SYSTEM4 APPROACH TO NAVY MEDICAL EDUCATION AND TRAINING. APPEN-ETC(Ul UCA AUG 74 NOOOIA-69-C-0246 UNCLASSIFIED. I JD~ h~hh~ EhT ~h~e

Transcription

1 SYSTEM4 APPROACH TO NAVY MEDCAL EDUCATON AND TRANNG. APPEN-ETC(Ul UCA AUG 74 NOOOA-69-C-0246 UNCLASSFED M JD~ h~hh~ EhT ~h~e

2 MW i/ 0e. APPENDX 5. NEUROPSYCHATRC TECHNCAN DTC APPLCATON OF A SYSTEM APPROACHD U. S. NAVY MEDCAL DEPARTMENT EDUCATON AND TRANNG PROGRAMS FNAL REPORT ELECTE JUN 19 C iquida 1f Prepared under Contract to OFFCE OF NAVAL RESEARCH U.S. DEPARTMENT OF THE NAVY C. Upchurch, Capt., NC, USN Program Manager Education and Training R&D Bureau of Medicine and Surgery (Code 71G) Bureau

3 ~UNCLASSFED SECURTY CLASSFCATON OF THS PAGE (*Wemi Date Kneeled) 3 REPORT DOCUMENTATON PAGE BEFORE complzetn FORM *. fp~t.umb GOVT ACCESSON No. 3. ARCPENT'S CATALOG MU~me Aoend Vols. & 10),T G V T 4 S. TYPE OF REPORT & PEROD COVERED, E-2 S. CONTRACT OR GRANT NUM8CRC.) e -5 ana.4-69-c-,6~46 S. PCRPRMNG ORGANZATON NAME AND ADDRESS 16. PROGRAM ELEMENT, PROJE9CT. TASK if office of Naval Research AREA a WOR UNTNMER * Department of the Navy Arlington, Virginia X.02. CONTROLLNG OFFCE NAME AND0 ADDRESS 12. REPORT DATE Office of Naval Research 31/- J' -71 Department of the Navy 13. NUMBER OF PAGES Arlington, Virginia V4. MONTORNG AGENCY NAME G ADORESS(Si different from Consroiltnd 0ffice) 15. SECURTY CLASS. (of tis :eotrt) Office of Naval Research Department of the Navy Arlington, Virginia DSTRBUTON STATEMENT (of this RoprtiJ-"' Approved for public release; distr~i UNCLASSFED 13.jC SP AN ONRDN SCHEDOULE 17. DSTRBUTON STATEMENT (of thabowf*-0r.~ B.11d difii-ec-4t~~rpn) Approved for public release; distribution unlimited. None. S. SUPPLEMENTARY NOTES 19. Key WORDS (Coninue on revere& old@ neeeemvr and dentify by block numsber) Education and Training Medical Training Nurse Training Dentist Training AGSTNACT (Conthinua reversen side i eessary and identify by block nv.bee) Medical Technician Job Analysis Task Analysis Curriculum Development -The study objective consisted of a determination of what the health care personnel in the Navy's Medical Department, Bureau of Medicine and Surgery * actually do in their occupations; improving the personnel process (education and training); and building a viable career pathway for all health care personnel. Clearly the first task was to develop a system of job analyses applicable to all system wide health care manpower tasks. A means of postulating simplified occupational clusters covering some 50 DD ja1rmv 1413 EDTON or0novs is OBSOLETE AUNCLASSFED 3/N ~~~11 032SFAO~ u i vclasscaton OF THS PAGE (Who* &At&& btlie

4 UNCLASSFED LLJ41TY CL ASSFCATON OF THS PAGE(Whon Onto Batoid) currently designated Navy enlisted occupations, 20 Naval Enlisted Classification Codes (NEC's) were computterized. A set of 16 groupings that cover all designated occupations was developed so as to enhance thie effectiveness of professionals and sub-professionals alike. onceak 0r1. UNCLASSFED sacumity clasmptca1on OF THS PA~GL(Wb.. DW m atae.41

5 FOREWORD The project, "Application of a System Approach to the Navy Medical Department Education and Training Programs," was initiated in May of 1969 as a realistic, comprehensive response to certain objectives set forth in ADO 43-03X, and to memoranda from both the Secretary of.defense and the Assistant Secretary of Defense, Manpower and Reserve Affairs. The Secretary's concern was stated in his memorandum of 29 June 1965, "nnovation in Defense Training and Education." More specific concerns were stated in the Assistant Secretary's memorandum of 14 June 1968, "Application of a System Approach in the Development and Management of Training Courses." n this he called for "vigorous and imaginative effort," and an approach "characterized by an organized training program with precise goals and defined operational interrelation among instructional system components." He also noted, "Job analyses with task descriptions expressed in behavioristic terms are basic and essential to the development of precise training goals and learningobjectives." The Project System survey and analysis was conducted relative to all factors affecting education and training programs. Subsequently, a job-analysis.sub-system was defined and developed incorporating a series of task inventories "...expressed in behavioristic terms..." These inventories enabled the gathering of job activity data from enlisted job incumbents,. and data relating to task sharing and delegation from officers of the Medical, Nurse and Dental Corps. A data management sub-system was devised to process incumbent data, then carry out needed analyses. * The development of initial competency curricula based upon job analysis was implemented to a level of methodology determination. These methods and curriculum materials constituted a third * (instructional) sub-system. Thus, as originally proposed, a system capability has been developed in fulfillment of expressed need. The system, however, remains 'untested and unevaluated. ADO 43-03X called for feasibility tests and cost-effectiveness determination. The project was designed to so comply. Test and evaluation through the process of implementation has not proved feasible in the Navy Medical Department within the duration of the project. As designed and developed the system does have "...precise goals and defined operational interrelation among instructional system components." The latter has been achieved in terms of a recommended career structure affording productive, rewarding manpower utilization which bridges manpower training and health care delivery functions. 1.

6 Data Management Sub-System Job analysis, involving the application of comprehensive task inventories to thousands of job incumbents, generates many millions of discrete bits of response data. They can be processed and manipulated only by high speed computer capability using rigorously designed specialty programs. n addition to numerical data base handling, there is the problem of rapidly and accurately manipulating a task statement data base exceeding ten thousand carefully phrased behavioral statements. Through the use of special programs, task inventories are prepared, printouts for special purposes are created following a job analysis application, access and retrieval of both data and tasks are efficiently and accurately carried out, and special data analyses conducted. The collective programs, techniques and procedures comprising this sub-system are referred to as the Navy Occupational Data Analysis Language (NODAL). Job Analysis Sub-System Some twenty task inventory booklets (and associated response booklets) were the instruments used to obtain job incumbent response data for more than fifty occupations. An inventory booklet contains instructions, formatted questions concerning respondent information ("bio-data"),. response dimension definitions, and a list of tasks which may vary in number from a few hundred to more than a thousand per occupational field. By applying NODAL and its associated indexing techniques, it is possible to assemble modified or completely different inventories than those used in this research. Present inventories were applied about three years ago. While they have been rendered in operational format, they should not be re-applied.until their task content is updated. Response booklets were designed in OPSCAN mode for ease of recording and processing responses. Overall job analysis objectives and a plan of administration were established prior to inventory preparation, including the setting of provisional sample target sizes. Since overall data attrition was forecast to approximate twenty percent, final sample and sub-sample sizes were adjusted accordingly. Stratified random sampling techniques were used. Variables selected (such as rating, NEC, environment) determined stratifications, together with sub-population sizes. About fifteen percent of large sub-populations were sought while a majority or all members of small sub-populations were sought..

