Hopelessness

 

Instructions: Fill out this form, print it, and hand it in with your assessment to your instructor. When you click on Next at the bottom of the page, you see the data you submitted. Please follow the instructions on how to save the data on the next page.

AOL users: Read this instruction.

Definition: a subjective state in which an individual sees no alternatives or personal choices available and cannot mobilize energy on own behalf

1. Your initials (required): 

2. Defining Characteristics- check those that apply to your client:

None- high risk diagnosis  profound overwhelming sustained apathy slowed responses lack of energy passiveness pessimism decreased affect decreased verbalization
lack of initiative lack of involvement in care decreased appetite
3. Related Factors- check those that apply to your client:

abandonment failing or deteriorating physical condition long term stress lost belief in transcendent values/God prolonged activity restrictions, isolation lack of social support


4. Goal (ultimate, long term) 

5. Outcome Criteria (short term) 

6. Evaluation: Was the outcome criteria met? 

Yes- Give Evidence: 

No- Explain how you would change the plan: 

7A. Interventions 

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7B. Rationale for each intervention
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