INFORMED CONSENT FOR RESEARCH
DEPARTMENT OF PSYCHOLOGY
DR MGR EDUCATIONAL AND RESEARCH INSTITUTE (DU)
I ______________________________ in a clear state of mind hereby submit my consent to voluntarily participate in this study conducted by
Mythili M on the topic “The Relationship between Emotional regulation and Professional quality of life among Palliative care professionals’’
Without any coercion or pressure, after understanding the objective and the procedures, which was explained to me by the researcher in the
language in which I could understand the subject clearly. I also understand that the information shared by me as part of the study will be kept
confidential and used only with anonymity. I also submit that I was not assured any financial or other gains for participating in the study and I
will not benefit directly from participating in this research.
Signature of the Participant Signature of the Researcher
DEMOGRAPHIC DETAILS
Name / Initial:-
Age :-
Gender :-
Marital status:-
Educational Qualification :-
Profession / Job role :-
Years of Experience :-
Type of Healthcare Setting:-
Section A
Please indicate how much you agree with each statement by selecting one of the following options:
Strongly Somewhat Somewhat Strongly
No. Statement Neutral Agree
disagree Disagree Disagree agree agree
When I want to feel more positive emotion (such as
1
joy or amusement), I change what I’m thinking about
2 I keep my emotions to myself.
When I want to feel less negative emotion (such as
3
sadness or anger), I change what I’m thinking about.
When I am feeling positive emotions, I am careful not
4
to express them.
When I’m faced with a stressful situation, I make
5
myself think about it in a way that helps me stay calm.
6 I control my emotions by not expressing them.
When I want to feel more positive emotion, I change
7
the way I’m thinking about the situation.
I control my emotions by changing the way I think
8
about the situation I’m in.
When I am feeling negative emotions, I make sure not
9
to express them
When I want to feel less negative emotion, I change
10
the way I’m thinking about the situation.
Section B
Instructions: Throughout this section, the term "help" refers to the palliative care you provide to patients, and "helper" refers to you as a palliative
care professional. Please indicate how frequently you have experienced each of the following in the past 30 days.
No. Statement Never Rarely Sometimes Often Very often
1 I am happy
2 I am preoccupied with more than one person I [help].
3 I get satisfaction from being able to [help] people.
4 I feel connected to others.
5 I jump or am startled by unexpected sounds.
6 I feel invigorated after working with those I [help].
7 I find it difficult to separate my personal life from my life as a [helper].
I am not as productive at work because I am losing sleep over traumatic
8
experiences of a person I [help].
I think that I might have been affected by the traumatic stress of those I
9
[help].
I feel trapped by my job as a [helper].
10
11 Because of my [helping], I have felt “on edge” about various things.
12 I like my work as a [helper].
I feel depressed because of the traumatic experiences of the people I
13
[help].
I feel as though I am experiencing the trauma of someone I have
14
[helped].
15 I have beliefs that sustain me
I am pleased with how I am able to keep up with [helping] techniques
16
and protocols.
17 I am the person I always wanted to be.
18 My work makes me feel satisfied.
19 I feel worn out because of my work as a [helper].
I have happy thoughts and feelings about those I [help] and how I
20
could help them.
21 I feel overwhelmed because my work load seems endless.
22 I believe I can make a difference through my work.
I avoid certain activities or situations because they remind me of
23
frightening experiences of the people I [help].
24 I am proud of what I can do to [help].
As a result of my [helping], I have intrusive, frightening thoughts.
25
I feel “bogged down” by the system.
26
27 I have thoughts that I am a “success” as a [helper].
28 I can’t recall important parts of my work with trauma victims.
29 I am a very caring person.
30 I am happy that I chose to do this work.