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Blood and Marrow
Transplant Program
MMC 803
420 Delaware St. S.E.
Minneapolis, Minnesota 55455

University of Minnesota
Medical Center

www.uofmmedicalcenter.org

University of Minnesota
Amplatz Children's Hospital
www.uofmchildrenshospital.org

Patient Information:
612-273-2800 or 888-601-0787

Physician Referrals:
612-273-2800 or 888-601-0787


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Self-Assessment for BMT Caregivers

As the Caregiver for a Blood and Marrow Transplant (BMT) patient you are playing a very important role. You will be providing assistance and support during the patient’s treatment and recovery process. Your efforts and your presence are essential to transplant success. And your role is valued and respected by everyone in the University of Minnesota Medical Center BMT program.

The medical team and the patient rely on you for assistance and for information about a variety of issues. Your role can be physically and emotionally demanding. We strongly encourage you to devote time and attention to your own personal needs. Self-care is critical to your ability to provide care for the patient.

As you plan for your own caregiving experience, please take the time to reflect on your current satisfaction with various aspects of your caregiving role. It is important to note that few people are ever fully satisfied with all aspects. You can use this assessment tool for your own private reflection. It is also a good tool for self-care goal planning.

Caregiver Self-Assessment Tool
Consider your current status with each of the following statements. Mark if you are very satisfied, somewhat satisfied or very unsatisfied with each one. You can print out and use the version of the assessment below, or click here for a pdf version of the assessment tool.

The areas that you are able to circle that you are "very satisfied" will be your areas of strength. Pay attention also to the areas that you circle as "somewhat satisfied" or "very unsatisfied." These may help you to identify areas on which to focus your self-care efforts. They are also areas in which you may want to ask for help. After you complete the assessemnt, consider listing your current strengths as a caregiver and your current goals as a caregiver. 

VS – Very Satisfied
SS – Somewhat Satisfied
VU – Very Unsatisfied

I am eating a healthy balanced diet. 
VS    SS    VU

I am getting at least 7-9 restful hours of sleep each night.
VS    SS    VU

I have the information that I need in order to understand my patient’s disease and treatment.
VS    SS    VU

I am participating in regular physical exercise/activity.
VS    SS    VU

I devote time and attention to my emotional and spiritual health.
VS    SS    VU

I regularly practice some form of relaxation.
VS    SS    VU

I am managing my stress and am not misusing drugs or alcohol.
VS    SS    VU

My financial needs are being met.
VS    SS    VU

I am able to set limits on the demands of my caregiver duties.
VS    SS    VU

I am receiving adequate emotional, spiritual, and social support.
VS    SS    VU

I allow myself to take regular breaks to pursue my interests, hobbies, and other relationships.
VS    SS    VU

I make and keep medical and dental appointments for myself.
VS    SS    VU

I am able to meet my non-caregiver related responsibilities.
VS    SS    VU

I am able to state my needs and questions to the medical staff involved in my patient’s care.
VS    SS    VU


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