7 Administration procedures were established with great care for every step of the data collecting process, and were coordinated with sampling and data analysis plans. Once set, the procedures were formalized as a protocol and followed rigorously. - nstructional Sub-System Partial "competency curricula" have been composed as an integral sub-system bridging what is required as performance on the job with what is, accordingly, necessary instruction in the training process. Further, curriculum materials were developed to meet essential requirements for implementing the system so that the system could be tested and evaluated for cost effectiveness. However, due to the fact that test and evaluation was not feasible in the Navy Medical Department within the duration of the project, it was not possible to complete the development of the system through the test and evaluation phase. The inability to complete this phase also interrupted the planned process.for fully developing the curricula; therefore, instead of completed curricula ready for use in the system, the curricula were partially developed.to establish the necessary sub-system methodology. The competency curricula are based on tasks currently performed * by job incumbents in (The currency of a given curriculum depends upon periodic analysis of incumbents' jobs, and its quality control resides in the evaluation of the performance competency of the program's graduates.) A competency curriculum provides'a planned course of instruction or training program made up of sequenced competency unitswhich are, in turn, comprised of sequenced modules. These modules, emphasizing performance objectives, are the foundation of the curriculum. A complete module would be comprised of seven parts: a cluster of related tasks; a performance objective; a list of knowledges and skills implied by the objective; a list of instructional strategies for presenting the knowledges and skills to the learner; an inventory of training aids for supporting the instructional strategies; a list of examination modes; and a statement of the required training time. n this project, curriculum materials have been developed to various levels of adequacy, and usually comprise only the first three parts; the latter four need to be prepared by the user. The performance objective, which is the most crucial part of the module, is the basis for determining curriculum content. t is composed of five essential elements: the stimulus which initiates the behavior; the behavior; the conditions under which the behavior takes place; the criteria for evaluating the behavior; and the consequence or results of the behavior. A sixth element, namely next action, is not essential; however, it is intended to provide linkage for the next behavior. L-

8 Knowledges and skills listed in the module are those needed by the learner for meeting the requirements of the performance objective. nstructional strategies, training aids, examination modes and training time have been specified only for the Basic Hospital Corps Curriculum. The strategies, aids and modes were selected on the basis of those considered to be most supportive in presenting the knowledges and skills so as to provide optimum learning effectiveness and training efficiency. The strategies extend from the classroom lecture as traditionally presented by a teacher to the more sophisticated mediated program for selfinstruction. The training aids, like strategies, extend from the traditional references and handout material in the form of a student syllabus to mediated programs for self-instruction supported by-anatomical models. Examination modes extend from the traditional paper and pencil tests to proficiency evaluation of program graduates on the job, commonly known as feedback. Feedback is essential for determining learning effectiveness and for quality control of a training program. The kind of instructional strategies, training aids and examination modes utilized for training are limited only by such factors as staff capability and training budget. The training time specified in the Basic Hospital Corps Curriculum is estimated, based upon essential knowledge and skills and program sequence. The competency curriculum module, when complete, provides all of the requirements for training a learner to perform the tasks set forth in the-module. A module may be used independently or related modules may be re-sequenced into modified.competency units to provide training for a specific job segment. Since the curricula are based upon tasks performed by job incumbents in 1971, current analysis of jobs needs to be accomplished using task inventories that have been updated to reflect changes in performed tasks. Subsequent to job analysis, a revision of the curricula should be accomplished to reflect task changes. When the foregoing are accomplished, then faculty and other staff members may be indoctrinated to the competency curricula and to their relationship to the education and training system. n addition to the primary use for the systematic training of job incumbents, these curricula may be used to plan for new training programs, develop new curricula, and revise existing curricula; develop or modify performance standards; develop or modify proficiency examinations; define billets; credentialize training programs; counsel on careers; select students; and identify and select faculty. 7l

9 The System Three sub-systems, as described, comprise the proposed system for Education and Training Programs in The Navy Medical Department. This exploratory and advanced developmental research has established an overall methodology for improved education and training incorporating every possible means of providing bases for demonstrating feasibility and cost effectiveness. There remains only job analysis sub-system updating, instructional sub-system completion, and full system test and evaluation. Acknowledgements The authors wish to acknowledge the invaluable participation of the several thousands of Naval personnel who served as respondents in inventory application. The many military and civilian personnel who contributed to developmental efforts are cited by name in the Final Report. The authors also wish to acknowledge former colleagues for singularly important contributions, namely, Elias H. Porter, Ph.D., Carole K. Kauffman, R.N., M.P.H., Mary Kay Munday, B.S.N., R.N., Gail Zarren, M.S.W., and Renee Schick, B.A. dentity'and acknowledgement of the project Advisory Group during the project's final year is recorded in the Final Report. Lastly, the project could not have been commenced nor carried out without the vision, guidance and outstanding direction of Ouida C. Upchurch, Capt., NC, USN, Project Manager.

10 NAVY MEDCAL DEPARTMENT TASK NVENTORY BOOKLET NEUROPSYCHATRC

11 CONSTRANTS AND ETHCAL USE This task inventory was developed three years ago in a firstversion key punch format for education and training research purposes. The present "operational" format, using a mark-sense response booklet (Opscan), is recommended for future applications. The task and equipment statements comprising the bulk of the inventory are precisely the same (less duplicate entries) as in the original research tools but rearranged for Opscan mode. Biographical data questions have also been reformatted for Opscan (NEC codes should be updated). The processing, administering and formatting of this inventory have thus been readied for operational application. t is strongly recounended that this inventory be updated in its task and equipment statement sections before actual operational use. These reasons pertain: ochanges in medical or related procedures or techniques *Some tasks may violate current policy or be obsolete OEquipment changes may have occurred othe objective of task comprehensiveness may change *Objectives may shift to embrace manpower utilization as well as education and training n the latter regard, the present operational format includes a "time to perform" dimension (as well as frequency of performance and two additional optional blank response dimension fields). As a response dimension, "time to perform" has been validated within the context of inventories for professional personnel where the objectives embraced utilization (i.e., time associated with shared and delegable tasks). The original Enlisted inventory content was directed to education and training factors only. f "time to perform" is to be used operationally, each task and equipment statement should be examined by expert job incumbents to remove possible overlaps which could confound "time to perform" data. This review process would also serve other purposes cited above. A general precaution is in order. When task analysis inventories are poorly prepared, loosely administered, administered according to less than rigorous sampling, or are handled casually in processing or interpretation, they will inevitably produce poor or questionable data, at best. At worst, such practices will result in loss of money and time, and produce dangerous data. nventories should be prepared, applied, processed and interpreted only by knowledgeable professional and technical personnel. As in the cases of ethically controlled behavior tests, inventories should not be casually copied or distributed, and should remain under the control of authorized, trained personnel. Factors effecting reliability and validity should be fully appreciated. -, i

12 GENERAL NSTRUCTONS [ There are two parts to be completed for this survey: Part l[. Part A Career Background nformation (answers to be recorded in this TASK BOOKLET) List of Tasks (answers to be recorded on the accompanying RESPONSE BOOKLET)- B List of nstruments and Equipment (answers to be recorded on the accompanying, RESPONSE BOOKLET) Each part is preceded by a set of instructions. Be sure to read them carefully before you start answering each part. All instructions are found on the tinted pages. PLEASE USE ONLY NUMBER 2 LEAD PENCLS. ERASE ALL CHANGES CAREFULLY AND COMPLETELY. DO NOT PUT ANY MARKS OTHER THAN YOUR ANSWERS ON EACH RESPONSE PAGE. DO NOT FOLD. WRNKLE. CREASE OR DETACH PAGES 1 FROM ETHER TASK BOOKLET OR RESPONSE BOOKLET. [. WHEN RECORDNG YOUR ANSWERS YOU MAY WANT TO USE A RULER TO READ ACROSS ANSWER AND QUESTON COLUMNS. WHEN YOU HAVE COMPLETED YOUR RESPONSES, PUT THE TASK NVENTORY BOOKLET AND THE RESPONSE BOOKLET N THE ENCLOSED SELF-ADDRESSED ENVELOPE. SEAL AND RETURN TO THE OFFCER WHO GAVE YOU THS PACKAGE. COMPLETED. BOOKLETS SHOULD BE REURNED WTHN ONE WEEK OF! RECEPT. i [.Li

