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2014
October
P
Pilot hassle survey short ICSRLE
Pilot hassle survey short ICSRLE
SRNA daily hassles, mental health, and dispositional mindfulness pilot survey
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Exit Survey
Hello:
You are invited to participate in our pilot SRNA daily hassle, mental health, and dispositional mindfulness survey. In this survey, approximately 10 people will be asked to complete a survey that asks questions about your experiences and perception. It will take approximately 25 minutes to complete the questionnaire.
Your participation in this study is completely voluntary. There are no foreseeable risks associated with this project. However, if you feel uncomfortable answering any questions, you can withdraw from the survey at any point. It is very important for us to learn your experiences.
Your survey responses will be strictly confidental and data from this research will be reported only in the aggregate. Your information will be coded and will remain confidential. If you have questions at any time about the survey or the procedures, you may contact Kaori Donohue by email at the email address specified below.
Thank you very much for your time and support. Please start with the survey now by clicking on the
Continue
button below.
Sincerely,
Kaori Donohue, CRNA, MSN
PhD student
Oregon Health & Science University
School of Nursing
[email protected]
Using one of the response choices listed, indicate for each experience how much it has been a part of your life over the past month.
Not at all part of your life
Only slightly part of your life
Distinctly part of your life
Very much part of your life
*
1. Conflicts with boyfriend’s/girlfriend’s/spouse’s family
*
2. Being let down or disappointed by friends
*
3. Conflict with professor(s)/instructor(s)
*
4. Social rejections
*
5. Too many things to do at once
*
6. Being taken for granted
*
7. Financial conflicts with family members
*
8. Having your trust betrayed by a friend
*
9. Separation from people you care about
*
10. Struggling to meet your own academic standards
Not at all part of your life
Only slightly part of your life
Distinctly part of your life
Very much part of your life
*
11. Being taken advantage of
*
12. Not enough leisure time
*
13. Struggling to meet the academic standards of others
*
14. A lot of responsibilities
*
15. Dissatisfaction with school
*
16. Decisions about intimate relationship(s)
*
17. Not enough time to meet your obligations
*
18. Important decisions about your future career
*
19. Financial burdens
*
20. Important decisions about your education
Not at all part of your life
Only slightly part of your life
Distinctly part of your life
Very much part of your life
*
21. Loneliness
*
22. Lower grades than you hoped for
*
23. Not enough time for sleep
*
24. Conflicts with your family
*
25. Finding courses too demanding
*
26. Conflicts with friends
*
27. Hard effort to get ahead
*
28. Disliking your studies
*
29. Difficulties with transportation
*
30. Conflicts with boyfriend/girlfriend/spouse
*
31. Interruptions of your school work
*
32. Social isolation
*
33. Failing to get expected job
*
34. Dissatisfaction with your athletic skills
Please read each statement and choose your answer that indicates how much the statement applied to you
over the past week
. There are no right or wrong answers. Do not spend too much time on any statement.
Did not apply to me at all
Applied to me to some degree, or some of the time
Applied to me to a considerable degree, or a good part of time
Applied to me very much, or most of the time
*
1. I was aware of dryness of my mouth.
*
2. I couldn't seem to experience any positive feeling at all.
*
3. I experienced breathing difficulty (eg, excessively rapid breathing, breathlessness in the absence of physical exertion).
*
4. I found it difficult to work up the initiative to do things.
*
5. I experienced trembling (eg, in the hands).
*
6. I was worried about situations in which I might panic and make a fool of myself.
*
7. I felt that I had nothing to look forward to.
*
8. I felt down-hearted and blue.
*
9. I felt I was close to panic.
*
10. I was unable to become enthusiastic about anything.
*
11. I felt I wasn't worth much as a person.
*
12. I was aware of the action of my heart in the absence of physical exertion (eg, sense of heart rate increase, heart missing a beat).
*
13. I felt scared without any good reason.
*
14. I felt that life was meaningless.
The following questions ask you about your feelings and thoughts during the last month. In each case, please indicate by choosing how often you felt or thought a certain way.
Never
Almost never
Sometimes
Fairly often
Very often
*
1. How often have you been upset because of something that happened unexpectedly?
*
2. How often have you felt that you were unable to control the important things in your life?
*
3. How often have you felt nervous and "stressed"?
*
4. How often have you felt confident about your ability to handle your personal problems?
*
5. How often have you felt that things were going your way?
*
6. How often have you found that you could not cope with all the things that you had to do?
*
7. How often have you been able to control irritations in your life?
*
8. How often have you felt that you were on top of things?
*
9. How often have you been angered because of things that were outside of your control?
*
10. How often have you felt difficulties were piling up so high that you could not overcome them?
Please rate each of the following statements for how best describing
your own opinion
of what is
generally true for you
.
Never or very rarely true
Rarely true
Sometimes true
Often true
Very often or always true
*
1. I criticize myself for having irrational or inappropriate emotions.
*
2. I perceive my feelings and emotions without having to react to them.
*
3. When I do things, my mind wanders off and I’m easily distracted.
*
4. I don’t pay attention to what I’m doing because I’m daydreaming, worrying, or otherwise distracted.
*
5. I watch my feelings without getting lost in them.
*
6. I tell myself I shouldn’t be feeling the way I’m feeling.
*
7. I am easily distracted.
*
8. I believe some of my thoughts are abnormal or bad and I shouldn’t think that way.
*
9. I make judgments about whether my thoughts are good or bad.
*
10. I find it difficult to stay focused on what’s happening in the present.
Never or very rarely true
Rarely true
Sometimes true
Often true
Very often or always true
*
11. When I have distressing thoughts or images, I “step back” and am aware of the thought or image without getting taken over by it.
*
12. In difficult situations, I can pause without immediately reacting.
*
13. It seems I am “running on automatic” without much awareness of what I’m doing.
*
14. When I have distressing thoughts or images, I feel calm soon after.
*
15. I tell myself that I shouldn’t be thinking the way I’m thinking.
*
16. I rush through activities without being really attentive to them.
*
17. When I have distressing thoughts or images, I am able just to notice them without reacting.
*
18. I think some of my emotions are bad or inappropriate and I shouldn’t feel them.
*
19. When I have distressing thoughts or images, I just notice them and let them go.
*
20. I do jobs or tasks automatically without being aware of what I’m doing.
*
21. When I have distressing thoughts or images, I judge myself as good or bad depending what the thought or image is about.
*
22. I find myself doing things without paying attention.
*
23. I disapprove of myself when I have irrational ideas.
Do you currently meditate?
Yes
No
What kind(s) of meditation do you practice (name or describe)?
For how long have you been meditating (in years)?
How often do you meditate?
One or more times a day
One or more times a week
Less than weekly
How long do you meditate when you do on average in minutes?
To what extent do you carry your meditation practice into your daily life?
Not at all
Almost never
Very infrequently
Very frequently
Almost always
Always
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