READI SURVEY

(Army)

A. Demographics

Yes No

Male Female

Yes No

B. Clinical Nursing Competency
Shock/Documentation

Emergency Nursing

Yes No

Yes No

Yes No

What is your level of competence on each of the patient situations listed below:
  • 1 = Not competent at all
  • 2 = Have training but no experience
  • 3 = Have training & minimal experience
  • 4 = Have training & moderate experience
  • 5 = Fully competent
18.
1 2 3 4 5
19.
1 2 3 4 5
20.
1 2 3 4 5
21.
1 2 3 4 5
22.
1 2 3 4 5
23.
1 2 3 4 5
24.
1 2 3 4 5
25.
1 2 3 4 5
26.
1 2 3 4 5
27.
1 2 3 4 5
28.
1 2 3 4 5
29.
1 2 3 4 5
30.
1 2 3 4 5
31.
1 2 3 4 5
32.
1 2 3 4 5
Physical Assessment
Please rate yourself according to Level of Present Knowledge/Skill
  • 1 = Low
  • 2 = Somewhat low
  • 3 = Moderate
  • 4 = Nearly high
  • 5 = High
33.
1 2 3 4 5
34.
1 2 3 4 5
35.
1 2 3 4 5
 
C. Operational Nursing Competency
Consider the following situation. The 4 limb electrodes of a cardiac monitor-recorder are attached to a patient and you have just obtained an EKG tracing in the field. You have been asked to obtain a 12 lead EKG on the same patient. You have the following equipment and supplies: Field table; cardiac monitor; 4 metal limb electrodes attached to the patient with holding straps; 1 suction cup electrode; 1 tube of electrode gel; 1 roll of recoding paper; 1 box of alcohol pads; 1 patient on a hospital bed.

Consider this situation. You are providing patient care in a field environment and need to suction oropharyngeal secretions from a patient. You have the following equipment and supplies: Field table; 1 portable oropharyngeal suction apparatus; sterile patient suction tubing and suction catheter; 1 small container of water; 1 pair of clean gloves.

True False

True False

True False

What is your level of competence in these operational areas:
  • 1 = Not competent at all
  • 2 = Have training but no experience
  • 3 = Have training & minimal experience
  • 4 = Have training & moderate experience
  • 5 = Fully competent
7.
1 2 3 4 5
8.
1 2 3 4 5
9.
1 2 3 4 5
10.
1 2 3 4 5
11.
1 2 3 4 5
 
D. Soldier and Survival Skills
  • 1 = Not Competent
  • 2 = Minimally Competent
  • 3 = Moderately Competent
  • 4 = Highly Competent
  • 5 = Totally Competent

1 2 3 4 5

5.
1 2 3 4 5
6.
1 2 3 4 5
7.
1 2 3 4 5
8.
1 2 3 4 5
9.
1 2 3 4 5
10.
1 2 3 4 5
11.
1 2 3 4 5
E. Personal and Physical Readiness

Yes No Not Applicable

Yes No


Yes No Not Applicable

F. Psychosocial Readiness - Family
  • 1 = Poor
  • 2 = Fair
  • 3 = Good
  • 4 = Very Good
  • 5 = Excellent
1.
1 2 3 4 5
2.
Yes No
3.
Yes No
4.
1 2 3 4 5 n/a

Legal

5.
Yes No
6.
Yes No
7.
Yes No

Occupational

  • 1 poor
  • 2 fair
  • 3 satisfactory
  • 4 good
  • 5 excellent
8.
1 2 3 4 5
9.
1 2 3 4 5
Current Stressors and Coping Strategies Deployment brings with it stress and challenges which tend to compound pre-deployment stressors. How much stress are you experiencing in the following areas:
  • 1 = No Stress
  • 2 = Somewhat Stressed
  • 3 = Stressed
  • 4 = Quite Stressed
  • 5 = Very Much Stressed
10.
1 2 3 4 5
11.
1 2 3 4 5
12.
1 2 3 4 5
13.
1 2 3 4 5
14.
Yes No
  • Tobacco
  • Physical Exercise
  • Relaxation/Meditation Techniques
  • Talking With Friends
  • Religious Faith
16.
Yes No
To what extent are you prepared for:
  • 1 = Not Ready At All
  • 2 = Somewhat Ready
  • 3 = Moderately Ready
  • 4 = Mostly Ready
  • 5 = Totally Ready
17.
1 2 3 4 5
18.
1 2 3 4 5
19.
1 2 3 4 5
20.
1 2 3 4 5
21.
1 2 3 4 5
22.
1 2 3 4 5
Leadership and Administrative Support
Administration

Leadership

Group Integration and Identification

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