13 * DO NOT FLL N Part CAREER BACKGROUND NFORMATON * Check that the Form and Serial Number in this Form Serial No. box match those on the cover of this Booklet, Please fill out completely Name of your Duty Station City & State (if applicable) Your Name Social Security Number (14) PLEASE ANSWER QUESTONS BELOW BY ENTERNG THE PROPER ENTER NUMBER N THE BLANKS PROVDED. TWO BLANKS REQURE A ANSWERS TWO-DGT ANSWER. DSREGARD NUMBERS N PARENTHESS. HERE Ql. Select the number to indicate the Corps to Ql._ (23) which you belong: 1. Dental Technician 2. Hospital Corps Q2. ndicate your military status: Q2. (24) 1. USN 2. USNR Q3. ndicate your pay grade: Q3._ (25) 1. El 6. E6 2. E2 7. E7 3. E3 8. E8 4. E4 9. E9 5. E5 Q4. ndicate your total years of active duty in Q4.- (26) the Navy to date: (estimate to the nearest year) 1. Less than 2 years 2. 2 to 4 years 3. 5 to 8 years 4. More than 8 years i iii

14 ENTER ANSWERS HERE Q5. Select the number to indicate your present Q5. (27) immediate supervisor: 1. Physician 2. Dentist 3. Nurse 4. MSC Officer 5. HM or DT 6. Other (Specify) to Q6. Select the number to indicate the average Q6._ (28) number of hours you work per week: (estimate to the nearest hour) to 40 hours to 50 hours 3. More than 50 hours Q7. Please give an estimate of the percent of Q7. time you spend on the following (write five percent as 05): 1. npatient care 1. % (29) 2. Outpatient care (31) 3. Teaching (33) 4. Administration 4.- _-7 (35) 5. Other (specify)..... _5.-- % (37) Q8. Assuming that most or all of the following Q8. (39) factors are of importance to you, select the three which, if improved, would contribute (41) most to your job satisfaction: (3 --- (43) 01 Salary and/or promotion opportunities 02 Retirement benefits 03 Housing 04 Educational advancement opportunities 05 Stability of tour of duty 06 Physical facilities and equipment 07 Administrative and clerical support 08 Work load 09 Personal career planning 10 Opportunity to attend professional meetings iv

15 ENTTER ANSWERS HERE Q9. Using the list on page vi specify your Q9._ (45) current NEC by writing the last two digits of the CODE. Q1O. Select the number to indicate your years Q10._ (47) of experience corresponding to the NEC stated in Q9: (estimate to the nearest year) 1. Less than 1 year 4. 6 to 10 years 2. 1 to 2 years to 15 years 3. 3 to 5 years 6. More than 15 years Ql. f you have other NEC(s) in addition to Qlla._ (48) the one specified in Q9, check page vii b. (50) and indicate the last two digits of the CODE(s). f you have none, enter "99" in answer space for Q l and Q12. Q12. Select the number to indicate the years of Ql2a._ (52) experience you had in the NEC(s) stated in Qll (estimate to the nearest year). b._ (53) 1. Less than year 4. 6 to 10 years 2. 1 to 2 years to 15 years 3. 3 to 5 years 6. More than 15 years Q13. From the list below, write the two-digit CODE Q13. (54) to indicate the specialty of the department in which you are currently functioning. CODE 01 Administration 18 Urology 02 Education 19 ntensive Care 03 Anesthesiology 20 Operating Room 04 Coronary Care 21 Emergency Room 05 Dermatology 00 Other (specify) 06 Medicine - OPD 07.Medicine - Wards 08 Obstetrics/Gynecology 09 Ophthalmology 10 Orthopedics 11 Otolaryngology 12 Medical Laboratory 13 Pediatrics 14 Psychiatry 15 Public Health 16 Radiology 17 General Surgery-Wards V

16 !A ENTER ANSWER HERE Q14. Select the number to indicate the type Q14. (56) of duty station at which you currently work, and have least been working 30 days: for at 1. Hospital 2. Dispensary 3. Aboard ship/sub, no M.O. (or D.O.) aboard 4. Aboard ship/sub, M.O. (or D.O.) aboard 5. Aviation squadron/wing, Navy or Marine 6. Marine ground forces 7. Administrative Commands 8. Research Commands or PMJs 9. Dental Clinic 0. Other _._ Q15. ndicate the number of people you Q5._ (57) normally supervise: 0. None over 20! vi

17 4w MEDCAL/DENTAL NEC (NAVAL ENLSTED CODE) AND TTLE 0000 General Service, Hospital or Dental Corpsman 3371 Health Physics & Process Control Technician 3391 Nuclear Power Plant Operator 8402 Nuclear Submarine Medicine Technician 8403 Submarine Medicine Technician 8404 Medical Field Service Technician 8405 Advanced Hospital Corps Technician (Class B) * 8406 Aviation Medicine Technician 8407 Nuclear Medicine Technician 8408 Cardiopulmonary Technician Aviation Physiology Technician 8412 Clinical Laboratory Assistant Technician 8413 Tissue Culture.Technician 8414 Clinical Chemistry Technician 8415 Medical Technology Technician 8416 Radioactive sotope Technician 8417 Clinical Laboratory Technician 8432 Preventive Medicine Technician 8433 Tissue Culture and Tissue Bank Technician 8442 Medical Administrative Technician 8452 X-ray Technician 8453 Electrocardiograph/Basal Metabolism Technician 8454 Electroencephalograph Technician 8462 Optician (General) Technician 8463 Optician Technician 8466 Physical and Occupational Technician 8472 Medical Photography Technician 8482 Pharmacy Technician 8483 Operating Room Technician 8484 Eye, Ear, Nose, & Throat Technician 8485 Neuropsychiatry Technician 8486 Urological Technician 8487 Occupational Therapy Technician 8488 Orthopedic Appliance Mechanic 8489 Orthopedic Cast Room Technician 8492 Special Operations Technician 8493 Medical Deep Sea Diving Technician 8494 Physical Therapy Technician 8495 Dermatology Technician 8496 Embalming Technician 8497 Medical llustration Technician 8498 Medical Equipment Repair Technician 8703 DT General, Advanced 8707 DT Field Service 8713 DT Clinical Laboratory 8714 DTResearch Assistant 8722 VT Administrative 8732 DT Repair 8752 DT Prosthetic, Basic 8753 Dr Prosthetic, Advanced 8765 DT Maxillofacial Prosthetic 11 ~vi i

18 RESPONSE BOOKLET NSTRUCTONS * To complete Part, you need this TASK BOOKLET and the accompanying RESPONSE BOOKLET. Record all your answers to Part in the RESPONSE BOOKLET. * All pages of the RESPONSE BOOKLET are machine readable. n order for responses to be properly read, please be sure to: 1. Use a No. 2 pencil only 2. Carefully and completely shade the number corresponding to your answer under each column. * Complete Page 00 of the RESPONSE BOOKLET first. Follow instructions given on the page. Fill in Line 1. and Boxes 2, 3, 4, and 5. gnore all other boxes. BE SURE TO ENTER YOUR SOCAL SECURTY NUMBER (WRTE DOWNWARD) N THE BLANK SPACES N BOX 3: then darkly shade the corresponding number on each line. An example of a completed Page 00 is shown on the next page (the handwritten notes in this example are for clarification only. Please do not make similar notes on your RESPONSE BOOKLET.) " After completing Page 00, carefully read and follow instructions given on pages x through xiv. * PLEASE HANDLE YOUR RESPONSE BOOKLET CAREFULLY. KEEP T CLEAN AND AWAY FROM CHEMCALS. DO NOT DETACH, FOLD, WRNKLE OR CROSS OUT ANY PAGE. v viii "

19 PAGE 00 DO NOT MARK.., N REPOS ; ::, '" BOOKLET- THESE..... OXE Serial No ; ; NAME TASK ANALYSS BACKGrOUrD DATA SHEET NSTRUCT ONS $ i 3 4 S "913i 1. Use No. 2 pencil ONLY. 2. ndicate responses with solid black mark n space provided. 0 i i i, i i i Erase COMPLETELY all changes. T 4. Do not detach forms from packet Answer questions 2 through 5 below. 6. See Task Statement Booklet lo further instructions lot completing s a, 3 3 i k boxes to the right. T. LO T... F' 1 3 U -- 2 C 0 T N: 3 i' i "1 A C ' 0 0- A. L 1 ] '... o 1. D E 2316 A, A- 7 i, 5 U 7, 3. j F : J - R " A 1 0U _9_ 20._. SEE COVER OF YOUR TASK BOKLET 33 4NT - V Y. " S --- TO.ir. 10,?,J/0 ** 12 O. J/ Pl~y.... T..... E T

