Questionnaire

Name______________________ Age________________
Sex_______________ Civil Status_______
Assignments ______________

Below are statements to describe the correlations of

family Values and Environmental Practice of Staff Nurses of
PJGMRMC. Please encircle the number opposite each item to
determine your Conformance or nonconformance to the
statements by using the numerical guide below:

5 – Strongly Agree
4 – Agree
3 – Fairly Agree
2 – Disagree
1 –Strongly Disagree

Please answer honestly as possible. Your answers will be

kept confidential

How does Staff Nurses of PJGMRMC correlates Family Values

and Environmental Practices to their

Clients
1. Identify, and manage as appropriate, 5 4 3 2 1
treatment plans for patients based on the family
values and orientations of the hospital
2. Provide information and advice on prescribed 5 4 3 2 1
or over-the-counter drugs and teaching them to
be aware on the given drugs
3. Treat patients as individual with respect to 5 4 3 2 1
their hygiene and teaches them to be aware on
it
4. Respect dignity and rights of patients 5 4 3 2 1
5 Teaches patients to be aware on the 5 4 3 2 1
cleanliness of the hospital that will lead
them in their early recovery
 Superior
1. Proper respect to their superior is given and 5 4 3 2 1
listening to their expectations regarding
their works and follow instructions properly
with regards to rule sand regulations of the
hospital
2. Good Communication with their doctors is 5 4 3 2 1
establish
3. Proper hygiene and cleanliness in every 5 4 3 2 1
assignments is implemented
4. Respect to the regulations being implemented 5 4 3 2 1
to the hospital especially treatment of
hospital waste
5. Establish good rapport to the medical workers 5 4 3 2 1
of the hospital based on family orientation and
environmental practice that could lead to good
working environment

Hospital Performance
1. Wearing of proper uniform and mask when 5 4 3 2 1
treating patients based on the rule of hospital
2. proper address given to relative and patients 5 4 3 2 1
when performing duties
3. proper disposal of waste that could avoid 5 4 3 2 1
infections to other people
4.Alertness when others are seeking help and 5 4 3 2 1
courteous when establishing communication
5. Maintaining cleanliness and respect to the 5 4 3 2 1
clients relatives when visiting