Nurses’ Observation Scale for Inpatient Evaluation (NOSIE=30)
Name _____________________________ Age/Sex __________
Hosp. No:____ Date________ Time_____ AM/PM
Current Medical illness: ______________Duration of illness: _____
No. of Hospitalization: _______________Date of Discharge: _____
Final Diagnosis: ____________________Occupation: ___________
Education (in years)________________ Family History: ________
------------------------------------------------------------------------------------------------
1. Is sloppy. 0__ 1__ 2__ 3__ 4
2. Is impatient. 0__ 1__ 2__ 3__ 4
3. Cries. 0__ 1__ 2__ 3__ 4
4. Shows curiosity and interest in activities around him/her. 0__ 1__ 2__ 3__ 4
5. Sits, unless directed into activity. 0__ 1__ 2__ 3__ 4
6. Gets angry or annoyed easily. 0__ 1__ 2__ 3__ 4
7. Hears things that are not there 0__ 1__ 2__ 3__ 4
8. Keeps his/her clothes neat. 0__ 1__ 2__ 3__ 4
9. Tries to be friendly with others 0__ 1__ 2__ 3__ 4
10. Becomes upset easily if something doesn’t suit him/her. 0__ 1__ 2__ 3__ 4
11. Refuses to do the ordinary things expected of him/her. 0__ 1__ 2__ 3__ 4
12. Is irritable and grouchy. 0__ 1__ 2__ 3__ 4
13. Has trouble remembering. 0__ 1__ 2__ 3__ 4
14. Refuses to speak. 0__ 1__ 2__ 3__ 4
15. Laughs or smiles at funny comments or events. 0__ 1__ 2__ 3__ 4
16. Is messy in his/her eating habits. 0__ 1__ 2__ 3__ 4
17. Starts up a conversation with others 0__ 1__ 2__ 3__ 4
18. Says he/she feels blue or depressed 0__ 1__ 2__ 3__ 4
19. Talks about his/her interests. 0__ 1__ 2__ 3__ 4
20. Sees things that are not there. 0__ 1__ 2__ 3__ 4
21. Has to be reminded what to do. 0__ 1__ 2__ 3__ 4
22. Sleeps, unless directed into activity. 0__ 1__ 2__ 3__ 4
23. Says that he/she is no good. 0__ 1__ 2__ 3__ 4
24. Has to be told to follow hospital routine. 0__ 1__ 2__ 3__ 4
25. Has difficulty completing even simple tasks on his/her own 0__ 1__ 2__ 3__ 4
26. Talks, mutters, or mumbles to him/her. 0__ 1__ 2__ 3__ 4
27. Is slow moving or sluggish. 0__ 1__ 2__ 3__ 4
28. Giggles or smiles to him/herself for no apparent reason. 0__ 1__ 2__ 3__ 4
29. Is quick to fly off the handle. 0__ 1__ 2__ 3__ 4
30. Keeps him/herself clean. 0__ 1__ 2__ 3__ 4
-------------------------------------------------------------------------------
Rater’s Signature________________
0 comments:
Post a Comment