20 PART A PART B LST OF TASKS PART LST OF NSTRUMENTS AND EQUPMENT [ HOW TO RESPOND TO TASK STATEMENTS AND NSTRUMENTS Your responses to each statement should be marked on the corresponding page, column and item number in your RESPONSE BOOKLET. Note that each page in your RESPONSE BOOKLET has two response blocks. The left-hand block (items 1-25) is for entering responses to statements printed on LEFT pages of this TASK BOOKLET; the right-hand block (items 26-50) is for the responses to statements printed on RGHT pages. Make sure that your answers are recorded in the appropriate block on every page. DO NOT MAKE ANY MARKS OTHER THAN YOUR ANSWERS! Each time you start a new page in your RESPONSE BOOKLET, check the page on your TASK BOOKLET. See that the numbers match; then mark the page number in "Box V" in the response page (see! instructions at the top of response page.) This is necessary for computer processing. Tear the Response Guide (p. xiii) at the perforation, and use the correct side to respond to each task or instrument found on the following white pages. Note the following detailed explanation of responses. :, xl ~L'

21 Column A - (the responses to Column A differ for Part A and Part B, be sure to use the appropriate set of responses.) Part A How often did you do this task within the last month? (f you were on leave, consider your immediate past working month.) 0 - Did not do - Did less than 5 times 2 - Did 5 to 20 times 3 - Did 21 to 50 times 4 - Did 51 to 100 times 5 - Did more than 100 times Part B How often did you use this instrument or piece of equipment within the last month? (f you were on leave, consider your immediate past working month.) 0 - Did not use 1 - Used less than 5 times 2 - Used 5-20 times 3 - Used times 4 - Used times 5 - Used more than 100 times f answer in Column A is 0, go to the next statement. f answer is 1, 2, 3, 4 or 5, answer also Columns B, C & D. xi 1 x

22 Co lumn B ndicate the approximate time you spent on a single performance the last time you performed this task. 0 = less than one minute 1 = 1 to 4 minutes 2 = 5 to 10 minutes 3 = 11 to 20 minutes to 30 minutes [ 5-31 to 60 minutes 6 = to 2 hours 7 = more than 2 hours j Column C Do you feel you need additional training to perform this task? 0= No - Yes [

23 a,7 C: u 4.1 0~ Qv4) -Jr4 (1 C Z, > or4 -r4 -r r4 C.,- C,,~ -C 4OE w w- N E-4 E- C/),4 ~ ~ Z > o4: it i 9 o W E- rz4 * ~ H H - W HH- H4 E-H o0hr2rt C ) azh W 0 C 4 -,t c4e- 0 r-4nhh 0& 0- E-4 lz 4.rE -A Ca Q N r-4 v-4h i f a 1 a 00 H E ~E-4 En W E4 C ZZ 0 14 En Fj E-4 HfE-4 C, 0 H

24 C; r4 r4 U- z-40) a,).-4 -A 4-00 (1 "4 rr z 0 cie- H4 Lr F4 <H E- H H : M z 11 0 E Ci2/ 0 H co w (n - E-4 Cf] 0O (1)-i- 0- E-4 00 z H z u C*4OH nc%.d :3E- r- C/3h ~ HH- %-. W HE-4 r U Ln 4 <q Cn V- cn 00, a A0~H E- LZ4 E-4rco H E-4t Zu

25 Part A LST OF TASKS i.

26 LEFT PAGE 01 NEUROPSYCHATRC TASK BOOKLET TASK NO. ENTER RESPONSES TO STATEMENTS BELOW N LEFT SDE OF PAGE 01 OF RESPONSE BOOKLET 1 1OBSERVE PATENT'S GENERAL APPEARANCE, E.G. DRESS, GROOMNG 2' OBSERVE PATENT'S BEHAVOR PATTERNS "3 OBSERVE PATENT FOR PECULAR/ABNORMAL BEHAVOR, E.G. POSTURNG RTUALSM, NAPPROPRATE AFFECT 4 OBSERVE PATENT FOR BEHAVORAL CHANGES 5 EVALUATE PATENT'S SOCO-CULTURAL BACKGROUND FOR NFLUENCES ON 1HEALTH CARE 6 DETERMNE PATENTS "PATTERN OF NTERACTON WTH OTHERS 7 OBSERVE PATENTS BODY MOVEMENTS/TONE/POSTONNG N WARD/GROUP B OBSERVE PHYSCAL PROXMTY PATENT MANTANS N WARD/GROUP 9 ASSESS PATENT'S SOCAL BEHAVOR 10 ASSESS PATENT'S ATTTUDE TOWARD STAFF 11 OBSERVE PATENT'S ORENTATON TO TME, PLACE, PERSON 12 ASSESS PATENT'S THOUGHT/COGNTVE PROCESSES L3 ASSESS PATENT'S MEMORY PROCESS 14 OBSERVE PATENT'S MODES OF COMMUNCATON, E.G. VERBAL, NONVERBAL j 15 )OBSERVE PATENT'S LEVEL OF COMMUNCATON, E.G. DRECTNESS, AMOUNT, DEPTH 16 ASSESS CONTENT OF PATENT'S VERBAL COMMUNCATON 17 DENTFY/DESCRBE MANFESTATONS OF LOSS OF CONTACT WTH REALTY, EeG. HALLUCNATONS, DELUSONS s OBSERVE PATENT'S GENERAL EMOTONAL CONDTON, E.G. FACAL AND : EYE EXPRESSONS, QUALTY OF VOCE 19 OBSERVE PATENT'S GENERAL MENTAL ATTTUDE 20 ASSESS PATENT'S LEEOFO OATOD 20 ASSESS PATENT'S MEEOOD OVTO 22 OBSERVE FOR PATENT'S NEED TO VENTLATE FEELNGS 23 DENTFY PATENT'S SUPPRESSED/TRUE FEELNGS 24 ASSESS PATENTS SURFACE (MANFEST FEELNGS j( 25 DENTFY PATENTS PSYCHOLOGCAL NEEDS AND/OR PROBLEMS, E.G. 'AFFECTON, RECOGNTON GO TO RGHT HAND PAGE

27 RGHT PAGE 01 NEUROPSYCHATRC TASK BOOKLET TASK NOe ENTER RESPONSES TO STATEMENTS BELOW N RGHT SDE OF PAGE DL OF RESPONSE BOOKLET 26 1DENTFY FACTORS THAT NFLUENCE PATENT'S PSYCHOLOGCAL STATE 27 ASSESS PATENT'S LEVEL OF ANXETY 28 ASSESS PATENT'S DEGREE OF DEPRESSON 29 OBSERVE FOR/DENTFY DEFENSE MECHANSMS USED BY PATENTS 30 OBSERVE PATENT FOR PSYCHOTC BEHAVOR 31 ASSESS PATENT'S DEGREE OF PSYCHOTC BEHAVOR 32 1DENTFY FACTORS THAT MAY CONTRBUTE TO A PSYCHOTC EPSODE 33 OBSERVE PATENT FOR NEUROTC BEHAVOR 34 ASSESS PATENT'S DEGREE OF NEUROTC BEHAVOR 35 OSSERVE PATENT FOR CHARACTER DSORDER BEHAVOR 36 BDENTFY FACTORS THAT MAY CONTRBUTE TO AN ACTNG-OUT EPSODE 37 OBSERVE FOR/REPORT TENDENCES TOWARD SUCDAL BEHAVOR 38 ASSESS SUCDAL TENDENCES, E.G. VERBALZATONS, BEHAVOR 39 DENTFY FACTORS THAT MAY CONTRBUTE TO A SUCDAL GESTURE 40 CHECK TEXTURE OF SKN, E.Ge DRY, OLY, SCALY 41 CHECK TEMPERATURE OF SKN 42 CHECK COLOR OF SKN, E.G. CYANOSS, BLANCHNG, JAUNDCE, MOTTLNG 43 CHECK FOR EOMA (SWELLNG) OF EXTREMTES, EYES 44 CHECK SKN FOR ABNORMAL CONDTONS, E.G. PRESSURE SORES, BRUSES, NEEDLE MARKS 45 CHECK SKN TURGOR (ELASTCTY) 46 OBSERVE FOR/REPORT SYMPTOMS OF CELLULTS 47 1EXAMNE AND DESCRBE BURNS,. E. SOURCE, AREAt DEGREE 48 1EXAMNE AND DESCRBE CHARACTERSTCS OF HVES, RASHES 49 EXAMNE ANMAL OR HUMAN BTES 50 CHECK PATENT FOR SWEATNG/DAPHORESS TURN PAGE

