, and escalation or referral needs.

Review date:

Adjustment plan:

Referral / escalation:

Self-Care Inventory

PSS-10

Details

Responses

Determinants Assessment

Details

Item 1

Item 2

Item 3

Item 4

Item 5

Item 6

Item 7

Item 8

Item 9

Item 10

Item 1

Item 2

Item 3

Item 4

Item 5

Self-Care Behavior Inventory

Plan and Follow-Up

General - Self Care Questionnaire

Preview