Write a brief explanation of why you feel as you do about the quality of nursing services. Please make additional comments you have regarding nursing services delivered during your hospital stay.
PSC 495: Questionnaire Examples
Demographic Information:
For each of the following items, put an X beside the choice that best describes you:
1. Gender Male Female
2. Total number of
years as a nurse 1-5 6-10
11-15 16-20
>20
3. Assigned Department (please list)
Checklist Items:
Below is a list of educational resources. Put a check in front of each resource you think is adequately available in your department:
4. Up-to-date textbooks and manuals
5. Instructional VCRs
6. Department-based computers
7. Educational programs
8. ___________________ Trade journals
Likert Scale Items:
The following are statements that describe a school’s curriculum. Read each statement and place a check in the box as to whether you strongly agree (SA), agree (A), are uncertain (U), disagree (D), or strongly disagree (SD) with each statement.
In my school, the curriculum: SA A U D SD
9. Is up to date
10. Emphasizes critical thinking outcomes
11. Is familiar to all teachers
12. Is followed by all teachers
13. Can be adapted to meet individual student needs
Free Response Items:
14. How you would rate the nursing service quality you received? Very good
Good
Fair Poor
15. Write a brief explanation of why you feel as you do about the quality of nursing services.
16. Please make additional comments you have regarding nursing services delivered during your hospital stay.
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