28 LEFT PAGE 02 NEUROPSYCHATRC TASK BOOKLET TASK NO. ENTER RESPONSES TO STATEMENTS BELOW N LEFT SDE OF PAGE 02 OF RESPONSE BOOKLET OBSERVE FOR/REPORT SYMPTOMS OF WOUND NFECTON 2 OBSERVE/RECORD OR DESCRBE CHARACTERSTCS OF DRANAGE FROM 1NCSONS/WOUNDS 3 CHECK/EXAMNE NCSONS/WOUNDS FOR PROGRESS OF HEALNG 4 OBSERVE FOR/REPORT CHARACTERSTCS OF COUGH 5 OBSERVE/RECORO OR DESCRBE CHARACTERSTCS OF SPUTUM, MUCUS 6 OBSERVE FOR/REPORT SYMPTOMS OF HEAD COLDS 7 OBSERVE FOR/REPORT SYMPTOMS OF SNUS BLOCKAGE 8 EXAMNE MOUTH AND PHARYNX FOR LESONS, SORES, LEUKOPLAKA 9 OBSERVE FOR/REPORT SYMPTOMS OF NFECTON OF ORAL MUCOSAt E.G. BTHRUSH 10 OBSERVE FOR/REPORT SYMPTOMS OF CARES, SMPLE AND ADVANCED 1L,EXAMNE FOR/REPORT SYMPTOMS OF ORAL ABSCESS 12 OBSERVE FOR/REPORT SYMPTOMS OF DENTURE RRTATON 13 OBSERVE FOR REPORT OR DESCRBE VSUAL DSTURBANCES, E.G. BLURRED, DOUBLE, MRROR, TUNNEL 14 OBSERVE FOR/DESCRBE HEARNG DSTURBANCES, E.G. RNGNG, HEARNG LOSS L5 EXAMNE TYMPANC MEMBRANE FOR REDNESS, SWELLNG L6 OBSERVE/RECORD OR DESCRBE CHARACTERSTCS OF DRANAGE FROM EYES/EARS 17 OBSERVE FOR/REPORT SYMPTOMS OF HYPOTENSON/HYPERTENSON L8 OBSERVE PATENT'S EATNG PATTERNS 19 OBSERVE FOR/REPORT SYMPTOMS OF DEHYDRATON 20 OBSERVE FOR/REPORT SYMPTOMS OF FOOD POSONNG 21 CHECK/OBSERVE ELMNATON PATTERNS, E.G. FREQUENCY, URGENCY, NCONTNENCE 22 PALPATE (FEEL) ABDOMEN FOR DSTENSON (HARDNESS/SOFTNESS 23 OBSERVE/RECORD OR DESCRBE CHARACTERSTCS OF URNE OR FECES OR VOMTUS OR REGURGTATON 24 OBSERVE FOR/REPORT SYMPTOMS OF DARRHEA 25 OBSERVE FOR/REPORT SYMPTOMS OF URNARY TRACT NFECTON GO TO RGHT HAND PAGE

29 RGHT PAGE 02 NEUROPSYCHATRC TASK BOOKLET TASK NO. ENTER RESPONSES TO STATEMENTS BELOW N RGHT SDE OF PAGE 02 OF RESPONSE BOOKLET 26 EVALUATE SYMPTOMS OF DECREASED URNARY OUTPUT 27 PALPATE (FEEL BLADDER FOR DSTENSON (FULLNESS 28 OBSERVE PATENTS SLEEPNG PATTERNS 29 OBSERVE FOR/REPORT SYMPTOMS OF DRUG ABUSE, E.G. ACD, SPEED 30 DETERMNE DRUG ABUSER'S ROUTE OF DRUG NTAKE, E.G. ORAL, 1NJECTON 31 OBSERVE FOR/REPORT SYMPTOMS OF DRUG/CHEMCAL NGESTON (POSONNG 32 1OBSERVE FOR/REPORT SYMPTOMS OF DRUG DEPENDENCY, E.Ge FREQUENT REQUEST FOR PAN MEDCATON 33 1OBSERVE FOR/REPORT SYMPTOMS OF NEBRATON (DRUNKENESS 34 OBSERVE FOR/REPORT SYMPTOMS OF HANGOVERS 35 OBSERVE FOR/REPORT SYMPTOMS OF DELRUM TREMENS 36 OBSERVE/REPORT PATENT'S MUSCLE TONE, E.G. RGD, FLACCD, SPASTC, SPASMS 37 OBSERVE FOR/REPORT PATENT'S LEVEL OF PHYSCAL ACTVTY, E.G. LETHARGY, HYPERACTVTY 38 1ASSESS PATENT'S TOLERANCE OF EXERCSE OR ACTVTY 39 1EXAMNE FOR SGNS OF SPRANS 40 1EXAMNE FOR SYMPTOMS OF FRACTURES 41 EVALUATE PATENT'S COMPLANTS OR SYMPTOMS OF PAN 42 OBSERVE/RECORD PATENT'S PHYSCAL/EMOTONAL RESP3NSE TO TREATMENT/DAGNOSTC PROCEDURES 43 1OBSERVE FOR/REPORT SYMPTOMS OF NFLUENZA 44 CHECK PUPL REACTON TO LGHT 45 CHECK PATENT'S RESPONSE TO PANFUL STMULUS AND TEMPERATURE 46 CHECK BLNK REFLEX 47 CHECK PATENT'S RESPONSE TO TOUCH, PRESSURE, TEMPERATURE 48 CHECK PATENT'S SENSORY RESPONSES TO TASTE, SMELL 49 OBSERVE PATENT FOR SGNS OF CHLLNG 50 PERFORM NEUROLOGCAL (CRANE) CHECKS, E.Go PUPLS, VTAL SGNS, PATENT RESPONSE TURN PAGE

30 LEFT PAGE 03 NEUROPSYCHATRC TASK BOOKLET TASK NOe ENTER RESPONSES TO STATEMENTS BELOW N LEFT SDE OF PAGE 03 t OF RESPONSE BOOKLET 1 OBSERVE PATENT'S ABLTY TO RECEVE OR EXPRESS SPOKEN, WRTTEN lop PRNTED COMMUNCATON 2' OBSERVE FOR/DESCRBE OR REPORT CHARACTERSTCS OF TWTCHNG, TREMORS, TCS 3 OBSERVE/DESCRBE OR REPORT CHARACTERSTCS OF CONVULSONS/ SEZURES 4 OBSERVE PATENT FOR/REPORT AND DESCRBE ABNORMAL RESPRATONS 5 CHECK PATENT'S ARWAY FOR PATENCY/OBSTRUCTON 6 OBSERVE FOR/REPORT SYMPTOMS OF ASPRATON 7 1AUSCULTATE LUNGS TO DETECT ABNORMAL SOUNOSoEo RALES,WHEEZERONCH 8 PERFORM CRCULATON CHECK, E.G. COLOR, PULSE, TEMPERATURE OF SKN, CAPLLARY RETURN 9 1EXAMNE FOR VRAL NFECTONS OF THE SKN, E.G. WARTS 10 EXAMNE FOR PRESENCE OF/OR CONTACT WTH LCE, FLEAS, TCKS, LEACHES 11 EXAMNE FOR SYMPTOMS OF EXTERNAL FUNGAL NFECTONS, EeGs RNGWORM 12 1OBSERVE FOR/REPORT DECREASED URNE OUTPUT OF PATENTS SUSCEPTBLE TO RENAL SHUTDOWN 13 1AUSCULTATE ABDOMEN FOR BOWEL SOUNDS 14 1EXAMNE FOR/PEPORT SYMPTOMS OF EXTERNAL HEMORRHODS 15 OBSERVE/PECORD OR DESCRBE CHARACTERSTCS OF DRANAGE FROM VAGNA, E.G. LOCHA 16 OBSERVE FOR/REPORT SYMPTOMS OF SHOCK 17 1OBSERVE FOR/REPORT SYMPTOMS OF EXTERNAL HEMORRHAGE 1 EVALUATE SYMPTOMS OF PATENT COMPLANNG OF CHEST PAN 19 1EXAMNE FOR SYMPTOMS OF CONGESTVE HEART FALURE 20 1EXAMNE FOR SYMPTOMS OF VENEREAL DSEASE 21 OBSERVE FOR/REPORT SYMPTOMS OF MALARA 22 STAND WATCH ON FEMALE/DEPENDENT WARD! 23 1OBTAN PRELMNARY MEDCAL HSTORY,.E. PAST/PRESENT COMPLANTS, ALLERGES, MEDCATONS 24 OBTAtN PATENT'S SOCAL AND FAMLY HSTORY 25 CONDUCT NTAKE NTERVEW ON PSYCHATRC PATENT 6O TO RGfT

31 RGHT PAGE 03 NEUROPSYCHATRC TASK BOOKLET TASK NO., ENTER RESPONSES TO STATEMENTS BELOW N RGHT SDE OF PAGE 03 OF RESPONSE BOOKLET nnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnn PRESENT PATENrOS CASE HSTORY AT NTAKE/HSTORY GATHERNG SESSON 27 1ADMNSTER SHPLEY HARTFORD PSYCHOLOGCAL TEST 28 SCORE SHPLEY HARTFORD PSYCHOLOGCAL TEST 29 ADMNSTER BENDER GESTALT PSYCHOLOGCAL TEST 30 SCORE BENDER GESTALT PSYCHOLOGCAL TEST 31 1ADMNSTER MNNESOTA MULTPHASC PERSONALTY NVENTORY 32 SCORE MNNESOTA MULTPHASC PERSONALTY NVENTORY S33 ADMNSTER WECHSLER-BELLEVUE ADULT NDVDUAL NTELLGENCE SCALE 34 SCORE WECHSLER-BELLEVUE ADULT NDVDUAL NTELLGENCE SCALE * 35 'ADMNSTER WECHSLER MEMORY SCALE PSYCHOLOGCAL TEST 36 SCORE WECHSLER MEMORY SCALE PSYCHOLOGCAL TEST 37 1ADMNSTER MEMORY FOR DESGNS PSYCHOLOGCAL TEST 38 SCORE MEMORY FOR DESGNS PSYCHOLOGCAL TEST 39 ADMNSTER NDANA NEURO-PSYCHOLOGCAL BATTERY TEST 40 SCORE NDANA NEURO-PSYCHOLOGCAL BATTERY TEST 41 JADMNSTER SENTENCE COMPLETON PSYCHOLOGCAL TEST 42 NTERPRET SENTENCE COMPLETON PSYCHOLOGCAL TEST 43 ladmnster HOUSE-TREE-PERSON TEST 44 NTERPRET HOUSE-TREE-PERSON TEST 45 ADMNSTER PSYCHATRC RATNG SCALE 46 ADMNSTER SELF RATNG DEPRESSON TEST 47 SCORE SELF RATNG DEPRESSON TEST 48 ADMNSTER NTELLGENCE TESTS 49 SCORE NTELLGENCE TESTS 50 ADMNSTER THEMATC APPERCEPTON TEST TURN PAGE

32 LEFT PAGE 04 NEUROPSYCHATRC TASK BOOKLET TASK NO. ENTER RESPONSES TO STATEMENTS BELOW N LEFT SDE OF PAGE 04 OF RESPONSE BOOKLET NTERPRET THEMATC APPERCEPTON TEST 2' ADMNSTER AZtMA BATTERY DAGNOSTC TEST 3 NTERPRET AZMA BATTERY DAGNOSTC TEST 4 CHECK PATENTS TEMPERATURE 5 CHECK RADAL (WRSTO PULSE 6 DETERMNE APCAL PULSE RATEfRHYTHM WTH STETHESCOPE 7 CHECK/COUNT RESPRATONS 8 TAKE BLOOD PRESSURE 9 MEASURE/WEGH PATENT OR PERSONNEL 10 MEASURE CONTENTS OF DRANAGE CONTANER, E.G. BAGS, BOTTLES, i BASNS, URNALS 11 RECORD/TALLY FLUD NTAKE AND OUTPUT 12 REPORT CHANGES OR MBALANCES N NTAKE AND OUTPUT 13 FT CRUTCHES 14 CHECK RETURNED LAB REPORT FOR COMPLETON OF REQUESTED TESTS 15 ARRANGE FOR/FOLLOW UP COMPLETON OF CLNCAL LABORATORY TEST 16 PREPARE, LABEL AND SEND ROUTNE SPECMENS E.G. URNE, BLOOD TO LABORATORY 17 PREPAREt LABEL AND SEND SPNAL FLUD SPECMEN TO LABORATORY 18 PREPARE, LABEL AND SEND CULTURE SPECMENS TO LABORATORY 19 PREPAREv LABEL AND SEND STOOL SAMPLE FOR OVA AND PARASTE TESTNG 1g 20 PCK UP/DELVER SPECMENS 21 MEASURE/DLUTE/PRESERVE LAB SPECMEN E.G. URNE, BLOOD FOR SUBSEQUENT TESTNG 22 CHECK URNE SUGAR BY DP STK/CLNTEST 23 CHECK URNE FOR ACETONE/KETONE BODES 24 CHECK URNE PH BY PAPER STRP/DP STK 25 COLLECT BLOOD BY VENPUNCTURE GO TO RGHT HAND PA GE (

33 RGHT PAGE 04 NEUROPSYCHATRC TASK BOOKLET TASK NO. ENTER RESPONSES TO STATEMENTS BELOW N RtGHT SDE OF PAGE 04 OF RESPONSE BOOKLET 26 COLLECT CAPLLARY BLOOD SAMPLE,.E. FROM FNGER TP, TOE OR EAR LOBE 27 COLLECT TMED SPECMENS, E.G. 24 HOUR URNE, BLOOD FOR GLUCOSE TOLERANCE 28 GVE TUBERCULN PP TEST 29 GVE TUBERCULN TNE TEST 30 READ TUBERCULN TEST REACTON 31 TAKE NASAL/EAR/THROAT SPECMEN BY STERLE SWAB 32 COLLECT THROAT/NOSE/EAR CAVTY SECRETONS/SPECMEN BY SUCTON TRAP 33 1ASPRATE GASTRC SECRETON FOR ANALYSS 34 TEST FOR OCCULT BLOODUSNG CHEMCAL SOLUTON E.Ge GUAAC 35 TAKE VAGNAL SMEAR FROM PATENT 36 TAKE WOUND SPECMEN FROM PATENT 37 JTAKE PUS SPECMEN FROM PATENT 38 TAKE SWAB TEST SAMPLES FROM FOOD AND BEVERAGE OUTLET/CONTANERS 39 TAKE SWAB CULTURES FROM HOSPTAL EQUPMENT/FLOORS 40 LOOK UP NORMAL VALUES FOR LABORATORY TESTS FROM REFERENCE TABLE/ BOOK ' 41 SCREEN PATENT VA TELEPHONE TO DETERMNE NEED FOR MEDCAL 1ATTENTON 42 SCREEN PATENT ON ARRVAL TO DETERMNE WHCH STAFF MEMBER PATENT SHOULD SEE 43 DETERMNE NEED TO NOTFY DOCTOR/NURSE OF PATENT'S CONDTON 44 REFER PATENT TO DOCTOP FOR TREATMENT 45 REFER PATENT TO NURSE FOR TREATMENT 46 NFORM DOCTOR/NURSE OF PATENT'S CONDTON, E.G. DESCRPTON OF NJURY, SYMPTOMS, RESPONSE 47 MAKE PATENT ROUNDS OF WARDS/SECTON/UNT/HOSPTAL 48 MAKE PATENT ROUNDS/SCK CALL WTH DOCTOR 49 DETERMNE PRORTES FOR TREATMENT OF PATENTS 50 REVEW PAST AND PRESENT MEDCAL/DENTAL HSTORY TO PLAN CARE TURN PAGE

34 LEFT PAGE 05 NEUROPSYCHATRC TASK BOOKLET TASK NO* ENTER RESPONSES TO STATEMENTS BELOW N LEFT SDE OF PAGE 05 OF RESPONSE BOOKLET REVEW TEST/EXAMNATON/CONSULTATON REPORTS FOR ABNORMAL POSTVE) FNDNGS 2" REVEW PATENTOS CURRENT MEDCAL RECORD, E.G. RESULTS OF TESTS, CONSULTS, VTAL SGNS, NURSES NOTES 3 MAKE SUGGESTON REGARDNG NEED FOR DAGNOSTC TESTS. 4 NTATE AND ORDER DAGNOSTC TEST 5 COLLECT UNORDERED SPECMENS FOR NURSE/DOCTOR TO EVALUATE 6 NFORM DOCTOR OF ANY CONTRANDCATONS TO STUDY 7 MAKE SUGGESTON REGARDNG PATENT CARE, E.G. NEED OF MEDCATON, TREATMENT a RECOMMEND NEED FOR SPECALTY CONSULT/REFERRAL 9 RECOMMENO NEED FOR PARAMEDCAL CONSULT OR REFERRAL, EeGe SOCAL WORKER9 OoTo, PeT[ 10 NTATE CONSULT/REFERRAL N ABSENCE OF DOCTOR 11 FOLLOW UP PATENT TO DETERMNE F NEEDED SERVCES WERE OBTANED 12 EVALUATE PATENT'S PROGRESS/RESPONSE TO THERAPEUTC REGME 13 CONSULT DOCTOR OR NURSE TO OBTAN NFORMATON/ADVCE ON PATENT CARE 1 14 REVEW DOCTOR'S ORDERS AND NSTRUCTONS WTH DOCTOR t5 t6. OBTAN CLARFCATON OF CONFLCTNG OOCTORS ORDERS, CARRY OUT OOCTORS VERBAL ORDERS 17 ENSURE THAT DOCTOR'S ORDERS ARE CARRED OUT 18 NOTFY MEDCAL PERSONNEL OF TREATMENT NEEDS FOR PATENT 19 ARRANGE ROOM/UNT FOR NDVDUAL PATENT NEEDS, E.G. BLND/ BEDRODEN/POST-OP PATENT 20 NTATE TREATMENT PROCEDURES N THE ABSENCE OF A DOCTOR 21 DETERMNE NEED TO CHECK VTAL SGNS MORE OFTENLESS OFTEN THAN ORDERED BY DOCTOR 22 DETERMNE NEED FOR EMERGENCY EQUPMENT/MEDCATON FOR POSSBLE PATENT USE 23 MODFY/CHANGE PATENT TREATMENT PLAN 24 MODFYCHANGE PATENT'S DET N ACCORD WTH PERSONAL FOOD PREFERENCES 25 CALCULATE/PLAN ORAL FLUD RESTRCTONS

35 RGHT PAGE 05 NEUROPSYCHATRC TASK BOOKLET TASK NO. ENTER RESPONSES TO STATEMENTS BELOW N RGHT SDE OF PAGE 05 OF RESPONSE BOOKLET MODFY PATENT CARE ACCORDNG TO PATENT'S RESPONSE/NEED. EeGo PHYSCAL ACTVTY 1 27 CONFER WTH PARAMEDCAL PERSONNEL TO DSCUSS PATENT PROGRESSf PROBLEMS, EeG. OeT., PeT., SOCAL WORKER 1 28 CONFER WTH CHAPLAN TO DSCUSS PATENT/FAMLY NEEDS/PROBLEMS 29 CONFER WTH PATENT/FAMLY TO PLAN PATENT CARE 30 CONFER WTH CORPSMAN TO DSCUSS PATENT TREATMENT/PROGRESS/ PROBLEM 1 31 CONDUCT TEAM/WARD CONFERENCE (CLASS ON PROBLEM/PROGRESS OF NDVDUAL PATENT 32 PREPARE A CARE PLAN FOR PATENT 33 SUGGEST CHANGES N NURSNG CARE PLAN FOR PATENT 34 NTATE AND MPLEMENT CHANGE N PATENT CARE PLAN 35 EVALUATE QUALTY OF NURSNG CAPE GVEN TO NDVDUAL PATENT 36 CLASSFY PATENT FOR AR EVACUATON t 37 RECOMMEND OCCUPATON/NAVY ENVRONMENT FOR PATENT TO DOCTOR PLANNNG DSCHARGE 38 EVALUATE PATENT/FAMLY RESOURCES/PREPARATON FOR ADMSSON/ DSCHARGEEoGe TRANSPORTATONCHLD CARE 39 PLAN PATENT DSCHARGE, E.G. REFERRALS NEEDED, HEALTH EDUCATON NEEDS, FAMLY/HOME PREPARATON 40 LOAD/UNLOAD PATENTS FROM STRETCHERS GURNEY) 41 LOAD/UNLOAD PATENT FROM AMBULANCE 42 ACCOMPANY AMBULANCE ON CALLS 43 DRVE AMBULANCES OR AMBULANCE BUSES 44 ACCO4PANY PATENT TO OTHER DEPARTMENTS/CLNCS 45 ASSST PATENT TO STAND/WALK/DANGLE 46 ASSST PATENTS N/OUT OF BED, EXAM OR OoRo TABLES 47 ASSST PATENTS DURNG EVACUATON PRCCEDURES 468 BACCOMPANY PATENTS ON MEDCAL AR EVACUATONS 49 SUPERVSE PATENT EVACUATON E.Ge ENSURE PATENT S MEDCALLY SECURED FOR TRANSPORT so ADMT PATENT UNDER SECURTY SURVELLANCE, E.G. HANDCUFFS, POLCE GUARD i TURNP,

36 LEFT PAGE 06 NEUROPSYCHATRC TASK BOOKLET TASK NO. ENTER RESPONSES TO STATEMENTS BELOW N LEFT SDE OF PAGE OF RESPONSE BOOKLET! ADMT ACUTELY PSYCHOTC/COMBATVE PATENT 3 2 ADMT/DSCHARGE AR EVAC PATENT ADJUST SDERALS/HEGHT OF BED FOR PATENT COMFORT/SAFETY 4 REMOVE/SECURE/RETURN PATENTS PERSONAL EFFECTS GVE OR HELP PATENT WTH ORAL HYGENE, E.G. BRUSH TEETH, CLEAN DENTURES, MOUTHWASH 6 NSERT/REMOVE DENTURES 7 GROOM PATENT, E.G. SHAMPOO/COMB HAR, GVE TOENAL, FNGERNAL CAPE, SHAVE BEARD 8 ASSST PATENT WTH TUB, STZ BATH, OR SHOWER 9 ASSST PATENT N PUTTNG ON CLOTHES 10 CHANGE PATENT'S SOLED LNEN AND CLOTHNG 11 :OSTRBUTE/COLLECT MENUS 12 1HELP PATENT SELECT FOOD FRO% MENU 13 PASS NOURSHMENTS TO PATENTS 14 DSTRBUtE/COLLECT MEAL TRAYS 15 POSTON PATENT FOR MEALS. 16 FEED OR HELP PATENTS N EATNG 17 ARRANGE FOR SPECAL DR LATE MEALS FOP PATENTS/VSTOR/STAFF 18 SSUE HOSPTAL COMFORTS TO PATENTSE.Ge KLEENEX,SOAP,TOOTHPASTERED CROSS SUPPLES 19 PERFORM ERRANDS FOR PATENTS, E.G. MAKE PHONE CALLS, GO TO STORE L 20 DELVER SUPPLES FOR PATENT'S ENTERTANMENT OR RECREATON, E.G. RA0O, TV, GAMES 21 WATE LETTERS, MESSAGES FOR PATENT 22 -READ TO PATENT 23 SETTLE PATENT FOR REST PEROD/NGHT 24 ENSURE PATENTS OBSERVE QUET HOURS r 25 ASSST PATENT N RELGOUS RTES, E.G. PRAYNG, READNG SCRPTURES go TO RON

37 RGHT PAGE 06 NEUROPSYCHATRC TASK BOOKLET TASK NO* ENTER RESPONSES TO STATEMENTS BELOW N RGHT SDE OF PAGE 06 2OF RESPONSE BOOKLET 26 TRANSPOPT NON AMBULATORY PATENT TO OTHER DEPARTMENTS/CLNCS 2T ACCOMPANY/ASSST WHEELCHAR PATENTS TO RESTROOM 28 TAKE PATENTS CONFNED TO BED OR WHEELCHAR OUTDOORS 29 POSTTON PATENT N BODY ALGNMENT 30 MOVE/POSTON COMATOSE/ANESTHETZED PATENT 31 STMULATE/AROUSE PATENT AFTER ANESTHESA 32 XPOSTON PATENT WHO HAS DFFCULTY BREATHNG 33 POSTON PATENT WHO HAS SYMPTOMS OF SHOCK 34 POSTON EXTREMTES TO REDUCE SWELLNG OR BLEEDNG 35 MOVE/POSTON PATENT WTH SUSPECTED FRACTURES OF EXTREMTES 36 GVE BED BATH TO PATENTS 37 GVE BACK RUB TO PATENTS 38 ASSST PATENT WTH BEOPANS/URNALS/COMMOOE CHARS 39 MAKE OCCUPED BED 40 MOVE PATENT NTOOUT OF SOLATON 41 GVE POST MORTEM CARE 42 TRANSPORT THE BODY COMPLETE WTH DOCUMENTS TO THE MORGUE 43 DRENT PATENT/FAMLY TO FACLTY, E.G. ROUTNES, REGULATONS, PHYSCAL LAYOUT, PERSONNEL 44 RECEVE PATENTS ON ARRVAL,.E. NTRODUCE SELF, OBTAN PATEN''S NAME 45 NFORM PATENT OF PROCEDURES REQURED PROR TO/DURNG EXAM NATON/TEST/TREATMENT 46 EXPLAN/ANSUER PATENT'S QUESTONS REGARDNG EXAMNATON/TEST/ TREATMENT PROCEDURES 47 EXPLAN/ANSWER QUESTONS ABOUT DOCTOR'S NSTRUCTONS TO PATENT/ FAMLY 48 EXPLAN/ANSWER QUESTONS ABOUT TREATMENT PROCEDURE VA TELEPHONE 49 WRTE STANDARD NSTRUCTONS FOR PATENT CONCERNNG EXAMNATONSt THERAPY OR PROCEDURES 50 REVEW WTH PATENT PRNTED NSTRUCTONS FOR EXAMNATONTHERAPY PROCEDURES TURN PAGE

38 LEFT KPAGE 07 NEUROPSYCHATRC TASK BOOKLET TASK NO. ENTER RESPONSES TO STATEMENTS BELOW N LEFT SDE OF PAGE 07 OF RESPONSE BOOKLET 1EXPLAN SCAN PROCEDURES TO PATENT 2.EXPLAN EEG PROCEDURE TO PATENT V 3 EXPLAN ECG PROCEDURE TO PATENT 4 1EXPLAN LUMBAR PUNCTURE PROCEDURES TO PATENT 5 EXPLAN X-RAY PROCEDURES TO PATENT 6 1EXPLAN PROCEDURES FOR PULMONARY FUNCTON TESTS TO PATENT 7 texplan MNOR SURGCAL PROCEDURE/OPERATON TO PATENT/FAMLY 8 REASSURE/CALM APPREHENSVE (ANXOUS$ PATENT 9 task/nstruct PATENT TO COLLECT SPECMEN 10 ASSST PATENT N COLLECTNG CLEAN CATCH URNE 11 CHECK WTH PATENT TO ENSURE THAT HE HAS COLLECTED SPECMEN AS NSTRUCTED LZ,ORAPE/GOWN PATENT FOR EXAMNATON/TREATMENT 13 POSTON/HOLD PATENT FOR EXAMNATONt TREATMENT, SURGERY 14 :VERFY DENTFCATON OF PATENT, EoG. FOR TREATMENT, MEDCATONS, EXAMNATON 15 ASCERTAN F PATENT HAS BEEN PREPPED FOR TEST/TREATMENT PPOCEDURE 16 JASK PATENT/CHECK CHART FOR CONTRANDCATON FOR TREATMENT, 1PROCEDURE, TEST 17 STANO BY DURNG EXAMNATON OF FEMALE PATENTS 18 CLEAN AND CLOTHE PATENTS AFTER SURGERY/TREATMENT/EXAMNATON! 19 ELCT NFORMATON TO ASCERTAN PATENTOS UNDERSTANDNG/ ACCEPTANCE OF LLNESS/TREATMENT 20 EXPLAN/ANSWER PATENT'S QUESTONS REGARDNG SYMPTOMS/DSEASE/ TREATMENT 21 EXPLAN PHYSOLOGCAL BASS FOR THERAPY/TREATMENT TO PATENT/ FAMLY 22 EXPLAN/ANSWER QUESTONS ABOUT THERAPEUTC DETS TO PATENT/ FAMLY 23 JEXPLAN/ANSWER QUESTONS ABOUT VENEREAL DSEASE, E.G. PREVENTON, SYMPTOMS 24 TEACH PATENT/FAMLY HEALTH PROMOTON PRACTCES, E.G. ROUTNE PHYSCALS, EXERCSE, DET 25 NFORM PATENT OF PROGRESS OF THERAPY GO TO RGHT NANO PA

39 RGHT PAGE 07 NEUROPSYCHATRC TASK BOOKLET TASK NO. ENTER RESPONSES TO STATEMENTS BELOW N RGHT SDE OF PAGE 07 1 OF RESPONSE BOOKLET 26 NFORM PATENT/FAMLY WHERE TO OBTAN MEDCAL SUPPLES 27 COUNSEL PATENT/FAMLY ON WHEN AND WHERE TO SEEK MEDCAL CARE 28 NFORM PATENT ON AVALABLTY OF SERVCES N THE COMMUNTY, SE.G. LEGAL AD, EMPLOYMENT 29 NFORM PATENT/FAMLY OF MLTARY SERVCES, E.G. NAVY RELEF, VETERANS BENEFTS 30 (NFORM PATENT/FAMLY OF RECREATONAL ACTVTES N THE COMMUNTY, E.G. SENOR CTZEN CLUB 31 (REFER PATENT TO LEGAL RESOURCES 32 (EXPLAN MAJOR SURGCAL PROCEDURE/OPERATON TO PATENT/FAMLY 33 (REASSURE/CALM PATENT BEFORE SURGERY 34,PREPARE SKN STE WTH ANTSEPTC SOLUTON PROR TO NCSON/ (SUTURNG/TREATMENT OR.EXAMNATON 35 SHAVE AND SCRUB PATENT FOR SURGERY OR DELVERY OR TREATMENT OR EXAMNATON 36 EXPLAN/ANSWER QUESTONS ABOUT METHODS OF CONTRACEPTON 37 1EXPLAN PREVENTVE/CORRECTVE MEASURES FOR DERMATTS 38 (NSTRUCT PATENT N PREVENTVE CARE OF FNGER AND TOENAL (ABNORMALTES 39 (COUNSEL PATENT WTH TERMNAL LLNESS OR HS FAMLY 40 TEACH PATENT/FAMLY CARE OF SPECFC DSEASES/DSABLTES, E..G. DABETES, CVA 41 JCONDUCT CLASSES FOR GROUPS OF PATENTS REGARDNG CARE OF SPECFC DSABLTY/OSEASE 42 TEACH PATENT/FAMLY NURSNG CARE PROCEDURES, E.G. DRESSNG (CHANGE, CAST CARE 43 TEACH PATENT TO COUGH AND DEEP BREATHE 44 TEACH BREATHNG EXERCSES 45 TEACH POSTURAL DRANAGE EXERCSES 46 TEACH ACTVE RANGE OF MOTON EXERCSES 47 (TEACH MUSCLE STRENGTHENNG/PROGRESSVE RESSTANT EXERCSES 48 (TEACH PATENT SWNG TO OR SWNG THROUGH GAT (TEACH PATENT TWO PONT CRUTCH GAT s0 (TEACH PATENT/FAMLY TRANSFER TECHNQUES, E.G. BED TO CHAR, rhar TO COMMODE 1_ U L.....